Journal of Infection and Public Health

The A(H1N1)pdm09 virus remains a major global health threat. This study examined the burden of ICU admission, mortality, and associated predictors among patients with A(H1N1)pdm09 pneumonia in a leading center for infectious diseases in Vietnam. Information on demographic, clinical, and laboratory characteristics, and outcomes was retrieved from medical records of adults admitted with influenza A(H1N1)pdm09 during 2009-2019. Among 729 cases, 21.7% (158/729) developed pneumonia. Among 158 pneumonia cases, 36.7% (58/158) developed moderate-to-severe acute respiratory distress syndrome (ARDS), and 15.2% (24/158) received invasive ventilation. ICU admission and mortality rates were 48.7% (77/158, 95%CI 41.1-56.5%) and 8.2% (13/158, 95%CI 4.9-13.6%), respectively. Predictors of ICU admission included being >60 years old (adjusted OR [AOR] 13.864, 95%CI 2.185-87.956, P=0.005), comorbidities (AOR 6.527, 95%CI 1.710-24.915, P=0.006), AST (AOR 1.013, 95%CI 1.001-1.025, P=0.029), and moderate-to-severe ARDS (AOR 14.027, 95%CI 4.220-46.627, P<0.001). Predictors of mortality were invasive ventilation (AOR 55.355, 95%CI 1.486-2062.375, P=0.030) and double-dose oseltamivir or combination therapy (AOR 32.625, 95%CI 1.594-667.661, P=0.024). In conclusion, mortality is not rare in A(H1N1)pdm09 infection. Monitoring of older patients and those with comorbidities, liver enzyme elevation, or moderate-to-severe ARDS is essential for the timely detection of complications requiring intensive care.

Use of fungal mycelia, which has antiviral properties, constitutes a novel strategy for addressing existing and newly emerging viral diseases. We evaluated safety and feasibility of fungal mycelia (Fomitopsis officinalis and Trametes versicolor, FoTv) for treatment of COVID-19 and assessed its antiviral effects and potential to reduce symptoms. In a randomized, double-blind, placebo-controlled, dual site (UCSD/UCLA medical centers) clinical trial we examined non-hospitalized patients who contracted mild-to-moderate COVID-19 [&le;] 96 hours, and experienced symptom onset [&le;] nine days, before enrollment. FoTv was safe, well-tolerated, and feasible for COVID-19 treatment. Minor differences in biochemical markers were observed between groups (26 FoTv, 24 Placebo). FoTv significantly reduced the number and severity of symptoms, particularly sore throat/cough, and in vitro SARS-CoV-2 (pseudovirus) cellular infection. In conclusion, FoTv was safe and reduced COVID-19 symptoms and cellular viral infection. Future studies should investigate therapeutic benefits of fungal mycelia for SARS-CoV-2 and other viruses. Clinicaltrials.gov registration:NCT04667247.

Background: The Colour Blind Quality of Life Scale (CBQoL) is a questionnaire developed to assess the quality of life of individuals with congenital colour vision deficiency (CVD). This study aimed to translate the English version of the CBQoL into Vietnamese and evaluate the validity and reliability of the Vietnamese version (CBQoL-VN). Methods: A forward-backward translation method was performed to produce the Vietnamese text. Content validity was assessed by six experts in vision care. Reliability testing involved 30 participants with congenital CVD, while discriminant validity was evaluated by comparing this group against 30 participants with normal colour vision. Results: Following expert consensus, two items were removed and one transportation-related item was added. The content validation index (CVI) values of 1.0 for relevance, clarity, and understandability indicated excellent content validity. Internal consistency was high, with a Cronbach's alpha of 0.95 for the full scale. Discriminant validity analysis showed that participants with congenital CVD scored significantly lower across all CBQoL-VN domains compared to those with normal colour vision. Conclusions: The modified CBQoL-VN is a valid and reliable instrument for assessing the quality of life of individuals with congenital CVD in the Vietnamese population.

BackgroundHow post-COVID-19 condition (PCC) differs from post-acute infection syndromes (PAIS) caused by other respiratory viruses remains uncertain. Comparing these conditions may clarify whether post-acute symptoms reflect specific consequences of SARS-CoV-2 infection or broader post-viral mechanisms. MethodsWe conducted a systematic review and meta-analysis of cohort studies comparing persistent symptoms or conditions in adults after SARS-CoV-2 infection with those following other acute respiratory viral infections. PubMed, Embase, and Scopus were searched. Random-effects models were used to estimate pooled risks. ResultsAmong 9,371 records screened, 22 studies were included and 14 contributed to the meta-analysis. Increased risk after SARS-CoV-2 infection was observed for pulmonary embolism, abnormal breathing, fatigue, hemorrhagic stroke, memory loss/brain fog, and palpitations; heart rate abnormalities showed borderline significance. For most other outcomes pooled estimates were inconclusive. ConclusionsOnly a subset of outcomes appears more frequent after SARS-CoV-2 infection, suggesting many symptoms attributed to PCC may reflect broader post-viral syndromes.

Introduction: Stroke care is time-sensitive, yet patients in low-resource settings may reach tertiary services only after passing through multiple formal and informal care options. This study examined documented care-seeking pathways and time to presentation among stroke cases recorded at the University of Medical Sciences Teaching Hospital (UNIMEDTH), Ondo State, Nigeria. Methods: A retrospective hospital record review was conducted using secondary data from the Stroke Registry, radiology department records, referral notes, and ambulance records at UNIMEDTH. The analysis included 371 stroke cases with documented time from symptom onset to UNIMEDTH presentation and reconstructable care pathways. First-contact routes were classified as hospital/biomedical, self/informal or traditional/faith-based care, and the number of documented steps defined pathway complexity before and including tertiary presentation. Frequencies and percentages described pathway patterns; median presentation times were compared using Mann-Whitney U and Kruskal-Wallis tests. Results: The median time to tertiary presentation was 24 hours (interquartile range [IQR] 9-72), and 317 patients (85.4%) presented after four hours. Only 30 patients (8.1%) presented directly to UNIMEDTH; 44 distinct care-pathway sequences were recorded. Hospital-facility first contact was documented for 81 patients (21.8%). It was associated with a median presentation time of 3 hours (IQR 2-6), compared with 48 hours (IQR 24-72) among patients whose initial contact was outside a hospital facility (U = 699.50, p < 0.001). The median time also differed across grouped first-contact categories and pathway complexity levels (both p < 0.001). Conclusion: Non-hospital or multi-step care-seeking pathways commonly preceded tertiary stroke presentations in this setting. The findings indicate that delayed tertiary arrival is partly embedded in the pathway followed after symptom onset. Interventions should combine public recognition of stroke warning signs with urgent referral linkages involving hospitals, patent medicine vendors, traditional and faith-based providers, and emergency transport systems.

BackgroundDengue virus infection remains a significant public health concern in India, with changing serotype dynamics influencing disease epidemiology. Understanding local serotype distribution and clinical characteristics is crucial for effective disease management and surveillance. ObjectivesTo determine the prevalence of dengue virus serotypes and analyze their clinical characteristics among NS1-positive patients at a tertiary-care hospital in Gujarat, India. MethodsA cross-sectional study was conducted on NS1-positive dengue patients admitted to AIIMS Rajkot from September 2023 to November 2024. Real-time reverse transcription polymerase chain reaction (RT-PCR) was performed for serotype identification. Clinical and demographic data were collected and analyzed. ResultsNS1-positive patients (70) were confirmed by RT-PCR. DENV-2 was the predominant serotype (53 cases, 75.7%), followed by DENV-1 and DENV-3 (7 cases each, 10.0%), and DENV-4 (2 cases, 2.9%). One co-infection case (DENV-2 + DENV-3) (1.4%) was identified. The mean age was 27.7 {+/-} 14.4 years, with male predominance (58.6%). Young adults (19-35 years) were most affected (45.7%), followed by pediatric patients [&le;]18 years (32.9%). Severe dengue occurred in only one case (1.4%), while hospitalization was required in 25 cases (35.7%). All patients presented with fever, chills, headache (50%), rashes (56%), and malaise (56%), being the most common associated symptoms. ConclusionsDENV-2 showed clear predominance in the Rajkot region during the study period, with low rates of severe disease. The significant pediatric and young adult involvement highlights the need for targeted prevention strategies. These findings contribute to the understanding of regional dengue epidemiology and support evidence-based surveillance and control measures.

Objective. To evaluate the diagnostic and prognostic significance of C reactive protein (CRP) level dynamics within the first five days after surgery for the early detection of surgical site infections (SSI) and to identify independent risk factors, taking into account regional specifics of surgical management (types of surgeries, duration of procedures), as well as the local hospital microbial landscape. Materials and Methods. A single-center retrospective cohort analysis of data from 127 patients who underwent surgical procedures between 2022 and 2024 was conducted. CRP levels on postoperative days 1, 3, and 5 were assessed, and delta values were calculated. Descriptive statistics, ROC analysis, and multivariate logistic regression were used to identify predictors of SSI. Results. Patients with SSI lacked the physiological decrease in CRP levels by day 5. The most informative indicator was the CRP level on day 3: a threshold of >106 mg/L was associated with a high risk of SSI (AUC=0.76; sensitivity 85%, specificity 63%). Independent predictors of SSI included surgery duration (OR=1.015 per 1 min; p<0.001) and the increase in CRP between days 3 and 5 (delta CRP3-5: OR=1.027; p=0.023). A combined model (clinical parameters + CRP) demonstrated the highest predictive ability (AUC=0.79). Conclusion. Monitoring CRP dynamics, particularly on days 3 and 5, is a highly informative and accessible method for the early diagnosis of SSI. A CRP threshold of >100 mg/L on day 3 and its subsequent increase should serve as a trigger for in-depth diagnostic investigation and rationalization of antimicrobial therapy. Keywords: C reactive protein, postoperative complications, surgical site infection, antibiotic therapy, predictive factors, diagnosis

To explore the safety of combined use of lidocaine/prilocaine aerosol and condoms of different materials, this study conducted compatibility tests between them. By observing changes in various physical properties of condom materials after exposure to the aerosol, the compatibility of different polymer materials with the aerosol was analyzed.The results showed that within 15 minutes of exposure to the aerosol, there was no significant difference in all physical properties of natural rubber latex condoms compared with the blank control group (P>0.05), indicating they can be used together. In contrast, obvious changes in physical properties of polyurethane condoms occurred within 5 minutes of exposure (P<0.05), and their performances failed to meet industrial application standards, so combined use is strictly prohibited.This study clarifies the compatibility differences between two mainstream condom materials and lidocaine/prilocaine aerosol, providing experimental evidence and theoretical references for rational matching in clinical and daily use as well as avoiding potential safety risks.

A systematic review and meta-analysis of sleep studies in schizoaffective disorder were conducted using published articles researched in major databases within the period from inception to December 1, 2025. The sleep parameters: total sleep time, sleep efficiency, sleep latency, wakefulness, REM time and percentage, REM latency, REM density, stage 1, 2, 3 and 4 sleep time and percentage, delta sleep time and percentage, of drug-free schizoaffective patients were analyzed and, where available, compared with case-control data of healthy controls, depressed unipolar patients and schizophrenic patients. Forty studies were identified in the systematic review. Nine case-control studies with 67 schizoaffective patients, 88 schizophrenic patients, 79 healthy controls and 131 depressed patients were included in the meta-analyses. The primary outcome was the standard mean difference. Data were fitted with a random-effects model. Publication bias assessment was checked by Egger's Regression and funnel plot asymmetry. Patients with schizoaffective disorder showed reduced total sleep time, increased sleep latency and wakefulness, along with reduced REM time and shortened REM latency, reduced stage 4 sleep time and percentage compared to healthy controls. Patients with schizoaffective disorder differed from depressed patients only for increased sleep latency, while they did not show any difference compared to patients with schizophrenia. SZA showed a non-significant trend (p=0.08) towards increased REM density compared to SCZ, suggesting the need to better clarify the role of REM density in mood and psychotic disorders.

BackgroundUnderstanding antimicrobial use and factors driving it in communities is essential to devise its stewardship and reduce emergence of antimicrobial resistance. ObjectivesTo study the intersectional influence of socioeconomic status, migration and place of treatment on antimicrobial use in a semi urban area in Tamil Nadu, India. MethodsWe conducted a cross-sectional survey among systematically sampled 525 adult men and women from three villages in a semi-urban area in Tiruvallur district. We collected data through structured interviews on incidence of infections in the past 3 months, treatment seeking behaviour, and audited the antimicrobial prescription or empty packs of medicines used. We analyzed the data using R statistical software and performed a multilevel analysis of individual heterogeneity and discriminatory accuracy to study intersectional effects. ResultsWe found that the incidence of infection syndrome was 37% with a majority of them being acute respiratory infections. 143 of them sought treatment, with 40% going to a private general practitioner. People belonging to middle class had a 3.7 times greater odds of going to private sector compared to lower class. Twenty eight (19.6%) of those who sought treatment received an antimicrobial prescription. Sixty percent of them belonged to Access group, 35.7% Watch and 3.6% Restrict group. There was a significant intersectional effect showing middle class- non migrant - private care seekers having 22% probability of antimicrobial use versus lower class - migrant - government care seekers having 16% probability. The variance partition coefficient was 2.6% showing a small by significant portion of the variance contributed by intersectional identities. ConclusionAntimicrobial use in the community is significantly shaped by the intersection of socioeconomic status, migrant status and place of seeking care for the infection. Regulation of private sector prescription patterns and improving access to health care for migrants are key policy interventions.

Background Complementary and Alternative Medicine (CAM) contributes significantly to the utilization of healthcare services in mental health care in sub-Saharan Africa. However, there is limited evidence on the utilization of CAM in the particular setting of post-conflict northern Uganda. This study sought to establish the prevalence, forms, and socio-demographic determinants of CAM use among patients attending the Mental Health Unit at Gulu Regional Referral Hospital (GRRH). Methods This is a cross-sectional study conducted in a hospital setting from June to August 2025. Convenience sampling was employed to recruit 407 participants. A structured questionnaire was employed for data collection. Data analysis was done using STATA software version 18.0. Descriptive statistics were calculated, and bivariate analysis with Prevalence Ratios (PR) with 95% confidence intervals was employed to determine factors that are significantly associated with the use of CAM. Results The lifetime prevalence of CAM use was 63.4% (258/407), with 41.3% (168/407) using CAM currently. The most frequent CAM practices used were herbal medicine (50.4%), spiritual practices (33.7%), and traditional medicine (19.8%). For current users, spiritual practices were most frequent (88.7%). The reasons for using CAM were recommendations from others (84.8%) and cultural or religious beliefs (63.4%). Predictors of CAM use were primary education (PR = 1.36, p = 0.017), living in an urban area (PR = 1.23, p = 0.007), separated (PR = 1.39, p = 0.050), and having a mental health disorder for six or more months (PR range = 1.55-1.72). Catholics (PR = 0.72, p = 0.0007) and Protestants (PR = 0.76, p = 0.011) were less likely to use CAM than Born Again Christians. Conclusion The level of CAM use among patients accessing mental health services in GRRH of northern Uganda is significantly high, while the reporting of CAM use to healthcare providers is remarkably low. This is a challenge that requires urgent attention. Recommendations include integrating the use of CAM into medical practice, developing national policy guidelines on CAM, working in collaboration with traditional/spiritual healers, and conducting public education campaigns.

Objectives: To better define the clinical features of Acinetobacter spp. infection in Northern Thailand, including a comparison of hospital- and community-acquired infections (HAIs and CAIs). Methods: A prospective clinical study of Acinetobacter spp. infections at two Northern Thailand hospitals from 2019 to 2022, collecting data on sample sources, patient demographics, comorbidities, antimicrobial resistance profiles, and outcomes. Results: Of 129 enrolled patients, 81.4% had Acinetobacter spp. isolated from a respiratory sample. A significant minority (25.6%) of infections were CAIs, 33.3% of which were admitted to ITU within 24 hours of admission. Compared to HAIs, CAIs were significantly more likely to be caused by blood (15.2%, p=0.0258), wound (21.2%, p=0.0120), or urine infections (12.1%, p=0.0370). Acinetobacter spp. HAIs mainly occurred after admission to ITU (87.7%, p<0.0001) and were more likely to be multidrug-resistant than CAIs (76.3% vs. 34.4%, p<0.0001). Overall, the median length of hospital stay was 27 days and there was a 27.1% in-hospital mortality, which was increased in patients with CVA/brain (p=0.005), and multidrug-resistant (p=0.010) or carbapenem-resistant infections (p=0.003). Conclusions: These data define the clinical profile of Acinetobacter spp. infections in Northern Thailand, confirming their high mortality and demonstrating CAIs are a significant proportion of all cases.

The blood-sucking ectoparasite Rhipicephalus B. microplus represents one of the greatest economic threats to livestock worldwide. The discovery of novel acaricidal molecules based on environmentally sustainable technologies is therefore required, particularly those suitable for use in dairy and meat-producing livestock without generating contaminant residues. This study aimed to identify and validate plant-derived metabolites with dual activity on acetylcholinesterase and mitochondrial targets as sustainable acaricidal agents against R. microplus, integrating computational screening, biochemical assays and field evaluation. Following in silico screening of 1.300 plant metabolites targeting acetylcholinesterase and mitochondrial function, fourteen compounds were selected for in vitro and in vivo mortality assays using immersion and larval vessel methods. Carvacrol was identified as the most promising metabolite and showed an inhibitory mechanism of action on acetylcholinesterase and mitochondrial complexes I, III, and IV. Its acaricidal efficacy was subsequently confirmed under field conditions using ethanolic and oily formulations (spray and pour-on) applied to cattle (Bos taurus). The spray formulation significantly reduced tick infestation, decreasing tick counts by 20% every 10 days (p < 0.001), whereas the pour-on formulation showed no significant reduction (p = 0.093). These results demonstrate that an integrated discovery pipeline from computational screening to field validation provides a robust strategy for identifying plant-derived acaricidal agents targeting key physiological pathways in R. microplus. HighlightsO_LIStructured and sequential workflow (pipeline) from in silico to Bos taurus C_LIO_LIIdentification and validation of phytometabolites against R. microplus C_LIO_LICarvacrol multitarget activity on acetylcholinesterase and bioenergetic in ticks C_LIO_LIThe spray formulation reduces tick infestation by 20% every 10 days C_LI Graphical abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=91 SRC="FIGDIR/small/727743v1_ufig1.gif" ALT="Figure 1"> View larger version (29K): org.highwire.dtl.DTLVardef@11c9931org.highwire.dtl.DTLVardef@8d6088org.highwire.dtl.DTLVardef@1bcc09aorg.highwire.dtl.DTLVardef@108d1d1_HPS_FORMAT_FIGEXP M_FIG C_FIG Created in BioRender. Avendano, G. (2026) https://BioRender.com/7pm1ffj

A cassane diterpene, 6{beta}-cinnamoyl-7-hydroxyvouacapen-5-ol (6{beta}CHV), isolated from Caesalpinia pulcherrima, has emerged as a promising anticancer drug lead with reported Wnt/{beta}-catenin pathway inhibitory activity and in vivo safety. The present study reports the in vivo pharmacokinetics and tissue distribution of 6{beta}CHV in Wistar rats following a single oral dose of 200 mg/kg. A reproducible RP-HPLC-UV method was developed and validated for quantifying 6{beta}CHV in rat plasma and tissues. Chromatographic separation was achieved using a gradient elution of methanol and water. The method was subsequently applied to investigate the pharmacokinetics and tissue distribution of 6{beta}CHV. Plasma pharmacokinetic analysis revealed delayed and moderate absorption, with a Tmax of 4 h and a Cmax of 1314.12 ng/mL. Following absorption, 6{beta}CHV is distributed widely across peripheral tissues, including the liver, heart, lungs, spleen, and kidneys, as well as pharmacological sanctuary sites such as the brain and testes. The highest concentrations were observed in the stomach, small intestine, and liver, with detectable levels persisting up to 24 h, reflecting extensive tissue partitioning and retention. Overall, these findings demonstrate that oral administration of 6{beta}CHV is feasible. However, the delayed absorption suggests that further optimization of formulation or alternative administration routes may enhance systemic exposure. This study provides the first comprehensive pharmacokinetic and tissue distribution profile of 6{beta}CHV, supporting its continued preclinical development as a potential anticancer therapeutic. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=125 SRC="FIGDIR/small/715187v1_ufig1.gif" ALT="Figure 1"> View larger version (18K): org.highwire.dtl.DTLVardef@4ae86forg.highwire.dtl.DTLVardef@1e1e51aorg.highwire.dtl.DTLVardef@1881c43org.highwire.dtl.DTLVardef@f7789f_HPS_FORMAT_FIGEXP M_FIG C_FIG

ObjectiveTo describe the clinical characteristics of term neonates with neonatal bacterial meningitis (NBM) and explore the association between different pathogens and imaging complications, providing clinical evidence for early identification and individualized management. MethodsA retrospective study was conducted on 531 term neonates diagnosed with NBM admitted to the Capital Institute of Pediatrics from 2013 to 2025. Demographics, clinical manifestations, laboratory parameters, etiological results, imaging complications and treatment measures were collected. Patients were divided into favorable/adverse discharge outcome groups and pathogen-positive/negative groups. Statistical analyses were performed using appropriate tests, and Cramers V coefficient was used to analyze the association between pathogens and imaging complications. ResultsO_LIThe most common clinical manifestations were abnormal body temperature (79.85%), altered consciousness (55.18%) and jaundice (46.52%). CSF/blood culture was positive in 133 cases (25.05%), with Escherichia coli (27.07%), group B streptococcus (17.29%) and Staphylococcus species (16.54%) as predominant pathogens. The overall incidence of imaging complications was 22.22%, mainly hydrocephalus (5.84%), subdural effusion (4.90%) and encephalomalacia (2.64%). C_LIO_LIAdverse discharge outcomes occurred in 107 cases (20.15%). Compared with the favorable group, the adverse group had higher incidences of convulsions, altered consciousness, anterior fontanelle bulging, abnormal muscle tone and primitive reflexes (all P<0.001), more obvious laboratory abnormalities (higher CRP, CSF leukocytes and protein, lower CSF glucose, all P<0.05), higher culture positive rates and greater need for adjuvant therapy (all P<0.001). C_LIO_LIPathogen-positive patients had higher imaging complication rates. Gram-negative infections were associated with higher hydrocephalus and subdural effusion rates, while Gram-positive infections had higher brain abscess risk. Specifically, Escherichia coli correlated with hydrocephalus and subdural effusion; group B streptococcus with cerebral infarction and encephalomalacia; LMs with intracranial hemorrhage and brain abscess; negative cultures correlated with no imaging complications (all P<0.05). C_LI ConclusionTerm NBM neonates have non-specific manifestations, mainly abnormal body temperature and altered consciousness. Predominant pathogens areEscherichia coli, group B streptococcus and Staphylococcus species, with hydrocephalus and subdural effusion as common imaging complications. Adverse outcomes are associated with severe symptoms, obvious laboratory abnormalities and higher pathogen positivity. Specific pathogens correlate with distinct imaging complications.

BackgroundBefore obtaining professional medical care, many people in peri-urban and rural Pakistan contact herbalists, spiritual healers, and unlicensed caregivers. This study examined the social, economic, and cultural factors influencing the use of informal care by analysing the health-seeking behaviours of individuals in the Faisalabad District. MethodsAn exploratory mixed-methods study was conducted in Makkuana and the surrounding villages of Faisalabad District, Punjab. The quantitative component involved a cross-sectional survey of 69 adults using a structured questionnaire adapted from the I-CAM-Q. The qualitative component comprised twelve in-depth interviews and two focus group discussions. Descriptive statistics and chi-square analysis were used for quantitative data. Thematic analysis, guided by the Health Belief Model and Andersens Behavioural Model, was applied to qualitative data. ResultsThe mean age of participants was 40.4 years; 62.3% were female, and 79.7% had monthly household incomes below PKR 60,000. Of the 69 participants, 68 (98.6%) sought care from an informal provider first, most commonly an unqualified practitioner (50.7%), herbal practitioner (29.0%), or homeopath (17.4%). Trust was the leading reason for provider choice (43.5%), followed by proximity (24.6%) and low cost (15.9%). Complications were reported by 21.7% of participants, and 39.1% later required formal care for the same illness. Eight qualitative themes emerged: structural and economic barriers to formal care; proximity and convenience as determinants of informal care; trust, familiarity, and social networks; cultural and religious normalisation of traditional practices; poor doctor-patient communication in formal settings; perceived safety and naturalness of alternative remedies; awareness deficits about provider qualifications; and treatment-related harm and delayed escalation to formal care. ConclusionInformal health care seeking is nearly universal in this community, driven by intersecting economic, structural, cultural, and interpersonal factors. Enhancing primary care affordability, accessibility, and the quality of provider-patient communication together with culturally sensitive health literacy programs, is essential to redirect care seeking toward qualified providers.

Background: With the emergence of drug-resistant strains and an unprecedented threat to control initiatives, tuberculosis remains to be a major public health risk in Ethiopia. Resistance to rifampicin (RR) is an important indicator, since RR is an acceptable surrogate for multidrug-resistant TB (MDR-TB). Over 95% of RR is based on mutations in an 81base pair segment of the rpoB gene, detected using rapid molecular assays. Despite this, detailed molecular epidemiological information is scarce. This study characterized the specific rpoB gene mutation patterns among patients in Addis Ababa, Ethiopia. Methods: A cross-sectional study was conducted in 753 Mycobacterium tuberculosis complex (MTBC) clinical samples, corroborated as positive for MTBC from 2020 to 2024; respective probe mutation patterns were generated by the Xpert MTB/RIF platform. Demographic and clinical variables were also assessed for detecting the potential risk factors. Results: The overall RR-TB rate was 2.3% (17/753). Molecular analysis showed a distinct pattern of mutation, with codon 526 mutations being the most frequent, occurring in 54.3% of the resistance mechanisms. This was followed by those at codons 531 (21.7%) and 533 (15.2%). Most significant was the fact that 100% of RR-TB was observed among treatment-naive patients, providing unequivocal evidence that primary transmission is the exclusive cause of resistance in this population. Moreover, there were no statistically significant correlations between RR-TB and demographic factors, including sex, age, or HIV co-infection. Conclusion: The study demonstrates a steady, low-grade epidemic of RR-TB in Addis Ababa, dominated by a virulent bacterial strain with a distinctive mutation at codon 526. These observations highlight the imperative necessity for a strategic shift from a reactive, clinically-oriented model to proactive public health measures. To effectively break the chains of transmission, we recommend the universal application of drug susceptibility testing, enhanced and socially-directed contact tracing, and integrating molecular surveillance into the TB control program.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has continuously evolved since its emergence in the human population in 2019. As of 1st August 2025, more than 1,700 Omicron subvariants have been designated by the Pango nomenclature system. The Pango nomenclature system designates a new lineage based on genetic and epidemiological information of SARS-CoV-2 strains. However, there is a possibility that strains that have similar genetic backgrounds and the same phenotype are given different Pango lineage names. In this paper, we propose a new algorithm, called FindPart-w, which can identify groups of viral lineages that share the same relative effective reproduction numbers. We introduced a new lineage replacement model, called the constrained RelRe model, which constrains groups of lineages to have the same relative effective reproduction numbers. The FindPart-w algorithm searches the equality constraints that minimise the Akaike Information Criterion of constrained RelRe models. Using hypothetical observation count data created by simulation, we found that the FindPart-w algorithm can identify groups of lineages having the same relative effective reproduction number in a practical computational time. Applying FindPart-w to actual real-world data of time-stamped lineage counts from the United States, we found that the Pango lineage nomenclature system may have given different lineage names to SARS-CoV-2 strains even if they have the same relative effective reproduction number and similar genetic backgrounds. In conclusion, this study showed that viruses that had the same relative effective reproduction number were identifiable from temporal count data of viral sequences. These findings will contribute to the future development of lineage designation systems that consider both genetic backgrounds and transmissibilities of lineages.

Snakebite envenoming is a neglected tropical disease responsible for an estimated 1.8-2.7 million envenomings and 80,000-140,000 deaths annually, with Bothrops asper accounting for 66.7% of cases and 73.2% of deaths in Colombia. The inhibitory activity of three semi-synthetic ergosterol-derived compounds (2, 3, and 4) was evaluated against the major enzymes of Bothrops asper venom--snake venom metalloproteinases (SVMPs), phospholipases A2 (PLA2s), and serine proteinases (SVSPs)--through in vitro and in silico studies, aiming to identify potential adjuvants for the treatment of local damage. In vitro assays were developed to assess the inhibition of procoagulant, amidolytic, proteolytic, phospholipase A2, and esterase activities using compound concentrations ranging from 62.5 to 500 M, along with molecular docking studies to predict enzyme-ligand interactions. Compound 4 was the most effective inhibitor of coagulant activity (SVSP), showing a significant dose-dependent effect (p < 0.001) at all tested concentrations (62.5-500 M), prolonging plasma clotting time by up to 300 s at the highest doses. For amidolytic activity (SVSP), compounds 2 and 4 showed inhibitory capacity, although with variability across concentrations. In contrast, compounds 2 and 3 were the most potent inhibitors of PLA2 activity inhibitors, exhibiting a significant dose-dependent effect. Notably, none of the compounds inhibited SVMP proteolytic activity. Molecular docking and molecular dynamics simulations were performed to investigate the binding mechanisms of the selected compounds with PLA2 and SVSPs. Compound 2 was analyzed in complex with PLA2, and compounds 3 and 4 were evaluated against SVSP. The results revealed that ligand binding was primarily driven by hydrophobic interactions, supported by key electrostatic contributions, leading to stable ligand-receptor complexes throughout the simulations. MM-GBSA calculations showed favorable binding free energies consistent with experimental inhibitory activity, highlighting ergostane-based compounds as promising scaffolds for the development of novel inhibitors targeting PLA2 and SVSP. Author summaryEvery year, hundreds of thousands of people are bitten by snakes, most of them farmers or children living in rural areas far from hospitals. Many suffer permanent damage or do not survive. Snakebite is a serious global health problem that rarely receives the attention it deserves. In Colombia, Bothrops asper -- known locally as mapana or terciopelo -- is responsible for most of these cases. Its venom acts quickly, destroying tissue, causing bleeding, and disrupting the bloods ability to clot. Although treatments exist, they often cannot prevent the severe damage that occurs within the first minutes after a bite. With this in mind, we explored whether molecules derived from ergosterol, a natural compound found in mushrooms, could help block some of the most harmful effects of the venom. Through laboratory experiments and computer simulations, we found that some of these molecules were able to reduce venom activity linked to tissue damage and clotting disorders, although they did not block all of its effects. We hope these findings represent a step toward developing complementary treatments that are simpler and more accessible, ultimately improving care for the people who need it most.

BackgroundThere is currently no approved antiviral therapy against measles virus (MeV). Repurposing available compounds with broad antiviral activity may rapidly identify candidate drugs for clinical evaluation. Here we evaluated the antiviral activity of the clinically approved drugs azelastine hydrochloride and zafirlukast as well as the flavonoids quercetin and isoquercetin against MeV in preventative and therapeutic in vitro studies. MethodsCompounds were tested for antiviral activity against MeV in preventative (prophylactic and virucidal) and therapeutic (steady-state and persistent) assays in Vero/hSLAM cells. Viral loads and cell viability were measured 48h post-infection, and dose-response curves were used to calculate EC50 values. Flavonoids were also tested in the presence of 1 mM ascorbic acid. ResultsAzelastine hydrochloride did not show evidence of antiviral activity against MeV under these conditions, whereas zafirlukast, quercetin, and isoquercetin showed therapeutic activity against MeV. The addition of ascorbic acid enhanced the therapeutic potency of quercetin to 4.2-4.8 {micro}M and of isoquercetin to 10.7-10.9 {micro}M. Antiviral activity was dose-dependent when administered post-infection. ConclusionAmong the four compounds tested, quercetin showed the most potent therapeutic antiviral activity against MeV in vitro. Isoquercetin and zafirkulast also showed therapeutic activity. These findings support further evaluation of quercetin, isoquercetin, and zafirlukast as candidate antiviral drugs for MeV and highlight the utility of in vitro platforms for rapid antiviral drug screening.