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Persistence of soil-transmitted helminth infections among school-age children after multiple rounds of mass drug administration in Machame Narumu, Hai District, north-eastern Tanzania
No full textAbstract Background All districts in Tanzania Mainland are endemic for soil-transmitted helminth (STH) infections, and have implemented at least five rounds of preventive chemotherapy targeting school-age children (SAC) in primary schools. However, there is limited information on the prevalence of STH infections in many parts of the country. Therefore, the present study was carried out to determine the prevalence and factors associated with STH infections among 5 to 14-year-old in primary schools in Machame Narumu, Hai District, north-eastern Tanzania. Methods A school-based cross-sectional study was conducted between May and June 2022. A two-stage random sampling method was used where one ward out of ten wards and four out of five primary schools were selected at stage one by simple random sampling technique During stage two sampling, the pupils from each of the four selected schools were stratified by their classes, then randomly selected based on the probability-proportional-to-size (PPS) method. A structured questionnaire was used to collect information on socio-demographic information and risk factors for STH infections from each participant. Stool samples were examined under the microscope following formol-ether concentration for the detection of helminth eggs. Data were analyzed using STATA Corp Software version 16.0. Logistic regression was employed to assess factors associated with STH infections among school-age children in primary schools, Hai District. Prevalence of STH infections was obtained by dividing the number of children who were infected with STH by the total number of children who participated in the study. A p-value < 0.05 was considered statistically significant. Results The overall prevalence of STH infections was 26.6% (95% CI: 22.3%-31.4%), relatively higher than the national prevalence of 8.4% that was reported about 9 years ago. Trichuris trichiura was the most prevalent, with the prevalence of 10.2% (95% CI: 7.3%-13.7%), followed by Ascaris lumbricoides, 8.9% (95% CI: 6.2%-12.2%), and hookworms, 0.5% (95% CI: 0.1%-1.9%). However, multiple infections were also observed where children were infected by more than one roundworm species. Factors that were significantly associated with STH infections among SAC were age(AOR = 1.21, 95% CI: 1.03–1.42, p = 0.019), sex (AOR = 0.52, 95% CI: 0.29–0.92, p = 0.038), use of spring water (AOR = 0.41, 95% CI: 0.19–0.86, p = 0.86), and information about STH infections (AOR = 2.14, 95% CI: 1.01–4.53, p = 0.046). Conclusion Despite annual mass drug administration, STH infections remain a public health concern among school children in the study area, with moderate prevalence relative to the World Health Organization (WHO) thresholds of 20% to 50% prevalence. This calls for an integrated approach to include other interventions such as health and hygiene education, and programs for improving sanitation in the study area. This is the first report of STH infections in the Kilimanjaro region. Clinical trial number Not applicable
Between stigma, misinformation and delay of diagnosis: healthcare worker’s perspectives on leprosy care in Sindh, Pakistan
No full textAbstract Background Beyond the physical symptoms of leprosy, persons affected by leprosy (PAL) continue to face stigma and discrimination, also in the low-endemic setting of Pakistan. Leprosy-related stigma and misinformation impacts treatment adherence and health-seeking behavior of PAL, ultimately increasing risks of disability and increased disease transmission. Healthcare workers (HCW) play a pivotal role in detecting, diagnosing, counseling and supporting PAL. Their insights are essential in developing effective interventions to combat the stigma and improve the overall well-being and confidence in healthcare of those affected. Methods Twenty-one in-depth individual interviews were conducted with dermatologists, dermatology residents, general physicians, leprosy technicians and nurses. A combined inductive-deductive thematic analysis approach was applied based on a “conceptual framework of the dimensions of stigma, its manifestations and impact on health outcomes” developed by Mukerji and Turan. Results The study revealed that stigma and misinformation were shaped by contextual factors, including the absence of a national leprosy program, limited public awareness, patriarchal gender norms and socio-economic disadvantages. HCW reported frequent delays in diagnosis, psychological distress, limited awareness and socio-economic burden due to leprosy and its stigma among PAL. Although HCW demonstrated strong medical knowledge, low levels of leprosy exposure outside specialized centers reduced diagnostic confidence of non-dermatologists. Trust-building, psychosocial counseling and sensitive handling of disclosure proved essential for treatment adherence. Gender dynamics also affected care: women were more likely to hide symptoms due to the anticipated stigma, whereas men were more likely to comprise treatment adherence due to economic responsibilities. Conclusions In low-endemic settings like Pakistan, stigma, misinformation, and structural barriers intersect to drive diagnostic delay and limited access to care. Strengthening leprosy care requires (1) Increasing public awareness and reaching broader audiences through social media and digital health tools (2) collaboration with local and alternative medicine providers to reduce misdiagnosis (3) targeted training for HCW on psychosocial counselling and gender responsive care; and (4) evaluating and improving care interventions through close collaboration with PAL and community leaders. Further, integrating leprosy control into national programs and mental health services would improve comprehensive care and support stigma reduction. Clinical trial number Not applicable
Hospitalization rate and patterns of clinical reasons among Mpox-confirmed cases: a systematic review and meta-analysis
No full textAbstract Background Mpox, caused by the monkeypox virus, has recently re-emerged as a global public health concern. The hospitalization rates and the reasons for mpox-confirmed patients remain inconsistently reported, with prior studies using different case definitions and reasons for admission. In light of these inconsistencies and the resurgence of the mpox threat, this systematic review and meta-analysis aimed to provide an updated assessment of the hospitalization rate and clinical reasons among mpox-confirmed patients. Methods Online database searches, including PubMed, Hinari, CINHAL, EMBASE, Google, and Google Scholar, as well as manual searches from national and international reporting websites, were conducted. Studies were included if they reported on laboratory-confirmed mpox cases with or without hospitalization reasons. Data extraction followed a standardized protocol, and the quality of the included studies was assessed using the Joanna Briggs Institute critical appraisal tool. A meta-analysis was performed to pool the effect sizes. A random effect model was used to estimate the pooled effect sizes. Heterogeneity among the included studies was assessed using Cochran’s Q test and I2 statistics. Subgroup analysis, sensitivity analysis, and meta-regression were carried out to identify the source of heterogeneity. A funnel plot and Egger’s test were used to assess publication bias. Result Among the 441 studies identified, 45 that fulfilled the eligibility criteria were included for the final analysis, consisting of 25,367 mpox confirmed study participants and 1606 hospitalized cases. The pooled hospitalization rate across the included studies was 8.0% (95% CI: 6.0, 11.0) with significant heterogeneity. Subgroup analysis by region revealed that the highest pooled rate of hospitalization was observed in Africa, and the lowest was in Europe. A significant publication bias was detected, and a trim-and-fill analysis identified nine missing studies. After adjusting for these, the pooled hospitalization rate for mpox increased slightly to 10.5% (95% CI: 8.3, 12.8). Of the total included studies, 34 studies involving 792 confirmed mpox patients reported clinical reasons for hospitalization, and 15 clinical reasons were analyzed. The most common reasons were unspecified severe pain (46.0%), followed by non-anogenital cellulitis/cutaneous bacterial superinfection (38.8%) and genital edema with or without phimosis/paraphimosis (34.9%). Significant heterogeneity was also observed across several hospitalization reasons. Conclusion Hospitalization among mpox-confirmed patients was relatively low, and the most common clinical reasons for admission were unspecified severe pain, followed by bacterial infections of the skin. The study highlights the need for improved pain management, infection control, and early intervention to reduce hospital admissions. It also calls for standardized hospitalization criteria and reporting to improve comparisons across studies that aid clinicians and public health authorities in the management of mpox outbreaks
Toll-like receptor 5 on monocyte as a biomarker of mortality risk in patients with sepsis
No full textAbstract Objective To evaluate the expression of Toll-like receptor 5 on monocyte at ICU admission as a potentially novel early screening biomarker to predict the mortality risk of sepsis. Methods Patients with sepsis (n = 107), ICU non-septic controls (n = 53) and healthy controls (n = 55) from May 2023 to December 2024 were enrolled. The expression of Toll-like receptor 5 on monocyte were detected by Flow cytometry within 4 h at ICU admission. The efficacy of Toll-like receptor 5 for predicting mortality risk of sepsis were analyzed by receiver operating characteristic curves. The Toll-like receptor 5 was categorized into higher and lower groups on the basis of the cutoff value, and Kaplan-Meier survival rates were analyzed to evaluate the relationship between Toll-like receptor 5 and the mortality risk of sepsis. Results Toll-like receptor 5 levels on monocyte at ICU admission in patients with sepsis were significantly higher than those in ICU non-septic patients and the healthy controls. The expression of Toll-like receptor 5 on monocyte in septic non-survivors were significantly higher than that in survivors. Moreover, the AUC of Toll-like receptor 5 (0.6983, P = 0.0006) for predicting mortality risk of sepsis were higher than PCT (0.5741, P = 0.2012) ,CRP (0.5820, P = 0.1582) and WBC (0.6381, P = 0.0172), but lower than APACHE II (0.7101, P = 0.0003) and SOFA score (0.7888, P < 0.0001). The AUC of Toll-like receptor 5 combined with SOFA score for estimating 28-day mortality in septic patients increased from 0.6983 to 0.8030 (P < 0.0001). Toll-like receptor 5, SOFA and APACHE II scores at ICU admission were found to be independent predictors of sepsis 28-day mortality. In addition, septic patients with higher Toll-like receptor 5 level (≥ 2.05) had poorer survival than those with lower levels (< 2.05) (P = 0.0002). Conclusion The expression of TLR5 on monocyte at ICU admission were valuable for predicting the mortality risk of sepsis. These findings can be used as a early screening biomarker to predict the mortality risk of sepsis
Development and validation of a risk nomogram model for predicting superficial fungal infections in patients with type 2 diabetes mellitus : a cross-sectional study
No full textAbstract Objective To develop and validate a nomogram for the individualized prediction of superficial fungal infections (SFI) risk in patients with type 2 diabetes mellitus (T2DM). Methods This cross-sectional study enrolled patients with T2DM from the Affiliated Anning First People’s Hospital of Kunming University of Science and Technology between December 2023 and December 2024. Risk factors were identified using multivariable logistic regression, and a nomogram was developed subsequently for predicting SFI in T2DM patients. The model’s performance was evaluated using receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA) and clinical impact curve (CIC) in the training and validation sets. Results Among 308 hospitalized T2DM patients screened by multiplex quantitative polymerase chain reaction (qPCR), 220 (71.40%) were diagnosed with SFI. Trichophyton rubrum (107 cases) was the most common pathogen, and monoinfection was the most frequent presentation (90 patients). Patients were randomly divided into a training (n = 216) and a validation cohort (n = 92) in a 7:3 ratio. Multivariable logistic regression analysis identified eight key variables: body mass index (BMI), blood glucose (Glu), hemoglobin A1c (HbA1c), urinary albumin-to-creatinine ratio (UACR), serum potassium (K+), sodium (Na+), hyperlipidemia (HLP) and hypertension (HTN). The nomogram demonstrated excellent predictive ability. The ROC analysis indicated good discrimination in the training cohort (area under the curve (AUC) = 0.966; 95% CI, 0.945–0.987) and the validation cohort (AUC = 0.931; 95% CI, 0.877–0.985). The optimal cut-point of the nomogram was 0.624 with a sensitivity of 92.3% and specificity of 86.7% (Youden’s index: 0.79). Calibration curves showed good agreement. DCA confirmed the clinical utility of the nomogram. Conclusion This nomogram effectively predicts the risk of SFI in T2DM patients and provides an objective tool to facilitate early identification and intervention by clinicians
Predictors of mortality in a Chinese medical ICU: a focus on ICU-acquired bloodstream infections
No full textAbstract Background Bloodstream infection (BSI) is a leading cause of morbidity and mortality among critically ill patients. This retrospective study aimed to determine the frequency of a medical intensive care unit (ICU)-acquired BSIs and identify the mortality risk factors associated with BSIs in critically ill patients within the medical ICU who were transferred from the internal medicine department, not from the surgical department after a surgery. Methods Blood samples were processed using the BACTEC 9240 blood culture system, with species identification conducted for culture-positive cases using a Bruker mass spectrometer, and susceptibility tests by Vitek-2 system, or TDR YEAST-AST system. Pre-specified risk factors for mortality were analyzed through logistic regression. Results Over a 9-year period, 113 isolates of BSI occurred in 106 (2.2%) of 4820 patients. Gram-negative bacteria predominated as the primary pathogens, accounting for 64.6% of all isolated pathogens. The most frequent pathogen was Enterobacteriaceae (36.3%), primarily Klebsiella pneumoniae (25.7%). The lungs were the most common source of infections. Septic shock was present at the onset of BSI in 71 (67.0%) patients. Of the total, 66 (62.3%) patients died within 1 month following the onset of BSIs. Multivariate analysis identified the following independent factors for 1-month all-cause mortality: lymphocyte count < 0.5 × 10⁹/L (OR = 4.305) and septic shock (OR = 3.275), while BMI ≥ 23 (OR = 0.181) and appropriate antibiotic treatment (OR = 0.333) remained protective. Conclusions This study, focusing on a high-risk medical ICU population with BSIs, identifies key factors associated with mortality: septic shock as the predominant risk factor, the prognostic relevance of severe lymphopenia, the critical role of appropriate antibiotics, and the potential consideration of the “obesity paradox” (BMI ≥ 23) in patient assessment
Aortoesophageal fistula as a late-onset complication of infected aortic arch aneurysm caused by Salmonella enterica serotype Choleraesuis: a case report
No full textAbstract Background Salmonella enterica serotype Choleraesuis (S. Choleraesuis) is a nontyphoidal Salmonella serotype that can cause foodborne illness in a broad range of animals. In healthy individuals, S. Choleraesuis infections most often cause self-limiting acute gastroenteritis. However, more serious infections can develop and be associated with high mortality in immunocompromised patients. Case presentation We report a 71-year-old male patient who presented to the emergency department with a 3-week history of fever and chest discomfort. Chest computed tomography revealed an infected aortic aneurysm in the distal aortic arch with an infected hematoma in the mediastinum. S. Choleraesuis was identified in both the blood cultures on admission and the hematoma specimen culture obtained from the surgical mediastinal drainage. Despite appropriate antimicrobial therapy with thoracic endovascular aortic repair and surgical mediastinal drainage, the patient died of massive hematemesis due to an aortoesophageal fistula. Conclusions S. Choleraesuis tends to invade the bloodstream, leading to bacteremia and infected aortic aneurysms. Aortoesophageal fistula is a rare but life-threatening cause of upper gastrointestinal bleeding that may be due to an infected aortic aneurysm. To save the patient’s life, further studies on the proper management of infected aortic arch aneurysms complicated with aortoesophageal fistulas are needed. Clinical trial number Not applicable
Homing ability of Melipona quadrifasciata in fragmented landscapes extends to 7.5 km
No full textAbstract Understanding how pollinators navigate human-modified landscapes is essential for conservation planning, yet movement ecology remains poorly resolved for most stingless bees. We experimentally assessed the homing ability of Melipona quadrifasciata by releasing 1,200 RFID-tagged workers across four seasonal periods. A total of 165 individuals returned (13.75%), including two bees that successfully returned from 7.5 km—the longest homing distance recorded for this species. Return probability declined steadily with distance (~ 41% lower odds per km), with model comparison showing that this pattern does not reflect a discrete homing threshold. Landscape structure significantly influenced navigational success: higher maximum NDVI along least-cost corridors increased return probability, while greater NDWI range along corridors—indicating moisture variability—also favored successful returns. Survival analyses yielded consistent patterns for return time, and including remote-sensing metrics substantially improved model performance relative to distance-only formulations. A multi-criteria prioritization revealed a temporally dynamic but spatially constrained network of return routes, including a subset of persistent core corridors that remained functional across all seasons, in contrast with transient seasonal corridors sensitive to environmental fluctuations. Collectively, our findings show that M. quadrifasciata possesses greater navigational capacity than previously assumed and that stable structural features of the landscape repeatedly provide favorable conditions for orientation and successful homing. By integrating RFID tracking, remote sensing, and resistance-based modeling, this study provides an empirical framework for identifying pollinator movement corridors and guiding connectivity-oriented conservation strategies in fragmented tropical landscapes
Comparative transcriptome analysis reveals ABI3/VP1-WRKY25-STR1 regulatory module linking specialized metabolism with root system development and stress response in Rauvolfia serpentina
No full textAbstract Secondary metabolites play crucial roles in plant defense, development, and ecological interactions, making them valuable for medicinal and agricultural applications. However, the regulatory mechanisms governing their biosynthesis remain incompletely understood. Here, we conduct a meta-analysis of publicly available Rauvolfia serpentina transcriptome data from different plant tissues to investigate secondary metabolite biosynthesis and root system development. Our analysis points to the involvement of distinct biosynthetic routes and associated co-expression networks that may collectively contribute to metabolite production in R. serpentina. The co-expression analysis revealed two putative modules—plum1 and steelblue—that showed a coordinated transcriptional pattern with genes implicated in secondary metabolism. Within these modules, hub-gene analysis identified three key candidates, STR1, ABI3/VP1, and WRKY25, which appear to be linked not only to secondary metabolite biosynthesis but also to aspects of root system development. Subsequent promoter analysis and qRT-PCR validation revealed tissue-specific regulation of WRKY25, STR1, and ABI3/VP1, with significant stress-responsive expression detected primarily in roots, particularly under salicylic acid and drought treatments. This induction pattern reinforces their potential involvement in both metabolite production and broader stress-tolerance mechanisms. Overall, this study provides a useful set of candidate genes and regulatory elements that can be pursued in future functional assays. It also offers preliminary insights into the tissue-specific regulation of secondary metabolite biosynthesis in R. serpentina
Development of a novel magnetic nanocomposite crosslinker for enhanced polymer gelation applications
No full textAbstract High-temperature degradation and excessive syneresis severely limit the lifespan of polymer gels used for water shutoff in mature reservoirs. This study investigates the synthesis and application of a novel Fe3O4@saponin/Cu(II) nanocomposite as a multifunctional reinforcement for Hydrolyzed Polyacrylamide (HPAM)/Cr(III) systems, specifically designed to overcome stability failures in harsh environments. Magnetite cores were surface-functionalized with saponin and copper(II) ions to create a dual-mechanism crosslinker, which was subsequently characterized via FTIR, TGA, and DLS. The performance of the resulting nanocomposite gels was evaluated through rheological profiling, long-term thermal aging at 105 °C, and high-pressure core flooding experiments in sandstone plugs. Results indicate that an optimal loading of 500 ppm increased the gel’s storage modulus by threefold compared to the nano-free control and accelerated gelation time to a field-practical 10 h. Critically, the nanocomposite effectively arrested network collapse, reducing syneresis from 72.8% to only 10% after two months. Furthermore, core flooding tests revealed a dramatic enhancement in sealing capacity, with Residual Resistance Factors (RRF) exceeding 1000, more than 30 times higher than that of the conventional system. These findings demonstrate that the synergistic combination of steric stabilization by saponin and secondary coordination bonding by Cu(II) creates a highly durable network, positioning this nanocomposite as a promising candidate for sustainable conformance control in high-temperature, high-salinity reservoirs
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