Justine Daudi Maganira, Noel Mark Makwinya, Beda John Mwang'onde
Porcine cysticercosis, caused by the larval stage of Taenia species, poses significant health and economic challenges in low and lower-middle-income regions. This study assessed the seroprevalence and risk factors associated with the transmission of porcine cysticercosis in Mpwapwa District, eastern-central Tanzania, using a commercial antigen enzyme linked immunosorbent assay (Ag- ELISA). A cross-sectional survey was conducted in Gulwe, Ving'hawe, and Igovu villages during the dry season in June 2024. Blood samples were collected from 159 household pigs, and structured questionnaires were administered to heads or representatives of 51 pig-keeping households to identify potential risk factors. Serum samples from 29 pigs tested positive for porcine cysticercosis in the Ag-ELISA assay with an apparent prevalence of 18.24 % (95 % CI: 12.57 %–25.13 %), and estimated true prevalence of 17.91 % (95 % CI: 12.66 %–24.67 %). The apparent prevalence of porcine cysticercosis varied across the villages with Gulwe showing the highest prevalence (22.58 %; 95 % CI: 12.93 %–34.79 %), followed by Ving'hawe (21.21 % 95 % CI: 8.98 %–38.91 %), and Igovu (12.50 %; 95 % CI: 5.55 %–23.15 %). Female pigs exhibited a relatively higher seropositivity rate (13.84 %; 95 % CI: 8.88 %–20.20 %) compared to male pigs (4.40 %; 95 % CI: 1.79 %–8.86 %) although this difference was not statistically significant (χ2 = 0.629, p-value = 0.428). DNA extracted from cysticerci isolated from infected pigs slaughter in the study villages was confirmed via gel electrophoresis to belong to Taenia solium. Seropositivity was higher in adult pigs (14.47 %; 95 % CI: 9.84 %–20.77 %) than in growers (3.77 %; 95 % CI: 1.74 %–7.99 %), but this difference was not statistically significant (χ2 = 0.385, p = value = 0.535). Risk factor analysis identified the pig management system (OR = 2.47, p = 0.005), household pig herd size (OR = 3.08, p = 0.003), pig pen design (OR = 2.49, p = 0.002), feed source (OR = 3.08, p = 0.000), ignorance of porcine cysticercosis (OR = 1.57, p = 0.031) and presence of open-field defecation (OR = 1.47, p = 0.025) as significant contributors to the transmission of porcine cysticercosis. This study identifies a significant burden of porcine cysticercosis in Mpwapwa District, highlighting the need for effective control strategies to combat this zoonotic disease, protect smallholder livelihoods, and align with the WHO's 2030 targets for intensified T. solium control.
Adama Ouedraogo, Patrice Ngangue, David Jean Simon
et al.
Objective This study estimated the proportion of children aged 12–23 months who were fully vaccinated in sub-Saharan Africa (SSA), explored geographical disparities across subregions and countries, and identified country-level factors associated with full vaccination (FV).Design Cross-sectional study.Setting SSA.Participants Children aged 12–23 months.Primary outcome FV.Methods Data for this study were extracted from the most recent Demographic and Health Survey (DHS) conducted in 34 SSA countries between 2012 and 2023. The study included a total weighted sample of 69 218 children. Univariate analyses were performed to describe the socio-demographic profile of the participants and estimate the proportion of FV and the proportion for each of the eight vaccines (BCG, DTP1, DTP2, DPT3, Polio1, Polio2, Polio3, Measles1) at regional level. Bivariate and spatial analyses were produced to examine existing disparities at regional, subregional and countries’ income levels. A multivariate logistic regression analysis was fitted for identifying country-level factors associated with FV.Results 54.1% (95% CI 53.7% to 54.5%) children aged 12–23 months in SSA were fully vaccinated. In addition, substantial inequalities emerged in FV coverage across countries ranging from 23.9% in Guinea to a high of 95.5% in Rwanda. The same pattern was observed for the eight vaccines. Findings also showed that children of birth order 3 and above, who were delivered at home, had received less than four antenatal visits, from poor households and households with more than 5 members, whose mothers were under 25, had primary education level and below, and had no income-generating activities were less likely to be fully vaccinated.Conclusion To achieve WHO’s global vaccination coverage target of 90% by 2030 in SSA, vaccination programmes must take account of regional, subregional and national inequities. Our findings also underline the need for interventions tailored to each SSA country’s socio-cultural context.Ethical consideration Ethical approval was not required as this is a secondary analysis of publicly available data.
Medicine (General), Infectious and parasitic diseases
N. Soni, Daniel J. Schnobrich, Benji K Matthews
et al.
Many hospitalists incorporate point-of-care ultrasound (POCUS) into their daily practice to answer specific diagnostic questions or to guide performance of invasive bedside procedures. However, standards for hospitalists in POCUS training and assessment are not yet established. Most internal medicine residency training programs, the major pipeline for incoming hospitalists, have only recently begun to incorporate POCUS in their curricula. The purpose of this document is to inform a broad audience on what POCUS is and how hospitalists are using it. This document is intended to provide guidance for the hospitalists who use POCUS and administrators who oversee its use. We discuss POCUS 1) applications, 2) training, 3) assessments, and 4) program management. Practicing hospitalists must continue to collaborate with their local credentialing bodies to outline requirements for POCUS use. Hospitalists should be integrally involved in decision-making processes surrounding POCUS program management.
Lusine Paronyan, Lilit Babayan, Haykuhi Vardanyan
et al.
Abstract Background Armenia is considered particularly vulnerable to life-threatening vector-borne diseases (VBDs) including malaria, West Nile virus disease and leishmaniasis. However, information relevant for the control of the vectors of these diseases, such as their insecticide resistance profile, is scarce. The present study was conducted to provide the first evidence on insecticide resistance mechanisms circulating in major mosquito and sand fly populations in Armenia. Methods Sampling sites were targeted based mainly on previous historical records of VBD occurrences in humans and vertebrate hosts. Initially, molecular species identification on the collected vector samples was performed. Subsequently, molecular diagnostic assays [polymerase chain reaction (PCR), Sanger sequencing, PCR-restriction fragment length polymorphism (RFLP), quantitative PCR (qPCR)] were performed to profile for major insecticide resistance mechanisms, i.e. target site insensitivity in voltage-gated sodium channel (vgsc) associated with pyrethroid resistance, acetylcholinesterase (ace-1) target site mutations linked to organophosphate (OP) and carbamate (CRB) resistance, chitin synthase (chs-1) target site mutations associated with diflubenzuron (DFB) resistance and gene amplification of carboxylesterases (CCEs) associated with resistance to the OP temephos. Results Anopheles mosquitoes were principally represented by Anopheles sacharovi, a well-known malaria vector in Armenia, which showed no signs of resistance mechanisms. Contrarily, the knockdown resistance (kdr) mutations V1016G and L1014F/C in the vgsc gene were detected in the arboviral mosquito vectors Aedes albopictus and Culex pipiens, respectively. The kdr mutation L1014S was also detected in the sand fly, vectors of leishmaniasis, Phlebotomus papatasi and P. tobbi, whereas no mutations were found in the remaining collected sand fly species, P. sergenti, P. perfiliewi and P. caucasicus. Conclusions This is the first study to report on molecular mechanisms of insecticide resistance circulating in major mosquito and sand fly disease vectors in Armenia and highlights the need for the establishment of systematic resistance monitoring practices for the implementation of evidence-based control applications. Graphical Abstract
ObjectivesThis study aimed to elucidate the influences of 1p/19q co-deletion on structural connectivity alterations in patients with dominant hemisphere insular diffuse gliomas.MethodsWe incorporated 32 cases of left insular gliomas and 20 healthy controls for this study. Using diffusion MRI, we applied correlational tractography, differential tractography, and graph theoretical analysis to explore the potential connectivity associated with 1p/19q co-deletion.ResultsThe study revealed that the quantitative anisotropy (QA) of key deep medial fiber tracts, including the anterior thalamic radiation, superior thalamic radiation, fornix, and cingulum, had significant negative associations with 1p/19q co-deletion (FDR = 4.72 × 10–5). These tracts are crucial in maintaining the integrity of brain networks. Differential analysis further supported these findings (FWER-corrected p < 0.05). The 1p/19q non-co-deletion group exhibited significantly higher clustering coefficients (FDR-corrected p < 0.05) and reduced betweenness centrality (FDR-corrected p < 0.05) in regions around the tumor compared to HC group. Graph theoretical analysis indicated that non-co-deletion patients had increased local clustering and decreased betweenness centrality in peritumoral brain regions compared to co-deletion patients and healthy controls (FDR-corrected p < 0.05). Additionally, despite not being significant through correction, patients with 1p/19q co-deletion exhibited lower trends in weighted average clustering coefficient, transitivity, small worldness, and global efficiency, while showing higher tendencies in weighted path length compared to patients without the co-deletion.ConclusionThe findings of this study underline the significant role of 1p/19q co-deletion in altering structural connectivity in insular glioma patients. These alterations in brain networks could have profound implications for the neural functionality in patients with dominant hemisphere insular gliomas.
Introduction
The increasing global suicide rates pose a considerable strain on healthcare professionals. Subsequently, their attitudes toward suicide prevention may influence suicide risk and management, affecting the quality of care.
Objectives
To investigate the attitudes of Pakistani medical students toward suicide and its comparison with different sociodemographic factors.
Methods
A total of 1392 undergraduate medical students belonging to all five years took part in the cross-sectional study conducted in September 2022. In addition to socio-demographic factors, participants were asked about their attitudes toward suicide on a 5-point Likert scale using the ATTS (Attitudes towards suicide) questionnaire. Questions explored competence, religion, experience, and views on suicidal behavior and its treatment. Data were analyzed by using SPSS 26.
Results
The majority of respondents had no prior experience of looking after patients with suicide attempts (88.9%), the experience of having known someone who died by suicide (67.1%), or participation in suicide workshops (94.3%). Statistically significant items showed that males believed more strongly that suicide could be used to end suffering and would consider the possibility of doing it, revenge is the major driving factor, talking about suicide lessens its incidence, and people should have the right to take their own lives. Females more strongly believed that loneliness is the major driving factor, and that suicide is preventable. Preclinical students more strongly believed thought suicide was less justified, especially among young people, not a solution to end incurable illnesses, and that people should not have the right to take their own lives. 996 (71.6%) of respondents expressed their willingness to participate in workshops regarding suicide.
Conclusions
Our study suggests that medical students have little experience in handling suicidal patients and vastly differ in their attitudes. There is a need for suicide management training and further study data to support these findings.
Disclosure of Interest
None Declared
Muneto Izuhara, Muneto Izuhara, Kentaro Matsui
et al.
IntroductionSleep enhances the antibody response to vaccination, but the relationship between sleep and mRNA vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is not fully understood.MethodsIn this prospective observational study, we investigated the influence of sleep habits on immune acquisition induced by mRNA vaccines against SARS-CoV-2 in 48 healthy adults (BNT-162b2, n=34; mRNA-1273, n=14; female, n=30, 62.5%; male, n=18, 37.5%; median age, 39.5 years; interquartile range, 33.0–44.0 years) from June 2021 to January 2022. The study measured sleep duration using actigraphy and sleep diaries, which covered the periods of the initial and booster vaccinations.ResultsMultivariable linear regression analysis showed that actigraphy-measured objective sleep duration 3 and 7 days after the booster vaccination was independently and significantly correlated with higher antibody titers (B=0.003; 95% confidence interval, 0.000–0.005; Beta=0.337; p=0.02), even after controlling for covariates, including age, sex, the type of vaccine, and reactogenicity to the vaccination. Associations between acquired antibody titer and average objective sleep duration before vaccination, and any period of subjective sleep duration measured by sleep diary were negligible.DiscussionLonger objective, but not subjective, sleep duration after booster vaccination enhances antibody response. Hence, encouraging citizens to sleep longer after mRNA vaccination, especially after a booster dose, may increase protection against SARS-CoV-2.Study registrationThis study is registered at the University Hospital Medical Information Network Center (UMIN: https://www.umin.ac.jp) on July 30, 2021, #UMIN000045009.
Over the last decade there has been increasing interest and enthusiasm in point-of-care ultrasound (POCUS) as an aide to traditional examination techniques in assessing acutely unwell adult patients. However, it currently remains the domain of a relatively small handful of physicians within the UK. There are numerous reasons for this, notably a lack of training pathways and supervisors but also a lack of understanding of the evidence base behind this imaging modality. This review article aims to explore some of the evidence base behind POCUS for a number of medical pathologies, and where possible compare it to evidenced traditional examination techniques. We discuss the issues around training in bedside ultrasound and recommend a push to integrate POCUS training into internal medicine curricula and support trainers to comprehensively deliver this.
Ciro Romano, Olga Tortorella, Liliana Dalla Mora
et al.
BackgroundChronic immune stimulation by hepatitis C virus (HCV) may cause occurrence of several autoantibodies in infected patients, with or without features of clinically overt autoimmune diseases. The recent introduction of direct-acting antivirals (DAAs) has dramatically changed the natural history of chronic HCV infection. The aim of this study was to assess the effects of DAA therapy on serum autoantibodies in chronic hepatitis C (CHC) patients.MethodsThe medical records of 113 CHC patients were reviewed to assess autoantibody behavior following DAA-directed HCV eradication. Statistical analysis was performed to assess correlations between DAA treatment and autoantibody titers, HCV genotypes, and viral loads.ResultsAnti-nuclear (ANA), anti-smooth muscle cell (ASMA) and anti-mitochondrial (AMA) antibody testing was available in 77 patients; 31 out of 77 patients (40%) had one or more serum autoantibodies prior to treatment. Measurement of autoantibody titers before and after HCV eradication was performed in 20 of 31 patients. DAA treatment significantly affected ANA and ASMA titers, leading to disappearance or reduction of autoantibody titers; conversely, AMA were not influenced by DAA treatment. No correlations were observed between autoantibody specificity and both HCV genotypes and viral loads at baseline. Likewise, serum autoantibody titers were independent of HCV genotypes.ConclusionsDAA-directed HCV clearance may interrupt chronic immune stimulation by removing the drive for autoantibody induction. The isolated persistence of autoantibodies in the small fraction of patients who did not show clearance following DAA treatment may require long-term vigilance.
Abstract Background Undifferentiated carcinoma with osteoclast-like giant cells (OGCs) of pancreas (UCOGCP) is a rare subtype of pancreatic ductal adenocarcinoma (PDAC), which had poorly described histopathological and clinical features. Methods In this study, single-cell RNA sequencing (scRNA-seq) was used to profile the distinct tumor microenvironment of UCOGCP using samples obtained from one UCOGCP patient and three PDAC patients. Bioinformatic analysis was carried out and immunohistochemical (IHC) staining was used to support the findings of bioinformatic analysis. After quality control of the raw data, a total of 18,376 cells were obtained from these four samples for subsequent analysis. These cells were divided into ten main cell types following the Seurat analysis pipeline. Among them, the UCOGCP sample displayed distinct distribution patterns from the rest samples in the epithelial cell, myeloid cell, fibroblast, and endothelial cell clusters. Further analysis supported that the OGCs were generated from stem-cell-like mesenchymal epithelial cells (SMECs). Results Functional analysis showed that the OGCs cluster was enriched in antigen presentation, immune response, and stem cell differentiation. Gene markers such as LOX, SPERINE1, CD44, and TGFBI were highly expressed in this SMECs cluster which signified poor prognosis. Interestingly, in myeloid cell, fibroblasts, and endothelial cell clusters, UCOGCP contained higher percentage of these cells and unique subclusters, compared with the rest of PDAC samples. Conclusions Analysis of cell communication depicted that CD74 plays important roles in the formation of the microenvironment of UCOGCP. Our findings illustrated the genesis and function of OGCs, and the tumor microenvironment (TME) of UCOGCP, providing insights for prognosis and treatment strategy for this rare type of pancreatic cancer.
Neoplasms. Tumors. Oncology. Including cancer and carcinogens