This document provides an overview of Crimean-Congo hemorrhagic fever (CCHF). It discusses that CCHF is a tick-borne viral disease caused by the CCHF virus, which causes severe hemorrhagic fever outbreaks with a fatality rate of 10-40%. The virus is found across Africa, the Middle East, Asia, and parts of Europe. The first cases of CCHF in India were reported in 2011 in Gujarat. While there is no approved treatment, supportive care and the antiviral ribavirin may increase survival rates when administered early.
Hundred samples viz. urine, blood, wound, pus and sputum collected from different patients were found to harbour Pseudomonas aeruginosa (P. aeruginosa) (27%) with a maximum isolation from wound samples (33.33%) and minimum from blood samples (11.11%). The degree of resistance of P. aeruginosa isolates to different antibiotics like Ceftazidime (30µg), Amikacin (30µg), Imipenem (10µg), Ciprofloxacin (30µg), Tetracycline (30µg), Gentamicin (10µg), Norfloxacin (10µg), Penicillin (30µg), Chloramphenicol (30µg), and Ofloxacin (5µg) varied from 56% to 100%. Antiseptics i.e. Betadine and Dettol were found to be more effective against the MDR strain of P. aeruginosa at the dilutions of 10-1 and 10-2. Duration of the disease and hospitalization duration, evaluated as risk factors for P. aeruginosa colonization were found to be statistically significant while age and gender were found to be statistically non- significant. The incidence of multidrug resistance of P. aeruginosa is increasing fast due to the frequent use of antibiotics and antiseptics, which are used extensively in hospitals and healthcare centers, therefore it is a need to develop alternative antimicrobial agents for the treatment of infectious diseases.
Key-words- Antibiotic, Antiseptic, Betadine and Dettol, Disinfectants, P. aeruginosa
Astaxanthin is a naturally occurring carotenoid which is derived from the microalgae Haematococcuspluvialis. As well as being the most powerful antioxidant known to science, it also has potent anti-inflammatory properties. Naturalastaxanthin´s distinct advantage in comparison to other antioxidants, is its ability to span the entire lipid bilayer of the cell membrane, thus providing superior protection from the inside out. Natural astaxanthin has a strong ability to both balance and strengthen the immune system. This article reviews the current available scientific literature regarding the effect of astaxanthin from the algae Haematoccus pluvialis in Astashine capsules as a natural immune booster in covid-19 infections.
Monkey Bites and Herpes B –Virus Infection in Humansinventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Malaria is still considered globally as a leading cause of morbidity with Nigeria carrying the highest burden of 19%. Coinfection of malaria and Human Immunodeficiency Virus (HIV) accelerate disease progression of HIV/AIDS subjects. This study investigated the prevalence and predictors of malaria among HIV infected subjects attending the antiretroviral therapy Clinic at Federal the Medical Centre, Keffi, Nigeria. After ethical clearance, 200 whole blood specimens were collected from patients who gave informed consent and completed a self-structured questionnaire. The specimens were examined for malarial parasite using rapid kits and microscopy. The overall prevalence of the infection was 78/200 (39.0%). The prevalence was higher in male (44.7%) than female (34.0%) subjects. Those subjects aged < 20 years (54.5), male gender (44.7%), non-formal education holders (61.5%), farmers (62.5%), stream water users (48.1%), those that lives in rural setting (43.6%), those that do not use Insecticides Treated Nets (ITNs) (39.4%) and swampy environment dwellers (41.7%) were identified predictors for malaria infection in the area. All the predictors studied did not show any statistically significant difference with the infection but some arithmetic difference exists (P > 0.05). The 39.0% prevalence of malaria in HIV infected subjects is a public health concern. Therefore, Public health surveillance and health education among HIV population should be advocated to help eradicate malaria comes 2030. Further study that will characterize the genes of the parasite should be carried out.
Hundred samples viz. urine, blood, wound, pus and sputum collected from different patients were found to harbour Pseudomonas aeruginosa (P. aeruginosa) (27%) with a maximum isolation from wound samples (33.33%) and minimum from blood samples (11.11%). The degree of resistance of P. aeruginosa isolates to different antibiotics like Ceftazidime (30µg), Amikacin (30µg), Imipenem (10µg), Ciprofloxacin (30µg), Tetracycline (30µg), Gentamicin (10µg), Norfloxacin (10µg), Penicillin (30µg), Chloramphenicol (30µg), and Ofloxacin (5µg) varied from 56% to 100%. Antiseptics i.e. Betadine and Dettol were found to be more effective against the MDR strain of P. aeruginosa at the dilutions of 10-1 and 10-2. Duration of the disease and hospitalization duration, evaluated as risk factors for P. aeruginosa colonization were found to be statistically significant while age and gender were found to be statistically non- significant. The incidence of multidrug resistance of P. aeruginosa is increasing fast due to the frequent use of antibiotics and antiseptics, which are used extensively in hospitals and healthcare centers, therefore it is a need to develop alternative antimicrobial agents for the treatment of infectious diseases.
Key-words- Antibiotic, Antiseptic, Betadine and Dettol, Disinfectants, P. aeruginosa
Astaxanthin is a naturally occurring carotenoid which is derived from the microalgae Haematococcuspluvialis. As well as being the most powerful antioxidant known to science, it also has potent anti-inflammatory properties. Naturalastaxanthin´s distinct advantage in comparison to other antioxidants, is its ability to span the entire lipid bilayer of the cell membrane, thus providing superior protection from the inside out. Natural astaxanthin has a strong ability to both balance and strengthen the immune system. This article reviews the current available scientific literature regarding the effect of astaxanthin from the algae Haematoccus pluvialis in Astashine capsules as a natural immune booster in covid-19 infections.
Monkey Bites and Herpes B –Virus Infection in Humansinventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Malaria is still considered globally as a leading cause of morbidity with Nigeria carrying the highest burden of 19%. Coinfection of malaria and Human Immunodeficiency Virus (HIV) accelerate disease progression of HIV/AIDS subjects. This study investigated the prevalence and predictors of malaria among HIV infected subjects attending the antiretroviral therapy Clinic at Federal the Medical Centre, Keffi, Nigeria. After ethical clearance, 200 whole blood specimens were collected from patients who gave informed consent and completed a self-structured questionnaire. The specimens were examined for malarial parasite using rapid kits and microscopy. The overall prevalence of the infection was 78/200 (39.0%). The prevalence was higher in male (44.7%) than female (34.0%) subjects. Those subjects aged < 20 years (54.5), male gender (44.7%), non-formal education holders (61.5%), farmers (62.5%), stream water users (48.1%), those that lives in rural setting (43.6%), those that do not use Insecticides Treated Nets (ITNs) (39.4%) and swampy environment dwellers (41.7%) were identified predictors for malaria infection in the area. All the predictors studied did not show any statistically significant difference with the infection but some arithmetic difference exists (P > 0.05). The 39.0% prevalence of malaria in HIV infected subjects is a public health concern. Therefore, Public health surveillance and health education among HIV population should be advocated to help eradicate malaria comes 2030. Further study that will characterize the genes of the parasite should be carried out.
Una nuova ricerca spiega le possibilità delle terapie di neuromodulazione di intervenire nella cura dei problemi neurologici derivati dalla pandemia da COVID-19
Correlation between Human Origin and the Severity of COVID19ijtsrd
It has been reported that the severity of coronavirus infectious disease COVID 19 is due to several factors such as age and the presence or absence of chronic disease. Furthermore, it has been reported that genetic factors affect the severity of COVID 19. A recently published study of the COVID 19 Host Genetics Initiative suggests that genetic manifolds in the region located on chromosome 3 may increase the risk of the severity of COVID 19. Takuma Hayashi | Ikuo Konishi "Correlation between Human Origin and the Severity of COVID19" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-6 , October 2020, URL: https://www.ijtsrd.com/papers/ijtsrd33684.pdf Paper Url: https://www.ijtsrd.com/medicine/other/33684/correlation-between-human-origin-and-the-severity-of-covid19/takuma-hayashi
Viral infections have always been of major concern in communities, health care settings and medical fields including radiotherapy and Radiology. Recently corona virus infection has attained global attention in the wake of covid-19 outbreak and consequently highlighted importance of viral prevention, diagnostic and therapeutic strategies to control and treat viral disease. In view of the recent events, the author reviewed the current and past literature to discuss contagious versus infectious viral transmission, as well as simple and effective ways of preventing the spread of viral diseases in community and health care setting so that this information can be used for preventing viral transmission at all levels. The article is written for a wide variety of audiences i.e. scientific and medical communities policy makers and general public.
A Geographical Distribution of Aids Cases in Tamilnadu District Wise (2008 – ...IJERA Editor
The present study was undertaken to characterize the various opportunistic pathogens (fungi and bacteria) which are responsible for high morbidity and mortality in 25 HIV seropositive patients, either hospitalized (5 Nos) (or) coming to antiretroviral therapy centre in Government hospital, TamilNadu, were included in the study for finding the spectrum of opportunistic pathogens. Blood serum, urine, sputum, and oral swabs were collected and processed. A total of eight pathogens were detected.
FOURNIER’S GANGRENE: REVIEW OF 57 CASES IN TERTIARY INSTITUTIONAnil Haripriya
Fournier’s gangrene which is a rapidly progressive, fulminant polymicrobial synergistic infection of the perineum and genitals is now changing its pattern. Both genders can be affected and the mortality is still high (around10%). The clinical presentation in many patients in early stage may not be prominent. Thus rapid and accurate diagnosis is must for prompt treatment. Extensive surgical debridement and broad spectrum intravenous antibiotic remains the mainstay of treatment in order to reduce the morbidity and mortality.
An overview on Monkeypox, Current Paradigms and Advances in its Vaccination, ...Dr Varruchi Sharma
Monkeypox virus is an orthopoxvirus sharing the common genus with variola and vaccinia virus. Most of the monkeypox (MPX) cases had been reported from the central and west African region (the main endemic areas) prior to 2022 but there was a sudden outbreak in May, 2022 disseminating the infections to thousands of people even in non-endemic countries, posing a global public health emergency. MPX was considered a rae and neglected disease, however the 2022 MPX outbreaks in multiple countries attracted attention of worldwide researchers to pace up for carrying out researches on various aspects of MPXV including attempts to design and develop diagnostics, vaccines, drugs and therapeutics counteract MPX. Apart from being a zoonotic disease, the current outbreaks highlighted rapid human-to-human transmission of MPXV, besides the reverse zoonosis has also been documented with recent first report of human-to-dog transmission, urging a call for the importance of one health approach. Atypical and unusual disease manifestations as well asymptomatic MPXV infections have also been observed during 2022 MPX outbreak. the affected patients typically develop a rash resulting in a mild disease followed by recovery with some supportive care and use of antivirals such as tecovirimat, cidofovir and brincidofovir in severe disease cases. Modified vaccinia Ankara (MVA) vaccine with an excellent safety profile has been recommended to patients with higher risk exposure and immunocompromised individuals. Moreover, another vaccine the replication-competent vaccine (ACAM2000) could be a suitable alternative to MVA’s non-availability to some selective immunocompetent individuals. Current review highlights the salient aspects of management and treatment of monkeypox along with underlying promises in terms of therapeutics and a variety of challenges posed due to current global public health emergency situation to counteract MPX.
Una nuova ricerca spiega le possibilità delle terapie di neuromodulazione di intervenire nella cura dei problemi neurologici derivati dalla pandemia da COVID-19
Correlation between Human Origin and the Severity of COVID19ijtsrd
It has been reported that the severity of coronavirus infectious disease COVID 19 is due to several factors such as age and the presence or absence of chronic disease. Furthermore, it has been reported that genetic factors affect the severity of COVID 19. A recently published study of the COVID 19 Host Genetics Initiative suggests that genetic manifolds in the region located on chromosome 3 may increase the risk of the severity of COVID 19. Takuma Hayashi | Ikuo Konishi "Correlation between Human Origin and the Severity of COVID19" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-6 , October 2020, URL: https://www.ijtsrd.com/papers/ijtsrd33684.pdf Paper Url: https://www.ijtsrd.com/medicine/other/33684/correlation-between-human-origin-and-the-severity-of-covid19/takuma-hayashi
Viral infections have always been of major concern in communities, health care settings and medical fields including radiotherapy and Radiology. Recently corona virus infection has attained global attention in the wake of covid-19 outbreak and consequently highlighted importance of viral prevention, diagnostic and therapeutic strategies to control and treat viral disease. In view of the recent events, the author reviewed the current and past literature to discuss contagious versus infectious viral transmission, as well as simple and effective ways of preventing the spread of viral diseases in community and health care setting so that this information can be used for preventing viral transmission at all levels. The article is written for a wide variety of audiences i.e. scientific and medical communities policy makers and general public.
A Geographical Distribution of Aids Cases in Tamilnadu District Wise (2008 – ...IJERA Editor
The present study was undertaken to characterize the various opportunistic pathogens (fungi and bacteria) which are responsible for high morbidity and mortality in 25 HIV seropositive patients, either hospitalized (5 Nos) (or) coming to antiretroviral therapy centre in Government hospital, TamilNadu, were included in the study for finding the spectrum of opportunistic pathogens. Blood serum, urine, sputum, and oral swabs were collected and processed. A total of eight pathogens were detected.
FOURNIER’S GANGRENE: REVIEW OF 57 CASES IN TERTIARY INSTITUTIONAnil Haripriya
Fournier’s gangrene which is a rapidly progressive, fulminant polymicrobial synergistic infection of the perineum and genitals is now changing its pattern. Both genders can be affected and the mortality is still high (around10%). The clinical presentation in many patients in early stage may not be prominent. Thus rapid and accurate diagnosis is must for prompt treatment. Extensive surgical debridement and broad spectrum intravenous antibiotic remains the mainstay of treatment in order to reduce the morbidity and mortality.
An overview on Monkeypox, Current Paradigms and Advances in its Vaccination, ...Dr Varruchi Sharma
Monkeypox virus is an orthopoxvirus sharing the common genus with variola and vaccinia virus. Most of the monkeypox (MPX) cases had been reported from the central and west African region (the main endemic areas) prior to 2022 but there was a sudden outbreak in May, 2022 disseminating the infections to thousands of people even in non-endemic countries, posing a global public health emergency. MPX was considered a rae and neglected disease, however the 2022 MPX outbreaks in multiple countries attracted attention of worldwide researchers to pace up for carrying out researches on various aspects of MPXV including attempts to design and develop diagnostics, vaccines, drugs and therapeutics counteract MPX. Apart from being a zoonotic disease, the current outbreaks highlighted rapid human-to-human transmission of MPXV, besides the reverse zoonosis has also been documented with recent first report of human-to-dog transmission, urging a call for the importance of one health approach. Atypical and unusual disease manifestations as well asymptomatic MPXV infections have also been observed during 2022 MPX outbreak. the affected patients typically develop a rash resulting in a mild disease followed by recovery with some supportive care and use of antivirals such as tecovirimat, cidofovir and brincidofovir in severe disease cases. Modified vaccinia Ankara (MVA) vaccine with an excellent safety profile has been recommended to patients with higher risk exposure and immunocompromised individuals. Moreover, another vaccine the replication-competent vaccine (ACAM2000) could be a suitable alternative to MVA’s non-availability to some selective immunocompetent individuals. Current review highlights the salient aspects of management and treatment of monkeypox along with underlying promises in terms of therapeutics and a variety of challenges posed due to current global public health emergency situation to counteract MPX.
Travel-related infectious diseases on the rise
International travel has an important role in the transmission of emerging and re-emerging infectious diseases across geographical areas.
Since 1980, the world has been threatened by different waves of emerging disease epidemics.
In the twenty-first century, these diseases have become an increasing global concern because of their health and economic impacts in both developed and resource-constrained countries.
It is difficult to stop the occurrence of new pathogens in the future due to the interconnection among humans, animals, and the environment.
As many as 43%–79% of travelers to low- and middle-income countries become ill with a travel-related health problem.
Although most of these illnesses are mild, some travelers become sick enough to seek care from a health care provider.
Coronaviruses are important human and animal pathogens. At the end of 2019, a novel coronavirus was identified as the cause of a cluster of pneumonia cases in Wuhan, in the Hubei Province of China. It is rapidly spreading, resulting in an epidemic throughout china, followed by an increasing number of cases in other countries throughout the world. In February 2020, the WHO designated the disease COVID 19, which stands for corona viruses 2019. The virus that causes COVID 19 is designated severe acute respiratory syndrome coronavirus 2 SARS COV 2 previously, it was referred to as 2019 nCoV. Anushka Bharti | Dr. Gaurav Kumar Sharma | Dr. Kaushal Kishore Chandul "COVID-19" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-6 , October 2021, URL: https://www.ijtsrd.com/papers/ijtsrd46439.pdf Paper URL : https://www.ijtsrd.com/pharmacy/pharmaceutics/46439/covid19/anushka-bharti
Corona virus was first identified as a cause of the common cold in 1960. Until 2002, the virus was considered a relatively simple, nonfatal virus.Over the last three decades there have been three attacks of three different coronaviruses, SARS-CoV, MERS CoV and the recent one 2019 novel coronavirus (2019-nCoV).
The SARS-Cov2 is highly pathogenic and has spread very rapidly.
Here we have tried to present an overview of the prevailing COVID-19 situation in terms of health impact, pathophysiology, clinical manifestations, diagnosis, management, emergency responses and preparedness.
The research literature is growing rapidly and hopefully it will help in finding an effective vaccine (many in trials) and the best practice for the management and treatment of symptomatic cases.
The health, social and economic impacts would be high by this global killer.
We should be able to learn lessons and hopefully we will be more prepared for any such event in future.
Corona viruses are a group of RNA viruses. In late December 2019, Patients with pneumonia with unknown etiology was get admitted in health care facilities in Wuhan, China, and resulted in a pandemic disease which affected more than 200 countries and responsible for 182,989 deaths world wide. The disease is officially named as Coronavirus Disease 2019 COVID 19, by WHO on February 11, 2020 . COVID 19 is a potential zoonotic disease with low to moderate estimated 2 -5 mortality rate. Currently, there is no definite treatment for COVID 19 although some trials are under investigation. Hence, appropriate use of PPE, regular hand hygiene, Respiratory and cough etiquettes, social distancing are some key elements to prevent the spread of disease. Ms. Pabalpreet Kaur | Ms. Eenu | Ms. Pooja Jaswal | Dr. (Mrs.) Jyoti Sarin "The Outbreak of COVID-19: An Overview" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-4 , June 2020, URL: https://www.ijtsrd.com/papers/ijtsrd30859.pdf Paper Url :https://www.ijtsrd.com/medicine/nursing/30859/the-outbreak-of-covid19-an-overview/ms-pabalpreet-kaur
To Assess the Severity and Mortality among Covid 19 Patients after Having Vac...YogeshIJTSRD
The severity and mortality of COVID 19 cases has been associated with the Three category such as vaccination status, severity of disease and outcome. Objective presently study was aimed to assess the severity and mortality among covid 19 patients. Methods Using simple lottery random method 100 samples were selected. From these 100 patients, 50 patients were randomly assigned to case group and 50 patients in control group after informed consents of relative obtained. Patients in the case group who being died after got COVID 19 whereas 50 patients in the control group participated who were survive after got infected from COVID 19 patients. Result It has three categories such as a Vaccination status For the vaccination status we have seen 59 patients were not vaccinated and 41 patients was vaccinated out of 100. b Incidence There were 41 patients were vaccinated whereas 59 patients were not vaccinated. c Severity In the case of mortality we selected 50 patients who were died from the Corona and I got to know that out of 50 patients there were 12 24 patients were vaccinated whereas 38 76 patients were non vaccinated. Although for the 50 control survival group total 29 58 patients were vaccinated and 21 42 patients was not vaccinated all graph start. Conclusion we have find out that those people who got vaccinated were less infected and mortality rate very low. Prof. (Dr) Binod Kumar Singh | Dr. Saroj Kumar | Ms. Anuradha Sharma "To Assess the Severity and Mortality among Covid-19 Patients after Having Vaccinated: A Retrospective Study" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd45065.pdf Paper URL: https://www.ijtsrd.com/other-scientific-research-area/other/45065/to-assess-the-severity-and-mortality-among-covid19-patients-after-having-vaccinated-a-retrospective-study/prof-dr-binod-kumar-singh
Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans.
EVD outbreaks have a case fatality rate of up to 90%.
EVD outbreaks occur primarily in remote villages in Central and West Africa, near tropical rainforests.
The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.
Fruit bats of the Pteropodidae family are considered to be the natural host of the Ebola virus.
Severely ill patients require intensive supportive care. No licensed specific treatment or vaccine is available for use in people or animals.
Tarannum Yasmin1*, Krishan Nandan2
1Associate Professor, Department of Microbiology, Katihar Medical College Katihar, Bihar, India
2Assistant Professor, Department of Microbiology, Katihar Medical College Katihar, Bihar, India
*Address for Correspondence: Dr Tarannum Yasmin, Associate Professor, Department of Microbiology, Katihar
Medical College, Katihar, Bihar, India
Received: 15 September 2016/Revised: 03 October 2016/Accepted: 22 October 2016
ABSTRACT- INTRODUCTION- HIV/AIDS pandemic is responsible for the resurgence of Tuberculosis worldwide,
resulting in increased morbidity and mortality. Co-infection with HIV infection leads to difficulty in both the diagnosis
and treatment of Tuberculosis, increased risk of death, treatment failure and relapse.
OBJECTIVE- The present study highlights the correlation of Pulmonary Tuberculosis in HIV positive cases and its
association with CD4 count.
MATERIAL & METHODS- A total of 72 known case of HIV were screened for tuberculosis infection by clinical
examination, radiology & ZN staining.
RESULTS AND CONCLUSIONS- From our study 60 (83.33%) were diagnosed as tuberculosis and 12 (16.67%) were
negative. More common HIV infection in case of male 48 (66.67%). Out of 60 tuberculosis infection 53 (88.33%) were
diagnosed as Pulmonary Tuberculosis and 7 (11.67%) were diagnosed as Extrapulmonary Tuberculosis. The result of
study emphasizes that co-infection of tuberculosis in HIV/AIDS patient is a concern. There is direct correlation between
CD4 counts depletion and Pulmonary Tuberculosis in HIV/AIDS patients.
Key-words- Pulmonary Tuberculosis, HIV, AIDS, CD4 count
this presentation put insights on the most important pivots of the Crimean-Cong Hemorrhagic Fever in Iraq and the World and was a part of institutional efforts represented by University of Misan/Iraq as step of many steps to educate community to this dangerous zoonotic disease.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
2. Agravat VJ et al. Int J Res Med Sci. 2014 May;2(2):392-397
International Journal of Research in Medical Sciences | April-June 2014 | Vol 2 | Issue 2 Page 393
human health, and the second most widespread of all
medically important arbo viruses, after dengue virus.4
Status in India
Developing countries such as India suffer
disproportionately from the burden of CCHF given the
confluence of existing environment, socio-economic and
demographic factors.7
The emergence of this deadly viral
infection in a huge country like India having all
ecological suitability for the virus is a challenge for the
entire medical fraternity.4
Jan 2011 marks first ever
reports of outbreak of CCHF in India, total 5 cases were
detected of CCHF from Gujarat.8
CCHF has recently in
news again, 6 human cases9
and 32 animal samples10
test
positive for CCHF in test done by National Institute of
Virology (NIV) Pune, from Kariyana village of Amreli
district (Gujarat state) July 2013. The village has around
5000 population and their main occupation is animal
husbandry and agriculture. Amreli district is one of the 26
administrative districts of the state of Gujarat in western
India.11
CCHF outbreak constitute a threat to public health
because of its epidemic potential, its high case fatality
ratio, its potential for nosocomial outbreaks; and the
difficulties in treatment and prevention.12
EPIDEMIOLOGY
Causative agent
Crimean-Congo hemorrhagic fever virus (CCHFV),
member of genus Nairovirus in the family Bunyaviridae.3
CCHF virus is a spherical enveloped virus with
approximately 100nm diameter and has glycoprotein
spikes 8-10nm in length. Under electron microscopy, the
virion of CCHF can be distinguished from other members
within the Bunyaviridae family, as they possess small
morphologic surface units with no central holes arranged
in no obvious order.4
Vector and reservoir
Numerous genera of ixodid ticks serve both as vector and
reservoir for CCHFV; however occurrence of CCHF
closely approximates the known world distribution of
ticks in the genus Hyalomma spp. ticks.13
The most
important source for acquisition of the virus by ticks is
considered to be infected small vertebrates on which
immature Hyalomma ticks feed.14
Once infected, the tick
remains infected through its developmental stages and the
mature tick may transmit the infection to large
vertebrates, such as livestock. Domestic ruminant
animals, such as cattle, sheep and goats are remained
viraemic (virus circulating in the bloodstream) for around
one week after becoming infected, allowing the tick-
animal-tick cycle to continue when another tick bites.
Differences in tick feeding preferences and vertebrate
host availability in the various regions will likely mold
the evolutionary landscape of the virus.15
Host
Human beings are the only host of CCHF in whom the
disease manifestations are visible (4)
. Reservoir host are
nares and Hyalomma ticks where as domestic animals act
as amplifying host.2
Human acquire the infections through tick bites, direct
contact with blood or tissue of infected livestock, or
drinking unpasteurized milk.3
Human-to-human
transmission is possible and is an important route in a
nosocomial set up when skin or mucous membranes are
exposed to blood and body fluids of patients with
haemorrhage.4
Figure 1: Transmission cycle of CCHFV.
Risk factors
a) History of tick bite
b) Having contact with livestock
c) High risk occupations (butchers, physicians,
veterinarians) are important risk factors in CCHF.
This majority of cases have occurred in people involved
in the livestock industry, such as agricultural workers,
slaughterhouse workers and veterinarians.3
Izadi et al.
stated that even occasional contact with livestock could
be effective in transmission of virus.16
Many birds are resistant to infection, but ostriches are
susceptible.3
Shepherd et al. reported death of an ostrich
abattoir from CCHHF, confirmed by isolation of CCHF
virus from the patient's serum and by demonstration of a
specific antibody response.17
It was suspected that
infection was acquired either by contact with ostrich
blood or by inadvertently crushing infected Hyalomma
ticks while skinning ostriches.
Increasing number of cases have occurred among the
medical and nursing staff caring for patients in hospital
and in laboratory personnel carrying out investigations of
these patients. In these cases the infection has apparently
been acquired by contagion, particularly by contact with
the patient's blood or blood-contaminated specimens.18
Indeed, two cases of nosocomial contamination (a doctor
and a nurse) were reported in 2011 in India following the
hospitalization of a CCHFV infected patient.19
Naderi et
al. also reported a nosocomial spread of CCHF in north-
eastern Iran to a medical student who died within 1 week
of exposure.20
Zavitsanou et al. stated that most
dangerous conditions for acquiring CCHF in nosocomial
3. Agravat VJ et al. Int J Res Med Sci. 2014 May;2(2):392-397
International Journal of Research in Medical Sciences | April-June 2014 | Vol 2 | Issue 2 Page 394
setting are interventions for controlling gastrointestinal
bleedings and emergency operations in patients who have
not been diagnosed with CCHF virus before operation.21
CCHF has also occurred in hospitals due to improper
sterilization of medical equipment, reuse of injection
needles, and contamination of medical supplies.22
Masayunki et al. stated the possibility of horizontal
transmission of CCHF virus from mother to child.23
As for all vector-borne diseases, environmental factors,
climate and human behaviour are critical determinants for
the establishment and maintenance of CCHF endemicity
in an area. Dikid et al. stated that changes in climatic
conditions is one of the factors that has facilitated
survival of a large no of Hyalomma spp. Ticks and of the
hosts of both immature and adult stages and consequently
increase incidence of CCHF.7
Kara et al. states that global
warming will make the world as a better place for
parasites, biting flies or ticks which serve as vectors of
diseases remain alive throughout the year and that
increases the risk of occurrence of CCHF.24
Zavitsanou et
al. stated that high mortality rates of CCHF may imply its
usage as bioterrorism agent.21
CCHF virus has been listed
in US as an CDC/NIAID Category C priority pathogen.25
CLINICAL MANIFESTATIONS
The typical course of CCHF infection has four distinct
phases - incubation period, prehaemorrhagic phase,
haemorrhagic phase, and convalescent phase.4
The length of the incubation period depends on the mode
of acquisition of the virus.3
Figure 2: Incubation period of CCHF infection.
The onset of prehaemorrhagic phase is sudden, with
initial signs and symptoms including headache, high
fever, back pain, joint pain, stomach pain, and vomiting
(26)
similar to other viral illness lasting for 4-5 days. Red
eyes, a flushed face, a red throat, and petechiae (red
spots) on the palate are common. Symptoms may also
include jaundice, and in severe cases, changes in mood
and sensory perception. As the illness progresses,
haemorrhagic phase evident in the form of large areas of
severe bruising, severe nosebleeds, conjuctival
haemorrhage, uncontrolled bleeding at injection sites,
hematemesis and melena can be seen.27,28
There is usually
evidence of hepatitis, and severely ill patients may
experience rapid kidney deterioration, sudden liver
failure or pulmonary failure after the fifth day of illness.3
There is no relation between the temperature of the
feverish patient and the onset of haemorrhage.29
In
patients who recover, improvement generally begins on
the ninth or tenth day after the onset of illness.3
In the
survivors, the convalescent period begins 10-20 days
after the onset of illness. During this phase, patients may
have feeble pulse, tachycardia, loss of hearing, and loss
of memory and hair. However, these after effects have
been reported only in few outbreaks.4,30
There is no
known relapse of the infection.21
In documented outbreaks of CCHF, fatality rates in
hospitalized patients have ranged from 9% to as high as
50%.26
High mortality rate in nosocomial infection than
after tick bite is related to virus dose.25
Clinical picture of CCHF are non-specific and overlap
with other tropical infections like Falciparum malaria,
leptospirosis, dengue haemorrhagic fever, typhoid fever,
septicemic plague, Rickettsial infections,
meningococcemia and other viral infections.19
DIAGNOSIS
Clinical picture of CCHF is nonspecific thus; cannot
be used by clinicians to support making early
diagnosis. Early diagnosis is an essential
requirement, not only for patient management but
also for prevention of further transmission of disease,
as it is a highly contagious disease.4
CCHF virus infection can be diagnosed by several
different laboratory test which include enzyme linked
immunosorbent assay (ELISA), antigen detection,
serum neutralisation, reverse transcriptase
polymerase chain reaction (RT-PCR) and virus
isolation.3
The most definitive way of diagnosis is the
demonstration of virus or viral genome.4
Reverse-transcriptase PCR (RT PCR) is the method
of choice for rapid laboratory diagnosis of CCHF
virus infection.
The ELISA test is considered the most sensitive and
specific.31
IgG and IgM antibodies may be detected
in serum by ELISA from about six days of illness.29
CCHF is confirmed either by detection of specific
IgM antibodies or a four-fold increase of IgG titters.1
Other laboratory investigations showed cytopenia,
raised prothrombin time (PT) and activated partial
thromboplastin time (aPTT), raised creatinine
phosphokinase (CPK) and lactic dehydrogenase
4. Agravat VJ et al. Int J Res Med Sci. 2014 May;2(2):392-397
International Journal of Research in Medical Sciences | April-June 2014 | Vol 2 | Issue 2 Page 395
(LDH) as well as altered liver and renal functions.
Patients with above symptoms can rapidly progress
to bleeding from multiple sites and death.32
High
serum ferritin levels have also been reported as
indicator of severity of disease.8
Extreme biohazard risk is associated with testing of
patient samples and conducted only under maximum
biological containment situations.3
The deadly virus
requires biosafety level 4 containment.33
TREATMENT
Hospitalisation in special care unit with constant
laboratory monitoring is cornerstone for treatment of
CCHF. Till date there is no FDA approved drug or
definitive treatment for CCHF.21
Supportive care includes
fluid management by IV crystalloids, oxygen, cardiac
monitoring and administer blood and blood products as
clinically indicated.34
Care should include careful
attention to fluid balance and correction of electrolyte
abnormalities, oxygenation and hemodynamic support,
and appropriate treatment of secondary infections.35
Ribavirin has been used for treatment for CCHF based
mainly on in vitro sensitivity testing and efficacy studies
in animals, but only a limited number of studies and/or
anecdotal experience in humans.36
Anecdotal experience
from small CCHF cohort suggests a possible increase in
survival with ribavirin administered within 72 hours after
onset of illness. Use of oral ribavirin for treatment or
post-exposure prophylaxis of CCHF is an off-label use of
drug.
According to World Health Organization (WHO),
ribavirin is the anti-viral medication used to treat CCHF
and the recommended dose is an initial dose of 30mg/kg
followed by 15mg/kg for four days and then 7.5mg/kg for
six days for a total of 10 days.4
PREVENTION
Prevention and control of this infection require
application of sophisticated epidemiologic and molecular
biologic techniques, changes in human behaviour, a
national policy on early detection of and rapid response
to infection and plan of action.7
Clingiroglu et al. stated
lack of knowledge regarding CCHF in study population.37
1. High index of clinical suspicion:
Agricultural workers and others working with
animals should use insect repellent on exposed skin
and clothing.
Insect repellents containing DEET (N, N-diethyl-m-
toluamide) are the most effective in warding off
ticks.38
Wearing gloves and other protective clothing is
recommended.
In endemic areas ticks should be eliminated from
animals two weeks before they are slaughtered (e.g.
with a pyrethroid acaricide).39
Eating well cooked meat.40
2. Early laboratory diagnosis:
CCHF must be included in differential diagnosis of
unexplained fever with hemorrhagic manifestations
especially in endemic region.41
Development of strong laboratory capacity in areas
where virus is expected to circulate.6
Approaches for diagnostic methods should be
standardised and the assays validated.
Development of rapid diagnostic test.
3. Institution of containment measures curtailed further
spread of disease.
Use of personal protective equipment (PPE).42
Strict barrier-nursing techniques should be enforced:
all persons entering the patient's room should wear
disposable gloves, gowns, masks, and shoe covers.43
Protective eye wear should be worn by persons
dealing with disoriented or uncooperative patients or
performing procedures that might involve the
patient's vomiting or bleeding.
Accidental exposures need to be dealt promptly.44
Contacts should be monitored for 14 days from date
of last contact with the patient or other source of
infection by taking temperature twice daily.2
Administration of prophylactic therapy to healthcare
workers after exposure.
4. Factors that trigger incidence and spreading of
CCHF should be further identified.
5. Role of environment change should be further
studied.
6. Development of new therapies and an effective and
safe vaccine against CCHF.
7. Awareness of general public as well as health
workers about the disease in all endemic regions
should be increased.
Launching general information campaign, inclusive
advice to people visiting areas with CCHF risk.
Broachers, posters and TV spots informing about the
risk of CCHF infection should be distributed to
educate people.
Education programmes to be conducted door to door
in endemic areas.
For a country size and population of India, CCHF
remains a real and present danger. A meaningful response
must approach the problem at system level.
5. Agravat VJ et al. Int J Res Med Sci. 2014 May;2(2):392-397
International Journal of Research in Medical Sciences | April-June 2014 | Vol 2 | Issue 2 Page 396
PROPHYLAXIS PROTOCOL
Direct contact Blood or secretions such as needle stick
injury or contact with mucous membrane such as eye or
mouth from confirmed CCHF patients baseline blood
studies and start high dose oral ribavirin therapy which
constitutes:
2gm loading dose
4gm/day in 4 divided doses (6 months) for 4 days
2gm/day in 4 divided doses for 6 day
Indirect contact Household or contacts who may have
had same exposure to infected ticks or animals or who
recall indirect contact with patients body fluids should be
monitored for 14 days from last date of contact by taking
temperature twice daily and if found 38.5 degree Celsius
or higher, muscle pain and headache. Hospitalised and
start high dose oral ribavirin therapy as mentioned above.
CONCLUSION
CCCHF is a disease of public health importance with a
high fatality rate that had risen in incidence and displayed
geographical spread over the past decade. The present
scenario in India suggests the need to look seriously into
various important aspects of this zoonotic disease, which
includes identifying areas at risk, diagnosis, intervention,
patient management, vaccine development, control of
laboratory acquired and nosocomial infection, tick
control, livestock survey and this, should be done in
priority before it further spreads to other states.
A comprehensive national strategy on CCHF cutting
across all relevant sectors with emphasis on strengthened
surveillance, rapid response to protect valuable human
lives, partnership building and research to guide public
policy is needed.
Funding: No funding sources
Conflict of interest: None declared
Ethical approval: Not required
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DOI: 10.5455/2320-6012.ijrms20140504
Cite this article as: Agravat VJ, Agarwal S, Piparva
KG. Crimean - Congo haemorrhagic fever: an
overview. Int J Res Med Sci 2014;2:392-7.