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Background: The emergence and persistence of multidrug-resistant (MDR) Salmonella Typhi (S. Typhi) infections is a significant global health problem. The carrier state of typhoid makes it prudent to conduct routine surveillance for both acute cases and carriers especially those caused by MDR S. Typhi. We report on the prevalence of MDR S. Typhi, resistance phenotypes and antimicrobial resistance genes detected in symptomatic and asymptomatic children living in informal settlements in Nairobi, Kenya. Methods: 215 archived presumed S. Typhi isolates from stool samples provided by children ≤ 16 years collected from 2013 to 2018 were revived in May, 2022 and confirmed using culture and antisera serotyping. The Kirby Bauer disc diffusion technique was used to test the S. Typhi against 14 antibiotics. The MDR S. Typhi (resistant to ampicillin, chloramphenicol and sulfamethoxazole trimethoprim) which in addition were also resistant to either a cephalosporin or a fluoroquinolone were analyzed for Beta lactams and quinolone resistance genes using polymerase chain reaction. Results: A total of 215 isolates were confirmed to be positively S. Typhi; of these, 105 (49%) and 110 (51%) were from symptomatic and asymptomatic children respectively. On average, S. Typhi resistance from asymptomatic and symptomatic children against 1st line drugs was observed at; 77% &70%, ampicillin; 60% & 64%, sulfamethoxazole-trimethoprim, and 45% & 54%, chloramphenicol respectively. Multi drug resistance was observed in 90 (42%) of the isolates, of these, 44 (49%) were isolated from symptomatic and 46 (51%) from asymptomatic children. Fifteen resistance phenotypes (p) were observed with, ampicillin/chloramphenicol/sulfamethoxazole-trimethoprim/nalidixic acid (amp/chl/sxt/na) as the most common among the symptomatic 43/90 (48%) and asymptomatic 55/90 (61%) children. The blaTEM−D, AMR genes were detected in 37/44 (84%) S. Typhi isolates, out of this 18 (49%) were from symptomatic while 19 (51%) were from asymptomatic children respectively. Conclusion: The carriage of MDR S. Typhi among the asymptomatic children is concerning as they can act as potential transmitters of the typhoid disease to unsuspecting children. These study findings highlight the need for continued surveillance of antimicrobial resistance and mass immunization of children living in these urban informal areas. [ABSTRACT FROM AUTHOR]

We describe a 13-year-old boy with piso-hamate coalition confirmed by X-ray. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed type 1 coalition according to the classification of DeVilliers Minnaar. Piso-hamate coalition is rare, and suspicions should be raised in instances of chronic ulnar-sided wrist pain, particularly in individuals with a history of elevated hand usage, especially amongst athletes engaging in intensive hand grip activities. Surgical resection of the synchondrosis site between the pisiform and the hamate is an efficacious intervention that can mitigate pain. Level of Evidence: Level V (Therapeutic) [ABSTRACT FROM AUTHOR]

L. donovani and L. infantum infections are associated with a broad clinical spectrum, ranging from asymptomatic cases to visceral leishmaniasis (VL) with high mortality rates. Clinical manifestations such as post-kala-azar dermal leishmaniasis (PKDL) and visceral leishmaniasis-associated hemophagocytic lymphohistiocytosis-mimic (VL-associated HLH-mimic) further contribute to the diversity of clinical manifestations. These clinical variations are intricately influenced by the complex interplay between the host's immune response and the parasite's escape mechanisms. This narrative review aims to elucidate the underlying immunological mechanisms associated with each clinical manifestation, drawing from published literature within the last 5 years. Specific attention is directed toward viscerotropic Leishmania sinfection in patients with inborn errors of immunity and acquired immunodeficiencies. In VL, parasites exploit various immune evasion mechanisms, including immune checkpoints, leading to a predominantly anti-inflammatory environment that favors parasite survival. Conversely, nearly 70% of individuals are capable of mounting an effective pro-inflammatory immune response, forming granulomas that contain the parasites. Despite this, some patients may experience reactivation of the disease upon immunosuppression, challenging current understandings of parasite eradication. Individuals living with HIV and those with inborn errors of immunity present a more severe course of infection, often with higher relapse rates. Therefore, it is crucial to exclude both primary and acquired immune deficiencies in patients presenting disease relapse and VL-associated HLH-mimic. The distinction between VL and HLH can be challenging due to clinical similarities, suggesting that the nosological entity known as VL-associated HLH may represent a severe presentation of symptomatic VL and it should be considered more accurate referring to this condition as VL-associated HLH-mimic. Consequently, excluding VL in patients presenting with HLH is essential, as appropriate antimicrobial therapy can reverse immune dysregulation. A comprehensive understanding of the immune-host interaction underlying Leishmania infection is crucial for formulating effective treatment and preventive strategies to mitigate the disease burden. [ABSTRACT FROM AUTHOR]

Aim: Faecal immunochemical tests (FIT) are highly sensitive for colorectal cancer (CRC) detection. Little evidence exists regarding repeat FIT. The repeat FIT (RFIT) study aimed to determine whether second and third FIT provide reassurance and improve CRC or significant bowel disease (SBD) identification. Methods: This was a prospective observational study. Patients recruited from urgent referrals returned three FIT and underwent colonoscopy. Chi‐square tests compared categorical data. Diagnostic accuracy variables (sensitivity/specificity/positive predictive value [PPV]/negative predictive value [NPV]) were calculated for one, two and three FIT (95% CI). Three negative FIT (<10 μg Hb/g of faeces [μg/g]) groups (one, two, three) were compared with positive groups (one or more FIT ≥10 μg/g). CRC and SBD detection rates were compared by strategy. Results: A total of 460 patients (mean age: 66.8 years, 233 males and 227 females, 23 CRC, 80 SBD) were included in the study. For one, two and three negative FIT, CRC sensitivity remained static (95.7%); specificity (44.6%, 40.7% and 38.4%) and NPV decreased (99.5%, 99.4% and 99.4%). For SBD, sensitivity increased (78.8%, 83.8% and 86.3%), specificity decreased (47.4%, 43.7% and 41.6%) and NPV increased (91.4%, 92.7% and 93.5%). In one, two and three positive FIT groups, CRC detection was 8.3%,16.1% and 20.9%. CRC mean FIT was 150 μg/g, <6 μg/g for benign pathology. Conclusions: One or more negative FIT increases the sensitivity for CRC/SBD. Repeating FIT provides greater differentiation of patients with and without CRC/SBD compared to single FIT but is associated with decreased specificity and PPV. Multiple negative FIT may offer reassurance; however, application of repeating FIT may be restricted given the associated increase in investigations. [ABSTRACT FROM AUTHOR]

Background: Patients with symptomatic chronic internal carotid artery occlusion (ICAO) face a high risk of recurrent stroke despite receiving aggressive medical therapy. This study aimed to evaluate the effectiveness and safety of hybrid surgery in treating symptomatic chronic ICAO. Methods: This retrospective case series was conducted at a single center. From January 2019 to December 2022, patients with symptomatic chronic ICAO who underwent hybrid surgery were included. We collected baseline data, lesion characteristics, revascularization rates, perioperative complications, and follow-up outcomes. Results: The study enrolled 27 patients, comprising 22 males and 5 females, with symptomatic chronic ICAO. The hybrid surgery achieved a technical success rate of 100% for revascularization (n = 27), with a perioperative complication rate of 14.8% (n = 4). Following a median follow-up of 6.0 months (IQR, 4–10), 21 patients underwent a DSA or CT angiography reexamination, confirming a vascular patency rate of 90.5% (n = 19). One patient required surgery for severe in-stent restenosis, and another experienced asymptomatic occlusion. Clinical follow-ups were conducted for all 26 patients; no new strokes were reported in the qualifying artery territory, with 13 patients scoring 0, 12 scoring 1, and 1 scoring 2 on the mRS. Conclusion: Although hybrid surgery represent a promising option for treating chronic ICAO, they are also associated with a relatively high incidence of treatment-related complications. The application of composite surgery should be based on standardized technical guidelines and the careful selection of patients who are genuinely at high risk for recurrent strokes. [ABSTRACT FROM AUTHOR]

This study aimed to retrospectively evaluate the baseline and follow‐up viral loads and viral clearance times in cases followed for asymptomatic and symptomatic congenital cytomegalovirus (cCMV) infection between August 2010 and August 2022. Among 93 cases, they had asymptomatic (n: 55) and symptomatic (n: 38). The median baseline blood viral load detected in the symptomatic cCMV (ScCMV) infection (13 054 IU/mL) was significantly higher than that of asymptomatic cCMV (AcCMV) infection (4636 IU/mL) (p < 0.013). There was no difference in median viral clearance times (75 and 90 days, respectively) in baseline viremic cases in the ScCMV and AcCMV infection groups. There were no differences in median baseline blood viral load (6930 IU/mL and 14 268 IU/mL, respectively) and median viral clearance times (75 and 85 days, respectively) between the 6‐week and 6‐month antiviral treatment group. No correlation was found between baseline blood viral load, clinical severity, and the number of systems involved. However, in initial viremic cases, the viral load threshold for a symptomatic case was 8856 IU/mL, with 85.7% sensitivity and 54.5% specificity. [ABSTRACT FROM AUTHOR]

Purpose: Asymptomatic SARS-CoV-2 infections were widely reported during the COVID-19 pandemic, acting as a hidden source of infection. Many existing studies investigating asymptomatic immunity failed to recruit true asymptomatic individuals. Thus, we conducted a longitudinal cohort study to evaluate humoral- and cell-mediated responses to infection and vaccination in well-defined asymptomatic young adults (the Asymptomatic COVID-19 in Education [ACE] cohort). Methods: Asymptomatic testing services located at three UK universities identified asymptomatic young adults who were subsequently recruited with age- and sex-matched symptomatic and uninfected controls. Blood and saliva samples were collected after SARS-CoV-2 Wuhan infection, and again after vaccination. 51 participant’s anti-spike antibody titres, neutralizing antibodies, and spike-specific T-cell responses were measured, against both Wuhan and Omicron B.1.1.529.1. Results: Asymptomatic participants exhibited reduced Wuhan-specific neutralization antibodies pre- and post-vaccination, as well as fewer Omicron-specific neutralization antibodies post-vaccination, compared to symptomatic participants. Lower Wuhan and Omicron-specific IgG titres in asymptomatic individuals were also observed pre- and post-vaccination, compared to symptomatic participants. There were no differences in salivary IgA levels. Conventional flow cytometry analysis and multi-dimensional clustering analysis indicated unvaccinated asymptomatic participants had significantly fewer Wuhan-specific IL-2 secreting CD4+ CD45RA+ T cells and activated CD8+ T cells than symptomatic participants, though these differences dissipated after vaccination. Conclusions: Asymptomatic infection results in decreased antibody and T cell responses to further exposure to SARS-CoV-2 variants, compared to symptomatic infection. Post-vaccination, antibody responses are still inferior, but T cell immunity increases to match symptomatic subjects, emphasising the importance of vaccination to help protect asymptomatic individuals against future variants. [ABSTRACT FROM AUTHOR]

Malaria transmission and endemicity in Africa remains hugely disproportionate compared to the rest of the world. The complex life cycle of P. falciparum (Pf) between the vertebrate human host and the anopheline vector results in differential expression of genes within and between hosts. An in-depth understanding of Pf interaction with various human genes through regulatory elements will pave way for identification of newer tools in the arsenal for malaria control. Therefore, the regulatory elements (REs) involved in the over- or under-expression of various host immune genes hold the key to elucidating alternative control measures that can be applied for disease surveillance, prompt diagnosis and treatment. We carried out an RNAseq analysis to identify differentially expressed genes and network elucidation of non-coding RNAs and target genes associated with immune response in individuals with different clinical outcomes. Raw RNAseq datasets, retrieved for analyses include individuals with severe (Gambia—20), symptomatic (Burkina Faso—15), asymptomatic (Mali—16) malaria as well as uninfected controls (Tanzania—20; Mali—36). Of the total 107 datasets retrieved, we identified 5534 differentially expressed genes (DEGs) among disease and control groups. A peculiar pattern of DEGs was observed, with individuals presenting with severe/symptomatic malaria having the highest and most diverse upregulated genes, while a reverse phenomenon was recorded among asymptomatic and uninfected individuals. In addition, we identified 141 differentially expressed micro RNA (miRNA), of which 78 and 63 were upregulated and downregulated respectively. Interactome analysis revealed a moderate interaction between DEGs and miRNAs. Of all identified miRNA, five were unique (hsa-mir-32, hsa-mir-25, hsa-mir-221, hsa-mir-29 and hsa-mir-148) because of their connectivity to several genes, including hsa-mir-221 connected to 16 genes. Six-hundred and eight differentially expressed long non coding RNA (lncRNA) were also identified, including SLC7A11, LINC01524 among the upregulated ones. Our study provides important insight into host immune genes undergoing differential expression under different malaria conditions. It also identified unique miRNAs and lncRNAs that modify and/or regulate the expression of various immune genes. These regulatory elements we surmise, have the potential to serve a diagnostic purpose in discriminating between individuals with severe/symptomatic malaria and those with asymptomatic infection or uninfected, following further clinical validation from field isolates. [ABSTRACT FROM AUTHOR]

Clostridium perfringens is an opportunistic bacterium that causes intestinal diseases in both humans and animals. This study aimed to assess the frequency of C. perfringens and the presence of toxin-encoding genes in fecal samples from individuals with or without gastrointestinal symptoms in the Department of Boyacá, Colombia. Additionally, risk factors associated with carriage and disease development were analyzed. A total of 114 stool samples were analyzed using a molecular test based on specific polymerase chain reaction (PCR) targeting 16S-rRNA and alpha toxin (cpa) genes. For individuals with a positive result for the PCR test, stool samples were cultured on Tryptose Sulfite Cycloserine (TSC) agar. Two to five colonies forming units were selected based on phenotypic characteristics, resulting in 56 bacterial isolates. These isolates were then analyzed for toxin-coding genes associated with gastrointestinal diseases. In addition, sociodemographic and clinical data from 77 individuals were also analyzed. The overall frequency of C. perfringens was 19.3% (n = 22/114). The detection frequency in 77 individuals with clinical data was 16.6% (n = 5/30) among symptomatic individuals and 21.2% (n = 10/47) among asymptomatic individuals. All 56 isolates obtained carried the cpa gene, while cpb2 was present in 10.7% (n = 6/56); cpe and cpb genes were not detected. Notably, diabetes and autoimmune diseases are significantly associated with an increased risk of C. perfringens detection (adjusted OR 8.41: 95% CI 1.32–35.89). This study highlights an elevated frequency of C. perfringens and the presence of the cpb2 gene in asymptomatic individuals compared with their symptomatic counterparts. These findings offer insights into the distribution and virulence factors of C. perfringens at a micro-geographical level. This information supports the need for developing tailored prevention strategies based on local characteristics to promote active surveillance programs based on molecular epidemiology. [ABSTRACT FROM AUTHOR]

Background: In 2023, Burkina Faso experienced the largest dengue epidemic ever in Africa. This study aimed to estimate the prevalence of symptomatic, subclinical, and asymptomatic dengue and determine the associated factors among adult contacts of dengue in the Central Region, Burkina Faso. Methods: This cross-sectional study included contacts of dengue probable cases through cluster sampling in 2022–2023. These suspected cases that tested positive were identified from the five health facilities (Pissy CMA, Saaba CM, Kossodo CMA, Samandin CM, and Marcoussis CSPS) that reported the highest number of cases in 2021 per district. All participants underwent dengue and malaria rapid diagnostic tests (RDT). Samples positive for non-structural 1 protein antigen (AgNS1) and/or immunoglobulin M (IgM) were tested for serotype detection by reverse transcription polymerase chain reaction (RT-PCR). Binary logistic regression was done to identify the determinants of asymptomatic, subclinical, and symptomatic dengue among contacts of probable dengue cases. Results: A total of 484 contacts were included, mostly in 2023 (75.2%). Most participants were females (58.6%), residing (24.3%) and passing their daytime (23.1%) in Saaba. The overall prevalence of dengue was estimated at 15.1% [95% confidence interval (CI): 12.0–18.6%], representing cases not seeking care in hospitals. Asymptomatic cases represented 2.9% (95% CI: 1.6–4.8%). Subclinical and symptomatic cases accounted for 6.0% (95% CI: 4.1–8.5%) and 6.2% (95% CI: 4.2–8.7%), respectively. Of the 58 samples tested by RT-PCR, 10 were confirmed for serotype 3 in 2023. Malaria cases were estimated at 5.6% (95% CI: 3.7–8.0%). After adjustment, participants claiming that a virus transmits dengue were likelier to have asymptomatic dengue [adjusted odds ratio (aOR) = 7.1, 95% CI: 2.4–21.0]. From the multivariable analysis, subclinical dengue was statistically associated with being included in the study in 2023 (aOR = 30.2, 95% CI: 2.0–455.5) and spending the daytime at Arrondissement 4 (aOR = 11.5, 95% CI: 1.0–131.0). After adjustment, symptomatic dengue was associated with living less than 50 m away from cultivated land (aOR = 2.8, 95% CI: 1.1–6.9) and living less than 50 m from a stretch of water (aOR = 0.1, 95% CI: 0.0–0.6). Conclusions: The overall burden of dengue among populations not seeking care in hospitals was quite high, with few asymptomatic cases. Efforts to manage dengue cases should also target non-hospital cases and raise population awareness. The 2023 epidemic could be due to dengue virus (DENV)-3. [ABSTRACT FROM AUTHOR]

Purpose: To investigate differences in key clinical parameters between asymptomatic and highly symptomatic soft contact lens (CL) wearers after 14 h of wear. Methods: In this pilot investigation, Phase 1 identified asymptomatic (CLDEQ‐8 score ≤ 7) and highly symptomatic (CLDEQ‐8 score ≥ 20) subjects after fitting with nelfilcon A CLs. Phase 2 investigated the following over a single nelfilcon A CL‐wearing day (14 ± 2 h): blinking characteristics, tear meniscus height (TMH), non‐invasive tear break‐up time (NIBUT), tear film osmolarity and eyelid margin staining. Parameters for the two groups were compared using linear mixed models and post‐hoc testing. The relationship between comfort scores and the clinical parameters was also investigated. Results: Overall, 161 and 42 subjects were enrolled into Phase 1 and 2, respectively. Twenty‐five asymptomatic and 17 symptomatic subjects completed Phase 2. Lower eyelid TMH was decreased after 14 h in symptomatic compared with asymptomatic subjects (least square mean [LSM] difference −0.04 mm, 95% CI: −0.07, −0.01). Osmolarity was lower in symptomatic than in asymptomatic subjects at fitting (LSM difference −9.89, 95% CI: −18.91, −0.86). Upper eyelid margin staining was greater after 14 h in symptomatic than in asymptomatic subjects (LSM difference 0.53, 95% CI: 0.01, 1.05) and greater after 14 h than baseline in the symptomatic group (LSM difference 0.61, 95% CI: 0.16, 1.07). There was a significant relationship between comfort and upper eyelid margin staining (r = −0.40, 95% CI: −0.63, −0.11) and blink rate (r = −0.31, 95% CI: −0.57, −0.003). Conclusion: The potential parameters most effective in differentiating asymptomatic from symptomatic wearers were upper eyelid margin staining and lower TMH. The parameter with the strongest relationship to comfort was upper eyelid margin staining, where higher comfort scores were associated with lower levels of staining. [ABSTRACT FROM AUTHOR]

Background: Medications are commonly used for symptom control in cancer patients at the end of life. This study aimed to evaluate medication utilization among home care palliative patients with cancer at the end of life and assess the appropriateness of these medications. Method: This retrospective observational study included adult cancer patients who received home care in 2020. Medications taken during the last month of the patient's life were reviewed and classified into three major categories: potentially avoidable, defined as medications that usually have no place at the end of life because the time to benefit is shorter than life expectancy; medications of uncertain appropriateness, defined as medications that need case-by-case evaluation because they could have a role at the end of life; and potentially appropriate, defined as medications that provide symptomatic relief. Results: In our study, we enrolled 353 patients, and 2707 medications were analyzed for appropriateness. Among those, 1712 (63.2%) were classified as potentially appropriate, 755 (27.9%) as potentially avoidable, and 240 (8.9%) as medications with uncertain appropriateness. The most common potentially avoidable medications were medications for peptic ulcers and gastroesophageal reflux disease (30.5%), vitamins (14.6%), beta-blockers (9.8%), anticoagulants (7.9%), oral antidiabetics (5.4%) and insulin products (5.3%). Among the potentially appropriate medications, opioid analgesics were the most frequently utilized medications (19.5%), followed by laxatives (19%), nonopioid analgesics (14.4%), gamma-aminobutyric acid analog analgesics (7.7%) and systemic corticosteroids (6%). Conclusion: In home care cancer patients, approximately one-third of prescribed medications were considered potentially avoidable. Future measures to optimize medication use in this patient population are essential. [ABSTRACT FROM AUTHOR]

Background: Cross-reactive SARS-CoV-2-specific memory CD4+ and CD8+ T cells are present in up to 50% of unexposed, pre-pandemic, healthy individuals (UPPHIs). However, the characteristics of cross-reactive memory CD4+ and CD8+ T cells associated with subsequent protection of asymptomatic coronavirus disease 2019 (COVID-19) patients (i.e., unvaccinated individuals who never develop any COVID-19 symptoms despite being infected with SARS-CoV-2) remains to be fully elucidated. Methods: This study compares the antigen specificity, frequency, phenotype, and function of cross-reactive memory CD4+ and CD8+ T cells between common cold coronaviruses (CCCs) and SARS-CoV-2. T-cell responses against genome-wide conserved epitopes were studied early in the disease course in a cohort of 147 unvaccinated COVID-19 patients who were divided into six groups based on the severity of their symptoms. Results: Compared to severely ill COVID-19 patients and patients with fatal COVID-19 outcomes, the asymptomatic COVID-19 patients displayed significantly: (i) higher rates of co-infection with the 229E alpha species of CCCs (a-CCC-229E); (i i) higher frequencies of cross-reactive functional CD134+CD137+CD4+ and CD134+CD137+CD8+ T cells that cross-recognized conserved epitopes from a-CCCs and SARS-CoV-2 structural, non-structural, and accessory proteins; and (iii) lower frequencies of CCCs/SARS-CoV-2 cross-reactive exhausted PD-1+TIM3+TIGIT+CTLA4+CD4+ and PD-1+TIM3+TIGIT+CTLA4+CD8+ T cells, detected both ex vivo and in vitro. Conclusions: These findings (i) support a crucial role of functional, poly-antigenic a-CCCs/SARS-CoV-2 cross-reactive memory CD4+ and CD8+ T cells, induced following previous CCCs seasonal exposures, in protection against subsequent severe COVID-19 disease and (ii) provide critical insights into developing broadly protective, multi-antigen, CD4+, and CD8+ T-cell-based, universal pan-Coronavirus vaccines capable of conferring cross-species protection. [ABSTRACT FROM AUTHOR]

This paper presents a novel approach to analyzing the dynamics of COVID-19 using nonstandard finite difference (NSFD) schemes. Our model incorporates both asymptomatic and symptomatic infected individuals, allowing for a more comprehensive understanding of the epidemic's spread. We introduce an unconditionally stable NSFD system that eliminates the need for traditional Runge–Kutta methods, ensuring dynamical consistency and numerical accuracy. Through rigorous numerical analysis, we evaluate the performance of different NSFD strategies and validate our analytical findings. Our work demonstrates the benefits of using NSFD schemes for modeling infectious diseases, offering advantages in terms of stability and efficiency. We further illustrate the dynamic behavior of COVID-19 under various conditions using numerical simulations. The results from these simulations demonstrate the effectiveness of the proposed approach in capturing the epidemic's complex dynamics. [ABSTRACT FROM AUTHOR]

Although clinical outcomes in metastatic melanoma have improved in recent years, the morbidity and mortality of symptomatic brain metastases remain challenging. Response rates and survival outcomes of patients with symptomatic melanoma brain metastases (MBM) are significantly inferior to patients with asymptomatic disease. This review focusses upon the specific challenges associated with the management of symptomatic MBM, discussing current treatment paradigms, obstacles to improving clinical outcomes and directions for future research. [ABSTRACT FROM AUTHOR]

Serum interleukin-1 (IL-1) are possibly indicative of the inflammation in the intracranial aneurysm (IA) wall. This study aimed to investigate whether IL-1 could discriminate the unstable IAs (ruptured intracranial aneurysms (RIAs) and symptomatic unruptured intracranial aneurysms (UIAs)) from stable, asymptomatic UIAs. IA tissues and blood samples from 35 RIA patients and 35 UIA patients were collected between January 2017 and June 2020 as the derivation cohort. Blood samples from 211 patients with UIAs were collected between January 2021 and June 2022 as the validation cohort (including 63 symptomatic UIAs). Blood samples from 35 non-cerebral-edema meningioma patients (non-inflammatory control) and 19 patients with unknown-cause subarachnoid hemorrhage (hemorrhagic control) were also collected. IL-1β and IL-1.ra (IL-1 receptor antagonist) were measured in serum and IA tissues, and the IL-1 ratio was calculated as log10 (IL-1.ra/IL-1β). Based on the derivation cohort, multivariate logistic analysis showed that IL-1β (odds ratio, 1.48, P = 0.001) and IL-1.ra (odds ratio, 0.74, P = 0.005) were associated with RIAs. The IL-1 ratio showed an excellent diagnostic accuracy for RIAs (c-statistic, 0.91). Histological analysis confirmed the significant correlation of IL-1 between serum and aneurysm tissues. IL-1 ratio could discriminate UIAs from non-inflammatory controls (c-statistic, 0.84), and RIAs from hemorrhagic controls (c-statistic, 0.95). Based on the validation cohort, the combination of IL-1 ratio and PHASES score had better diagnostic accuracy for symptomatic UIAs than PHASES score alone (c-statistic, 0.88 vs 0.80, P < 0.001). Serum IL-1 levels correlate with aneurysm tissue IL-1 levels and unstable aneurysm status, and could serve as a potential biomarker for IA instability. [ABSTRACT FROM AUTHOR]

Background: Malaria remains a major public health issue in the world despite a decline in the disease burden. However, though symptomatic malaria is diagnosed and treated, asymptomatic infections remain poorly known and support transmission. This study assessed the prevalence of symptomatic and asymptomatic Plasmodium spp. infections in three areas in Gabon to monitor and evaluate the impact of malaria. Methods and Results: A cross-sectional study was conducted in three areas of Gabon. Febrile and afebrile children aged 6 months to 15 years were included in this study. Malaria prevalence was determined by microscopy of and using rapid diagnostic test (RDT). Plasmodium spp. species were identified by PCR according to the Snounou method. The data were recorded in Excel, and the statistical analyses were performed using the software R version R 64 × 3.5.0. A total of 2381(333 asymptomatic and 107 symptomatic) children were included. The overall prevalence of malaria was 40% (952/2381), with the majority (77% symptomatic and 98% asymptomatic) of infections caused by Plasmodium falciparum. A high prevalence of malaria was found in infected children in rural and semi-rural areas. In these two areas, a higher prevalence of Plasmodium malariae was observed in asymptomatic. Furthermore, mixed infections were more prevalent in asymptomatic children than in symptomatic. Conclusion: This study showed that the prevalence of Plasmodium spp. infection varied according to the regions. The main species was Plasmodium falciparum, but in asymptomatic children the prevalence of Plasmodium malariae was high in rural areas. To help fight malaria more effectively asymptomatic infections should be taken into account and treated. [ABSTRACT FROM AUTHOR]

A model of epidemic dynamics is developed that incorporates continuous variables for infection age and vaccination age. The model analyzes pre-symptomatic and symptomatic periods of an infected individual in terms of infection age. This property is shown to be of major importance in the severity of the epidemic, when the infectious period of an infected individual precedes the symptomatic period. The model also analyzes the efficacy of vaccination in terms of vaccination age. The immunity to infection of vaccinated individuals varies with vaccination age and is also of major significance in the severity of the epidemic. Application of the model to the 2003 SARS epidemic in Taiwan and the COVID-19 epidemic in New York provides insights into the dynamics of these diseases. It is shown that the SARS outbreak was effectively contained due to the complete overlap of infectious and symptomatic periods, allowing for the timely isolation of affected individuals. In contrast, the pre-symptomatic spread of COVID-19 in New York led to a rapid, uncontrolled epidemic. These findings underscore the critical importance of the pre-symptomatic infectious period and the vaccination strategies in influencing the dynamics of an epidemic. [ABSTRACT FROM AUTHOR]

Background and purpose: Whether symptomatic unruptured intracranial aneurysms (UIAs) lead to change in circulating inflammation remains unclear. This study aims to evaluate the role of hematological inflammatory indicators in predicting symptomatic UIA. Methods: Adult patients diagnosed with saccular intracranial aneurysm from March 2019 to September 2023 were recruited retrospectively. Clinical and laboratory data, including the white blood cells (WBC), neutral counts (NEUT), lymphocyte counts (LYM), and monocyte counts (MONO) of each patient, were collected. The neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) were calculated as NLR = NEUT/LYM, LMR = LYM/MONO, SII = PLT*NEUT/LYM. The hematological inflammatory indicators were compared in symptomatic saccular and asymptomatic UIA patients. Multivariable logistic regression analyses were performed to explore the factors predicting symptomatic UIA. Results: One hundred and fifty UIA patients with a mean age of 58.5 ± 12.4 were included, of which 68% were females. The NLR and LMR were significantly associated with symptomatic UIA, and the association remained in small UIAs (< 7 mm). The multiple logistic regression analysis showed that NLR was independently associated with symptomatic UIA. On ROC curve analysis, the optimal cutoff value of NLR to differentiate symptomatic from asymptomatic was 2.38. In addition, LMR was significantly associated with symptomatic UIA smaller than 7 mm. Conclusion: There was a significant correlation between NLR and symptomatic UIA. The NLR was independently associated with symptomatic UIA. [ABSTRACT FROM AUTHOR]

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Background: Coexisting intracranial pathologies of distinct etiology which require intervention are rare. Only a handful of cases have been reported in the literature. The effects of each treatment option on both pathologies need to be considered during management. We describe the first report of the management of a patient with concurrent symptomatic tuberculum sellae meningioma (TSM) and idiopathic intracranial hypertension (IIH). Case Description: A 58-year-old male presented with 2 weeks of vision loss and 3 months of headaches. He was found to have an inferior hemi-field deficit in the left eye and bilateral papilledema. Imaging studies revealed bilateral transverse sinus stenosis and a TSM abutting the left optic nerve. The opening pressure was 40 cmH2O. An expanded-endoscopic endonasal approach was performed for mass resection. Intraoperatively, a lumbar drain was placed to aid skull base repair integrity before definitive treatment was obtained. On postoperative day 9, a right transverse-sigmoid sinus stent was placed for IIH treatment. The patient was discharged the following day. Conclusion: Our management of this patient targeted the etiologies of each symptomatic pathology. Stenting provided treatment for the IIH and mass resection for the vision loss. Both the order and approaches to treatment were felt to maximize patient benefit while minimizing harm. [ABSTRACT FROM AUTHOR]

Lassa fever is a deadly viral disease whose incubation period ranges from six to twenty-one days and about eighty percent of Lassa virus infection is asymptomatic. A deterministic model was formulated to quantify the transmission dynamics of the disease under isolation and treatment of the isolated asymptomatic and symptomatic humans for effective management and possible elimination of the disease. The solutions of the model were shown to be positive and bounded. Equilibrium analysis was conducted and both the disease-free and the endemic equilibria were derived. The threshold quantity for disease elimination, R0, was also obtained and used to derive conditions for the existence of stability of the eqilibria. The quantity was also employed to examine the sensitivity of the model parameters to disease propagation and reduction. The theoretical analysis was then complemented with the quantitative analysis by adopting a set of realistic values for the model parame- ters in order to show the effect of isolation and treatment on the spread and fatality of Lassa fever. Results from the quantitative study showed that death and infection from Lassa fever fell continuously as more and more exposed individuals were detected and isolated for treatment. The study therefore suggested that any measure taken to eradicate or curtail Lassa fever spread should include detection and isolation of the exposed humans for prompt treatments. [ABSTRACT FROM AUTHOR]

Background: The continued presentation of patient‐detected breast cancer (BC) and associated characteristics over time is understudied. Methods: In a large institutional cohort of first primary stage 0–IV patients with BC in 1990–2019 (n = 15,827), diagnostic method (patient‐detected [PtDBC] [n = 5844]; mammography‐detected [MamDBC] [nondiagnostic] [n = 9248]; and physician‐detected [PhysDBC] [n = 736]) and patient and tumor characteristics including age, race, TNM stage, and hormone‐receptor status were reviewed. Pearson χ2 tests for bivariate comparisons and logistic regression for patient detection–associated factors were used. Results: In a cohort from 1990 to 2019, the proportion aged 50–74 years (55%–63%; p <.001) and non‐White race (9%–37%; p <.001) increased over time. Percentage PtDBC decreased over time but case numbers increased (1990–1999: 44% [n = 1399]; 2010–2019: 34% [n = 2349]; p <.001). Excluding stage 0, PtDBC declined from 47% to 41% over time (p <.001). In 2010–2019, 21% of cases were stage 0, 91% of which were mammography detected (n = 1439). Seventy percent of patient‐detected cases were stage II–IV (stage II, 44%; stage III, 20%; stage IV, 6%; p <.001). In adjusted logistic regression, the odds of PtDBC decreased over time (2000–2009: odds ratio [OR],.65 [95% CI,.58–.72]; 2010–2019: OR,.54 [95% CI,.49–.60]), with age <40 years OR, 15.81, and Black and non‐White other at 50% increased risk. Conclusions: The relative proportion of PtDBC decreased to a constant 34%–40% of total cases after 1990–1999. PtDBC case numbers increased in subsequent years (2000–2019), and were consistently higher stage. Interval cancers, mammography‐screening uptake, breast health awareness of age groups outside screening guidelines, and underserved socioeconomic groups may be related to the continued significant PtDBC incidence. Plain Language Summary: After decades of mammography‐screening availability, symptomatic patient‐detected breast cancer declined over time from 44% to a persistent rate of 34% in our institutional cohort.The persistence of patient‐detected breast cancer over time presents a difficult situation for patients and care givers without clear diagnosis pathways for younger and older women outside recommended screening guidelines, who often present with higher stage and more lethal characteristics.More timely diagnosis and treatment including breast health awareness, prompt presentation of breast problems, outreach to younger age and minority groups, and provision of specialized training and care delivery for symptomatic patient‐detected breast cancer are needed. Over the most recent 3 decades with mammography‐screening guidelines in place, symptomatic patient‐detected breast cancer declined from 44% to a persistent rate of 34% in an institutional cohort with continued disproportionate presentation among younger women and minorities. Outreach opportunities exist to increase breast health awareness, provide specialized training and care delivery for symptomatic patient‐detected breast cancer, and increase uptake of mammography screening among age‐eligible women. [ABSTRACT FROM AUTHOR]

Chronic lymphocytic leukemia (CLL) is a clonal mature B‐cell neoplasm with a typically indolent clinical course. Though most clinicians follow these neoplasms through observation alone, an aggressive transformation to prolymphocytic leukemia, diffuse large‐B‐cell lymphoma (Richter transformation) or classical Hodgkin lymphoma requires immediate attention. We present a case of extreme leukocytosis (>1 million/μL) in a previously diagnosed CLL patient. Due to symptomatic leukostasis, she was started on cytoreductive therapies including leukocytapheresis. After three rounds of leukocytapheresis (LCP) and concurrent chemotherapy, her white blood cell count decreased from a maximum 1262 × 103/μL to 574 × 103/μL. To our knowledge, CLL with symptomatic leukostasis that required therapeutic LCP is rarely reported in literature. We propose that therapeutic LCP is of value in such rare, yet dangerous settings like our case. [ABSTRACT FROM AUTHOR]

Norovirus (NoV) is the leading cause of viral gastroenteritis, mostly affecting young children worldwide. However, limited data are available to determine the severity of norovirus-associated AGE (acute gastroenteritis) and to correlate it with the NoV-specific IgA antibodies' level. Between October 2019 and September 2021, two hundred stool samples were randomly collected from symptomatic cases for the vesikari score and NoV-specific IgA assessment in young children from rural South Africa. Additionally, one hundred saliva specimens were concomitantly sampled within the same cohort to evaluate the NoV-specific salivary IgA levels. In addition, 50 paired saliva and stool samples were simultaneously collected from asymptomatic children to serve as controls. NoV strains in stool samples were detected using real-time RT-PCR, amplified, and genotyped with RT-PCR and Sanger sequencing. ELISA using NoV VLP (virus-like particles) GII.4 as antigens was performed on the saliva specimens. Dehydrated children were predominantly those with NoV infections (65/74, 88%; p < 0.0001). NoV-positive infections were significantly associated with the severe diarrhea cases having a high vesikari score (55%, 33/60) when compared to the non-severe diarrheal score (29.3%, 41/140; p < 0.0308). NoV of the GII genogroup was mainly detected in severe diarrhea cases (50.9%, 30/59; p = 0.0036). The geometric means of the NoV-specific IgA level were higher in the asymptomatic NoV-infected group (0.286) as compared to the symptomatic group (0.174). This finding suggests that mucosal immunity may not protect the children from the NoV infection. However, the findings indicated the contribution of the pre-existing NoV-specific IgA immune response in reducing the severity of diarrheal disease. A high vesikari score of AGE associated with the NoV GII genogroup circulating in the study area underscores the need for an appropriate treatment of AGE based on the severity level of NoV-associated clinical symptoms in young children. [ABSTRACT FROM AUTHOR]

In recent decades, deep brain stimulation (DBS) has been extensively studied due to its reversibility and significantly fewer side effects. DBS is mainly a symptomatic therapy, but the stimulation of subcortical areas by DBS is believed to affect the cytoarchitecture of the brain, leading to adaptability and neurogenesis. The neurological disorders most commonly studied with DBS were Parkinson's disease, essential tremor, obsessive-compulsive disorder, and major depressive disorder. The most precise approach to evaluating the location of the leads still relies on the stimulus-induced side effects reported by the patients. Moreover, the adequate voltage and DBS current field could correlate with the patient's symptoms. Implantable pulse generators are the main parts of the DBS, and their main characteristics, such as rechargeable capability, magnetic resonance imaging (MRI) safety, and device size, should always be discussed with patients. The safety of MRI will depend on several parameters: the part of the body where the device is implanted, the part of the body scanned, and the MRI-tesla magnetic field. It is worth mentioning that drug-resistant individuals may have different pathophysiological explanations for their resistance to medications, which could affect the efficacy of DBS therapy. Therefore, this could explain the significant difference in the outcomes of studies with DBS in individuals with drug-resistant neurological conditions. [ABSTRACT FROM AUTHOR]

Norovirus (NoV) is a leading cause of epidemic and sporadic gastroenteritis in people of all ages. Humans are the primary source of NoV and household contact is one of the risk factors for NoV transmission. However, the mechanisms underlying person‐to‐person NoV transmission are poorly understood. Here we conducted a survey to profile the frequency and characteristics of intrafamily NoV transmission. Stool samples were collected every week from three households between 2016 and 2020; the total number of samples was 1105. The detection of NoV and the genotyping were performed by reverse transcription‐polymerase chain reaction targeting the capsid region and direct sequencing methods. NoV was detected in 3.4% of all samples. Eight NoV genotypes were identified. The most common genotype was GII.17, followed in order by GII.6, GI.6, GII.4, GI.3, and GI.2/GI.8/GI.9. Most NoV‐positive samples were obtained from asymptomatic individuals. The highest number of NoV transmissions was found in household 3 (6 infections), followed by household 2 (2 infections), while household 1 had no NoV transmission, suggesting that asymptomatic NoV carriers play a major role in infection as NoV reservoirs in the households. Further clarification of the mode of infection will contribute to improved understanding and an appropriate prevention. [ABSTRACT FROM AUTHOR]

The prevalence of COVID-19 infections among school students has become a significant and ongoing concern. This study aimed to assess the severity and types of COVID-19 cases and associated symptoms among school students in Iraq. A comprehensive study was conducted by the Public Health Directorate of AL-Muthanna Governorate from November 29, 2020, to February 12, 2021, utilizing RT-PCR-based COVID-19 surveys. The survey included 9,357 students (4,261 male and 5,096 female) and 83 schools. The retrospective analysis of the survey records indicated that male and female students had a mean age of 9.2±1.16 years with notably higher rates of asymptomatic infections than older students. Male students showed lower odds of asymptomatic infection but higher odds of symptomatic and pre-symptomatic infections compared to their female peers, particularly among elementary students. Fever, abdominal pain, diarrhea, loss of taste and smell, shortness of breath, and muscle pain were significantly associated with COVID-19 infection. Sneezing was significantly associated with a lack of infection. Home nursing by parents and self-care practices have proven to be highly effective in controlling COVID-19 infection among children. These findings highlight the need for age- and gender-specific considerations in COVID-19 prevention and management strategies in schools. [ABSTRACT FROM AUTHOR]

Objective: In previous studies, different radiological measurement techniques could not reliably distinguish patients with symptomatic Chiari type 1 malformation (CMI) from those with asymptomatic CMI. We aimed to develop a new perspective to select patients with CMI for surgery by calculating the brainstem area (BA), cerebellar tonsillar area (CTA), foramen magnum area (FMA), and CTA/BA ratio in T2 MR axial imaging at the foramen magnum level. Materials and Methods: Eighty six symptomatic and 85 asymptomatic patients evaluated by neurosurgeons were included in the study. The patients' BA, CTA, FMA, and CTA/BA ratios were calculated by two neuroradiologists. In addition, the measurements of the operated patients in the postoperative period were re-made, and the pre-operative and postoperative measurements were compared. Results: The mean BA was 1.57 cm² and 1.76 cm² in symptomatic and asymptomatic patients, respectively (p<0.05). The cut-off value between symptomatic patients with BA and asymptomatic patients was 1.74 cm². The results of our study were found to be statistically significant in such a way that BA measurements can show the amount of compression on the brainstem. The mean postoperative BA (1.73±0.32) was higher than the mean pre-operative BA (1.58±0.35; p<0.001). There was no difference between the mean postoperative BA of symptomatic patients (1.73±0.33) and the mean BA of asymptomatic patients. Symptomatic patients' CTAs were wider than asymptomatic patients. In addition, FMA was different between symptomatic and asymptomatic patients (p<0.001). Conclusion: BA and FMA may provide a new perspective on the distinction between symptomatic and asymptomatic CMI. [ABSTRACT FROM AUTHOR]

Adenomyosis is a benign uterine disorder where endometrial glands and stroma are pathologically demonstrated within the uterine myometrium. The pathogenesis involves sex steroid hormone abnormalities, inflammation, fibrosis and neuroangiogenesis, even though the proposed mechanisms are not fully understood, the different type and extension of adenomyosis detected by transvaginal ultrasound could be associated with clinical symptoms. The current study was designed with an aim to correlate between ultrasound finding in symptomatic patient with adenomyosis and severity of the disease. It was a cross sectional study conducted on 100 symptomatic women with sonographic criteria of adenomyosis recruited from the outpatient gynecology and obstetrics clinic after proper counseling, history taking and ultrasound examination to detect ultrasound criteria of adenomyosis and doppler on uterine artery done to all patients to detect uterine artery resistance index, pulsatillity index and Vmax. There is a relation between Tumor vascular pattern and abnormal uterine bleeding mainly and chronic pelvic pain. We found non-statistically significant differences between sonographic findings and symptoms among the studied population. [ABSTRACT FROM AUTHOR]

Efficacy of the healthcare system and illumination (awareness) activities control COVID‐19. To defend public health, the spreading pandemic of COVID‐19 disease necessitates social distancing, wearing masks, personal cleanliness, and precautions. Due to inadequate awareness programs, COVID‐19 rapidly increases in India. The primary goal of this research is to investigate the spreading behavior of the COVID‐19 virus in India when people are aware of the disease. We find the optimum value of disease transmission rate and detection of the unidentified asymptomatic and symptomatic populations. An optimal control problem is designed with limited resource allocation to improve the recovered individuals. A stability analysis presents for emphasizes the relevance of disease awareness in preventing the spread of the disease. The control parameters are used to explore the increase and decrease of the infected individual with and without control in optimal control analysis. The model is simulated using the Hattaf‐fractional derivative to study the memory effect in the epidemic. To adapt the model to the total number of reported COVID‐19 cases in India, we collected data from March 20, 2021 to September 30, 2021. According to the simulation results, the pandemic would spread faster if awareness campaigns were improperly carried out. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the safety and efficacy of Enterprise stent angioplasty and risk factors for the prognoses in treating symptomatic severe posterior circulation atherosclerotic stenosis (SSPCAS). Materials and methods: Patients with SSPCAS who were treated with the Enterprise stent angioplasty were retrospectively enrolled. The clinical data, peri-procedural complications, postoperative residual stenosis, in-stent restenosis and recurrent stroke at follow-up were analyzed. Results: 262 patients with 275 stenotic lesions treated with the Enterprise stent angioplasty were enrolled. The stenosis degree was reduced from 86.3 ± 6.2% before to 19.3 ± 5.4% after stenting. Complications occurred in 14 (5.3%) patients. Clinical follow-up was performed in 245 (93.51%) patients for 16.5 ± 7.3 months. During 1 year follow-up, 7 patients (2.9%) had recurrent symptoms, including 4 patients with stenting in the intracranial vertebral artery and 3 in the basilar artery. Imaging follow-up was conducted in 223 (85.11%) patients. In-stent restenosis was present in 35 patients (15.7%), with the restenosis rate of 26.4% (n = 23) in the intracranial vertebral artery, which was significantly (P < 0.001) greater than in the basilar artery (8.8%). Six patients (17.1%) with in-stent restenosis were symptomatic. The stenotic length was the only significant (P = 0.026 and 0.024, respectively) independent risk factor for 1 year stroke or death events and in-stent restenosis. Conclusion: The Enterprise stent can be safely and efficaciously applied in the treatment of symptomatic severe posterior circulation atherosclerotic stenosis, with a relatively low rate of in-stent restenosis and recurrent stroke within 1 year. The stenotic length was the only significant independent risk factor for 1 year stroke or death events and in-stent restenosis. [ABSTRACT FROM AUTHOR]

Obesity is associated with an increased risk of contracting infections. This study aimed to estimate the risk of COVID-19 infection associated with obesity and to assess its role in the specific antibody response against SARS-CoV-2 in 2021. This study included 980 participants from the State of Mexico who participated in a serological survey where they were tested for SARS-CoV-2 IgG anti-S1/S2 and anti-RBD antibodies and asked for height, weight, and previous infection data via a questionnaire. Of the cohort of 980 participants, 451 (46.02%) were seropositive at the time of recruitment (45.2% symptomatic and 54.8% asymptomatic). The risk of SARS-CoV-2 infection with obesity was 2.18 (95% CI: 1.51–3.16), 2.58 (95% CI: 1.63–4.09), and 1.88 (95% CI: 1.18–2.98) for seropositive, asymptomatic, and symptomatic individuals, respectively, compared to those with normal weight. Anti-S1/S2 and anti-RBD IgG antibodies tended to be higher in overweight and obese participants in the seropositive group and stratified by different obesity classes. Additionally, there was a positive correlation between anti-S1/S2 and anti-RBD IgG antibodies and BMI in both men and women in the seropositive group. Obesity is an independent risk factor for SARS-CoV-2 infection when adjusted for confounding variables; however, the relationship between BMI and anti-S1/S2 and anti-RBD IgG antibody levels differed markedly in the presence or absence of symptoms. [ABSTRACT FROM AUTHOR]

Background: The optimal treatment for some symptomatic, benign osteopathy lesions is yet to be identified. Purpose: To investigate the clinical efficiency of cementoplasty in managing symptomatic, benign osteopathy. Material and Methods: Between June 2006 and January 2020, we retrospectively enrolled 31 patients (10 men, 21 women; mean age = 46.5 ± 16.6 years; age range = 20–85 years), accounting for 34 treatment sites, who underwent percutaneous osteoplasty (14 treatment sites) and percutaneous vertebroplasty (20 treatment sites) with digital subtraction angiography (DSA) or DSA combined with computed tomography (CT). All the participants experienced different degrees of clinical symptoms with benign osteopathy lesions. The technical success of the procedure and occurrence of complications were recorded. Follow-up examinations were conducted to assess the treatment outcome using the MacNab criteria. Results: All the participants had a diagnosis of benign osteopathy lesions before or after the cementoplasty. Surgery was successfully completed in all patients. Cement distributions were diffuse and homogeneous, with the complication of cement leakage occurring in 17.6% (6 of 34) of the lesions. The leakage occurred in the intervertebral disc (n = 1), the intra-articular space (n = 1), and the surrounding soft tissue (n = 4). Analysis of the treatment outcome using the MacNab criteria revealed that all patients showed improvement in their clinical symptoms to some extent and in the quality of life. Conclusion: Cementoplasty is an effective treatment for symptomatic, benign osteopathy, with the advantage of favorable clinical outcomes, and low complication rate. [ABSTRACT FROM AUTHOR]

Acute gastroenteritis (AGE) accounts for considerable morbidity and mortality in the paediatric population worldwide, especially in low-income countries. Human norovirus (HNoV), particularly GII.4 strains, are important agents of AGE. This study aimed to detect and characterise HNoV in children with and without AGE. Between 2019 and 2021, 300 stool samples (200 AGE and 100 without AGE) were collected from children below 5 years of age referred to the healthcare facilities of the rural communities of Vhembe District, South Africa. After detection using real-time RT-PCR, HNoV positive samples were subjected to RT-PCR and Sanger sequencing. Partial nucleotide sequences (capsid/RdRp) were aligned using the Muscle tool, and phylogenetic analysis was performed using MEGA 11. The nucleotides' percent identity among HNoV strains was compared using ClustalW software. A significant difference in HNoV prevalence between AGE children (37%; 74/200) and non-AGE (14%; 14/100) was confirmed (p < 0.0001). Genogroup II (GII) HNoV was predominant in AGE children (80%; 59/74), whereas most non-AGE children were infected by the GI norovirus genogroup (64%; 9/14). GII.4 Sydney 2012 [P31] strains were dominant (59%; 19/32) during the study period. A phylogenetic analysis revealed a close relationship between the HNoV strains identified in this study and those circulating worldwide; however, ClustalW showed less than 50% nucleotide similarity between strains from this study and those from previously reported norovirus studies in the same region. Our findings indicate significant changes over time in the circulation of HNoV strains, as well as the association between high HNoV prevalence and AGE symptoms within the study area. The monitoring of HuNoV epidemiology, along with stringent preventive measures to mitigate the viral spread and the burden of AGE, are warranted. [ABSTRACT FROM AUTHOR]

The detection of coronavirus disease 2019 cases represents a significant challenge at the epidemiological level. Limitations exist in effectively detecting asymptomatic cases, achieving good follow-up in hospitals without the infrastructure for reverse transcription-quantitative PCR (RT-qPCR) or in difficult-to-access areas and developing methods with the need for less invasive sampling procedures. Therefore, the present study evaluated the performance of the direct reverse transcription loop-mediated isothermal amplification (RT-LAMP) test for detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the saliva and nasal samples of asymptomatic individuals belonging to the university population. In addition, this test was also assessed for effectiveness in symptomatic individuals referred from a hospital with poor infrastructure in molecular biology and located outside the urban area. The RT-LAMP assay was compared with the results obtained from the RT-qPCR nasopharyngeal swab test, where the diagnosis was confirmed by lateral flow immunoassay test for rapid antigen detection. A total of 128 samples were analyzed, of which 43% were symptomatic positive individuals, 25% were asymptomatic positive individuals and 32% were SARS-CoV2-negative control individuals. Among positive individuals, no differences were found between the Cq values determined by RT-qPCR. A sensitivity of 96.5% and a specificity of 97.6% was reported for the detection of SARS-CoV-2 in symptomatic individuals by salivary and nasal RT-LAMP, as well as a sensitivity of 100% and a specificity of 97.6% for the detection of SARS-CoV-2 in asymptomatic individuals. These findings indicated that performance of the direct RT-LAMP test using saliva and nasal samples has high sensitivity and specificity, which in turn suggest that it is a viable and reliable alternative for use in epidemiological monitoring. [ABSTRACT FROM AUTHOR]

Introduction: Optic pathway gliomas (OPGs) are associated with significant risk of visual and endocrine morbidity, but data on long-term outcomes in symptomatic patients is sparse. This study reviews the clinical course, disease progression, survival outcomes and long-term sequelae in pediatric patients with symptomatic OPGs in our institution over three decades. Methods: Retrospective review of patients with symptomatic OPG treated in a single tertiary pediatric oncology center from 1984 to 2016. Results: A total of 37 patients were diagnosed with symptomatic OPG. Decreased visual acuity was the commonest presenting symptom (75.7%). Surgical intervention was performed in 62.2%; 56.5% underwent biopsy, 26.1% surgical debulking and 17.4% had orbital decompression with cystic fenestration and cosmetic optic nerve excision at different treatment intervals. CSF diversion was performed in 47.8% patients. Histopathologic examination confirmed 86% to be pilocytic astrocytoma and 1 ganglioglioma. 46% received chemotherapy and 48% had radiotherapy, at different intervals. Median follow-up was 13.74 years. In NF1 patients, overall survival (OS) was 100% at 5 years and 55.6 ± 24.8% at 25 years while progression-free-survival (PFS) was 50 ± 15.8% at 5 and 20 years. In non-NF1 patients, OS was 96.2 ± 3.8% at 5 years and 87.4 ± 9% at 25-years. 5-year PFS was 53.8 ± 9.8% and 25-year PFS was 49.0 ± 10%. Cumulative PFS was 53 ± 8.3% at 5 years and 49.7 ± 8.4% at 20 years while cumulative OS was 97.2 ± 2.7% at 5 years and 77.5 ± 10.8% at 25 years. 59.5% patients developed postoperative endocrinopathy. Long-term vision was normal in 8.1%, improved in 13.5%, stabilized in 40.5% but worsened in 37.8% patients. Three patients treated with radiotherapy developed second brain tumors. Conclusion: 25-year OS in this cohort was 77.5% but survivorship carried significant long-term morbidities including radiation-induced second malignant brain tumors. [ABSTRACT FROM AUTHOR]

Background: Small ruminants are the most numerous of man's domestic livestock. Although sheep represent a great resource for Ethiopia, the net rate of productivity per animal is very low due to many factors including respiratory disorders. Objectives: The objectives of this work were to isolate and identify M. haemolytica and P. multocida as well as to assess the antibiotic susceptibility patterns of these isolates. Nasal swab samples were collected aseptically by using 70% alcohol as a disinfectant. Methods: A cross‐sectional study was conducted in three selected districts of the north Gondar zone, Ethiopia. Results: From 148 samples collected in 94 (63.5%) asymptomatic and 54 (35.5%) symptomatic sheep, a total of 23 were isolated successfully based on cultural, staining, and biochemical characteristics. Of these isolates, 18 (78.3%) and 5 (21.7%) were M. haeimolytica and P. multocida, respectively. Compared with the total animals examined, the proportion of M. haeimolytica and P. multocida were 12.16 % (n = 18) and 3.38% (n = 5), respectively. All of the isolates were subjected to a panel of 8 antibiotic discs for sensitivity testing. Of the tested antibiotics, chloramphenicol (100%), gentamicin, and tetracycline (82.6%) each and co‐trimoxazole (60.8%) were found to be the most effective drugs whereas, both species were completely resistant to vancomycin and showed a very low degree of susceptibility for the rest drugs. Conclusions: In conclusion, M. haemolytica was found to be the predominant isolate in all host‐related factors and most of the antibiotics were not fully effective against the isolates. Hence, treatment and/or vaccination of ovine pneumonic pasteurellosis should be emphasised to M. haeimolytica using the most effective drugs along with appropriate herd management practices. [ABSTRACT FROM AUTHOR]

Introduction: Reproductive tract infections/sexually transmitted infections (RTIs/STIs) and their sequelae are an important public health problem, particularly among women. Although high prevalence of RTIs has been reported by community-based studies in India, very few of them have included asymptomatic women. Objective: The objective of the study was to determine the prevalence of RTIs/STIs based on symptoms, clinical examination, and laboratory investigations and factors associated with it among married women of reproductive age in an urbanized village in Delhi. Methods: A community-based cross-sectional study was carried out among married women in the age group of 15-49 years, residing in an urban field practice area of the Department of Community Medicine of VMMC and Safdarjung Hospital from November 2017 to April 2019. The study was carried out using an interviewer-administered questionnaire in the field followed by clinical examination and sample collection for investigations conducted at urban health training center. Statistical Data Analysis: Data were entered into MS Excel and analyzed using licensed the Statistical Package for the Social Sciences (SPSS) software version 21.0. Results: The prevalence of RTI/STI based on symptoms was 53.7%, clinical 39.2%, and laboratory confirmed 36.7%. The prevalence of laboratory-confirmed RTI/STI among asymptomatic women was 21.6%. Women using cloth during menstruation (odds ratio [OR] = 2.242), having a positive history of abortion (OR = 2.373), not using condoms during last sexual intercourse (OR = 1.998), and washing genital area with only water during menstruation (OR = 1.929) had higher odds of having RTI/STI. Conclusions: The prevalence of laboratory-confirmed RTI/STI among married women was quite high even among asymptomatic women indicating the need for opportunistic screening for RTI/STI among women visiting hospitals or health centers for other health problems for its early diagnosis and management. [ABSTRACT FROM AUTHOR]

Gaining more appreciation on the protective/damaging aspects of anti-SARS-CoV-2 immunity associated with disease severity is of great importance. This study aimed to evaluate the avidity of serum IgG antibodies against SARS-CoV-2 spike (S) and nucleocapsid (N) in hospitalized symptomatic COVID-19 patients and asymptomatic RT-PCR-confirmed SARS-CoV-2 carriers as well as to compare antibody avidities with respect to vaccination status, vaccination dose and reinfection status. Serum levels of anti-S and anti-N IgG were determined using specific ELISA kits. Antibody avidity was determined by urea dissociation assay and expressed as avidity index (AI) value. Despite higher IgG levels in the symptomatic group, AI values of both anti-S and anti-N IgG were significantly lower in this group compared to asymptomatic individuals. In both groups, anti-S AI values were elevated in one-dose and two-dose vaccinees versus unvaccinated subjects, although significant differences were only detected in the symptomatic group. However, anti-N avidity showed no significant difference between the vaccinated and unvaccinated subgroups. Almost all vaccinated patients of different subgroups (based on vaccine type) had higher anti-S IgG avidity, while the statistical significance was detected only between those receiving Sinopharm compared to the unvaccinated subgroup. Also, statistically significant differences in antibody AIs were only found between primarily infected individuals of the two groups. Our findings indicate a key role for anti-SARS-CoV-2 IgG avidity in protection from symptomatic COVID-19 and calls for the incorporation of antibody avidity measurement into the current diagnostic tests to predict effective immunity toward SARS-CoV-2 infection or even for prognostic purposes. [ABSTRACT FROM AUTHOR]

Objectives Previous systematic reviews focused on the evidence of common risk factors for knee OA (KOA); however, the effect and strength of association between risk factors and KOA might be different between the two sexes. The aim of the present systematic review was to determine the current evidence on sex differences in the association between risk factors and KOA and their prevalence. Methods We searched the following electronic bibliographic databases: MEDLINE (PubMed), EMBASE and Web of Science. A methodological quality assessment was conducted independently by two researchers according to an adapted version of the standardized set of criteria known as the Newcastle-Ottawa Quality Assessment Scale (NOS). The NOS, a star system, was converted to three categories of quality. Results In total, 27 studies reported sex-specific risk estimates on several risk factors for KOA. Out of the 22 longitudinal cohort studies (except one nested case–control), 12 were of good quality and 10 were of fair quality. The five cross-sectional studies consisted of one of good, three of fair and one of poor quality. There was an indication of sex differences in risk factors leading to higher risk of KOA: high BMI, alcohol consumption, atherosclerosis and high vitamin E levels in women, and high physical activity, soft drink consumption and abdominal obesity in men. Knee injury, high blood pressure and low step rate seem to affect both women and men. Conclusion More good quality studies are needed to assess sex differences in risk factors for KOA, especially for symptomatic/clinical OA. [ABSTRACT FROM AUTHOR]

Purpose: To investigate morphological and inflamed-metabolism features of carotid atherosclerotic plaques between symptomatic and asymptomatic patients with hybrid 18F-FDG PET/MR imaging. Methods: A total of 20 symptomatic and 20 asymptomatic patients with carotid plaques underwent hybrid 18F-FDG PET/MR scans. American heart association (AHA) lesion types were classified, and plaque compositions were further determined on consecutive MRI axial sections in both carotid arteries. 18FFDG uptake in carotid arteries was quantified using region of interest (ROI) methods based on maximum standardized uptake values (SUVmax) and target-to-background ratio (TBR) on corresponding positron emission tomography (PET) images. Results: A total of seventy-one carotid plaques were quantified. AHA type VI was the most common (23, 32.4%), and the region of carotid bifurcation was the most common place presenting lesions (32, 45.1%). Compared with the asymptomatic group, the prevalence of high-risk features including plaque burden, lumen stenosis, maximum necrotic core area, and maximum intra-plaque hemorrhage area increased in the symptomatic group. Carotid TBR values of plaque in symptomatic group (TBR = 2.56 ± 0.34) was significantly higher than that in asymptomatic group (TBR = 1.57 ± 0.14) (P < 0.05). hs-CRP is an independent risk factor for the stability of carotid plaque. The correlation between normalized wall index (NWI) and TBR values was significantly positive in both the symptomatic and the asymptomatic groups (P < 0.01), and both NWI and TBR were significantly correlated with the level of hs-CRP (P < 0.01). Conclusion: Integrated 18F-FDG PET/MR scans presented distinct risk features between symptomatic and asymptomatic patients. Hybrid 18F-FDG PET/MR systems combined with clinical serum hs-CRP may help distinguish vulnerable carotid plaques. [ABSTRACT FROM AUTHOR]

Background: Rapid antigen tests have emerged to deal with the COVID‐19 pandemic. Rapid diagnosis of SARS‐CoV‐2 infection is essential to reduce the spread of the disease. The aim of this study was to estimate the prevalence of COVID‐19 infection and test the sensitivity and specificity in Temara‐Skhirat in symptomatic adults through PANBIOS® test. Methods: A prospective observational study was conducted in mid‐September 2021. Two investigators conducted data collection from symptomatic adult patients. The diagnostic performance of the PANBIOS®, and the PCR was assessed to calculate sensitivity and the specificity. Results: Among 206 symptomatic participants, the mean age was 38 ± 12 years, and the majority were women (59%). In our population, 80% had benefited from the anti‐COVID vaccine. The median duration of symptoms was 4 days; the most common symptoms were fatigue (62%), headache (52%), fever (48%), cough (34%), loss of smell (25%), loss of taste (24%), and sore throat (22%). Results revealed 23% of cases tested positive with PANBIOS® test versus 30% with the PCR test. The calculated medical decision between PCR versus PANBIOS® test showed high specificity of 95.7% and a sensitivity of 69.4%. There was concordance between the PANBIOS® test and the PCR. Conclusion: The prevalence tested remain high, and the sensitivity and specificity of the PANBIOS® versus PCR test are similar to other literatures and close to value described in WHO recommendations. PANBIOS® is a useful test for controlling the spread of COVID‐19 allowing identification of active infection. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to explore the determinants of time to presentation of women with breast cancer symptoms within a rural setting in Kenya. Design: A critical ethnographic study. Methods: Data were collected between July 2019 and April 2020 using semi‐structured interviews and focus groups with 12 women and 23 disclosure recipients, respectively. Interviews and focus group discussions were audio recorded, transcribed verbatim, translated into English and thematically analysed. Further analysis using an intersectional lens added new insights into the data. Ethics approval was obtained in both Kenya and United Kingdom. Results: Participants narrated their experiences from the time they self‐discovered breast cancer symptoms to the time they first came into contact with a healthcare professional. The core themes identified included local cancer knowledge, embodied experience, women's responses, social networks, cultural cancer schemas, gendered social structures and healthcare system experiences. Conclusion: The findings revealed that symptomatic women predominantly faced multiple intersecting barriers to timely presentation. The key drivers of timeliness to presentation of women with breast cancer symptoms were identified. Several proximal and distal determinants, including economic, social, psychological and cultural determinants intersected to shape women's timeliness to symptomatic presentation. Impact: This study identified intersectional structural determinants to timely symptomatic presentation of women with breast cancer symptoms. The findings have global health implications for social inequalities in female breast cancer and may inform the development of intersectional interventions to promote timely symptomatic presentation. Furthermore, this study identified an additional interval, precursory interval and revision of the Model of pathway to treatment may be needed should this interval be validated by future studies. Patient or public contribution: To ensure the interview guides were culturally sensitive, they were co‐designed with a female breast cancer survivor, nurses providing reproductive health care to women and a bilingual expert. Both women and disclosure recipients participated in scheduling for the interviews, including the mutually agreeable days and time. Participants were frequently contacted during data analysis and report writing to clarify meaning of certain words or pieces of data. [ABSTRACT FROM AUTHOR]

A substantial proportion of coronavirus disease 2019 (COVID-19) survivors continue to suffer from long-COVID-19 (LC) symptoms. Our study aimed to determine the risk factors for LC by using a patient population from Northern Cyprus. Subjects who were diagnosed with severe acute respiratory syndrome-2 (SARS-CoV-2) infection in our university hospital were invited and asked to fill in an online questionnaire. Data from 296 survivors who had recovered from COVID-19 infection at least 28 days prior the study was used in the statistical analysis. For determination of risk factors for "ongoing symptomatic COVID-19 (OSC)" and "Post-COVID-19 (PSC)" syndromes, the patient population was further divided into group 1 (Gr1) and group 2 (Gr2), that included survivors who were diagnosed with COVID-19 within 4-12 weeks and at least three months prior the study, respectively. The number of people with post-vaccination SARS-CoV-2 infection was 266 (89.9%). B.1.617.2 (Delta) (41.9%) was the most common SARS-CoV-2 variant responsible for the infections, followed by BA.1 (Omicron) (34.8%), B.1.1.7 (Alpha) (15.5%), and wild-type SARS-CoV-2 (7.8%). One-hundred-and-nineteen volunteers (40.2%) stated an increased frequency of COVID-19-related symptoms and experienced the symptoms in the week prior to the study. Of those, 81 (38.8%) and 38 (43.7%) were from Gr1 and Gr2 groups, respectively. Female gender, chronic illness, and symptomatic status at PCR testing were identified as risk factors for developing OSC syndrome, while only the latter showed a similar association with PSC symptoms. Our results also suggested that ongoing and persistent COVID-19-related symptoms are not influenced by the initial viral cycle threshold (Ct) values of the SARS-CoV-2, SARS-CoV-2 variant as well as vaccination status and type prior to COVID-19. Therefore, strategies other than vaccination are needed to combat the long-term effect of COVID-19, especially after symptomatic SARS-CoV-2 infection, and their possible economic burden on healthcare settings. [ABSTRACT FROM AUTHOR]

Objective: Symptomatic abdominal aortic aneurysms (sAAA) are considered surgically urgent. Recent data suggest delaying surgery allows for medical optimization without affecting outcomes. We investigated the association of the hospital day of surgery with 30 day outcomes. Methods: Patients with infrarenal sAAA undergoing endovascular aortic repair (EVAR) between 2011 and 2018 in the American College of Surgeons National Surgery Quality Improvement Project database were included. The primary outcome was 30 day mortality. Additional outcomes included myocardial infarction, pulmonary complications, length of stay, and discharge disposition. Days-to-surgery were classified as the day of presentation (D0), day 1, day 2, days 3 and 4, days 5 to 7 (D5), and day 8 or more (D8). Results: A total of 804 patients were identified. D8 patients had higher proportions of dyspnea on exertion, chronic obstructive pulmonary disease, congestive heart failure, and history of dialysis. D0 surgery appeared protective of mortality (odds ratio [OR] 0.34, p=0.0132). Each additional day increased the mortality risk (OR 1.23, p<0.001) although not within the first 4 days. There was increased mortality for patients having surgery at D5 (7.7%) and D8 (23.8%) compared with repair earlier (1%–4%, p=0.03). Bivariable analysis revealed no significant differences in secondary outcomes. Multivariable modeling revealed increased mortality for D8 versus D0 (adjusted OR of 6.8, 95% confidence interval 1.7–26.5). Conclusions: While D0 appears to have the lowest risk of mortality, EVAR for sAAA up to 4 days may not be associated with increased mortality. Further research should determine delay etiologies and whether they improve operative planning and optimization without impacting morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: COVID19 pandemic had affected millions of people worldwide. In contrast with adults, children had milder disease though transmission rate was high. During second wave of COVID 19, more children were affected Aim: To describe and compare the clinical profile of COVID 19 infection in children between the first and second waves. Methods: This was a descriptive cross-sectional study done by retrospective chart analysis. The study population included children from age group 1 month to 12 years admitted with a diagnosis of COVID 19 infection at a tertiary care centre in Kerala. Results: A total of 322 case records were analyzed and 52 were excluded due to incomplete data. Of the 270 records of children, 51(18.9%) were in 1st wave and 219 (81.1%) were in 2nd wave. Among the major clinical symptoms, fever and respiratory complaints were more common. There was significant difference in the mean age of children in 2 waves (2.47 years in 1st wave and 3.70 in second wave, P value 0.023). The proportion of asymptomatic patients were significantly higher during the 1st wave 39 (77%) compared to 2nd wave 98 (45%) with a significant p value of <0.001. Subgroup analysis was done for the presenting symptoms in which gastrointestinal and respiratory symptoms were predominant in the 2nd wave. There was no child mortality during both waves. Conclusion: The study showed significant difference in the presenting symptoms during the 1st and 2nd waves of COVID19 pandemic with higher rate of respiratory and gastrointestinal symptoms during the 2nd wave and more asymptomatic cases during the 1st wave. Since the symptomatology of presentation was evolving, the suspicion of COVID 19 as causative agent for respiratory and gastrointestinal symptoms should remain high. [ABSTRACT FROM AUTHOR]

Purpose: To investigate morphological and inflamed-metabolism features of carotid atherosclerotic plaques between symptomatic and asymptomatic patients with hybrid 18F-FDG PET/MR imaging. Methods: A total of 20 symptomatic and 20 asymptomatic patients with carotid plaques underwent hybrid 18F-FDG PET/MR scans. American heart association (AHA) lesion types were classified, and plaque compositions were further determined on consecutive MRI axial sections in both carotid arteries. 18FFDG uptake in carotid arteries was quantified using region of interest (ROI) methods based on maximum standardized uptake values (SUVmax) and targetto-background ratio (TBR) on corresponding positron emission tomography (PET) images. Results: A total of seventy-one carotid plaques were quantified. AHA type VI was the most common (23, 32.4%), and the region of carotid bifurcation was the most common place presenting lesions (32, 45.1%). Compared with the asymptomatic group, the prevalence of high-risk features including plaque burden, lumen stenosis, maximum necrotic core area, and maximum intra-plaque hemorrhage area increased in the symptomatic group. Carotid TBR values of plaque in symptomatic group (TBR = 2.56 ± 0.34) was significantly higher than that in asymptomatic group (TBR = 1.57 ± 0.14) (P < 0.05). hs-CRP is an independent risk factor for the stability of carotid plaque. The correlation between normalized wall index (NWI) and TBR values was significantly positive in both the symptomatic and the asymptomatic groups (P < 0.01), and both NWI and TBR were significantly correlated with the level of hs-CRP (P < 0.01). Conclusion: Integrated 18F-FDG PET/MR scans presented distinct risk features between symptomatic and asymptomatic patients. Hybrid 18F-FDG PET/MR systems combined with clinical serum hs-CRP may help distinguish vulnerable carotid plaques. [ABSTRACT FROM AUTHOR]

A 62-year-old man was presented with transient ischemic attack 1 day after percutaneous coronary intervention. Magnetic resonance imaging demonstrated fresh cerebral infarction in the left hemisphere. Digital subtraction angiography showed left Riles type 1A common carotid artery occlusion (CCAO). Blood flow in the internal carotid artery (ICA) was derived from the external carotid artery, which came through the anastomosis between the left occipital artery and a muscular branch of left vertebral artery. We performed short jump graft from CCA to ICA using saphenous vein, followed by ligation of CCA. The graft remained patent at the 1-year follow-up. [ABSTRACT FROM AUTHOR]

Individuals infected with Leishmania (L.) chagasi may present different asymptomatic and symptomatic stages of infection, which vary in the clinical–immunological profiles that can be classified as asymptomatic infection (AI), subclinical resistant infection (SRI), indeterminate initial infection (III), subclinical oligosymptomatic infection (SOI), and symptomatic infection (SI) (=American visceral leishmaniasis, AVL). However, little is known about the molecular differences between individuals having each profile. Here, we performed whole-blood transcriptomic analyses of 56 infected individuals from Pará State (Brazilian Amazon), covering all five profiles. We then identified the gene signatures of each profile by comparing their transcriptome with those of 11 healthy individuals from the same area. Symptomatic individuals with SI (=AVL) and SOI profiles showed higher transcriptome perturbation when compared to those asymptomatic III, AI and SRI profiles, suggesting that disease severity may be associated with greater transcriptomic changes. Although the expression of many genes was altered on each profile, very few genes were shared among the profiles. This indicated that each profile has a unique gene signature. The innate immune system pathway was strongly activated only in asymptomatic AI and SRI profiles, suggesting the control of infection. In turn, pathways such as MHC Class II antigen presentation and NF-kB activation in B cells seemed to be specifically induced in symptomatic SI (=AVL) and SOI profiles. Moreover, cellular response to starvation was down-regulated in those symptomatic profiles. Overall, this study revealed five distinct transcriptional patterns associated to the clinical–immunological (symptomatic and asymptomatic) profiles of human L. (L.) chagasi-infection in the Brazilian Amazon. [ABSTRACT FROM AUTHOR]