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Challenges in sustaining the elimination of visceral leishmaniasis in India.
Get PDFThe South East Asian initiative for elimination of kala-azar from the Indian subcontinent that began in 2005 is coming to fruition, with India in the last mile of elimination. This aptly timed commentary based on the publication of Pandey et al. (2025) entitled 'Kala-azar elimination in India: reflections on success and sustainability' highlights the complementarity of political commitment that ensured socioeconomic development, along with evidence-based operational research, that needs to be sustained for zero transmission to become a reality
Do alcohol industry-funded organisations act to correct misinformation? A qualitative study of pregnancy and infant health content following independent analysis.
Get PDFBACKGROUND: Access to reliable, accurate, and up-to-date health information is a crucial component of global population health. Like other health-harming industries, the alcohol industry is known to provide misinformation to the public, including on alcohol, pregnancy, and infant health. It is unknown whether industry information changes following independent public health analysis.
METHODS: We extracted data using the homepage, menu, and search tool functions (where available) from seven industry-funded charity and nonprofit company websites (Aware, South Africa; Drinkaware, Ireland; Drinkaware, United Kingdom; Éduc'alcool, Canada; DrinkWise, Australia; Foundation for Advancing Alcohol Responsibility, United States; and International Alliance for Responsible Drinking) that have previously been found to misrepresent the evidence on alcohol, pregnancy, and infant health. We conducted a qualitative, thematic analysis using a published framework of 'dark nudges and sludge' misinformation techniques.
RESULTS: Omission of information, functionality problems, and the positioning and sequencing of information in ways that framed or obfuscated its meaning were the most common forms of misinformation identified. These types of misinformation were often mixed with (limited) relevant information and were most often found in combination. We found pregnancy and infant health information for the consumer on five of the seven websites studied (Drinkaware, Ireland; Drinkaware, United Kingdom; DrinkWise; Éduc'alcool; and Aware). Information on pregnancy and fetal alcohol spectrum disorder was found on these five sites, although they did not all provide information on miscarriage, breastfeeding, or fertility. We could not find any pregnancy and infant health information directed to the consumer on the remaining sites (Foundation for Advancing Alcohol Responsibility and International Alliance for Responsible Drinking). Six of the seven websites had a search tool function; these often produced irrelevant information.
CONCLUSIONS: Following independent public health analysis of their informational outputs, misinformation about pregnancy and infant health remains present on alcohol industry-funded websites. Warnings to the public to avoid alcohol industry-funded information sources should form an essential part of the global effort to tackle health misinformation
The safety, physiological response and repeatability of the incremental shuttle walk test in survivors of COVID-19.
Get PDFBACKGROUND: The incremental shuttle walk test (ISWT) may be a valuable tool for measuring exercise tolerance in patients after a hospital admission with COVID-19. However, the safety, physiological response and repeatability of the ISWT are unknown in this cohort. The present study aimed to explore the properties of this test using the Post-Hospital COVID-19 (PHOSP-COVID) study.
METHODS: Participants performed two ISWTs, with a 30-min rest between tests, at 5 and 12 months post-hospital discharge for COVID-19. Heart rate and fingertip peripheral oxygen saturation were recorded pre- and post-test. Reasons for test termination were noted.
RESULTS: 1593 individuals (median (interquartile range) age 58 (50-66) years and body mass index 31.2 (27.6-35.8) kg·m- 2; 967 (60.7%) males) performed an ISWT; two tests were performed by 1034 and 390 participants at the 5- and 12-month visit, respectively. At 5 months post-discharge, six patients (0.4%) had an adverse event and the most common reason contributing to test termination was breathlessness (826 (54.2%) participants). 336/1470 (22.9%) participants experienced exertional desaturation. Distance walked was greater in the second ISWT compared to the first ISWT at 5 and 12 months post-discharge (mean±sd difference: 5 months: 19±94 m; 12 months: 11±80 m; p<0.05), with an intraclass correlation coefficient estimate of 0.96 (95% CI 0.95-0.97) at 5 months and 0.97 (95% CI 0.96-0.97) at 12 months.
CONCLUSIONS: The ISWT appeared to be safe in this large cohort, supporting use of this field walking test for this population in clinical and research settings. A familiarisation test is recommended, with further study needed to determine the number of familiarisation tests required to achieve acceptable within-day repeatability
Camel milk is a neglected source of brucellosis among rural Arab communities.
Get PDFThe World Health Organization describes brucellosis as one of the world's leading zoonotic diseases, with the Middle East a global hotspot. Brucella melitensis is endemic among livestock populations in the region, with zoonotic transmission occurring via consumption of raw milk, amongst other routes. Control is largely via vaccination of small ruminant and cattle populations. Due to sociocultural and religious influences camel milk (camelus dromedarius) is widely consumed raw, while milk from other livestock species is largely boiled. To investigate the potential public health impact of Brucella in camels we conduct a cross-sectional study in southern Jordan including 227 herds and 202 livestock-owning households. Here we show daily consumption of raw camel milk is associated with Brucella seropositive status among the study population, ORadj 2.19 (95%CI 1.23-3.94) on multivariable analysis, highlighting the need for socioculturally appropriate control measures; targeted interventions among the camel reservoir being crucial for effective control
Do the Drivers of Food Choice Differ Between Healthier and Less Healthy Foods? A Systematic Review of Reviews.
Get PDFCONTEXT: This review is intended to fill gaps in reported literature reviews on food choices by performing a comprehensive overview of the similarities and differences in the drivers of more and less healthy food choices reported in published reviews. OBJECTIVE: We sought to examine similarities and differences in drivers of healthier vs less healthy food choices in the reported literature on food choices. DATA SOURCES: Searches were conducted in the Ovid (APA PsycINFO, Embase, MEDLINE), Econlit, and Scopus databases. A systematic review of reviews was undertaken according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. DATA EXTRACTION: Reviews with samples of adults from high-income countries were eligible. Included reviews were appraised using the Critical Appraisal Skills Programme (CASP) checklist for systematic reviews, and the results were synthesized narratively. Original searches yielded 4887 results from which 102 full-text articles were screened. Updated searches in March 2024 led to a total of 59 included reviews. DATA ANALYSIS: Synthesized findings from included reviews were grouped into overarching categories of drivers and described narratively. Drivers of both less healthy and healthier food choices were income, availability, accessibility, social norms, health status, and the food environment. In contrast, some factors were reported primarily in relation to healthier or less healthy food. Being health conscious and motivated, having nutrition knowledge, and female gender were reported in relation to choices of healthier foods whereas price and/or affordability, stress, lack of time, and need for convenience were reported as drivers of choices of less healthy foods. The most common concern identified from the CASP checklist was a lack of quality appraisal among reviews. CONCLUSIONS: In this review we identified differences between drivers of food choice for healthier and less healthy food, indicating a possibility for policy interventions to target inappropriate drivers if this difference is not recognized. Rather, interventions targeting increasing healthier (or decreasing less healthy) food consumption may be more effective when targeting those relevant drivers. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration No. CRD42022363956
Unmasking rifampicin mono-resistance in tuberculosis patients in Cross River State, Nigeria
Get PDFBackground: Rifampicin resistance has been assumed to be synonymous with multi-drug resistant tuberculosis (MDR-TB), but this approach could be exposing tuberculosis (TB) patients with rifampicin mono-resistance to unduly long and toxic treatment regimens. The current tuberculosis management algorithm in Nigeria recommends commencement of MDR-TB treatment on rifampicin resistance detection, based on GeneXpert results and subsequent phenotypic testing. With the current dearth of phenotypic drug susceptibility testing facilities in Nigeria, several rifampicin mono-resistant tuberculosis patients may be inappropriately placed on toxic second-line drugs used for MDR-TB treatment for prolonged periods before susceptibility results are available. Methods: XpertMTB/Rif were performed on a total of 3,580 patient samples from 10 sites across Cross River State, Nigeria, as a prospective cross-sectional study. Rifampicin-resistant specimens were reprocessed and cultured on Lowenstein-Jensen medium. Indirect susceptibility testing following the microscopic observation drug susceptibility technique was performed using Rifampicin (1 µg/ml), Isoniazid (0.4 µg/ml), Fluoroquinolone (Ofloxacin-1.0 µg), Capreomycin (2.5 µg/ml), Amikacin (2 µg/ml) and Kanamycin (5.0 µg/ml). Results: Mycobacterium tuberculosis was detected in 21.3% (763) of the 3,580 presumptive tuberculosis cases recruited, of which 4.6% (35/763) were resistant to rifampicin. Culture yielded isolates from 89.6% (31/35) of these rifampicin resistant cases while susceptibility testing using first and second line antimicrobials, revealed 32.2% (10/31) and 64.5% (20/31) rifampicin mono-resistant and MDR-TB, respectively. When categorized into treatment groups, 25.7% (27/105) and 1.2% (8/658) of patients with rifampicin resistance belonged to retreatment and naïve patient groups respectively. There was no correlation between rifampicin mono-resistant and MDR-TB with gender (χ2 = 0.793, P = 0.308) or HIV status (χ2 = 0.416, P = 0.398). Patients who presented with first-line treatment failure were most likely to have MDR-TB (χ2 = 9.121, P = 0.028). Conclusion: Our finding that 32.2% of cases were rifampicin mono-resistant, underscores the critical need for phenotypic drug susceptibility testing. The MODS can fill in the gap created when there is a dearth of the more conventional (and costly) DST platforms in a resource-limited setting like Nigeria. More programmatic support and scale up of simpler susceptibility techniques are required in Nigeria and similar contexts
Epidemiology of human metapneumovirus among children with severe or very severe pneumonia in high pneumonia burden settings: the Pneumonia Etiology Research for Child Health (PERCH) study experience.
Get PDFOBJECTIVES: After respiratory syncytial virus (RSV), human metapneumovirus (hMPV) was the second-ranked pathogen attributed to severe pneumonia in the PERCH study. We sought to characterize hMPV-positive cases in high-burden settings, which have limited data, by comparing with RSV-positive and other cases.
METHODS: Children aged 1-59 months hospitalized with suspected severe pneumonia and age/season-matched community controls in seven African and Asian countries had nasopharyngeal/oropharyngeal swabs tested by multiplex PCR for 32 respiratory pathogens, among other clinical and lab assessments at admission. Odds ratios adjusted for age and site (adjusted OR [aOR]) were calculated using logistic regression. Aetiologic probability was estimated using Bayesian nested partial latent class analysis. Latent class analysis identified syndromic constellations of clinical characteristics.
RESULTS: hMPV was detected more frequently among cases (267/3887, 6.9%) than controls (115/4976, 2.3%), among cases with pneumonia chest X-ray findings (8.5%) than without (5.5%), and among controls with respiratory tract illness (3.8%) than without (1.8%; all p ≤ 0.001). HMPV-positive cases were negatively associated with the detection of other viruses (aOR, 0.18), especially RSV (aOR, 0.11; all p < 0.0001), and positively associated with the detection of bacteria (aORs, 1.77; p 0.03). No single clinical syndrome distinguished hMPV-positive from other cases. Among hMPV-positive cases, 65.2% were aged <1 year and 27.5% had pneumonia danger signs; positive predictive value for hMPV aetiology was 74.5%; mortality was 3.9%, similar to RSV-positive (2.4%) and lower than that among other cases (9.6%).
DISCUSSION: HMPV-associated severe paediatric pneumonia in high-burden settings was predominantly in young infants and clinically indistinguishable from RSV. HMPV-positives had low case fatality, similar to that in RSV-positives
UK guidelines for the investigation and management of eosinophilia in returning travellers and migrants.
Get PDFEosinophilia is a common finding in returning travellers, migrants and other travelling groups. In this setting, it often indicates an underlying helminth infection. Infections associated with eosinophilia are frequently either asymptomatic or associated with non-specific symptoms but some can cause severe disease. Here the British Infection Association guidelines group has comprehensively reviewed and updated the UK recommendations for the investigation and management of eosinophilia in returning travellers, migrants and other relevant groups, first published in 2010.1 Literature reviews have been undertaken to update the evidence on the prevalence and causes of eosinophilia in these groups and on the treatment of relevant pathogens and clinical conditions. Diagnostic tests available to UK-based clinicians are summarised. Changes made to the guidelines include updates in the sections on the investigation and empirical treatment of asymptomatic eosinophilia and on the treatment of trichuriasis, lymphatic filariasis, onchocerciasis, hookworm, fascioliasis and taeniasis. Pathogens which are rarely encountered in UK practice have been removed from the guidelines and others added, including an expanded section on fungal infection. A section on off-license and rarely used drugs has been included
Alterations of Hepcidin and Iron Markers Associated with Obesity and Obesity-related Diabetes in Gambian Women
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Aims Obesity, type 2 diabetes (T2D), and chronic inflammation are associated with disturbances in iron metabolism. Hepcidin is hypothesized to play a role in these alterations owing to its strong association with inflammation via the JAK-STAT3 pathway. The current study investigated the differences between inflammatory markers and iron indices and their association with hepcidin in lean women, women with obesity, and women with obesity and T2D (obesity-T2D) in The Gambia. Materials and methods In a cross-sectional study design, fasted blood samples were collected from three groups of women: lean women (n=42, geometric mean (GM) body mass index (BMI)=20.9 kg/m
2
), women with obesity (n=48, GM BMI=33.1 kg/m
2
) and women with obesity-T2D (n=30, GM BMI=34.5 kg/m
2
). Markers of inflammation (IL-6 and CRP) and iron metabolism [hepcidin, iron, ferritin, soluble transferrin receptor (sTfR), transferrin, transferrin saturation, and unsaturated iron-binding capacity (UIBC)] were compared using linear regression models. Simple regression analyses were performed to assess the association between hepcidin levels and respective markers. Results Women with obesity and obesity-T2D showed elevated levels of inflammatory markers. There was no evidence that markers of iron metabolism differed between lean women and obese women, but women with obesity-T2D had higher transferrin saturation, higher serum iron concentration, and lower UIBC. Serum hepcidin concentrations were similar in all the groups. Hepcidin was not associated with markers of inflammation but was strongly associated with all other iron indices (all P<0.002). Conclusion Contrary to our original hypothesis, hepcidin was not associated with markers of inflammation in the three groups of Gambian women, despite the presence of chronic inflammation in women with obesity and obesity-T2D.
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Advancing pharmacovigilance through artificial intelligence: A review of applications and ethical considerations
Get PDFArtificial intelligence (AI) is increasingly applied in pharmacovigilance (PV) to identify, prioritize, and interpret adverse drug reactions (ADRs) across real-world data sources. This narrative review synthesizes recent peer-reviewed studies (2015 – 2024) and maps AI use across four domains: extraction of ADRs from social and clinical text, supervised and ensemble signal detection in spontaneous reporting systems and electronic health records (EHRs), knowledge-graph-based discovery of drug–event associations, and prediction of outcome seriousness to support triage. Across domains, implementations most consistently enhance intake, coding, prioritization, and the timeliness of safety assessment, while graph-based methods surface plausible associations for follow-up and seriousness models aid risk stratification. Cross-cutting challenges include heterogeneous and shifting data, annotation burden, class imbalance (especially for rare events), and concerns around transparency, privacy, and fairness. Evidence remains predominantly retrospective, with uneven external validation, underscoring the need for prospective studies, standardized reporting and calibration, fairness audits, and closer alignment with regulatory signal-management workflows spanning detection, validation, analysis, prioritization, and assessment. By clarifying where AI is already dependable and where methodological and ethical gaps persist, this review offers practical directions for integrating AI into routine PV with auditable thresholds, monitoring, and human oversight