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# Background Since its emergence, Coronavirus Disease 2019 (COVID-19) has infected over half a billion people, killed over 6 million others, and ravaged the global economy on a scale that is unprecedented in recent history. In response, a global health emergency was launched that led to further disruptions in the ordinary way of life of people. The knowledge, attitudes, and practices (KAP) of people towards COVID-19 are central to infection control policies and the future course of the pandemic. # Methods We employed an interviewer-administered, cross-sectional survey to examine the KAP of salespersons in a local market and sanitation workers of a public institution within the Cape Coast Metropolis of Ghana. Results were analysed by frequencies of responses for each KAP item on the questionnaire. Sociodemographic variables that predicted good knowledge of COVID-19 or preventive practices were determined using adjusted odds ratios (aORs). # Results Out of the 206 participants, 123 (59.7%) obtained a knowledge score ≥16.75 out of a total of 21, which was the threshold for good knowledge, while 41.3% were classified as possessing poor knowledge. On good attitudes towards COVID-19 prevention, 141 participants (68.4%) scored ≥10.69 out of 12 to pass the threshold, while 31.6% had poor attitudes. Being female (aOR=6.19, *P*

Abstract Background Secondary hypertension accounts for 5% of all cases of hypertension. Renal artery stenosis is one of the common causes of secondary hypertension. Atherosclerosis and fibromuscular dysplasia are the commonest types of stenosis associated with renal vascular hypertension, with the former accounting for 70–80% of all cases and the latter accounting for 10% of the incidence. The greatest incidence atherosclerosis is in men over the age of 40 years, mostly affecting the proximal part of the renal arteries, whereas fibromuscular dysplasia affects women ranging in age from 30 to 50 years. Currently, possible treatments are medical treatment using blood pressure-lowering drugs, balloon angioplasty with or without stent insertion, and surgery to reconstruct the artery. Case presentation We report a case of a 46-year-old Asian woman with stenosis of two branches of renal artery bifurcation treated by percutaneous balloon dilatation and stenting of both branches after referral to our department for a renal angiogram following 8 months of uncontrolled hypertension despite receiving medications. Initially, the patient presented with severe headache and fatigue. She was a known nonsmoker, was not diabetic, and had no history of diabetes in her family. She had no history of atherosclerosis. Apart from high blood pressure, the result of her physical examination was unremarkable. Laboratory investigations revealed normal serum cholesterol, lipid profile, and serum creatinine. She had been attending a hypertension clinic and receiving antihypertensive drugs for the past 8 months on a regular basis under close observation. Despite this treatment and care, her blood pressure remained high at 175/110 mmHg, which the attending doctor concluded to be uncontrolled blood pressure. Initial imaging indicated left renal artery stenosis, and the patient was referred to our department. Conclusions For patients with uncontrolled hypertension despite receiving medications, renal Doppler ultrasound should be included in the diagnostic workup for secondary hypertension. Once renal artery stenosis is suspected, renal angiography is highly recommended because the technique is able to accurately diagnose stenosis in the branch arteries, unlike computed tomographic angiography and magnetic resonance angiography. Percutaneous transluminal renal angioplasty is the treatment of choice for renal artery stenosis in patients with renovascular hypertension or renal dysfunction.

El objetivo del presente trabajo fue diseñar un modelo experimental de Glomerulonefritis Membranosa (GM) en ratas Wistar, inducida con Seroalbúmina Bovina (BSA), y validarlo mediante la determinación de parámetros bioquímicos, histológicos, ultraestructurales y detección de inmunocomplejos por inmunofluorescencia (IF). Los animales del grupo experimental fueron inmunizados por vía subcutánea, con dosis de 3 mg c/u de BSA/PBS con adyuvante de Freund. Se efectuaron diferentes esquemas de inmunización. Cuando el título de anticuerpos fue ≥1/2, comenzó la administración diaria de 2 mg, por vía endovenosa de BSA/PBS, durante 15 días. Se evaluó la funcionalidad renal por la proteinuria; después de la 5° semana, desde su aparición, se determinó: depuración (clearance) de creatinina, uremia, proteinemia y perfil lipídico. Los dos riñones se usaron para estudios histológicos, ultraestructurales y detección de inmunocomplejos por IF. Los resultados mostraron que la inmunización fue efectiva con 5 R E S U M E N inoculaciones c/15 días. En los animales nefróticos la proteinuria, depuración (clearance) de creatinina, proteinemia , uremia y el perfil lipídico presentaron alteraciones significativas (p

A partir de 1960 vários países do continente africano proclamaram as suas “independências” política e administrativa do jugo colonial, fruto de conquistas efetivadas por um lado, por meio de negociação pacífica e por outro lado, pela luta armada. E foi por meio desta última que os moçambicanos alcançaram a independência nacional, à 25 de Junho de 1975. Pensadores e teóricos pós-coloniais movidos pela constatação da prevalência das colonialidades de poder vêm questionado as independências. É nesse viés que tecemos esse artigo, com objetivo de suscitar algumas reflexões que promovam e potencializam debates sobre a imposição cultural enraizado no sistema colonial, sustentado pelos discursos preconceituosos eurocentrados que buscavam incutir e enfatizar o mito de complexo de inferioridade atribuído aos homens negros; tanto como impor a homogeneização cultural eurocêntrica. Esses debates são embasados teórica e metodologicamente por viés pós-coloniais e decoloniais. Por meio de revisão bibliográfica, dialogamos com Fanon (2020) Cesáire (2020), Azagaia (2013), Ki-Zerbo (2010) Lopes (2010) e; vários autores para discutir as colonialidades que perpassam o tecido social dos moçambicanos. Portanto, das reflexões constata-se que as colonialidades podem ser desestabilizadas por meio de ações efetivas de desaprendizagem e reaprendizagem: desaprender as amaras ideológicas eurocêntricas “romper a dominação mental”, denunciar e insurgir-se contra a subalterinização, alienação cultural e desmascarar os paradigmas, estereótipos, preconceitos eurocêntricos e aprender a reconquistar e revalorizar as identidades socioculturais nativas, aprender a pensar e falar sobre o continente africano com os africanos.

Abstract Background Cerebral malaria (CM) is a preeminent cause of severe disease and premature deaths in Sub-Saharan Africa, where an estimated 90% of cases occur. The key features of CM are a deep, unarousable coma that persists for longer than 1 h in patients with peripheral Plasmodium falciparum and no other explanation for encephalopathy. Significant research efforts on CM in the last few decades have focused on unravelling the molecular underpinnings of the disease pathogenesis and the identification of potential targets for therapeutic or pharmacologic intervention. These efforts have been greatly aided by the generation and study of mouse models of CM, which have provided great insights into key events of CM pathogenesis, revealed an interesting interplay of host versus parasite factors that determine the progression of malaria to severe disease and exposed possible targets for therapeutic intervention in severe disease. Main Body This paper reviews our current understanding of the pathogenic and immunologic factors involved in CM. We present the current view of the roles of certain gene products e.g., the var gene, ABCA-1, ICAM-1, TNF-alpha, CD-36, PfEMP-1 and G6PD, in CM pathogenesis. We also present alterations in the blood–brain barrier as a consequence of disease proliferation as well as complicated host and parasite interactions, including the T-cell immune reaction, reduced deformation of erythrocytes and cytoadherence. We further looked at recent advances in cerebral malaria treatment interventions by emphasizing on biomarkers, new diagnostic tools and emerging therapeutic options. Conclusion Finally, we discuss how the current understanding of some of these pathogenic and immunologic factors could inform the development of novel therapeutic interventions to fight CM.

Abstract Objective The use of agarose in nucleic acid electrophoresis is the gold standard. However, agarose is very expensive and not readily available in resource limited developing countries like Ghana. Hence, finding a more affordable and readily available alternative to agarose will be a major boost to molecular research in developing countries. This study was aimed at investigating the use of corn starch as a potential substitute for agarose in DNA gel electrophoresis. Results Genomic deoxyribonucleic acid (DNA) extracted from Plasmodium falciparum and primers were obtained from the West African Centre for Cell Biology of Infectious Pathogens and amplified using polymerase chain reaction. The amplicon was run on agarose gel to ascertain the molecular weight (as a positive control). When visualized under both blue light and ultraviolet light, the DNA and ladder showed clear and clean bands with the expected molecular weight. Corn starch was then modified with sodium borate buffer, casted into a gel and used to run the same DNA sample. Our findings indicated that similar to agarose, the DNA sample and ladder migrated successfully through the modified starch gel but no bands were visible when visualized under blue and ultra-violet light.

Neste artigo, discute-se o aspecto financeiro, no âmbito da Educação para o Consumo Responsável. Descreve-se, didaticamente, o cenário financeiro atual, no qual se sobressai a crise financeira mundial. A crise influencia o movimento de estímulo e contenção das economias mundiais e tem reflexos nos padrões de consumo, podendo, em situações de oferta indiscriminada de crédito, favorecer o superendividamento das famílias. Nesse contexto, em 2010, surge, no Brasil, a Estratégia Nacional de Educação Financeira - ENEF, um programa de Estado que visa a educar financeiramente a população. Discutese, brevemente, esse programa e assume-se a posição de que a educação financeira deve ser inserida no âmbito do consumo responsável, o qual engloba as vertentes meio ambiente, saúde, publicidade, direito e ética. Analisam-se quatro exemplos de fatos/situações noticiados pela mídia, a fim de evidenciar a complexidade envolvida no consumo. Finalmente, situa-se a relação entre a educação para o consumo e o sentido de educação freiriano.

Este artigo apresenta um modelo, de cunho didático e dirigido prioritariamente aos profissionais de educação, que leva em conta os diversos aspectos que devem caracterizar um consumo como responsável. Além do usual aspecto Meio Ambiente, há outros, como a Publicidade, a Saúde e a Segurança, o Direito e a Ética e que foram aqui sintetizados a partir da coleção lançada conjuntamente pelo IDEC (Instituto de Defesa do Consumidor) e pelo Inmetro (Instituto Nacional de Metrologia, Normalização e Qualidade Industrial). Essa coleção é dirigida aos professores e alunos do terceiro e quarto ciclos do ensino fundamental e foi elaborada no contexto dos temas transversais apresentados pelos Parâmetros Curriculares Nacionais (PCNs). Colocando-se no papel de consumidor responsável e utilizando-se do referido modelo, inspirado na coleção do IDEC e do Inmetro, pretende-se analisar um caso-exemplo, Ambev, considerada a maior indústria cervejeira da América Latina e "Referência mundial na gestão da água". Por meio desse exemplo, procura-se mostrar que o "respeito à natureza", no caso, o elemento água, é um parâmetro necessário, mas insuficiente para caracterizar um consumo como responsável e que os demais aspectos apontados acima devem ser considerados.This paper presents a model of didactic feature and directed primarily to professional education, which takes into account the various aspects that should characterize a responsible consumption. Besides the usual environmental aspect, there are others aspects such as advertising, health and safety, and Law and ethics, which have been summarized from the collection launched jointly by the IDEC (Institute of Consumer Protection) and Inmetro (National Institute of Metrology, Standardization and Industrial Quality). This collection is addressed to teachers and students of the third and fourth cycles of elementary school and was elaborated in the context of cross-cutting themes presented by the National Curriculum Parameters (PCNs). Assuming the role of the responsible consumers and using the referred model, inspired by the collection by IDEC and Inmetro, we intend to analyze the case of AmBev, considered the largest brewery in Latin America and a "global reference in water management". Through this example, we seek to present that the "respect for nature" - in this case the water -, despite being a necessary parameter, is not sufficient to characterize a responsible consumption. Considering the latter, the others aspects raised above should be considered.

Background: Trachomatous trichiasis (TT) is a painful, potentially blinding eye condition that can be managed through epilation or surgery. Women are affected by TT approximately twice as often as men and are believed to face gendered barriers to receiving surgical care to prevent vision loss., Methods: We used data from 817 cross-sectional surveys conducted during 2015-2019 in 20 African countries to estimate the prevalence difference (PD) between female and male eyes for four outcomes potentially indicating gender-related differences in TT management: (1) received surgery and developed postoperative TT (PTT), (2) never offered surgery, (3) offered surgery but declined it, and (4) offered epilation but never offered surgery., Results: The prevalence was modestly elevated among female eyes compared with male eyes for having PTT (PD:1.8 [95% confidence limits (CL): 0.6, 3.0]) and having declined surgery for the eye (PD: 6.2 [95% CL: 1.8, 10.7]). The proportion offered epilation was similar by gender (PD:0.5 [95% CL: -0.4, 1.3]), while never having been offered surgery was somewhat more prevalent among male eyes (PD: -2.1 [95% CL: -3.5, -0.7])., Conclusions: Our results suggest potential gender differences in TT management. More research is needed to determine the causes and implications of the observed differences., (© The Author(s) 2023. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Purpose: Population-based prevalence surveys are essential for decision-making on interventions to achieve trachoma elimination as a public health problem. This paper outlines the methodologies of Tropical Data, which supports work to undertake those surveys., Methods: Tropical Data is a consortium of partners that supports health ministries worldwide to conduct globally standardised prevalence surveys that conform to World Health Organization recommendations. Founding principles are health ministry ownership, partnership and collaboration, and quality assurance and quality control at every step of the survey process. Support covers survey planning, survey design, training, electronic data collection and fieldwork, and data management, analysis and dissemination. Methods are adapted to meet local context and needs. Customisations, operational research and integration of other diseases into routine trachoma surveys have also been supported., Results: Between 29 th February 2016 and 24 th April 2023, 3373 trachoma surveys across 50 countries have been supported, resulting in 10,818,502 people being examined for trachoma., Conclusion: This health ministry-led, standardised approach, with support from the start to the end of the survey process, has helped all trachoma elimination stakeholders to know where interventions are needed, where interventions can be stopped, and when elimination as a public health problem has been achieved. Flexibility to meet specific country contexts, adaptation to changes in global guidance and adjustments in response to user feedback have facilitated innovation in evidence-based methodologies, and supported health ministries to strive for global disease control targets.

Low-income countries carry approximately 90% of the global burden of visual impairment, and up to 80% of this could be prevented or cured. However, there are only a few studies on the prevalence of retinal disease in these countries. Easier access to retinal information would allow differential diagnosis and promote strategies to improve eye health, which are currently scarce. This pilot study aims to evaluate the functionality and usability of a tele-retinography system for the detection of retinal pathology, based on a low-cost portable retinal scanner, manufactured with 3D printing and controlled by a mobile phone with an application designed ad hoc. The study was conducted at the Manhiça Rural Hospital in Mozambique. General practitioners, with no specific knowledge of ophthalmology or previous use of retinography, performed digital retinographies on 104 hospitalized patients. The retinographies were acquired in video format, uploaded to a web platform, and reviewed centrally by two ophthalmologists, analyzing the image quality and the presence of retinal lesions. In our sample there was a high proportion of exudates and hemorrhages-8% and 4%, respectively. In addition, the presence of lesions was studied in patients with known underlying risk factors for retinal disease, such as HIV, diabetes, and/or hypertension. Our tele-retinography system based on a smartphone coupled with a simple and low-cost 3D printed device is easy to use by healthcare personnel without specialized ophthalmological knowledge and could be applied for the screening and initial diagnosis of retinal pathology.

Bovine Trichomonosis (BT), a sexually transmitted disease endemic in countries with extensive cattle farming and natural service, is one of the most common causes of reproductive failure. 5-nitroimidazoles and their derivatives are used for its treatment, mainly metronidazole. The emergence of drug resistance mechanisms and treatment failures raise the need to investigate the effectiveness of new active compounds that contribute to parasite control. In this regard, extracts of Lantana camara (Verbenacea) have shown high biocidal potential against isolates of Trypanosoma cruzi and Leishmania braziliensis in vitro assays, although their effect on Tritrichomonas foetus has not been demonstrated yet. The available information on in vitro susceptibility of trichomonicidal drugs comes from the use of a diversity of methodologies and criteria, especially the observation of parasite motility under the optical microscope to assess their viability. Recently, in our laboratory, the use of flow cytometry has been described for the first time as a rapid and efficient method to evaluate the viability of T. foetus against metronidazole. The present study aimed to evaluate the cytostatic effect of L. camara extracts against T. foetus isolates by flow cytometry. Under aerobic conditions, IC 50 values of 22.60 µg/mL were obtained on average. Under anaerobic conditions, the IC 50 oscilated around 29.04 µg/mL. The results obtained allowed describing the susceptibility exhibited by these protozoa, being a valuable information for the development of potential BT treatments., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Trachoma is the leading infectious cause of blindness. To reduce transmission, water, sanitation, and hygiene (WaSH) improvements are promoted through a comprehensive public health strategy. Evidence supporting the role of WaSH in trachoma elimination is mixed and it remains unknown what WaSH coverages are needed to effectively reduce transmission., Methods/findings: We used g-computation to estimate the impact on the prevalence of trachomatous inflammation-follicular among children aged 1-9 years (TF1-9) when hypothetical WaSH interventions raised the minimum coverages from 5% to 100% for "nearby" face-washing water (<30 minutes roundtrip collection time) and adult latrine use in an evaluation unit (EU). For each scenario, we estimated the generalized prevalence difference as the TF1-9 prevalence under the intervention scenarios minus the observed prevalence. Data from 574 cross-sectional surveys conducted in 16 African and Eastern Mediterranean countries were included. Surveys were conducted from 2015-2019 with support from the Global Trachoma Mapping Project and Tropical Data. When modeling interventions among EUs that had not yet met the TF1-9 elimination target, increasing nearby face-washing water and latrine use coverages above 30% was generally associated with consistent decreases in TF1-9. For nearby face-washing water, we estimated a ≥25% decrease in TF1-9 at 65% coverage, with a plateau upon reaching 85% coverage. For latrine use, the estimated decrease in TF1-9 accelerated from 80% coverage upward, with a ≥25% decrease in TF1-9 by 85% coverage. Among EUs that had previously met the elimination target, results were inconclusive., Conclusions: Our results support Sustainable Development Goal 6 and provide insight into potential WaSH-related coverage targets for trachoma elimination. Targets can be tested in future trials to improve evidence-based WaSH guidance for trachoma., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: AB is employed by the International Trachoma Initiative at The Task Force for Global Health, which receives an operating budget and research funds from Pfizer Inc., the manufacturers of Zithromax (azithromycin); EMHE is funded by the International Trachoma Initiative, a program of The Task Force for Global Health, which receives funding from Pfizer Inc., the manufacturers of Zithromax (azithromycin). All other authors have no completing interests to declare., (Copyright: © 2023 Sullivan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Combined therapy constitutes the standard of care in RA. Jak inhibitors (Jaki) have shown efficacy in monotherapy, a modality used in cases where it is not possible to use Disease-Modifying Anti Rheumatic Drugs (csDMARDs)., Objectives: To estimate the prevalence (total and by drug), reason for using and the increase over the time of bDMARDs or tsDMARDs as monotherapy after the availability of the Jaki. To analyze the differential characteristics between patients with monotherapy vs combined therapy., Methods: Cross-sectional multicenter study. Consecutive patients with a diagnosis of RA (ACR/EULAR 2010) under treatment with bDMARDs or tsDMARDs started from 2013 were included. Socio-demographic, clinic, and therapeutic data were collected., Results: A total of 505 RA patients were included. Since 2013, the prevalence of monotherapy usage was (any) 49%. The drugs used as monotherapy were Jaki in 41% and TNF-blockers in 30%. The leading causes of monotherapy use were intolerance/adverse events (62%), medical decision or lack of adherence (37.7%). The highest socioeconomic level and a better functional status at diagnosis were predictors of monotherapy use. The use of the second line of treatments and less polypharmacy were independent factors associated with this therapeutic modality., Conclusions: The current prevalence of monotherapy in RA was 49%, the Jaki were the most used drug in this modality. Monotherapy increases from year to year. There are differential characteristics in patients using monotherapy.

Background: Global elimination of trachoma as a public health problem was targeted for 2020. We reviewed progress towards the elimination of active trachoma by country and geographical group., Methods: In this retrospective analysis of national survey and implementation data, all countries ever known to be endemic for trachoma that had either implemented at least one trachoma impact survey shown in the publicly available Trachoma Atlas, or are in Africa were invited to participate in this study. Scale-up was described according to the number of known endemic implementation units and mass drug administration implementation over time. The prevalence of active trachoma-follicular among children aged 1-9 years (TF 1-9 ) from baseline, impact, and surveillance surveys was categorised and used to show programme progress towards reaching the elimination threshold (TF 1-9 <5%) using dot maps, spaghetti plots, and boxplots., Findings: We included data until Nov 10, 2021, for 38 countries, representing 2097 ever-endemic implementation units. Of these, 1923 (91·7%) have had mass drug administration. Of 1731 implementation units with a trachoma impact survey, the prevalence of TF 1-9 had reduced by at least 50% in 1465 (84·6%) implementation units and 1182 (56·4%) of 2097 ever-endemic implementation units had reached the elimination threshold. 2 years after reaching a TF 1-9 prevalence below 5%, most implementation units sustained this target; however, 58 (56·3%) of 103 implementation units in Ethiopia showed recrudescence., Interpretation: Global elimination of trachoma as a public health problem by 2020 was not possible, but this finding masks the great progress achieved. Implementation units in high baseline categories and recrudescent TF 1-9 might prolong the attainment of elimination of active trachoma. Elimination is delayed but, with an understanding of the patterns and timelines to reaching elimination targets and a commitment toward meeting future targets, global elimination can still be achieved by 2030., Funding: None., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Evidence for Chagas disease reactivation (CDR) in rheumatologic patients under rheumatologic treatments (RTs) is scarce. To screen and follow-up patients with rheumatic diseases and concomitant Chagas disease under RT to detect CDR and to describe a possible relationship between CDR and specific RT. An observational, longitudinal, prospective, consecutive study was carried out between 2018 and 2020. Included patients were evaluated during the follow-up for clinical and laboratorial manifestations of CDR. Direct blood parasitological examination (Strout method) and polymerase chain reaction (PCR) were employed to diagnose CDR. The dynamic of anti-T. cruzi-specific antibodies was also assessed by IHA and ELISA (total IgG and Anti-SAPA). Fifty-one patients were included (86% women). Rheumatoid arthritis was the predominant disease (57%). Classic DMARDs (86.3%) and corticosteroids (61%) were the most frequent RT. CDR was developed in 6 patients (11.7%), exhibiting both positive Strout and PCR. Symptomatic reactivation of CD (fever, asthenia, arthralgias, myalgias) occurred in two patients who had previously been diagnosed with it. Regardless of the different RT, all patients who experienced CDR had previously received more than ≥ 20 mg/day of prednisone equivalent. Despite immunosuppression, patients with CDR exhibited increased levels of specific anti-T. cruzi and anti-SAPA antibodies, which decreased after anti-parasitic treatment. CDR is possible in rheumatologic patients, especially after receiving high doses of corticosteroids. Since CDR symptoms may mimic rheumatic disease activity, monitoring of Chagas disease is highly recommended before, during and after immunosuppression. Key Points • Chagas disease reactivation (CDR) in the context of rheumatological treatment was associated to high doses of corticosteroids. • CDR was associated with an increase in anti-T. cruzi antibodies despite the immunosuppressive treatment. • Suspecting and anticipating CDR is mandatory in this patient population to diagnose and treat it.