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Introduction. Hepatotropic viruses (HAV, HBV, HCV, HDV, and HEV) significantly impact global health, with varying prevalence across regions. Objective. This study aims to systematically consolidate data from diverse meta-analyses to provide a contemporary reference on virus distribution and prevalence. Materials and methods. Adhering to PRISMA guidelines, the study utilized a mixed effects model for data integration. Quality evaluation was carried out with QUOROM and AMSTAR tools, with heterogeneity assessed via the Higgins I2 statistic, Q-statistic and Tau squared (τ2) values. Results. The study analyzed 86 meta-analyses from 56 studies (2017–2022) with minimal overlap. Prevalence rates by region were as follows: MENA – 29.2%, Afghanistan – 9.14%, Africa – 8.10%. Prevalence rates by virus type: HAV – 82.5%, HBV – 8.6%, HCV – 15.1%, HDV – 8.9%, HEV – 13.9%, dual HBV-HCV coinfection – 2.2%. Prevalence rates by risk groups: general population – 8.3%, healthcare workers – 4.0%. Continent-specific HBV-HCV prevalence rates: Africa – 9.2%, China – 6.9%, others. HCVprevalence rates among at-risk groups: healthcare workers – 5.58%, hemodialysis patients – 34.8%. Regional HCV rates: Africa – 7.42%, Middle East – 25.30%. Conclusion. Diverse global hepatotropic virus prevalence patterns are influenced by multifaceted factors. MENA faces higher rates due to healthcare challenges, while Africa struggles with limited resources. Tailored public health strategies, including vaccination and awareness campaigns, are essential to alleviate burdens and enhance global health. This consolidated data serves as a valuable resource for informed decision-making.

Abstract Background Toxoplasmosis is a chronic protozoan parasitic infection that affects nearly one-third of the global population. During the COVID-19 pandemic, cases were observed in patients with COVID-19 and toxoplasmosis. Therefore, this systematic review and meta-analysis aimed to determine the frequency of Toxoplasma gondii exposure in patients with COVID-19. Methods A literature search was conducted in six databases or search tools (PubMed, Scopus, Embase, Web of Science, ScienceDirect, and Google Scholar) until March 3, 2024. Study selection, quality assessment, and data extraction were performed independently by three investigators. Statistical analysis was performed using R version 4.3, applying a random-effects model. The quality of the included observational studies was assessed using the “JBI-MAStARI”. Results A total of 5,936 studies were retrieved, 13 of which were included in the final meta-analysis. The sample included a total of 2,947 patients with COVID-19 from four countries, of whom approximately 43.3% were men and 49.4% were women. Among the patients, 1,323 showed evidence of exposure to T. gondii through IgG detection, while 1,302 COVID-19 patients were explicitly examined for T. gondii by IgM detection, and 36 positive cases were identified. The frequency of exposure to T. gondii, determined by the presence of IgG in patients with COVID-19, reached 49% (95% CI: 34–63%; 2,947 participants; 13 studies; I2 = 98%, p

Abstract Background Mpox is a severe viral zoonosis that has emerged as a public health concern due to its potential for human-to-human transmission and severe illness. Understanding its clinical manifestations is crucial for effective management and control. Several systematic reviews have assessed various manifestations of Mpox. This umbrella review synthesizes evidence on Mpox’s manifestations across different organ systems. Method We conducted an umbrella review, adhering to Joanna Briggs Institute (JBI) methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, focusing on systematic reviews of Mpox manifestations. We performed a literature search up to 25th September 2023, in databases like PubMed, Embase, and Web of Science. We included systematic reviews of observational studies, case reports, case series, or RCTs reporting any manifestations of Mpox in humans, focusing on a global scope. AMSTAR 2 was used to evaluate the quality of systematic reviews, and data has been synthesized in narrative and tabular manners. Results A total of 25 systematic reviews were included, uncovering diverse manifestations of Mpox, such as cutaneous, cardiovascular, oral, ophthalmic, gastrointestinal, respiratory, and pregnancy-related. Cutaneous manifestations (up to 100%) were the most prevalent, featuring lesions and rashes. Constitutional symptoms of viral illness were reported in ~ 60% to > 85% of the cases. Significant respiratory symptoms were present in ~ 50% of cases overall. Headaches were the leading neurological symptom present in > 30%. Symptoms of gastrointestinal involvement ranged from 39% (oral lesions) with decreasing frequency to low diarrhea at ~ 5%, with proctitis percentages ranging from high teens to mid-twenties. Ophthalmic manifestations (6% but with wide variations among studies). Many primary studies included in the systematic reviews consisted of case reports and case series. A wide range of manifestations across different organ systems was observed. Negative outcomes for pregnancies were reported, but evidence is limited. Adverse cardiovascular and neurological outcomes were identified, though only a few studies provided insights into these findings. Conclusion Mpox exhibits diverse manifestations, impacting multiple organ systems, with substantial variations. The findings highlight the importance of ongoing, nuanced, and region-specific research and management strategies for Mpox. The reliance on case reports and series underscores the need for more high-quality, long-term studies to deepen our understanding and management of this significant public health concern.

Abstract Background Although the recent literature indicates that mpox (monkeypox) primarily affects men, there are also multiple reports in women. Estimates of the sex distribution of mpox patients and patterns will enable a better understanding of the ongoing mpox outbreak. Methods In this systematic review and meta-analysis, seven databases were searched for studies published in English up to January 4th, 2023. The proportion of women with mpox was the primary outcome. A random-effects model was fitted for the primary outcome, and a sensitivity analysis was performed to check possible outliers in the studies. Results Here we screened 470 articles and included 60 studies for qualitative synthesis. 42 studies with 3125 women out of 47,407 confirmed cases were found suitable for meta-analysis. The pooled proportion of female patients is 17.22% (95% CI: 10.49-25.11; I2 = 98.86%). Subgroup analyses reveal higher proportion before 2022 [44.09% (42.93–46.86] than 2022 onwards [2.40% (1.17–3.98)], and in endemic countries [43.13% (37.63–48.72)] than in nonendemic countries [6.15% (2.20–11.65)]. Conclusions There is considerable caseload (17.22%) amongst women, which must be seen in the context of a much higher proportion (44.09%) in studies prior to 2022 compared to 2.40% in the 2022 outbreak indicating an epidemiological shift. Data on disease characteristics among women with mpox disease are scarce. Further studies should focus on these aspects to better understand the disease in women and empower epidemiologists and clinicians to make evidence-based decisions for this vulnerable group.

Abstract Background Proton pump inhibitors (PPIs) are commonly prescribed for gastroprotection in patients undergoing percutaneous coronary intervention (PCI), who are at increased risk of gastrointestinal bleeding due to antiplatelet therapy. However, emerging evidence suggests that PPIs may adversely impact cardiovascular outcomes. This systematic review and meta-analysis sought to assess the relationship between using PPIs and cardiovascular outcomes in patients following PCI. Methods We searched various databases up to March 15, 2024, for observational studies and randomized controlled trials (RCTs) assessing the cardiovascular effects of PPIs in PCI patients. Data were extracted on study characteristics, patient demographics, PPI use, and cardiovascular outcomes. The Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool 2 assessed study quality. Meta-analyses were conducted using a random-effects model using R software version 4.3. Results A total of 21 studies involving diverse populations and study designs were included. Observational studies suggested a moderate increase in risk for composite cardiovascular diseases (CVD), myocardial infarction (MI), and major adverse cardiac events (MACE) associated with PPI use, with pooled hazard ratios (HRs) of 1.20 (95% CI: 1.093–1.308) for CVD, 1.186 (95% CI: 1.069–1.303) for MI, and 1.155 (95% CI: 1.001–1.309) for MACE. However, RCTs showed no significant link between PPI therapy and negative cardiovascular events (Relative Risk: 1.016, 95% CI: 0.878–1.175). Substantial heterogeneity was observed among observational studies but not RCTs. Conclusion The findings indicate that while observational studies suggest a potential risk of adverse cardiovascular events with post-PCI use of PPI, RCTs do not support this association. Further large-scale, high-quality studies are required to understand the cardiovascular implications of individual PPIs better and optimize patient management post-PCI. This analysis shows the complexity of PPI use in patients with coronary artery diseases and the necessity to balance gastroprotective benefits against potential cardiovascular risks.

Background: The majority of available data on molnupiravir come from an unvaccinated COVID-19 population. Therefore, we conducted this meta-analysis to integrate evidence from recent randomized controlled trials (RCTs) as well as observational studies stratified by vaccination status to determine the clinical efficacy and safety of molnupiravir in COVID-19 outpatients. Methods: We searched PubMed, Embase, the Cochrane Library, medRxiv, and ClinicalTrials.gov from inception to November 2023. We conducted our meta-analysis using RevMan 5.4 with risk ratio (RR) as the effect measure. Results: We included 8 RCTs and 5 observational studies in our meta-analysis. Molnupiravir reduced the risk of all-cause mortality (RR 0.28; 95% CI: 0.20–0.79, I2 = 0%) but did not decrease the hospitalization rate (RR 0.67; 95% CI: 0.45–1.00, I2 = 53%) in the overall population; in the immunized population, no benefits were observed. Molnupiravir lowered the rate of no recovery (RR 0.78; 95% CI: 0.76–0.81, I2 = 0%) and increased virological clearance at day 5 (RR 2.68; 95% CI: 1.94–4.22, I2 = 85%). There was no increase in the incidence of adverse events. Conclusions: Molnupiravir does not decrease mortality and hospitalization rates in immunized patients with COVID-19. However, it does shorten the disease course and increases the recovery rate. The use of molnupiravir will need to be considered on a case-by-case basis in the context of the prevailing social circumstances, the resource setting, drug costs, and the healthcare burden.

Abstract Background and Aims Crimean‐Congo Hemorrhagic Fever (CCHF) is a significant public health concern transmitted by ticks. This study seeks to thoroughly grasp the epidemiology and transmission patterns of CCHF, which is caused by the CCHF virus (CCHFV), a member of the Nairovirus genus in the Bunyaviridae family. Methods The study investigates the global distribution and endemicity of CCHF, its mortality rates, modes of transmission (including tick bites, contact with infected animal blood, and limited person‐to‐person transmission), and factors influencing its prevalence across different regions. Genetic diversity within CCHFV and its impact on transmission dynamics are explored, along with efforts to control the disease through tick prevention, antiviral treatment, and the development of vaccines and diagnostics. Results CCHFV exhibits widespread distribution, particularly in the Middle East, Africa, Asia, and Eastern Europe, with an overall mortality rate of approximately 30% and a case fatality rate ranging from 10% to 40%. Transmission occurs primarily through tick bites and contact with infected animal blood, with limited person‐to‐person transmission. Livestock workers, slaughterhouse employees, and animal herders in endemic areas are most affected by their frequent interaction with sick animals and ticks. Genetic diversity within CCHFV contributes to variations in transmission dynamics, complicating control efforts. Antiviral ribavirin shows efficacy in treating CCHF infection. Conclusion This study underscores the importance of further research to understand the enzootic environment, transmission routes, and genetic diversity of CCHFV for effective control measures, including the development of vaccines, treatment options, and diagnostics.

Abstract Background Mpox infection is a zoonotic illness that resembles smallpox. Vaccination is widely regarded as a vital effective method of preventing mpox, however, there is lack of consensus of effectiveness of a single dose of mpox vaccine in the current 2022–2023 outbreak. We pooled data from real‐world studies to evaluate the efficacy of the JYNNEOS vaccination given as a single dosage. Method We carried out a thorough literature search in PubMed, Web of Science, and Scopus up until August 2023. We estimated the pooled vaccine effectiveness (VE) for mpox using inverse variance method in a random‐effects meta‐analysis. We expressed the results as VE, 95% confidence interval (95% CI), and 95% prediction interval (95% PI) using R v4.3.0. We assessed influence, heterogeneity contribution, and influence of studies using several tests and conducted sensitivity analysis accordingly. We used Doi plot and Luis Furuya‐Kanamori (LFK) index to evaluate publication bias. Results With a total sample size of 35,326 individuals, we involved 11 studies in the meta‐analysis. The VE of a single dose of JYNNEOS vaccine was 78.23% (95% CI: 62.79%–87.27%) by pooling data of 24,784 individuals over seven studies. The findings were heterogenous with a 95% PI of −32.14% to 96.41% depicting the expected range of VE in similar settings. Notably, VE increased to 83.02% (74.62%–88.64%) with a prediction interval of (44.67%–94.79) after sensitivity analysis by leaving out outliers. The results were robust in light of several sensitivity analyses. An asymmetric Doi plot with LFK index of −2.25 showed potential publication bias. Pooled prevalence of mpox infection among vaccinated individuals (breakthrough infection) in six studies was 2.19% (0.37%–5.32%). Conclusion The present findings provide compelling evidence that a single dose of JUNNEOS vaccine can protect recipients from mpox infection. With a 78.23% estimated efficacy rate, the vaccine is thought to be a useful tool in preventing further spread of mpox. However, more research and ongoing surveillance are required to fully understand the reasons behind breakthrough infections and to improve immunization strategies for better protection against mpox.

Abstract Background For healthcare delivery to be optimally effective, health systems must possess adequate levels and we must ensure a fair distribution of human resources aimed at healthcare facilities. We conducted a scoping review to map the current state of human resources for health (HRH) in India and the reasons behind its shortage. Methods A systematic search was conducted in various electronic databases, from the earliest available date till February 2024. We applied a uniform analytical framework to all the primary research reports and adopted the “descriptive-analytical” method from the narrative paradigm. Inductive thematic analysis was conducted to arrange the retrieved data into categories based on related themes after creating a chart of HRH problems. Results A total of 9675 articles were retrieved for this review. 88 full texts were included for the final data analysis. The shortage was addressed in 30.6% studies (n = 27) whereas 69.3% of studies (n = 61) addressed reasons for the shortage. The thematic analysis of data regarding reasons for the shortage yielded five kinds of HRH-related problems such as inadequate HRH production, job dissatisfaction, brain drain, regulatory issues, and lack of training, monitoring, and evaluation that were causing a scarcity of HRH in India. Conclusion There has been a persistent shortage and inequitable distribution of human resources in India with the rural expert cadres experiencing the most severe shortage. The health department needs to establish a productive recruitment system if long-term solutions are to be achieved. It is important to address the slow and sporadic nature of the recruitment system and the issue of job insecurity among medical officers, which in turn affects their other employment benefits, such as salary, pension, and recognition for the years of service.

Abstract Influenza (sometimes referred to as “flu”) is a contagious viral infection of the airways in the lungs that affects a significant portion of the world's population. Clinical symptoms of influenza virus infections can range widely, from severe pneumonia to moderate or even asymptomatic sickness. If left untreated, influenza can have more severe effects on the heart, brain, and lungs than on the respiratory tract and can necessitate hospitalization. This study was aimed to investigate and characterize all types of influenza cases prevailing in Nepal and to analyze seasonal occurrence of Influenza in Nepal in the year 2019. A cross sectional, retrospective and descriptive study was carried out at National Influenza Center (NIC), National Public Health Laboratory Kathmandu Nepal for the period of one year (Jan–Dec 2019). A total of 3606 throat swab samples from various age groups and sexes were processed at the NIC. The specimens were primarily stored at 4 °C and processed using ABI 7500 RT PCR system for the identification of Influenza virus types and subtypes. Data accessed for research purpose were retrieved from National Influenza Centre (NIC) on 1st Jan 2020. Of the total 3606 patients suspected of having influenza infection, influenza viruses were isolated from 1213 (33.6%) patients with male predominance. The highest number of infection was caused by Influenza A/Pdm09 strain 739 (60.9%) followed by Influenza B 304 (25.1%) and Influenza A/H3 169 (13.9%) and most remarkable finding of this study was the detection of H5N1 in human which is the first ever case of such infection in human from Nepal. Similar to other tropical nations, influenza viruses were detected year-round in various geographical locations of Nepal. The influenza virus type and subtypes that were in circulation in Nepal were comparable to vaccine candidate viruses, which the currently available influenza vaccine may prevent.

Background: Global diabetes prevalence has doubled since 1980; India has the second-largest diabetic population. Nearly half of type 2 diabetes mellitus (T2DM) cases go undiagnosed. This study assesses glycated hemoglobin A1c (HbA1c) for diagnosing T2DM and prediabetes in at-risk individuals. Materials and Methods: We conducted a community-based cross-sectional study in a rural area. We assessed glucose intolerance risk factors among 1353 individuals (age >20 years), categorizing participants into low and moderate–high risk using the Indian Diabetes Risk Score (IDRS). For 363 participants with moderate- or high-T2DM risk, we evaluated fasting plasma glucose, hemoglobin, and HbA1c. Receiver Operating Characteristics (ROC) were constructed for HbA1c against gold standard fasting plasma glucose and 2-h-postload glucose to determine diagnostic accuracy and cut-point values for prediabetes and T2DM. We used decision curve analysis (DCA) to assess the utility of the new HbA1c cut point for T2DM diagnosis. Results: The prevalence of newly diagnosed T2DM and prediabetes was 44.63% (95% CI: 39.44–49.91) and 48.48% (95% CI: 43.24–53.76), respectively in people with moderate to high risk of T2DM on IDRS. On ROC, the area under the curve was 90.36% and 79.18%, respectively, reflecting high diagnostic accuracy. The optimum cut point of HbA1c for diagnosis of T2DM was 6.34%, with sensitivity and specificity of 74% and 94%, respectively. The HbA1c cut point for prediabetes was 5.65%, with a sensitivity and specificity of 80% and 75%, respectively. The new cut point of 6.34% on DCA gives substantial net benefit at a 40% probability risk, identifying 31 additional cases per 100 individuals at risk of T2DM and reducing the false positive by 47%. Conclusion: Our findings offer potential for developing a diagnostic protocol for T2DM and prediabetes (impaired fasting glucose) using HbA1c cut-point in people with moderate- to high-T2DM risk in rural settings.

Abstract Background and objective Monkeypox virus (MPXV) is the causative agent of monkeypox’s zoonotic infection and was declared a global emergency by the World Health Organization (WHO). Studies from different countries have shown insufficient knowledge among the general public on MPXV. This study aimed to assess the knowledge of the general public of Nepal on MPXV. Methods Three hundred people were interviewed in person in October 2022, and 282 complete responses were recorded. The questionnaire related to the knowledge of MPXV was derived from a previous study conducted among the general population of Saudi Arabia. Twenty-two questions were included that assessed the knowledge and attitude of Nepalese toward monkeypox. Statistical comparison between high and low knowledge was performed using Pearson’s Chi-square test. Logistic regression models were deployed to establish the relationship between participants’ knowledge and socio-demographic characteristics. Results Among the total respondents, 53.8% demonstrated high knowledge of monkeypox. People aged 18–25 years, unmarried people, and those living in urban areas had significantly higher levels of knowledge. Most respondents believed that MPXV is not a conspiracy or bioterrorism (63.1%) and agreed that it is likely to affect people’s social and economic life as COVID-19 did (67.0%). The history of COVID-19 vaccination (aOR: 2.980; 95%CI: 1.227, 7.236) and the younger age (aOR: 2.975; 95%CI: 1.097, 8.069) were found to be significant determinants of the knowledge of the participants on monkeypox. Conclusion We observed that most Nepalese populations had a high knowledge of monkeypox and that social media was the most valuable source of information.

The recent global resurgence of Mpox (formerly monkeypox), primarily transmitted via close contact and respiratory droplets, highlights a significant shift in its epidemiology, particularly among men who have sex with men (MSM). This resurgence underscores the need for robust public health responses and improved surveillance. This comprehensive review of current literature focuses on recent outbreaks, virology, and available treatments. Epidemiological data were gathered from various international health reports and analysed to understand transmission dynamics and outbreak patterns. Mpox, characterised by symptoms like fever and rash, has shown variable clinical presentations, particularly among immunocompromised individuals. Recent outbreaks have prompted the development of new diagnostic methods and treatments, including antivirals like Tecovirimat and vaccines such as MVA-BN. Studies have demonstrated the effectiveness of these vaccines in preventing infection, which is crucial for outbreak containment. The global response to the Mpox resurgence requires integrated strategies combining vaccination, antiviral treatments, and public health policies tailored to high-risk populations. Future efforts should focus on vaccine distribution equity and enhancing diagnostic capabilities to effectively manage and mitigate the impact of Mpox.

Background: Malaria in pregnancy is a critical public health issue that can lead to severe adverse outcomes for both mother and fetus. This systematic review and meta-analysis evaluated the prevalence of adverse birth outcomes in malaria-infected pregnancies and examines their association with the condition. Method: We searched databases up to January 30, 2024, for observational studies on pregnant women with malaria. Data were analyzed using a random-effects model to calculate pooled prevalence rates and risk ratios (RRs) for adverse outcomes, with statistical support from R software version 4.3. Results: Thirty-one studies were included, showing high prevalence of low birth weight (LBW; 17.4 %), preterm birth (17.9 %), and small for gestational age (SGA; 16.1 %) in malaria-affected pregnancies. Infected mothers were significantly more likely to have LBW infants (RR = 1.755), preterm births (RR = 1.484), and SGA infants (RR = 1.554). The risk of stillbirth was not significantly increased (RR = 1.238). Conclusion: Malaria in pregnancy significantly elevates the risk of LBW, preterm birth, and SGA, underscoring the need for effective malaria prevention and treatment strategies in endemic regions. Future research should aim to refine and implement these strategies to enhance maternal and neonatal health outcomes.

ABSTRACTBackground and objective: Graft versus host disease (GVHD) is the common complication seen after allogeneic hematopoietic stem cell transplantation (HSCT) and a pleomorphic syndrome that resembles autoimmune and other immunologic disorders, leading to profound immune dysregulation and organ dysfunction. The most common targets of GVHD are skin, gastrointestinal tract and liver. GVHD is classified as acute graft versus host disease (aGvHD) if it occurs within the first 100 days after HSCT and chronic graft versus host disease(cGVHD) if it occurs after day 100. The skin is most frequently and earliest affected by aGvHD, followed by the gastrointestinal tract and liver. An ideal biomarker would predict the onset and severity of clinical acute GVHD and help to direct management, and this is an area of active research regarding the use of biomarkers for diagnosis and prognosis of acute GVHD. Recently, elafin has been identified as a potential plasma biomarker for aGVHD.Method: We searched the databases PubMed, Cochrane library, and medRxiv for all studies investigating the Diagnostic or prognostic role of elafin in GVHD. We set the search strategy incorporating the search terms, ‘elafin’, ‘graft versus host’, and ‘GVHD’, and operated using the Boolean operators ‘AND’, and ‘OR’. Thus, retrieved articles were then exported on an Excel® sheet, and duplicates were removed. The systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. After selecting the study based on inclusion criteria, data on study characteristics and biomarker description was extracted on a pre-determined data extraction table on the Microsoft Excel version. The quality assessment of the included studies was determined using the QUIPS tool.Result: The search revealed 547 studies and 6 studies that met the eligibility criteria of this review have been included. The major finding of our study is the significant elevation of elafin in skin aGVHD.Conclusion: Elafin is a significant biomarker for diagnosis and prognosis of skin aGVHD and should be assessed within 2 weeks of the onset of the disease.

Chikungunya virus (CHIKV), a single-stranded RNA virus transmitted by Aedes mosquitoes, poses a significant global health threat, with severe complications observed in vulnerable populations. The only licensed vaccine, IXCHIQ, approved by the US FDA, is insufficient to address the growing disease burden, particularly in endemic regions lacking herd immunity. Monoclonal antibodies (mAbs), explicitly targeting structural proteins E1/E2, demonstrate promise in passive transfer studies, with mouse and human-derived mAbs showing protective efficacy. This article explores various vaccine candidates, including live attenuated, killed, nucleic acid-based (DNA/RNA), virus-like particle, chimeric, subunit, and adenovirus vectored vaccines. RNA vaccines have emerged as promising candidates due to their rapid response capabilities and enhanced safety profile. This review underscores the importance of the E1 and E2 proteins as immunogens, emphasizing their antigenic potential. Several vaccine candidates, such as CHIKV/IRES, measles vector (MV-CHIK), synthetic DNA-encoded antibodies, and mRNA-lipid nanoparticle vaccines, demonstrate encouraging preclinical and clinical results. In addition to identifying potential molecular targets for antiviral therapy, the study looks into the roles played by Toll-like receptors, RIG-I, and NOD-like receptors in the immune response to CHIKV. It also offers insights into novel tactics and promising vaccine candidates. This article discusses potential antiviral targets, the significance of E1 and E2 proteins, monoclonal antibodies, and RNA vaccines as prospective Chikungunya virus vaccine candidates.

BackgroundDermatophytosis, commonly known as tinea, poses a significant public health concern worldwide, especially in environments with poor hygiene and overcrowding, such as prisons. Despite its prevalence and impact on quality of life, there is a lack of research on the knowledge and hygiene practices regarding dermatophytosis among prisoners, particularly in Nepal.ObjectiveThe study aimed to assess prisoners’ knowledge, hygiene practice and infection status regarding dermatophytosis in Central Prison, Nepal.MethodsA descriptive cross-sectional study with a sample size of 184 respondents was designed to collect data using a validated pre-tested questionnaire from September 2023 to January 2024. The collected data was then analyzed using IBM SPSS version 21. Knowledge and hygiene practices were measured on an eight and 11-point scale and rated as poor (≤4) and sound (>4), bad (≤6), and good (>6), respectively. Summary data were presented by descriptive, while Chi-square and logistic regression were used for inferential statistics at p

Summary: Background: Initial randomised controlled trials (RCTs) showed that prophylactic azithromycin in pregnant women improved maternal and neonatal outcomes; however, the recent evidence did not show any benefit to neonatal survival. There is conflicting evidence over the role of azithromycin prophylaxis in antenatal and intrapartum periods. We explored whether azithromycin prophylaxis in pregnant women improves maternal and neonatal outcomes. Methods: For this systematic review and meta-analysis registered on PROSPERO [CRD42023411093], we searched seven databases (PubMed, Scopus, Embase, Cochrane Library, EBSCOHost, ProQuest, and Web of Science) and clinical trial registries until 04/23/2024, for RCTs evaluating antenatal/intrapartum azithromycin prophylaxis against placebo/routine care in pregnant women. The primary outcome was neonatal mortality. Intrapartum and antenatal administration were assessed separately. We used random-effects meta-analysis. The risk of bias was assessed using the Cochrane RoB 2 tool. The GRADE approach was used to evaluate the certainty of the evidence. Findings: Screening 2161 records retrieved 20 RCTs (56,381 participants). Intrapartum azithromycin may make little or no difference to neonatal mortality [5 RCTs, 44,436 participants; Risk Ratio (RR): 1.02, 95% CI 0.86–1.20, I2 = 0%, very low certainty], and maternal mortality [3 RCTs, 44,131 participants, RR: 1.26, 0.65–2.42, I2 = 0%, low certainty]. Similarly, antenatal azithromycin may have little or no effect on neonatal mortality [3 RCTs; 5304 participants; RR: 0.74, 0.35–1.56, I2 = 43%, very-low certainty] and maternal mortality [3 RCTs; 8167 participants RR: 1.62, 0.67–3.91, I2 = 0%, low certainty]. There is no data on long-term adverse outcomes and antimicrobial resistance. Interpretation: Low to very low certainty evidence suggests that intrapartum or antenatal azithromycin prophylaxis in pregnant women might not reduce maternal or neonatal mortality. Funding: None.

Abstract Background The association of homocysteine with coronary artery disease (CAD) has been explored previously with mixed findings. The present Systematic Review and Meta-Analysis (SRMA) has assessed the pooled estimate of association between homocysteine (Hcy) and CAD, and its variation over the period and geography. Methods Systematic literature search was done in PubMed, Scopus and Cochrane to identify the observational studies that have reported mean Hcy among cases (CAD) and control. The SRMA was registered in PROSPERO (ID-CRD42023387675). Results Pooled standardized mean difference (SMD) of Hcy levels between the cases and controls was 0.73 (95% CI 0.55–0.91) from 59 studies. Heterogeneity was high (I2 94%). The highest SMD was found among the Asian studies (0.85 [95% CI 0.60–1.10]), while the European studies reported the lowest SMD between the cases and controls (0.32 [95% CI 0.18–0.46]). Meta-regression revealed that the strength of association was increasing over the years (Beta = 0.0227, p = 0.048). Conclusions Higher homocysteine levels might have a significant association with coronary artery diseases, but the certainty of evidence was rated low, owing to the observational nature of the studies, high heterogeneity, and publication bias. Within the population groups, Asian and African populations showed a greater strength of association than their European and American counterparts, and it also increased over the years.

Abstract Background Computer vision syndrome has become a significant public health problem, especially in developing countries. Therefore, this study aims to identify the prevalence of computer vision syndrome during the COVID-19 pandemic. Methods A systematic review and meta-analysis of the literature was conducted using the databases PubMed, Scopus, Web of Science, and Embase up to February 22, 2023, using the search terms "Computer Vision Syndrome" and "COVID-19". Three authors independently performed study selection, quality assessment, and data extraction, and the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument was used to evaluate study quality. Heterogeneity was assessed using the statistical test I 2 , and the R version 4.2.3 program was used for statistical analysis. Results A total of 192 studies were retrieved, of which 18 were included in the final meta-analysis. The total sample included 10,337 participants from 12 countries. The combined prevalence of computer vision syndrome was 74% (95% CI: 66, 81). Subgroup analysis based on country revealed a higher prevalence of computer vision syndrome in Pakistan (99%, 95% CI: 97, 100) and a lower prevalence in Turkey (48%, 95% CI: 44, 52). In addition, subgroup analysis based on study subjects showed a prevalence of 82% (95% CI: 74, 89) for computer vision syndrome in non-students and 70% (95% CI: 60, 80) among students. Conclusion According to the study, 74% of the participants experienced computer vision syndrome during the COVID-19 pandemic. Given this finding, it is essential to implement preventive and therapeutic measures to reduce the risk of developing computer vision syndrome and improve the quality of life of those affected. Trial registration The protocol for this systematic review and meta-analysis was registered in the international registry of systematic reviews, the International Prospective Register of Systematic Reviews (PROSPERO), with registration number CRD42022345965.

Abstract Background Immunization, as a preventive strategy against infectious diseases, has consolidated its position as a fundamental pillar in the field of public health. Therefore, the present study aimed to determine the prevalence of the intention to receive the monkeypox (Mpox) vaccine. Methods A systematic review and meta-analysis of the available evidence was performed using five databases (PubMed, Scopus, Web of Science, Embase, and ScienceDirect) with a search strategy until July 24, 2023. Data analysis was performed in R software version 4.2.3. The quality of the included cross-sectional studies was assessed using the “JBI-MAStARI”. In addition, a subgroup analysis by population and continent was developed. Results Twenty-nine cross-sectional articles with a total sample of 52 658 participants were included. The pooled prevalence of intention to vaccinate against Mpox was 61% (95% CI: 53–69%; 52,658 participants; 29 studies; I2 = 100%). In the subgroup analysis, the intention to be vaccinated against Mpox according to continents was 64% (95% CI: 53–74%; 13,883 participants; 17 studies; I2 = 99%) in Asian countries, 43% (95% CI: 39–47%; 1538 participants; 3 studies; I2 = 53%) in African countries, 62% (95% CI: 45–78%; 35,811 participants; 6 studies; I2 = 99%) in European countries, and 63% (95% CI: 32–89%; 1426 participants; 3 studies; I2 = 99%) in American countries. In the subgroup analysis on the intention to be vaccinated against Mpox, according to study subjects, it was 54% (95% CI: 45–62%; 10,296 participants; 11 studies; I2 = 99%) in the general population, 57% (95% CI: 33–79%; 3333 participants; 10 studies; I2 = 99%) in health care workers, and 76% (95% CI: 70–82%; 39,029 participants; 8 studies; I2 = 98%) in the lesbian, gay, bisexual, transgender, and intersex (LGBTI) community. In addition, as a secondary outcome, a prevalence of refusal of Mpox vaccination was found to be 22% (95% CI: 16–30%; 45,577 participants; 21 studies; I2 = 99%). Conclusion The study highlights the importance of recognizing regional and subgroup disparities in Mpox vaccine willingness and refusal. It emphasizes the importance of employing strategies to achieve widespread vaccination coverage and safeguard public health worldwide. Terms used Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI), Prospective International Registry of Systematic Reviews (PROSPERO), and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Zika virus (ZIKV) is the causative agent of a viral infection that causes neurological complications in newborns and adults worldwide. Its wide transmission route and alarming spread rates are of great concern to the scientific community. Numerous trials have been conducted to develop treatment options for ZIKV infection. This review highlights the latest developments in the fields of vaccinology and pharmaceuticals developments for ZIKV infection. A systematic and comprehensive approach was used to gather relevant and up-to-date data so that inferences could be made about the gaps in therapeutic development. The results indicate that several therapeutic interventions are being tested against ZIKV infection, such as DNA vaccines, subunit vaccines, live-attenuated vaccines, virus-vector-based vaccines, inactivated vaccines, virus-like particles, and mRNA-based vaccines. In addition, approved anti-ZIKV drugs that can reduce the global burden are discussed. Although many vaccine candidates for ZIKV are at different stages of development, none of them have received Food and Drug Authority approval for use up to now. The issue of side effects associated with these drugs in vulnerable newborns and pregnant women is a major obstacle in the therapeutic pathway.

Abstract The Nipah virus, a highly pathogenic zoonotic pathogen, has once again surfaced in the state of Kerala, India, with recent cases reported in 2023. This article delves into the epidemiological details of these cases, shedding light on the two fatalities that occurred in September 2023 and August 2023 as well as the suspected cases that have undergone testing. Nipah virus, known for its severe neurological and respiratory disease manifestations, remains a formidable health threat due to the lack of specific treatments or vaccines. The government’s response to these recent cases, including mass testing and quarantine measures, is discussed, drawing lessons from past outbreaks in the region. Kerala has experienced multiple Nipah virus outbreaks since 2018, prompting a closer examination of environmental factors, such as deforestation and urbanization, which increase the risk of zoonotic transmission. This article underscores the global implications of Nipah virus resurgence in Kerala and emphasizes the importance of preparedness and vigilance in the face of emerging infectious diseases. The lessons learned from Kerala’s experience with Nipah virus outbreaks provide valuable insights for public health professionals and policymakers worldwide.

Within group A Streptococcus (GAS), only Streptococcus pyogenes exhibits clinical significance. GAS is typed serologically based on unique surface proteins and critical virulence factors, such as a hyaluronic acid capsule that shields GAS from phagocytosis. The burden of GAS was estimated in the last five years as 14,000 to 25,000 cases of the invasive group A streptococcal disease in the USA with an estimated death from 1,500 to 2,300 cases per year. Early in the summer of 2022 in England, there was more scarlet fever than was anticipated. Early in the current season, the number of notifications rose to unusual heights. The analysis of invasive GAS (iGAS) isolate typing data shows that this season has seen a wide variety of encoding mature M protein (emm) gene sequence types found. Therefore, public health authorities should think about initiatives to increase clinicians’ and the general public’s awareness of GAS infections and to promote their quick diagnosis, molecular testing and antibiotic susceptibility testing, and standard treatment.

West Nile virus (WNV) has afflicted various countries around the world, affecting not only humans but also non-human animals, such as horses and birds. WNV is an arbovirus that is transmitted to humans by mosquito bites. The WNV epidemic was initially localized to Africa, Asia, Europe, and the Middle East. An outbreak of WNV recently occurred in the United States (US), and is currently ongoing. This article aims to elucidate the trajectory of this ongoing outbreak in the US to inform efforts to control the recurring infection. As of November 15, 2022, the Centers for Disease Control and Prevention (CDC) has reported 913 cases of WNV in humans in the US, of which 639 (70%) were categorized as neuroinvasive and 274 (30%) were categorized as non-neuroinvasive disease. Health authorities should swiftly act before WNV reaches a severe level, to prevent aggravation of existing challenges amidst the coronavirus disease 2019 and monkeypox pandemics in the US. Decreasing breeding habitats, ongoing surveillance of mosquito larvae, biological and microbial larval control methods (fish and copepods), chemical control methods (larvicides), controlling adult mosquito vector populations (hot or cold aerosols), and active practice of community-based preventive measures may avoid widespread outbreaks of WNV in the US. This brief article discusses the ongoing outbreak of WNV in the US, and highlights epidemiological and preventive measures related to WNV infection.

Abstract Introduction Human leukocyte antigen‐G (HLA‐G) is a non‐classical class I HLA molecule shown to regulate the immunomodulation of maternal immune cells to prevent fetal tissue destruction. Low levels of freely circulating maternal soluble HLA‐G (sHLA‐G) have been observed in pre‐eclampsia, however, no pooled evidence exists. This meta‐analysis aimed to generate pooled findings on the association of sHLA‐G levels with pre‐eclampsia and is the first study to perform a trimester‐wise comparison of the levels of sHLA‐G in preeclamptic cases and normal pregnant controls. Methods The databases PubMed, Emba, Web of Science, and Google Scholar through May 31, 2023. Preeclamptic women were defined as cases and normal pregnancies as controls. Data on the level of sHLA‐G in cases and controls was extracted and subjected to a meta‐analysis using a random‐effects model. The pooled effect was expressed in terms of standardized mean difference (SMD). Sensitivity analysis was performed to investigate the effect of the exclusion of each study on the pooled results. Publication bias was assessed statistically. Results Nine studies with altogether 567 PE cases and 1132 normal pregnancy controls were included in the meta‐analysis. The first and third trimester levels of sHLA‐G in PE cases were significantly lower than that of normal pregnant controls: (SMD: −0.84 [−1.29; −0.38]; p = .003; I2 = 54%) and (SMD: −0.39 [−0.71; −0.06]; p = .02; I2 = 79%) respectively. Sensitivity analysis revealed significant fluctuations in the pooled findings when few studies were excluded, raising questions on the consistency of results among studies. Conclusion Although we found that first and third‐trimester sHLA‐G levels in pre‐eclampsia are significantly lower, taking into consideration the inconsistent results from the sensitivity analysis, our findings advocate the demand for more studies with larger sample sizes to generate solid ground pooled evidence on the predictive role of sHLA‐G in pre‐eclampsia.

Objectives We conducted an updated systematic review and meta-analysis to investigate the effect of colchicine treatment on clinical outcomes in patients with COVID-19.Design Systematic review and meta-analysis.Data sources We searched PubMed, Embase, the Cochrane Library, medRxiv and ClinicalTrials.gov from inception to January 2023.Eligibility criteria All randomised controlled trials (RCTs) that investigated the efficacy of colchicine treatment in patients with COVID-19 as compared with placebo or standard of care were included. There were no language restrictions. Studies that used colchicine prophylactically were excluded.Data extraction and synthesis We extracted all information relating to the study characteristics, such as author names, location, study population, details of intervention and comparator groups, and our outcomes of interest. We conducted our meta-analysis by using RevMan V.5.4 with risk ratio (RR) and mean difference as the effect measures.Results We included 23 RCTs (28 249 participants) in this systematic review. Colchicine did not decrease the risk of mortality (RR 0.99; 95% CI 0.93 to 1.05; I2=0%; 20 RCTs, 25 824 participants), with the results being consistent among both hospitalised and non-hospitalised patients. There were no significant differences between the colchicine and control groups in other relevant clinical outcomes, including the incidence of mechanical ventilation (RR 0.75; 95% CI 0.48 to 1.18; p=0.22; I2=40%; 8 RCTs, 13 262 participants), intensive care unit admission (RR 0.77; 95% CI 0.49 to 1.22; p=0.27; I2=0%; 6 RCTs, 961 participants) and hospital admission (RR 0.74; 95% CI 0.48 to 1.16; p=0.19; I2=70%; 3 RCTs, 8572 participants).Conclusions The results of this meta-analysis do not support the use of colchicine as a treatment for reducing the risk of mortality or improving other relevant clinical outcomes in patients with COVID-19. However, RCTs investigating early treatment with colchicine (within 5 days of symptom onset or in patients with early-stage disease) are needed to fully elucidate the potential benefits of colchicine in this patient population.PROSPERO registration number CRD42022369850.

IntroductionThe COVID-19 pandemic has had a significant impact on mental health globally, with limited access to mental health care affecting low- and middle-income countries (LMICs) the most. In response, alternative strategies to support mental health have been necessary, with access to green spaces being a potential solution. While studies have highlighted the role of green spaces in promoting mental health during pandemic lockdowns, few studies have focused on the role of green spaces in mental health recovery after lockdowns. This study investigated changes in green space access and associations with mental health recovery in Bangladesh and Egypt across the pandemic.MethodsAn online survey was conducted between January and April 2021 after the first lockdown was lifted in Bangladesh (n = 556) and Egypt (n = 660). We evaluated indoor and outdoor greenery, including the number of household plants, window views, and duration of outdoor visits. The quantity of greenness was estimated using the normalized difference vegetation index (NDVI). This index was estimated using satellite images with a resolution of 10x10m during the survey period (January-April 2021) with Sentinel-2 satellite in the Google Earth Engine platform. We calculated averages within 250m, 300m, 500m and 1000m buffers of the survey check-in locations using ArcGIS 10.3. Multiple linear regression models were used to evaluate relationships between changes in natural exposure and changes in mental health.ResultsThe results showed that mental health improved in both countries after the lockdown period. People in both countries increased their time spent outdoors in green spaces after the lockdown period, and these increases in time outdoors were associated with improved mental health. Unexpectedly, changes in the number of indoor plants after the lockdown period were associated with contrasting mental health outcomes; more plants translated to increased anxiety and decreased depression. Refocusing lives after the pandemic on areas other than maintaining indoor plants may assist with worrying and feeling panicked. Still, indoor plants may assist with depressive symptoms for people remaining isolated.ConclusionThese findings have important implications for policymakers and urban planners in LMICs, highlighting the need to increase access to natural environments in urban areas to improve mental health and well-being in public health emergencies.

Background: Antenatal physical activity is an important physical, mental, and biochemical factor to consider. Several studies across the world have demonstrated the importance of physical activity during the antenatal period. Various factors are associated with knowledge, attitudes, and practices related to Antenatal PA. This study aimed to determine the knowledge, attitudes, and practices related to Antenatal PA among married women in Afghanistan. Methods: This community-based cross-sectional study was conducted in Herat province. In total, 316 married women age group–16-60 were included in this study. Participants were asked about their knowledge, attitudes, and practices regarding Antenatal exercise (ANEx). Results: More than half (56.3%) of the participants were between 16-30 years old. Two-thirds of the participants lived in urban areas, and one-sixth of the participants were illiterate (57.9%). Less than one-third of the participants had heard of antenatal exercises (32.0%). Approximately 72% of the participants had poor knowledge, 90% had poor attitudes, and only 4% practiced antenatal exercises. Higher education, residence in urban areas, and higher monthly family income were important predictors of knowledge regarding ANEx. Similarly, a greater number of children and higher education levels are determinants of ANEx practice. Conclusion: Poor knowledge, attitudes, and practices remained the main barriers to ANEx. In the current situation of political instability and a lack of healthcare facilities, community workers can only be a way to address this issue.

Background: Dengue fever is a zoonotic viral infection that raises a global alarm in the tropics and subtropics, with the potentially escalating into newer geographical regions. Severe dengue may be associated with fatal complications such as myocarditis. There is a paucity of available data on the prevalence of dengue-associated myocarditis. The objective of this systematic review and meta-analysis was to estimate the global prevalence of dengue-associated myocarditis. Methods: A systematic search was conducted utilizing the Cochrane library, PubMed, Scopus, ProQuest, Web of Science, and Preprint servers such as arXiv, medRxiv, bioRxiv, BioRN, ChiRN, ChiRxiv, and SSRN as of November 25, 2022. All primary studies (case series, cross-sectional, retrospective, and prospective) that reported confirmed cases of dengue myocarditis were included. The I2 statistic test assessed the heterogenic characteristics and publication bias was evaluated using Doi plot and Egger regression tests. Results: A total of 12 studies conducted between 2007 and 2022 with 2795 laboratory-confirmed dengue patients were included. Of the included cases, 502 were positive for myocarditis, with a prevalence of 2.4–78%. The pooled prevalence of dengue-induced myocarditis in the studied population was 21.0% (95% CI, 9 – 38%). The prediction interval was estimated to be 0.00 - 0.81. Conclusion: Myocarditis in dengue patients is a significant and understudied complication in many aspects. To prevent dengue-associated myocarditis, appropriate measures such as early detection of cases and signs, symptoms-based diagnosis via electrocardiography and echocardiography, as well as relevant vector control policies must be implemented.

This index meta-analysis estimated the pooled prevalence of human immunodeficiency virus (HIV) among individuals with monkeypox (mpox) globally. We searched seven databases: PubMed, Scopus, Web of Science, EMBASE, ProQuest, EBSCOHost, and Cochrane, for human studies published in English till 4 January 2023, as per International Prospective Register of Systematic Reviews (PROSPERO) registration protocol (CRD42022383275). A random effects regression model was used to estimate the pooled prevalence owing to high heterogeneity. The risk of bias in the included studies was assessed using the National Heart, Lung, and Blood Institute (NHLBI) quality assessment tool. The systematic search yielded 677 articles; finally, 32 studies were found eligible for systematic review and 29 studies for meta-analysis. The pooled prevalence of HIV infection was 41% (95% confidence interval [CI], 35–48). All studies were rated as fair or good quality. Studies from Europe and North America reported a high prevalence of HIV infection among individuals with mpox- 41% (95% CI 33–49) and 52% (95% CI 28–76), respectively, while studies from Nigeria, Africa reported a relatively low prevalence of HIV infection of 21% (95% CI 15–26). A history of sexual orientation and sexual partners in the last 21 days must be taken from individuals with mpox to identify the potential source and contacts for quarantining and testing them.

Abstract Introduction Previous studies have reported a decreased risk of dementia with herpes zoster vaccination. Given this background, this systematic review and meta‐analysis aimed to investigate the association between herpes zoster vaccination and the risk of dementia. Methods We searched five databases until November 2023 for case–control, cross‐sectional, or cohort studies investigating the association of herpes zoster vaccination and dementia. Odds ratios and 95% confidence intervals (95% CIs) were pooled in the meta‐analysis. Meta‐regression, subgroup, and sensitivity analysis were also conducted. Results We evaluated a total of five studies (one cross‐sectional, one case–control, and four cohort studies) that included a total number of 103,615 patients who were vaccinated with herpes zoster vaccine. All the studies were of high quality, ranging from 7 to 9. Due to the high heterogeneity (I2 = 100%, p

BackgroundThe increase in mpox incidence underscores the crucial need to understand and effectively address prevention, early detection, and agile response to this disease. Therefore, the present study aims to determine the knowledge and attitude towards mpox.MethodsA systematic review and comprehensive literature meta-analysis were conducted using prominent databases such as PubMed, Scopus, Web of Science, Embase, and ScienceDirect, with an updated search until June 25, 2023. The quality of the included observational studies was assessed using the Joanna Briggs Institute's Statistical Meta-Analysis Review Instrument. The collected data were recorded in a Microsoft Excel spreadsheet, and analyses were conducted using R software version 4.2.3. Additionally, Cochran's Q statistics were applied to assess the heterogeneity of the included studies.ResultsA total of 299 articles were retrieved from 5 databases. This study included 27 cross-sectional articles with a total sample of 22,327 participants, of which 57.13% were women. The studies were conducted in 15 countries through an online survey. All studies had a moderate level of quality. The combined prevalence of a good level of knowledge about mpox was 33% (95% CI: 22%-45%; 22,327 participants; 27 studies; I2 = 100%), and the combined prevalence of a positive attitude towards mpox was 40% (95% CI: 19%-62%; 2,979 participants; 6 studies; I2 = 99%). Additionally, as a secondary outcome, the combined prevalence of the intention to vaccinate against mpox was 58% (95% CI: 37%-78%; 2,932 participants; 7 studies; I2 = 99%).ConclusionGood knowledge and a positive attitude towards mpox were found to be low. The findings of this study highlight the need to identify gaps and focus on implementing educational programs on mpox.Terms usedJoanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI), Prospective International Registry of Systematic Reviews (PROSPERO), and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).