Tropical Diseases, Travel Medicine and Vaccines最新文献

The lack of dental travel health care has been deplored for some time. Travel medicine's remit is to prepare people for travel. People travel with their mouth firmly in their body, yet the mouth's wellbeing does not rate a mention. This article represents the first exploration of a range of topics relevant to an until now neglected, yet potentially highly important, area of health care. A range of dental mishaps can occur while away from home, from simple toothache to accidents, serious emergencies, or restoration failures. Other problems originate in unwise behaviour, including holiday-inspired body modifications.Unless there is pain, teeth are typically not thought about much. However, examining the practical side of dental hygiene during travels, several overlooked and perhaps surprising topics emerge that - through the travel lens - take on a different and important role: the oral microbiome, toothbrush hygiene, the toilet plume, and traveller diarrhoea. Based on this discussion, recommendations are made for clinical practice, education, and further research.The historical chasm between dentistry and medicine, despite long-standing calls for change, does not seem to go away and impairs holistic high quality travel health care. Travel medicine can bypass this unproductive division. It has the unique opportunity to be the first medical specialty cooperating closely with dentists to bridge this gap by providing quality travel health care to travellers with all their body parts attached.

Background: The COVID-19 pandemic (COVID) disrupted international travel. We sought to determine the impact of the COVID-19 pandemic on patient volume, traveler demographics, and income of our medium-sized travel clinic in Pennsylvania, USA.

Methods: We extracted de-identified pre-travel data on 3,510 pre-travel consultations for adults during: Pre-COVID-19 (January 2018-December 2019), Early COVID-19 (April 2020-March 2022) and Late COVID-19 (April 2022-March 2023). We compared traveler demographics, destinations, purpose of travel, medical conditions, and number of vaccinations administered over time, and our clinic's revenue obtained from our financial database (TruSource) for the Pre, Early and Late COVID-19 periods.

Results: We observed 84% and 85% relative decreases in traveler volume and revenue respectively from the Pre-COVID-19 to the Early COVID-19 period. The decrease (16-11%) in volume was highest for travelers over 65 years of age. Of those that sought care during Early COVID-19, a fewer proportion of travelers had multiple co-morbid conditions and were taking chronic medications. Trip length increased and there was a significant increase in travel to Africa. Travel to visit friends or family and for service work also increased during Early-COVID-19 (32.9%) versus Pre-COVID-19 (19.8%). Clinic volume and revenue began to increase in Late COVID-19 but did not return to Pre-COVID levels.

Conclusions: The COVID pandemic resulted in a large reduction in patient volume and revenue in our academic-based Pennsylvania travel clinic. We saw substantial changes in our traveler demographics, destinations, as well as reasons and durations of travel. Smaller travel clinics will need to have plans in place in order to survive the next pandemic and better serve their pre-travel populations.

Background: Disorders of the ear, nose and throat may be the most commonly occurring pre-existing health condition in international travellers. Despite their high incidence, there is limited guidance for travellers and their clinicians on their prevention and management. This narrative review addresses this deficit by compiling and discussing available evidence on this neglected subject.

Methods: A comprehensive review of the literature was undertaken using Medine and Scopus databases and multiple combinations of relevant MeSH search terms. Further references were obtained from focused searches on specific issues and manual review of the reference lists of articles obtained from the primary search.

Results: Nasal congestion or discharge are among the most common complaints amongst travellers and various causes are reviewed. Changes in elevation result in a pressure differential between the atmospheric pressure and the middle ear and paranasal sinuses. The effects of air travel, recreational high-altitude exposure and diving are considered. Various causes of epistaxis in travellers such as cold air exposure and recreational cocaine use are discussed. The aetiology of a discharging ear in travellers includes otitis externa. The most frequently described travel-specific aetiology of dizziness is motion sickness while mal de debarquement is a specific subtype which affects travellers and is most commonly associated with sea travel. Surgical tourism for treatment of ear, nose and throat pathology is well established and various precautions are presented for post-operative travel. Obstructive sleep apnoea is discussed from the perspective of international travel. The challenges facing travellers with hearing impairment are explored.

Conclusions: This review critically discusses the prevention, diagnosis, and management of acute and chronic ENT conditions in the travelling population. Several areas of inquiry are highlighted that require further investigation. Close communication between ENT specialists and travel medicine practitioners is recommended in the preparation of selected patients for international travel.

Background: With the surge in international travel, primary care physicians (PCPs) play a critical role in managing travel medicine (TM) challenges. This scoping review aims to comprehensively synthesize literature on PCPs' involvement in TM, covering their knowledge, practices, and training.

Methods: Systematic searches across various electronic databases identified empirical studies in English language peer-reviewed journals up to July 2023. Data synthesis involved charting evidence on PCPs' TM knowledge, practices, and training.

Results: Sixteen articles met inclusion criteria, offering insights into PCPs' engagement with TM in primary care. The findings reveal a general deficiency in PCPs' TM knowledge, with factors like prior TM experience, formal training, high traveler exposure, and multilingual abilities predicting higher knowledge scores. TM consultation duration and documentation were frequently reported as insufficient. Barriers to effective TM provision included physician-related factors such as lack of formal training, traveler-related factors like delayed presentation and low-risk perception, and practice-related factors such as low traveler exposure and resource constraints.

Conclusion: This review underscores the crucial role of PCPs in TM and the need for targeted interventions to enhance their expertise and practices. Overcoming barriers through tailored training and support is essential for optimizing TM delivery in primary care.

Monkeypox virus (MPXV) is an enclosed, double-stranded DNA virus from the Orthopoxvirus genus, which also contains variola, vaccinia, and cowpox. MPXV, which was once confined to West and Central Africa, has recently had a rebound, spreading beyond its original range since 2017. The virus is distinguished by its unique morphology, which includes an oval or brick-shaped structure and a complex lipid and protein makeup. The current multi-country outbreak designated a public health emergency in 2022, has highlighted MPXV's shifting epidemiology and ability to spread rapidly over the globe. 'No one is safe until everyone is safe' is a slogan we often heard during the COVID-19 pandemic, which is now also required for the growing global and regional mpox outbreaks. The epidemic is divided into two clades: Clade I and Clade II, which have distinct pathogenic characteristics. Diagnostic approaches have developed with advances in molecular techniques, yet problems persist in resource-constrained situations. This overview summarizes the virus's history, epidemiology, morphology, and clinical characteristics, offering insights into its recent comeback and current global response efforts.

Oropouche fever is an increasingly significant health concern in tropical and subtropical areas of South and Central America, and is primarily spread by midge vectors. The Oropouche virus (OROV) was first identified in 1955 and has been responsible for numerous outbreaks, particularly in urban environments. Despite its prevalence, the disease is often under-reported, making it difficult to fully understand its impact. OROV typically causes febrile illness characterized by symptoms such as headaches, muscle pain, and, occasionally, neurological issues such as meningitis. The ability of the virus to thrive in both forested and urban areas has raised concerns regarding its potential spread to new regions, particularly in the context of climate change. This paper delves into the epidemiology, clinical features, and transmission patterns of OROV, shedding light on the difficulties in diagnosing and managing the disease. The absence of specific treatments and vaccines highlights the urgent need for continued research and development of targeted public health strategies. Advancements in molecular diagnostics and vector control strategies can mitigate Oropouche fever's impact. However, a comprehensive public health approach involving increased surveillance, public education, and cross-border collaboration is needed, especially as the global climate crisis may expand vector habitats, posing risks to previously unaffected regions.

Tuberculosis represents a significant menace to health, leading to millions of cases and fatalities each year. Traditional diagnostic methods, while effective, have limitations, necessitating improved tools. Aptamers possessing remarkable specificity single-stranded DNA or RNA molecules promising in TB diagnosis due to their adaptability and precise biomarker detection capabilities. In this study, we aimed to evaluate the research on aptamer applications in TB diagnosis, evaluating the efficacy, limitations, and future prospects. The present systematic review study followed PRISMA guidelines, including peer-reviewed studies on aptamer efficacy in TB diagnosis. Eligibility criteria covered experimental and human studies on TB diagnosis, prognosis, progression, and treatment response. Of 1165 identified studies, 35 met inclusion criteria. Aptamers were utilized for MTB and mycobacterial antigen detection, showcasing notable sensitivity and specificity. Targeted antigens included ESAT-6, HspX, MPT 64, and IFN-γ. Various aptamer-based assays, such as electrochemical, fluorescent, and immunosensors, demonstrated effectiveness. Multiplex assays, particularly for IFN-γ, showed enhanced diagnostic accuracy. Aptamer-based assays exhibited discrimination between active TB and other conditions, showcasing their diagnostic value. Aptamers, especially in conjunction with nanomaterials, show promise in developing advanced TB biosensors with superior detection capabilities. Cost-effective devices with heightened sensitivity for clinical and screening use are crucial for TB control, emphasizing the need for ongoing research in this field.

Background: Climate change in the upcoming years will raise the health burden of zoonotic parasites. As a liver fluke, Fasciola depends on certain climate conditions to complete its life cycle and is significantly influenced by climate changes. We aimed to investigate the relationship between the increasing prevalence of human fascioliasis and climate changes in Upper Egypt.

Methods: Records of Fasciola cases in Assiut Governorate in Upper Egypt were evaluated between September 2018 and March 2023. The annual and monthly climate parameters of the region's temperature and humidity acquired from ERA5 and FLDAS were investigated between 2000 and 2023.

Results: A total of 303 patients were included. The mean age was 33.9 ± 17.4 years; 57.1% were females, and the majority were rural residents. Positive correlations were found between temperature and the recorded cases in 2018, 2020, 2021, and 2022 (r = 0.92, 0.41, 0.61, and 0.60, respectively). In 2018 and 2022, humidity and Fasciola frequency had a significant positive correlation (r = 0.97 and 0.49, respectively). An outbreak of fascioliasis was recorded in September 2018, coinciding with the peak temperature and high humidity levels, exceeding the average climatology range from 2000 to 2017. The recorded cases exhibited a seasonal pattern, with peaks in hot, humid summer and autumn.

Conclusion: The rise of human fascioliasis in Upper Egypt is influenced by local climate characteristics. A climate-based map of Fasciola distribution using forecast risk models is needed to predict future outbreaks and for better control.

Dengue virus (DENV) is a mosquito-borne virus that causes dengue fever, a significant public health concern in many tropical and subtropical regions. Dengue is endemic in more than 100 countries, primarily in tropical and subtropical regions of the world. Each year, up to 400 million people get infected with dengue. Approximately 100 million people get sick from infection, and 40,000 die from severe dengue. Unfortunately, dengue vaccine development is also marred with various complicating factors, as the forefront candidate vaccine performed unsatisfactorily. Moreover, the only licensed vaccine (Dengvaxia) for children 9 through 16 years of age is available in just a few countries. The treatment difficulties are compounded by the absence of an effective antiviral agent. Exploring plant-based therapeutics for dengue from the laboratory to clinical application involves a multi-stage process, encompassing various scientific disciplines. Individual investigators have screened a wide range of plant extracts or compounds for potential antiviral activity against DENV. In vitro studies help identify candidates that exhibit inhibitory effects on viral replication. Some of the most promising medicinal plants showing in vitro activity against DENV include Andrographis paniculate, Acorus calamus, and Cladogynos orientalis. Further laboratory studies, both in vitro and in animal models (in vivo), elucidate the mechanisms of action by which the identified compounds exert antiviral effects. Medicinal plants such as Carica papaya, Cissampelos pareira, and Ipomea batata exhibited potent platelet-enhancing activities while Azadirachta indica and Curcuma longa showed promising effects in both in vitro and in vivo studies. Based on positive preclinical results, researchers design clinical trials. This involves careful planning of trial phases, patient recruitment criteria, ethical considerations, and endpoints. The most important medicinal plants showing efficacy and safety in clinical trials include Carica papaya and Cissampelos pareira. This review suggests that several promising medicinal plants exist that have the potential to be turned into clinical drugs to treat dengue infection. However, in addition to developing synthetic and plant-based therapies against dengue infection, vector management strategies should be made robust, emphasizing the need to focus on reducing disease incidence.

Dengue is the most rapidly spreading vector-borne disease worldwide, with over half the global population at risk for an infection. Antibody-dependent enhancement (ADE) is associated with increased disease severity and may also be attributable to the deterioration of disease in vaccinated people. Two dengue vaccines are approved momentarily, with more in development. The increasing use of vaccines against dengue, combined with the development of more, makes a thorough understanding of the processes behind ADE more important than ever. Above that, due to the lack of treatment options, this method of prevention is of great importance. This review aims to explore the impact of ADE in dengue vaccinations, with the goal of enhancing potential vaccination strategies in the fight against dengue.