Journal of Tropical Medicine最新文献

Objective: Bloodborne pathogens including hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and Treponema pallidum pose a significant menace to transfusion medicine and the public health system. Conducted during the unprecedented global COVID-19 pandemic, this retrospective analysis (2020-2024) evaluated blood donors from Shiyan, China, aiming to ensure blood safety amidst the challenges posed by the pandemic.

Methods: Cases of transfusion-transmitted infections (TTIs) were analyzed by using ELISA. Infection rates were quantified as stratified percentages based on sociodemographic characteristics of the study population. Chi-square trend tests were performed to examine the variation in trends. The chi-square test was performed to evaluate associations between sociodemographic characteristics (age, gender, and occupation) and the risk of pathogen infection (HBV, HCV, HIV, and T. pallidum).

Results: Analysis of 231,733 blood samples from 114,593 donors revealed an overall 0.51% seropositivity for TTIs, with prevalence rates of HBV (0.23%), HCV (0.03%), HIV (0.03%), and syphilis (0.22%). During the COVID-19 pandemic, a declining trend was observed for all infections. The chi-square test disclosed that HBV and T. pallidum infection were higher in the other occupation group of women aged 35-60 years, HCV positivity was more pronounced in men in the same group, and HIV infection was mainly concentrated in the group of men aged 25-44 years.

Conclusions: Continuous monitoring of the prevalence of TTIs among blood donors offers valuable information for ensuring blood safety and new directions in the development of blood transfusion systems.

The increasing burden of schistosomiasis, compounded by the restriction imposed by monotherapeutic regimens, highlights the pressing need for new molecules that target specific molecular pathways. Schistosoma mansoni histone deacetylase 8 (SmHDAC8), a zinc-dependent epigenetic regulator, has emerged as a nonredundant and druggable enzyme, critical for parasite survival, fertility, and chromatin homeostasis. In this study, we outline multiple-mode computational analysis involving structure-based virtual screening against a chemically diverse ligand library, frontier molecular orbital analysis through DFT, large-scale molecular dynamics (MD) simulations (500 ns), and molecular mechanics/gas-phase/Generalized Born (MM/GBSA) energy component analysis, complemented with machine learning-guided pIC₅₀ model building and prediction. Our screening cascade comprising docking, MM, and MD identified the lead candidate, 24374890, with the best docking score (-9.5 kcal/mol) and desirable electronic configuration (HOMO-LUMO gap: 4.143 eV) for its optimal reactivity-stability balance. MD simulations confirmed its stability in the short term, as well as its conformational preservation in the SmHDAC8 catalytic pocket, as evidenced through low RMSD values, stable free energy basins, and sustained intermolecular interactions. Hydrogen bond analysis proved that compounds 24374890 and 24280440 kept 1-4 stable hydrogen bonds for the entire 500 ns simulation, supporting their strong and stable binding in SmHDAC8's active site. Thermodynamic calculations through MM/GBSA indicated 24374890 has the best energetics for binding (ΔG_total = -65.11 kcal/mol), comprising largely van der Waals and nonpolar solvation energies. Finally, the pIC₅₀ value for 24374890 was predicted, through supervised machine learning, as 8.1, better than the reference molecule. These convergent findings from quantum mechanical, molecular mechanical, and AI-based computations validate 24374890 as an SmHDAC8 inhibitor that is structurally and dynamically sound. These calculations need to be supported with in vitro enzyme inhibition experiments against recombinant SmHDAC8 and cytotoxicity profiling in schistosome cultures. Moreover, X-ray crystallography or cryo-EM analysis of the SmHDAC8-24374890 complex would reveal detailed binding conformations.

Background: Previous studies reported increasing herbal medicine (HM) use among patients with cardiovascular diseases, including hypertension. Although HMs are widely used for their therapeutic benefits, repeated use has raised concerns due to reported adverse effects and potential interactions with conventional treatments. This study assessed the prevalence, forms (preparation), and factors associated with HM use among hypertension patients in an urban setting in Uganda.

Methods: An analytical cross-sectional study was conducted in March 2021 among 121 patients with hypertension at Naguru Regional Referral Hospital using standardized questionnaires. Descriptive and multivariate analyses identified factors independently associated with HM use, with p  <  0.05 as the significance threshold.

Results: All 121 (100%) participants had ever used HM for hypertension; 86 (71.1%) reported consistent use in the past 12 months. Daily use was reported at 53 (43.8%), while 74 (61.2%) reported concurrent use with conventional medicine. The majority used HM in the liquid form [74 (61.2%)], but most HMs were ingested orally [101 (83.5%)]. 53 participants (43.8%) chose HMs themselves, and 46 (39.3%) procured from herbalists. The main HM knowledge source was family [53 (25.6%)]. High odds of HM use were observed among participants from the Central Region (AOR = 9.4; 95% CI = 1.7-51.0), those with easy access to herbalists and doctors (AOR = 1.6; 95% CI = 0.4-76.8), those who did not inform health workers about HM use (AOR = 5.3; 95% CI = 0.5-54.0), and those who perceived concurrent HM use as safe and beneficial (AOR = 2.2; 95% CI = 0.6-7.3) or free of side effects (AOR = 6.8; 95% CI = 1.6-28.9). Region (p = 0.009), accessibility (p = 0.049), and perception of no side effects (p = 0.009) were significantly associated with HM use.

Conclusion: HM is widely used by urban-dwelling patients with hypertension and is influenced by perceived benefits, safety, and ease of access. Health workers need to proactively inquire about HM use to effectively advise hypertension patients, tailor interventions appropriately, and monitor treatment outcomes. More research is needed to systematically measure and track outcomes in patients who use HM remedies to treat hypertension.

Dengue fever presents a growing public health challenge in tropical and subtropical regions, where early detection is crucial for effective intervention. This study conducts a comprehensive comparative analysis of 13 machine learning and deep learning models for nonclinical, symptom-based dengue prediction, focusing on the Bangladeshi population. Using a dataset of 500 patient records with 22 symptom-based features, we evaluated a wide spectrum of classifier algorithms, including tree-based (e.g., random forest, extra trees, bagging), linear (logistic regression, SGDClassifier), and an instance-based classifier. Our comparative evaluation revealed that a custom-built, hyperparameter-tuned artificial neural network (ANN) achieved the highest accuracy of 97.5%, significantly outperforming all other models. While tree-based models like random forest also demonstrated strong performance (93.2%), other classifiers showed considerably lower efficacy. To ensure transparency in our top-performing model, SHapley Additive exPlanations (SHAP) was employed, identifying critical predictors such as retro-ocular pain, swollen eyelids, and age. This study not only establishes the superiority of a well-tuned ANN for this task but also demonstrates the value of broad model comparison and explainability in building reliable diagnostic tools for public health.

Background: Despite being preventable and treatable, malaria continues to have a devastating impact on people's health and livelihoods around the world. In Ethiopia, it is one of the three leading causes of hospital admission and mortality. Therefore, the aim of this study was to assess the trend, burden, seasonal variations, and interventional assessment of malaria in Western Tigray, Ethiopia, from 2011 to 2019.

Methods: A hospital-based retrospective cross-sectional study was carried out to determine trend, burden, seasonal variations, and interventional assessment of malaria in Kahsay Abera General Hospital, Western Tigray, North Ethiopia, from 2011 to 2019. All recorded microscopically confirmed malaria cases in the Health Management Information System of the hospital were carefully taken and analyzed. Also, malaria intervention activities applied in the area were assessed using a checklist, personal communication with hospital administrators, and observations. All data of malaria cases were entered and analyzed using Microsoft Office Excel and presented in tables and figures.

Results: A total of 36,438 malaria cases with 50 (0.14%) hospital mortality and 2016 (5.5%) hospital admissions were recorded from 2011 to 2019. Plasmodium falciparum, with 22,621 cases (62.1%), was the predominant malaria species identified. The highest hospital malaria death was observed in the age group ≥ 15 years, with 38 cases (0.10%), and the highest hospital deaths occurred during October-December, with 21 cases (0.06%) of the total confirmed malaria cases. Although the fluctuating trend of malaria cases, with no shift in species, was statistically significant (p = 0.001) over the study period, the trend in hospital mortality due to malaria was not statistically significant (p = 0.62).

Conclusions: Despite Ethiopia's notable progress in malaria control, the disease remains a major health problem with fluctuating annual trends.

Background: Febrile illnesses can have devastating effects on the health, wellbeing and productivity of infected individuals. Fever is one of the most frequent reasons for seeking medical care globally. In Uganda, malaria is a major cause of fever and other nonmalarial causes such as typhoid and brucellosis. The aim of this study was to improve our understanding of the spatial and temporal distribution of malaria, typhoid fever and brucellosis in Uganda in order to inform the management and control of these diseases.

Methods: A retrospective analysis of data was conducted on human brucellosis, typhoid fever and malaria cases reported through the national disease surveillance system from 2016 to 2023. The data were downloaded from the health management information system into Microsoft Excel. The total number of malaria cases, typhoid fever cases and brucellosis cases over this period were 110,134,705, 1,572,162 and 361,563, respectively. Descriptive analyses were conducted using Epi Info, spatial distribution using Quantum Geographic Information System (QGIS) software. Choropleth maps were created showing cases per 100,000.

Results: Nationally, from 2016 to 2023, the prevalence for malaria, typhoid fever and brucellosis varied from 43,316 to 29,271; 538 to 445 and 151 to 89 cases/100,000 population, respectively. From 2016 to 2023, there was an overall 4% decrease in the malaria prevalence/100,000, 2% decrease in the typhoid fever prevalence/100,000 and 8% decrease in the brucellosis prevalence/100,000. The burden of malaria and the nonmalarial febrile illnesses, typhoid fever and brucellosis varied across regions throughout the eight years. Overall, the northern region had the highest prevalence/100,000 for malaria and brucellosis, while the central region had the lowest prevalence for both diseases. The central region had the highest prevalence for typhoid fever.

Conclusions: The study revealed the disproportionate burden of malaria and nonmalarial febrile illnesses, typhoid fever and brucellosis. The findings suggest a need to review the existing national malaria control program, to strengthen measures to mitigate the risk of typhoid fever infection and multisectoral prevention and control of brucellosis in the most affected regions and districts.

Introduction: One important measure of community and personal hygiene is the prevalence of lice. Healthcare providers and strategists must analyze this illness across several groups if they are to create sensible plans and services for its decrease. The objective of this study was to find the prevalence of head lice in Iranian endemic regions.

Methods: In this retrospective cross-sectional study, all patients referred to healthcare centers affiliated with Shiraz University of Medical Sciences from 2016 to 2021 who were diagnosed with head lice were included. Those confirmed with head lice were isolated and examined by a physician of the healthcare center. Patient information, including city, diagnosis date, type of disease, age, sex, nationality, and urban or rural status, was recorded. Data analysis was performed using descriptive methods in SPSS Version 24 and STATA 14.2.

Results: The results showed a total of 153,550 cases of lice infection (average annual prevalence 0.52% [95% CI: 0.52% to 0.53%]), with a declining trend from 20,951 infections to 5912 during the study period. The highest infection rate (49.3%) was observed in the 6-12 age range; most infected patients, 93.2%, were female. Furthermore, Qirokarzin, Zarrin Dasht, Mohr, and Rostam displayed the highest infestation levels, accounting for 55.4% of infections among the urban population.

Conclusion: Overall, the present study revealed a low prevalence of head lice in Fars Province, southern Iran; most of the individuals with head lice were elementary school-aged girls. Therefore, it is important to focus on interventions and policy-making with the aim of preventing infestation and the spread of disease among this population. Moreover, the general drop in yearly infestation shows how well Shiraz University of Medical Sciences' policies regulate the disease.

Bovine mastitis, a widespread disease in dairy cattle characterized by udder inflammation triggered primarily by pathogenic micro-organisms, poses a considerable challenge to the dairy industry. Staphylococcus epidermidis (S. epidermidis) stands out as a significant etiological factor in the incidence of bovine subclinical mastitis (SCM), further exacerbated by the diminishing efficacy of antibiotics due to the increase in antibiotic-resistant strains. This study sets out to comprehensively investigate the landscape of S. epidermidis in dairy cattle afflicted with SCM. We examined the prevalence of S. epidermidis, assessed its antibiotic resistance patterns, and probed for the presence of antibiotic-resistant genes (mecA, tetK, and ermC) within S. epidermidis strains isolated from 305 milk samples across four distinct dairy cattle breeds: Holstein Friesian, Red Sindhi, Sahiwal, and Cholistani. Among the sampled cows, 56.39% (172 out of 305) were found to have SCM. Within this group, S. epidermidis was identified in 27.90% (48 out of 172) of the cases. Our breed-specific analysis revealed significant disparities, with Red Sindhi cows displaying the highest prevalence at 75%, followed by Holstein Friesian at 45.45%, and significantly lower levels in Sahiwal (5.19%) and Cholistani (3.44%) breeds. To assess the efficacy of antibiotics, we conducted sensitivity testing using nine commonly prescribed antibiotics. Alarmingly, 18 out of the 48 isolates (37.5%) exhibited multidrug resistance (MDR). Our antibiogram results underscored a high resistance of S. epidermidis isolates, particularly against cefoxitin (56.25%) and penicillin (43.75%), while demonstrating remarkable susceptibility to amikacin (2.08%), clindamycin (0%), ciprofloxacin (0%), and chloramphenicol (0%). Furthermore, we employed PCR to ascertain the presence of resistant genes in all S. epidermidis isolates. mecA was detected in 38 isolates (79.16%), while tetK was identified in 33 isolates (68.75%). Notably, the study did not detect the presence of the ermC gene. Our investigation highlights the efficacy of chloramphenicol, clindamycin, and ciprofloxacin against S. epidermidis. However, the prevalence of multidrug-resistant strains calls for careful antibiotic use in veterinary practices. Further research is needed to examine geographic and farm-specific factors affecting S. epidermidis prevalence, and genetic techniques like multilocus sequence typing should be employed to study clonal spread and horizontal gene transfer. Routine antimicrobial sensitivity assessments and continuous monitoring of medication use are essential to develop sustainable strategies against antibiotic resistance in the dairy industry.

Background: COVID-19 continues to pose a major global health challenge. Despite its geographic distance from Brazil's major urban centers, Acre state has experienced notable outbreaks. This study assessed the detection and persistence of SARS-CoV-2 in the rural settlement of Santa Luzia, located in the remote municipality of Cruzeiro do Sul, Acre state, Brazil.

Methods: In July 2022, a cross-sectional survey was conducted at 40 sites from an ongoing environmental study, selected by deforestation patterns and proximity to health posts. Saliva samples were collected from residents aged 5-90 years, followed by nucleic acid extraction and multiplex RT-qPCR for SARS-CoV-2 detection.

Results: Among the 183 individuals from 40 participating families, an 8% positivity rate was observed, with variation by age and sex. In 30% of families, at least one member tested positive, indicating continued viral presence within the community. Spatial analysis using Global and Local Moran's I statistics showed a random distribution of positive samples, consistent with multiple introductions from nearby urban centers and intermittent local persistence.

Conclusion: These findings highlight the ongoing detection and persistence of SARS-CoV-2 in a remote Amazonian community, underscoring the need for continued surveillance in geographically isolated populations.

Background and aims: Antirabies vaccine postexposure prophylaxis (PEP) is effective in preventing rabies when administered promptly and in full. This study assessed factors associated with antirabies PEP full-dose completion among patients attending Nyagatare District Hospital.

Methods: A facility-based cross-sectional study was conducted using data from patients who sought antirabies PEP at the hospital's emergency department in 2022. Patient files and registers were reviewed, and data were analyzed in STATA. Logistic regression was performed to identify factors associated with vaccine completion.

Results: Of the 472 participants, 50.0% were under 16 years, 58.9% were male, and 63.6% lived in rural areas. Most (90.9%) had health insurance, 51.7% received PEP during the dry season, 11.0% received the antitetanus vaccine, and 82.2% had WHO wound Category II. Only 26.5% completed the full vaccination schedule, 16.1% missed appointments, and 57.4% dropped out before completion. Health insurance significantly increased the odds of completing PEP (AOR = 2.19, p = 0.032). Age, sex, and wound characteristics were not significantly associated with ARV full-dose completion.

Conclusion: Compliance with the full antirabies vaccine course was low, with only a quarter of patients completing all five doses. Improving completion requires targeted interventions such as reminder systems, community education, provider counseling, and financial support.