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AbstractBackgroundObjective and methodsResultsConclusionsClimate change significantly influences the distribution and severity of tropical diseases. Rising temperatures, changing precipitation patterns, and extreme weather events are transforming the habitats of vectors like mosquitoes and ticks, promoting their proliferation and geographic spread. These changes have facilitated the resurgence of diseases such as malaria, dengue, and chikungunya fever in previously unaffected areas, including parts of Europe and Italy.This review aims to explore the relationship between climate change and the spread of vector-borne and tropical parasitic diseases across Europe, with a particular focus on Italy. Recent studies are analyzed to identify emerging trends in disease transmission influenced by shifting climates. Genome-based monitoring and predictive models incorporating climatic and ecological data are highlighted as methods to enhance disease surveillance and preparedness.The analysis reveals a clear link between climate change and altered disease patterns. The proliferation of vectors into new territories is associated with increased incidence of diseases. Genome-based tools demonstrate their utility in tracking the evolution of pathogens, particularly regarding changes in virulence, drug resistance, and adaptability to new climates. Predictive models have proven effective in anticipating outbreaks and supporting timely public health interventions.To mitigate the risks posed by climate-induced changes in disease dynamics, continuous monitoring and international collaboration are essential. Strengthening health systems’ resilience through mitigation and adaptation strategies is crucial for preventing future epidemics. These insights contribute to the development of sustainable long-term policies for managing tropical diseases in the context of climate change, ensuring timely responses to public health emergencies. [ABSTRACT FROM AUTHOR]

Background: The European Union encompasses 30 outermost and overseas countries and territories (OCTs). Despite a recent increasing activity of renal transplantation in these territories, many patients still undergo transplantation in continental Europe, with follow‐up care coordinated between health professionals from both their transplant center and their home region. Each territory has its unique infectious epidemiology which must be known to ensure appropriate care for kidney transplant recipients (KTRs). Aims: This paper proposes a pragmatic approach to optimize pre‐transplant check‐up and to provide an overview of the specific epidemiological features of each region. It offers practical algorithms to help practitioners in managing infected KTR living in these territories. This work advocates for increased collaborative research among European OCTs. [ABSTRACT FROM AUTHOR]

Background Dermatophytes are the most common superficial fungal infections worldwide and are treated with prescribed regimens of terbinafine and itraconazole, or with weekly doses of fluconazole. Dermatologists are increasingly encountering treatment failures, and experts suggest that standard treatment regimens are not applicable anymore. We planned an open-label study to evaluate the results of fluconazole 150 mg daily for 8 weeks in patients with tinea cruris and tinea corporis. Methods Patients were enrolled from the La’Mer Clinic, Mumbai, India. We included adult subjects with uncomplicated dermatophytosis confirmed by microscopic examination of skin scrapings. Pregnancy, poor renal function, and recent exposure to anti-fungal therapy were exclusion criteria. Patients were reviewed on days 14, 28 and 56. The treating doctor scored the severity of erythema, scaling, and pruritus on a four-point scale: absent, mild, moderate, and severe. Of 107 subjects screened, 100 were finally included in the study. Eleven were lost to follow up and one subject withdrew consent. Results The site of disease was body alone in 29, groin alone in 7, and both body and groin in 64 cases. At 5 weeks, 98%, 100%, and 97% of patients had no scaling, erythema, and pruritus, respectively. Skin scrapings showed 100% mycological cure. In one patient the alanine transaminase level rose from 54.9 to 100.2 U/L, and qualified as a grade 1 adverse event not requiring intervention. No other significant adverse events were noted. Conclusions Our results suggest that fluconazole 150 mg daily for eight weeks effectively treats dermatophytosis. This regimen is safe and well-tolerated even in patients with co-morbidities. Fluconazole is about eight times less expensive than itraconazole or terbinafine and may be the preferred therapy. Registration The trial was registered with Clinical Trials Registry, India (Registration number CTRI/2020/06/026110) on 24 June 2020. FDC Company, India, provided financial support for the study.

Encompassing more than 70% of the Earth's surface, the ocean is an extensive and mostly unexplored repository of biodiversity, containing a remarkable variety of living organisms. Of these, marine species including algae, sponges, fungi, bacteria and invertebrates have attracted scientific attention because of their capacity to synthesize a diverse range of bioactive constituents. Recently, there has been considerable interest in marine natural products for their potential as innovative antiviral agents. The present review examines the latest progress in the identification and advancement of marine-derived chemicals exhibiting antiviral properties. We analyze the processes by which these chemicals exercise their effects, which include the suppression of viral entrance, replication and the adjustment of host immunological responses. In addition, we emphasize the role of these natural compounds in fighting new viral infections like SARS-CoV-2 and other respiratory viruses, as well as their possible application in treating neglected tropical diseases. Notwithstanding the encouraging outcomes, the advancement of antiviral drugs generated from marine sources encounters many obstacles, encompassing concerns pertaining to extraction, sustainability, and growth. Yet, progress in biotechnological methods, such as synthetic biology and nanotechnology, provide fresh possibilities to surmount these obstacles. The potential for the advancement of next-generation antiviral treatments may be found in marine natural compounds, suggesting a fruitful direction for the future of antiviral medication research. [ABSTRACT FROM AUTHOR]

This article provides an overview of the burden of malaria in pregnancy and recent advancements in prevention and treatment strategies. It highlights the use of intermittent preventive treatment in pregnancy (IPTp) as a targeted approach to administer antimalarial medication to pregnant women in endemic areas. The article also addresses challenges such as accessibility, affordability, and drug resistance in malaria treatment. It emphasizes the need for comprehensive programs and guidelines to effectively address malaria in pregnancy. The article also discusses the safety of antimalarials in pregnancy and explores potential alternatives to quinine-based treatment. Additionally, it calls for more research on the pharmacokinetics and pharmacodynamics of antimalarials in pregnancy and the potential use of malaria vaccines. Overall, the article emphasizes the importance of improved public health infrastructure, updated guidelines, and innovative strategies to tackle the challenges of malaria in pregnancy. [Extracted from the article]

Intestinal parasitism is an infection that affects people worldwide, with populations in developing countries being at a higher risk of acquiring it. This infection is contracted for various reasons, mainly related to poor sanitary conditions and inadequate food practices, leading to multiple health issues such as malnutrition, intestinal obstructions, epilepsy, and others. Identifying parasitic species is essential for establishing appropriate antiparasitic therapy, which in turn helps reduce the risk of associated morbidities. For this reason, a dataset named “ParasitoBank” was created, containing 779 images of the visual field of fresh stool samples analysed under a microscope using the serial coprological technique. These images were acquired using a Motorola G84 mobile phone, and a data-labeling process resulted in a total of 1,620 intestinal parasites, with a particular focus on intestinal protozoa. The images have an approximate aspect ratio of 1:1 with a resolution of 2100 × 2100. Label information and some metadata for the images have been included in a JSON file following the “Common Objects in Context” (COCO) format. Finally, the entire dataset and label content have been arranged in a compressed file. The presented information facilitates the use of the data for various studies, spanning education and artificial intelligence development.

Abstract Background and Objectives Zygomycosis, a severe form of fungal infection, is classified into two categories: Mucorales and Entomophthorales. Within the Entomophthorales category, Basidiobolomycosis is a rarely recognized genus that can have significant health implications. Prompt diagnosis and appropriate treatment, which includes the use of antifungal medication and surgical procedures, are vital for enhancing the prognosis of patients. The objective of this study is to investigate the response to treatment in patients hospitalized due to basidiobolomycosis. Methods We carried out a retrospective study, in which we analyzed data from 49 patients who were diagnosed with Entomophthorale, Zygomycosis, and Basidiobolomycosis at Namazi Hospital, Shiraz, between the years 1997 and 2019. The data included parameters such as demographic information, clinical symptoms, imaging findings, treatment methods, and patient outcomes. Results Out of 49 patients, 24 children, predominantly male (83.3%), were definitively diagnosed with basidiobolomycosis. The ages of the patients ranged from 1 to 16 years, with an average of 5.75 years. The most frequently observed clinical manifestations included abdominal pain (70.8%), fever (54.2%), hematochezia (41.7%), vomiting (20.8%), and anorexia (16.7%). Half of the patients exhibited failure to thrive (FTT), while abdominal distension was present in 25% of the cases, and a palpable abdominal mass was found in 37% of the patients. The primary treatment strategy incorporated surgical interventions complemented by a comprehensive antifungal regimen. This regimen included medications such as amphotericin B, cotrimoxazole, itraconazole, potassium iodide, and voriconazole. These were mainly administered in a combination therapy pattern or as a monotherapy of amphotericin B. Twenty-two patients were discharged, while two patients died due to complications from the disease. Conclusion Our findings indicate that the prevailing treatment modalities generally involve surgical intervention supplemented by antifungal regimens, including Amphotericin B, Cotrimoxazole, Potassium Iodide, and Itraconazole.

Abstract Apicidins are a class of naturally occurring cyclic tetrapeptides produced by few strains within the Fusarium genus. These secondary metabolites have gained significant attention due to their antiprotozoal activity through HDAC inhibition, thereby highlighting their potential for the treatment of malaria. Predominantly, apicidins have been isolated from Fusarium semitectum, offering a deep insight into the biosynthetic pathway responsible for their formation. A similar biosynthetic gene cluster has also been identified in the rice pathogenic fungus F. fujikuroi, leading the discovery of three additional apicidins through genetic manipulation. Routine mass spectrometric screening of these compound-producing strains revealed another metabolite structurally related to previously studied apicidins. By optimizing culture conditions and developing an effective isolation method, we obtained a highly pure substance, whose chemical structure was fully elucidated using NMR and HRMS fragmentation. Further studies were conducted to determine cytotoxicity, antimalarial activity, and HDAC inhibitory activity of this new secondary metabolite alongside the previously known apicidins. This work not only expands the apicidin class with a new member but also provides extensive insights and comparative analysis of apicidin-like substances produced by F. fujikuroi. Graphical Abstract

Abstract Cooperation and networking are powerful tools in the combating against tropical diseases. Cooperation on a global scale is essential due to the transboundary nature of tropical diseases. Networking plays a pivotal role in facilitating such cooperation. Both cooperation and networking can foster innovation in disease control programmes. Collaborative research can lead to the development of new drugs and vaccines, while shared surveillance data can enable the early detection and control of disease epidemics. Therefore, consensus of cooperation and networking has been reached during the 7th Symposium on Surveillance-Response Systems Leading to Tropical Diseases Elimination, which reflected in the two documents, i.e., Consensus for Transboundary Tropical Diseases Control, and Action Consensus of the Network of WHO Collaborating Centres Related to NTDs. These documents will improve the efforts in the fighting against tropical diseases through collective actions to achieve the United Nations’ Sustainable Development Goals (SDGs). Graphical Abstract

Apicidins are a class of naturally occurring cyclic tetrapeptides produced by few strains within the Fusarium genus. These secondary metabolites have gained significant attention due to their antiprotozoal activity through HDAC inhibition, thereby highlighting their potential for the treatment of malaria. Predominantly, apicidins have been isolated from Fusarium semitectum, offering a deep insight into the biosynthetic pathway responsible for their formation. A similar biosynthetic gene cluster has also been identified in the rice pathogenic fungus F. fujikuroi, leading the discovery of three additional apicidins through genetic manipulation. Routine mass spectrometric screening of these compound-producing strains revealed another metabolite structurally related to previously studied apicidins. By optimizing culture conditions and developing an effective isolation method, we obtained a highly pure substance, whose chemical structure was fully elucidated using NMR and HRMS fragmentation. Further studies were conducted to determine cytotoxicity, antimalarial activity, and HDAC inhibitory activity of this new secondary metabolite alongside the previously known apicidins. This work not only expands the apicidin class with a new member but also provides extensive insights and comparative analysis of apicidin-like substances produced by F. fujikuroi. [ABSTRACT FROM AUTHOR]

Background and Objectives: Zygomycosis, a severe form of fungal infection, is classified into two categories: Mucorales and Entomophthorales. Within the Entomophthorales category, Basidiobolomycosis is a rarely recognized genus that can have significant health implications. Prompt diagnosis and appropriate treatment, which includes the use of antifungal medication and surgical procedures, are vital for enhancing the prognosis of patients. The objective of this study is to investigate the response to treatment in patients hospitalized due to basidiobolomycosis. Methods: We carried out a retrospective study, in which we analyzed data from 49 patients who were diagnosed with Entomophthorale, Zygomycosis, and Basidiobolomycosis at Namazi Hospital, Shiraz, between the years 1997 and 2019. The data included parameters such as demographic information, clinical symptoms, imaging findings, treatment methods, and patient outcomes. Results: Out of 49 patients, 24 children, predominantly male (83.3%), were definitively diagnosed with basidiobolomycosis. The ages of the patients ranged from 1 to 16 years, with an average of 5.75 years. The most frequently observed clinical manifestations included abdominal pain (70.8%), fever (54.2%), hematochezia (41.7%), vomiting (20.8%), and anorexia (16.7%). Half of the patients exhibited failure to thrive (FTT), while abdominal distension was present in 25% of the cases, and a palpable abdominal mass was found in 37% of the patients. The primary treatment strategy incorporated surgical interventions complemented by a comprehensive antifungal regimen. This regimen included medications such as amphotericin B, cotrimoxazole, itraconazole, potassium iodide, and voriconazole. These were mainly administered in a combination therapy pattern or as a monotherapy of amphotericin B. Twenty-two patients were discharged, while two patients died due to complications from the disease. Conclusion: Our findings indicate that the prevailing treatment modalities generally involve surgical intervention supplemented by antifungal regimens, including Amphotericin B, Cotrimoxazole, Potassium Iodide, and Itraconazole. [ABSTRACT FROM AUTHOR]

Tropical diseases present significant challenges to global health, particularly in resource-limited regions. Early and accurate detection of these diseases is vital for effective management and control. In recent years, metallic-based LSPR sensors have emerged as promising diagnostic tools for sensitive and rapid detection of tropical diseases. This comprehensive review aims to provide an in-depth analysis of the current state of research on metallic-based LSPR sensors for the detection of various tropical diseases. In this study, we focused on the connection between neglected tropical diseases (NTDs) and its risk using metallic-based LSPR sensors to identify potential inflammatory biomarkers. We conducted a literature search using PubMed, Web of Science, and Google Scholar. Only published materials written in English were considered, resulting in the identification of ∼ 220 articles. After a comprehensive evaluation, we selected 35 relevant ones. Our analysis revealed 35 links to neglected tropical diseases, providing valuable insights into their relationship using metallic-based LSPR sensors. Moreover, we explore the potential of metallic-based LSPR sensors in point-of-care testing and their integration with emerging technologies such as microfluidics and smartphone-based diagnostics. This review underscores the need for continued research efforts to develop affordable, sensitive, and user-friendly metallic-based LSPR sensors for early detection and surveillance of tropical diseases. [ABSTRACT FROM AUTHOR]

Dengue fever, caused by the dengue virus (DENV), poses a significant global health threat, with a dramatic increase in cases driven by climate change, urbanization, and mosquito resistance. In Pakistan, a country with a population of 240 million, the world's fifth largest, dengue has emerged as an escalating public health crisis, with seasonal outbreaks severely straining the healthcare system. Despite decades of vector control efforts, there has not been much success, necessitating the introduction of dengue vaccination to boost population immunity. Recent advancements in vaccine development demonstrate promising efficacy and safety profiles, even in dengue-naive individuals. Implementing a dengue vaccination program in Pakistan could significantly reduce the disease burden, lower healthcare costs, and prevent future outbreaks. Integrating vaccination with existing public health initiatives can achieve high coverage and improve overall public health outcomes. [ABSTRACT FROM AUTHOR]

Cooperation and networking are powerful tools in the combating against tropical diseases. Cooperation on a global scale is essential due to the transboundary nature of tropical diseases. Networking plays a pivotal role in facilitating such cooperation. Both cooperation and networking can foster innovation in disease control programmes. Collaborative research can lead to the development of new drugs and vaccines, while shared surveillance data can enable the early detection and control of disease epidemics. Therefore, consensus of cooperation and networking has been reached during the 7th Symposium on Surveillance-Response Systems Leading to Tropical Diseases Elimination, which reflected in the two documents, i.e., Consensus for Transboundary Tropical Diseases Control, and Action Consensus of the Network of WHO Collaborating Centres Related to NTDs. These documents will improve the efforts in the fighting against tropical diseases through collective actions to achieve the United Nations' Sustainable Development Goals (SDGs). [ABSTRACT FROM AUTHOR]

The chikungunya virus (CHIKV) was first detected in Brazil in 2014 and has since caused major epidemics. In 2023, a major chikungunya epidemic occurred in Minas Gerais, one of the most populous states in the country. We analyzed the North and Northeast Health Macroregions of Minas Gerais, with 2.5 million inhabitants. The study used epidemiological data from the Ministry of Health’s laboratory surveillance, disease notification and mortality systems. A robust Poisson regression model was constructed to estimate expected monthly mortality. Excess deaths were calculated by comparing observed deaths with model estimates during the epidemic period. During the epidemic, there were 890 excess deaths attributed to chikungunya, translating into a mortality rate of 35.1/100,000 inhabitants. The excess mortality rate was significantly 60 times higher than the deaths reported by surveillance, with only 15 confirmed deaths. The correlation between excess deaths and laboratory-confirmed chikungunya cases was strong, while the correlation with dengue and COVID-19 was not statistically significant. The results highlighted the serious underestimation of chikungunya mortality by epidemiological surveillance. During the same year, only 420 chikungunya deaths were reported by all PAHO member countries. Routine epidemiological surveillance systems cannot capture the full impact of this disease. Excess mortality is a key measure for understanding the impact of epidemics, as demonstrated by COVID-19 and influenza pandemics. The study highlights the need for complementary tools to traditional surveillance to better assess impacts on morbidity and mortality and support priority setting in public health interventions.

Neglected Tropical Diseases (NTDs) are debilitating, chronic illnesses that have the power to prolong poverty due to their negative effects on productivity, child development, social embarrassment, and maternal problems. Insufficient resources are available to raise awareness of these illnesses or locate previously unknown cases. More than one billion people worldwide are still affected by NTDs, which have significant social and financial repercussions for developing nations. Global targets have been set by the World Health Organization to prevent, control, eliminate, or eradicate NTDs, as well as broad and interdisciplinary aims linked to the Sustainable Development Goals targets. The Kigali Declaration, in which leading organizations and countries declared fresh commitments to step up efforts to eradicate NTDs, and the London Declaration aimed to control and eradicate ten NTDs by 2020. We reviewed the epidemiology and burden of NTDs, the success and challenges of eliminating NTDs, as well as therapeutic interventions for the management of NTDs. We also opined on future directions necessary for effective and holistic eradication of NTDs in affected regions. The successful eradication of NTD will significantly increase the socioeconomic and educational levels of the affected countries, thereby increasing the productive workforce and assisting in the accomplishment of some sustainable development goals. As a result, there is a need for global commitment to funding drug research and development.

Aug 14, 2024, was the day the World Health Organization (WHO) announced, mpox (previously known as monkeypox) as a Public Health Emergency of International Concern (PHEIC-2024).1 While mpox undoubtedly remains a global public health problem, neglected tropical diseases (NTDs) such as dengue, chikungunya, rabies, snake bite, and leishmaniasis, listed among the 20 NTDs by WHO, predominate in Pakistan. The fragile health system of Pakistan, overwhelmed for the past decades by infectious diseases such as tuberculosis and malaria, further worsened due to the COVID-19 pandemic. The synchronal rise of mpox, dengue, and chikungunya infections is posing increasing concerns for the population and healthcare system further straining the economy's capacity to respond effectively. Mpox is a zoonotic infection caused by the monkeypox virus (MPVX), an orthopoxvirus in the same genus as the variola virus, which is the causative agent of smallpox and, vaccinia virus (the virus used in the smallpox vaccine).1 Mpox has two clades, Clade I (Central Africa) and Clade II (West Africa). Clade I, which was recently reported from Sweden, is more contagious and has a higher fatality rate (10%), raising global health concerns. The figures show that the global mpox count in 2024 surpassed last year's with 15,600 cases and 537 deaths.1 Integrated Disease Surveillance & Response (IDSR), NIH, Islamabad, Pakistan has recorded a total of 14 travel related cases including one death (co-infection of HIV). All confirmed cases in Pakistan have been identified as the Clade IIb strain, and no evidence of local transmission has been documented. A worrying aspect of mpox is that no antiviral treatment is currently available for mpox and the initial clinical trials of the antiviral 'Tecovirimat' are not very promising against Clade Ib.1 Moreover, controlling mpox infections in the younger age groups is particularly challenging as vaccination is not recommended for individuals that are 15 and under. This poses a grace concern as mpox infection is known to cause higher mortality in children younger than 15 as was reported in the Democratic Republic of Congo. Pakistan currently doesn't have the availability of the mpox vaccine, making it inaccessible for those in need. Another endemic NTD that accounts for a huge burden of disease in Pakistan is rabies. Human infections are mostly due to dog bites and cases are diagnosed on clinical grounds only. Pakistan ranks in the top five countries globally in rabies-related mortality, with an estimated 2700-5000 deaths attributed to rabies in Pakistan. Dengue fever is yet another daunting health threat in Pakistan. About half of the world's population is at risk of dengue with an estimated 100–400 million infections annually.2 In 2024, dengue cases surged globally, with the WHO reporting over 7.6 million cases by April, including 3.4 million confirmed cases, 16,000 severe cases, and more than 3,000 deaths. Re-infection with a different dengue serotype increases the risk of severe illness, adding to the complexity of the outbreak.2 Pakistan faces a critical public health emergency, with 2,800 new dengue cases reported in September 2024, mostly in Baluchistan. Since May 2024, Karachi has experienced a surge in mosquito-borne infections, including dengue and chikungunya. The situation is being exacerbated by inadequate sanitation, optimal monsoon weather for mosquito breeding, prolonged heat waves, inadequate vector control measures, as well as contributing factors such as climate change, increased vector abundance (primarily Aedes aegypti and Aedes albopictus mosquitoes), and population movements.2,3 Both diseases are transmitted by Aedes mosquitoes, also vectors for Zika and yellow fever. Thankfully, despite the presence of the vector, Pakistan remains free of yellow fever and Zika cases. Strengthening surveillance systems and training healthcare workers to ensure timely identification and management of mpox and other NTDs are crucial. The interconnected efforts for healthy ecosystems and communities are essential for resilience in the face of environmental challenges. By actively addressing climate change, we can enhance planetary health and ensure a sustainable future for all. Collaborative initiatives that involve governments, communities, and individuals will be crucial in achieving these goals. Strong advocacy and resource mobilization at national and global levels are essential to secure funding for outbreak preparedness, support the stockpiling of medical supplies, and reinforce public health measures. A multisectoral approach is required to tackle the rise in mpox and NTDs which remains a persistent challenge not only for Pakistan but also for planetary health. Despite the grim circumstances, there are positive breakthroughs, such as the recent success in eliminating trachoma, a long-standing NTD in Pakistan. This is a promising development for Pakistan, the 19th country to reach this milestone. The trachoma elimination reflects the government's commitment, WHO's support, and the contributions of partners and communities. Eliminating one disease is an achievement that reinforces our optimism in working towards controlling NTDs in the future for the well-being of our planet and all its inhabitants. Editor-in-Chief How to cite this: Alamgir W, Shan H. Mpox and Neglected Tropical Diseases in Pakistan: A Growing Planetary Health Concern. Life and Science. 2024; 5(4): 431-432. doi: http://doi.org/10.37185/LnS.1.1.835

Background: Superficial dermatomycosis is one of the most prevalent skin diseases worldwide. The diagnosis of superficial dermatomycosis is established clinically, and supported by several examinations, such as microscopic examination, fungal culture, and Wood's lamp examination for certain species. Purpose: This study is to evaluate the improvement of the knowledge of general practitioners and medical analysts after education and workshop. Methods: This cross-sectional observational study involved 70 subjects, consisting of 35 general practitioners and 35 medical analysts from 35 public health centers in Bojonegoro who were willing to participate in this study. The level of knowledge was assessed before and after the health education on laboratory examination for the diagnosis of superficial dermatomycosis. Result: There was a significant difference in mean scores between the pre-test and post-test after health education (p =

Objectives: Dengue Fever (DF) is an arboviral disease caused by the Dengue virus (DENV). This study aims to assess the association of dengue prevalence with patients' residential areas and hematological laboratory findings (Total platelet count, immunoglobulins, and dengue antigens) during COVID-19 pandemic. Methods: A retrospective study was conducted at the Emergency department of Jinnah Postgraduate Medical Center, Karachi from October to December 2021. All the patients irrespective of their ages presenting to the ED with either of the following complaints: fever; GIT problems; vomiting; body ache; bleeding were included in our study. Results: Our study comprised 189 patients in total in which the females (n = 172) outnumbered the males (n = 17). Out of all, 84.7%of the patients were febrile having a lowgrade fever on average. Korangi district had the most dengue cases, while Keamari had the fewest. There was no significant association reported between mean platelet count, mean TLC, and mean hemoglobin levels with dengue positivity. Conclusion: There is a concerning rise in DF cases in Karachi, particularly in the Korangi district. Despite the COVID-19 pandemic, DF demands urgent attention. [ABSTRACT FROM AUTHOR]

This essay introduces the forum by asking: what were the basic 'ingredients' of sugar in the eighteenth century? How did navies relate to each ingredient? [ABSTRACT FROM AUTHOR]

Most studies of Christian missionaries in British Assam have focused on their role in promoting Christianity or education, not to mention their contributions to the development and standardization of local languages. There has been a singular lack of studies concerning the immense contributions made by the missionaries in setting up a healthcare infrastructure in the region. This absence has further distorted the debate on whether the missionaries operated as independent agents or as auxiliaries of the state. This paper dwells on the medical work carried out by the missionaries in British Assam and contends that the missionaries fulfilled multiple roles and functions in the province. We argue that the significance of the work of the missionaries is enhanced by the utter neglect of healthcare by the colonial state in the frontier region. [ABSTRACT FROM AUTHOR]

Malaria is one of the most dangerous infectious diseases in the world. It occurs in tropical and subtropical regions and affects about 40% of the world´s population. In endemic regions, an estimated 200 million people contract malaria each year. Three-quarters of all global deaths (about 600 per year) are children under 5 years of age. Thus, malaria is one of the most relevant tropical and also childhood diseases in the world. Thanks to various public health measures such as vector control through mosquito nets or the targeted use of insecticides as well as the use of antimalarial prophylaxis drugs, the incidence has already been successfully reduced in recent years. However, to reduce the risk of malaria and to protect children effectively, further measures are necessary. An important part of these measures is an effective vaccination against malaria. However, the history of research shows that the development of an effective malaria vaccine is not an easy undertaking and is associated with some complications. Research into possible vaccines began as early as the 1960s. However, the results achieved were rather sobering and the various vaccines fell short of their expectations. It was not until 2015 that the vaccine RTS,S/AS01 received a positive evaluation from the European Medicines Agency. Since then, the vaccine has been tested in Africa. However, with the COVID-19 pandemic, there are new developments in vaccine research that could also benefit malaria research. These include, among others, the so-called mRNA vaccines. Already in the early 1990s, an immune response triggered by an mRNA vaccine was described for the first time. Since then, mRNA vaccines have been researched and discussed for possible prophylaxis. However, it was not until the COVID-19 pandemic that these vaccines experienced a veritable progress. mRNA vaccines against SARS-CoV-2 were rapidly developed and achieved high efficacy in studies. Based on this success, it is not surprising that companies are also focusing on other diseases and pathogens. Besides viral diseases, such as influenza or AIDS, malaria is high on this list. Many pharmaceutical companies (including the German companies BioNTech and CureVac) have already confirmed that they are researching mRNA vaccines against malaria. However, this is not an easy task. The aim of this article is to describe and discuss possible antigens that could be considered for mRNA vaccination. However, this topic is currently still very speculative. [ABSTRACT FROM AUTHOR]

Diffuse cutaneous leishmaniasis is a rare form of cutaneous leishmaniasis characterized by an inadequate immune response of the host cells to parasitic invasion (weak T-helper (Th)1 response or Th2 response with the production of interleukin IL-4 and IL-10). The characteristic features of the disease include diffuse nodular eruption, masquerading as leprosy and a frequent association with immunosuppression (HIV co-infection, for example). The Russian Federation is a non-endemic country for leishmaniasis, but this disease can be brought into the country by tourists, immigrants, refugees and military personnel. A clinical case of diffuse cutaneous leishmaniasis and HIV co-infection is presented. The patient was a citizen of Uzbekistan, a country endemic for leishmaniasis. The authors were unable to find domestic scientific publications describing cases of diffuse cutaneous leishmaniasis detected in the Russian Federation. The presented clinical case of diffuse cutaneous leishmaniasis in a patient with HIV is the first in the Russian literature.

Dengue fever, caused by the dengue virus (DENV), poses a significant global health threat, with a dramatic increase in cases driven by climate change, urbanization, and mosquito resistance. In Pakistan, a country with a population of 240 million, the world’s fifth largest, dengue has emerged as an escalating public health crisis, with seasonal outbreaks severely straining the healthcare system. Despite decades of vector control efforts, there has not been much success, necessitating the introduction of dengue vaccination to boost population immunity. Recent advancements in vaccine development demonstrate promising efficacy and safety profiles, even in dengue-naive individuals. Implementing a dengue vaccination program in Pakistan could significantly reduce the disease burden, lower healthcare costs, and prevent future outbreaks. Integrating vaccination with existing public health initiatives can achieve high coverage and improve overall public health outcomes.

Objectives: Dengue Fever (DF) is an arboviral disease caused by the Dengue virus (DENV). This study aims to assess the association of dengue prevalence with patients’ residential areas and hematological laboratory findings (Total platelet count, immunoglobulins, and dengue antigens) during COVID-19 pandemic.Methods: A retrospective study was conducted at the Emergency department of Jinnah Postgraduate Medical Center, Karachi from October to December 2021. All the patients irrespective of their ages presenting to the ED with either of the following complaints: fever; GIT problems; vomiting; body ache; bleeding were included in our study.Results: Our study comprised 189 patients in total in which the females (n = 172) outnumbered the males (n = 17). Out of all, 84.7% of the patients were febrile having a low-grade fever on average. Korangi district had the most dengue cases, while Keamari had the fewest. There was no significant association reported between mean platelet count, mean TLC, and mean hemoglobin levels with dengue positivity.Conclusion: There is a concerning rise in DF cases in Karachi, particularly in the Korangi district. Despite the COVID-19 pandemic, DF demands urgent attention.

Dapsone is employed for both non‐dermatological and dermatological indications but with non‐existent population pharmacokinetics (popPK) data in Nigerians. This study was therefore designed to develop a popPK model in Nigerians. Non‐compartmental analysis and nonlinear mixed effects modelling were utilized for data analysis. Eleven participants administered 50 mg dapsone tablet were included in the analysis. Derived pharmacokinetic parameters were: Cmax = 1.16 ± 0.32 μg/mL, Tmax = 3.77 ± 2.40 h, and t1/2z = 30.23 ± 11.76 h. PopPK model parameter estimates with inter‐individual variability were Tlag = 0.40 h (10.0%, fixed); ka = 1.78 h−1 (75.9%); V/F = 89.25 L (21.6%); and Cl/F = 1.32 Lh−1 (27.7%). Sex was significantly associated with Cl/F, and body weight with V/F. Best popPK model was one‐compartment with lag time, and first‐order absorption and elimination. Sex and body weight significantly influenced the clearance and distribution volume of dapsone respectively. [ABSTRACT FROM AUTHOR]

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Leishmania tropica is a vector-borne parasitic protozoa that is the leading cause of leishmaniasis throughout the global tropics and subtropics. L. tropica is a multidrug-resistant parasite with a diverse set of serological, biochemical, and genomic features. There are currently no particular vaccines available to combat leishmaniasis. The present study prioritized potential vaccine candidate proteins of L. tropica using subtractive proteomics and vaccinomics approaches. These vaccine candidate proteins were downstream analyzed to predict B- and T-cell epitopesbasedonhighantigenicity, non-allergenic, and non-toxic characteristics. The top-ranked overlapping MHC-I, MHC-II, and linear B-cell epitopes were prioritized for model vaccine designing. The lead epitopes were linked together by suitable linker sequences to design multi-epitope constructs. Immunogenic adjuvant sequences were incorporated at the N-terminus of the model vaccine constructs to enhance their immunological potential. Among different combinations of constructs, four vaccine designs were selected based on their physicochemical and immunological features. The tertiary structure models of the designed vaccine constructs were predicted and verified. The molecular docking and molecular dynamic (MD) simulation analyses indicated that the vaccine design V1 demonstrated robust and stable molecular interactions with toll-like receptor 4 (TLR4). The top-ranked vaccine construct model-IV demonstrated significant expressive capability in the E. coli expression system during in-silico restriction cloning analysis. The results of the present study are intriguing; nevertheless, experimental bioassays are required to validate the efficacy of the predicted model chimeric vaccine. [ABSTRACT FROM AUTHOR]

Leishmania tropica is a vector-borne parasitic protozoa that is the leading cause of leishmaniasis throughout the global tropics and subtropics. L. tropica is a multidrug-resistant parasite with a diverse set of serological, biochemical, and genomic features. There are currently no particular vaccines available to combat leishmaniasis. The present study prioritized potential vaccine candidate proteins of L. tropica using subtractive proteomics and vaccinomics approaches. These vaccine candidate proteins were downstream analyzed to predict B- and T-cell epitopes based on high antigenicity, non-allergenic, and non-toxic characteristics. The top-ranked overlapping MHC-I, MHC-II, and linear B-cell epitopes were prioritized for model vaccine designing. The lead epitopes were linked together by suitable linker sequences to design multi-epitope constructs. Immunogenic adjuvant sequences were incorporated at the N-terminus of the model vaccine constructs to enhance their immunological potential. Among different combinations of constructs, four vaccine designs were selected based on their physicochemical and immunological features. The tertiary structure models of the designed vaccine constructs were predicted and verified. The molecular docking and molecular dynamic (MD) simulation analyses indicated that the vaccine design V1 demonstrated robust and stable molecular interactions with toll-like receptor 4 (TLR4). The top-ranked vaccine construct model-IV demonstrated significant expressive capability in the E. coli expression system during in-silico restriction cloning analysis. The results of the present study are intriguing; nevertheless, experimental bioassays are required to validate the efficacy of the predicted model chimeric vaccine.

Infectious diseases significantly impact the health status of developing countries. Historically, infectious diseases of the tropics especially have received insufficient attention in worldwide public health initiatives, resulting in poor preventive and treatment options. Many molecular tests for human infections have been established since the 1980s, when polymerase chain reaction (PCR) testing was introduced. In spite of the substantial innovative advancements in PCR technology, which currently has found wide application in most viral pathogens of global concern, the development and application of molecular diagnostics, particularly in resource-limited settings, poses potential constraints. This review accessed data from sources including PubMed, Google Scholar, the Web of Knowledge, as well as reports from the World Health Organization’s Annual Meeting on infectious diseases and examined these for current molecular approaches used to identify, monitor, or investigate some neglected tropical infectious diseases. This review noted some growth efforts in the development of molecular techniques for diagnosis of pathogens that appear to be common in resource limited settings and identified gaps in the availability and applicability of most of these molecular diagnostics, which need to be addressed if the One Health goal is to be achieved.

Introduction. In Costa Rica, an incidence of nearly 40 % has been reported for a disease caused by Ceratocystis fimbriata in commercial plantations of Gmelina arborea (melina), which is the second most widely planted forest tree species in the country. Consequently, there is a pressing need to explore genetic material that exhibit resistance to this pathogen. Objective. To evaluate two methods of C. fimbriata inoculation and their effect on elite genotypes of melina, for their use within the melina genetic improvement program at the international forest genetic improvement cooperative GENFORES. Materials and methods. A pathogenicity test was established using the CIF 001 isolate of C. fimbriata under greenhouse conditions, in Santa Clara, San Carlos, Costa Rica. Two inoculation methods were evaluated in five elite genotypes from October 2019 to January 2020. The effect of the pathogen was evaluated by measuring total height development, basal diameter, number of leaves, incidence, and internal injury within the plant. The assessment was conducted at 30, 60, 90, and 120 days. Results. Mortality was observed from day 38 and reached an incidence of 26.7 % at 120 days. The treatment using solid medium displayed the highest incidence percentage. Genotypes 15N and 58 exhibited high susceptibility to the CIF 001 isolate, whereas genotypes 1 and 57 exhibited high tolerance. Based on the results, it was determined that the pathogenicity test of C. fimbriata on melina can be evaluated at 90 days. Conclusion. Solid medium was the most effective method for inoculating melina with C. fimbriata (isolate CIF 001). Evaluations showed the need to assess results at least 90 days after inoculation. Based on the analysis of the internal lesion, genotype 1 was identified as highly resistant to the effect of the pathogen. The inclusion of this genotype as an evaluation technique will substantially enhance the protocol for assessing tolerance to the pathogen.

A promising strategy for developing novel therapies against tropical diseases, including malaria, leishmaniasis, and trypanosomiasis, is to detect biological targets such as trypanothione reductase, a vital parasite enzyme that regulates oxidative stress. This enzyme is highly selective and conserved in the Trypanosotidae family and has an ortholog in the Plasmodium genus. Previous studies have established that an isosteric replacement of naphthoquinone's carbonyl group with a sulfone group leads to compounds with high bioactivity and selectivity (half-maximal inhibitory concentration = 3 μM against intracellular amastigotes of L. panamensis, selectivity index = 153 over monocytes U-937). In this study, we analyzed the reactive oxygen species (ROS) levels of parasites through indirect measurements of the tryparedoxin system after treatment with these isosteric compounds. This strategy proved that a significant increase in the ROS levels and strong mitochondrial perturbation led to the death of parasites due to cell homeostatic imbalance, confirming the compounds' effectiveness in disrupting this important metabolic pathway. To improve understanding of the parasite-molecule interaction, 27 new compounds were synthesized and assessed against parasites of the three principal tropical diseases (malaria, leishmaniasis, and trypanosomiasis), displaying an EC50 below 10 μM and good correlation with in-silico studies, indicating that the 4H-thiochromen-4-one 1,1-dioxide core is a special allosteric modulator. It can interact in the binding pocket through key amino acids like Ser-14, Leu-17, Trp-21, Ser-109, Tyr-110, and Met-113, leading to interhelical disruption.

Dacryodes Vahl. species, belonging to the Burseraceae family, are widely used in traditional medicine in tropical regions to treat a range of ailments including malaria, wounds, tonsillitis, and ringworms. This review discusses the distribution, ethnobotanical uses, phytochemistry, and bioactivities of Dacryodes species. The intent is to spur future research into isolating and identifying key active principles, secondary metabolites, and crude extracts, and evaluating their pharmacological and toxicological effects, as well as the mechanism of actions to understand their medicinal benefits. A systematic review of scientific electronic databases from 1963 to 2022 including Scifinder, Scopus, Pubmed, Springer Link, ResearchGate, Ethnobotany Research and Applications, Google Scholar, and ScienceDirect was conducted with a focus on Dacryodes edulis (G.Don) H.J. Lam and Dacryodes rostrata (Blume) H.J. Lam. Pharmacological data revealed that D. edulis isolates contain secondary metabolites and other phytochemical groups belonging to the terpenoids class with anti-microbial, anticancer, antidiabetic, antiinflammatory and hepatoprotective activities, highlighting its pharmacological potential in the therapy or management of diverse cancers, cardiovascular, and neurological diseases. Thus, phytochemicals and standardized extracts from D. edulis could offer safer and cost-effective chemopreventive and chemotherapeutic health benefits/regimen, or as alternative therapeutic remedy for several human diseases. Nevertheless, the therapeutic potential of most of the plants in the genus have not been exhaustively explored with regard to phytochemistry and pharmacology, but mostly complementary approaches lacking rigorous, scientific research-based knowledge. Therefore, the therapeutic potentials of the Dacryodes genus remain largely untapped, and comprehensive research is necessary to fully harness their medicinal properties. [ABSTRACT FROM AUTHOR]

Human populations adapting to diverse aspects of their environment such as climate and pathogens leave signatures of genetic variation. This principle may apply to people of West Central African descent in the United States, who are at increased risk of certain chronic conditions and diseases compared to their European counterparts. Less well known is that they are also at reduced risk of other diseases. While discriminatory practices in the United States continue to affect access to and the quality of healthcare, the health disparities affecting African Americans may also be due in part to evolutionary adaptations to the original environment of sub‐Saharan Africa, which involved continuous exposure to the vectors of potentially lethal endemic tropical diseases. Evidence is presented that these organisms selectively absorb vitamin A from the host, and its use in parasite reproduction contributes to the signs and symptoms of the respective diseases. These evolutionary adaptations included (1) sequestering vitamin A away from the liver to other organs, to reduce accessibility to the invaders; and (2) reducing the metabolism and catabolism of vitamin A (vA), causing it to accumulate to subtoxic concentrations and weaken the organisms, thereby reducing the risk of severe disease. However, in the environment of North America, lacking vA‐absorbing parasites and with a mainly dairy‐based diet that is high in vA, this combination of factors is hypothesized to lead to the accumulation of vA and to increased sensitivity to vA as a toxin, which contribute to the health disparities affecting African Americans. vA toxicity is linked to numerous acute and chronic conditions via mitochondrial dysfunction and apoptosis. Subject to testing, the hypothesis suggests that the adoption of traditional or modified West Central African‐style diets that are low in vA and high in vA‐absorbing fiber hold promise for disease prevention and treatment, and as a population‐based strategy for health maintenance and longevity. [ABSTRACT FROM AUTHOR]

Leishmaniasis, trypanosomiasis, and malaria are three parasitic diseases sharing a similar demographic and geographical distribution. These infections are intimately related to poverty, cause important local burdens, and are prevalent in tropical and subtropical regions. Treatment options are limited due to the toxicity of available drugs, parasite resistance, and long treatment requirements. Terminalia plants have long been used as alternative therapies for these parasitic infections. The present study aims to summarize up-to-date information on the antimalarial, antileishmanial and antitrypanosomal activities of plants from the genus Terminalia. The mechanisms of action of the antiparasitic compounds from Terminalia spp. are also highlighted. The embodied information was acquired without date limitation by June 2022 using a variety of electronic databases, such as SciFinder, Science Direct, PubMed (National Library of Medicine), SciELO (Scientific Electronic Library Online), ACS (American Chemical Society), Wiley, Google Scholar, Springer, and Web of Science. Upon in vitro and cytotoxicity experiments, natural products from Terminalia plants revealed a wide range (stretching from moderately to highly active) of antiparasitic activities against Plasmodium, Leishmania , and Trypanosoma species. However, very little is known about the in vivo effectiveness of Terminalia compounds against these parasites. Despite the variety of mechanisms of action attributed to most of these antiparasitic compounds, the exact mechanisms involved are still controversial. Overall, modern pharmacological studies have demonstrated the importance of natural products from Terminalia spp. in search of potential candidates for drug development against malaria, leishmaniasis, and trypanosomiasis. However, in vivo experiments, followed by cytotoxicity and pharmacokinetic studies, and detailed mechanisms of action of the most promising antiparasitic compounds should be the subject of future investigations. [Display omitted] • Traditional uses of terminalia plants to treat some protozoan diseases. • Documentation of antitrypanosomatid and antimalarial effects of terminalia species. • Antiprotozoal mechanisms of action of terminalia compounds are summarized. • Terminalia bioactives might serve as baseline for antiprotozoal drug discovery. [ABSTRACT FROM AUTHOR]

Objective: To analyze the effectiveness of telemedicine consultations during an outbreak in reducing the need for face-to-face consultations at a field hospital for patients with dengue. Methods: We performed a retrospective unicentric study between April and May 2015 with 4626 patients (≥15 years old) who spontaneously sought care at an emergency field hospital (Sāo Paulo/Brazil). A nurse initially assessed all patients with dengue through rapid diagnostic testing, automated complete blood count, and risk stratification. During overcrowded situations, a video-based telemedicine consultation was provided as an option to all low-to-moderate risk patients who tested positive. The management was carried out according to current dengue guidelines. The primary end point was a referral to immediate face-to-face medical evaluation. Results: Of all patients suspected of dengue infection, 2003 presented positive testing, 1978 were classified as low-moderate risk, and 267 patients with dengue were evaluated by telemedicine. The mean age was 38.17 ± 13.7 years (54.6% female). Oral medications were recommended in 169 (63.3%), intravenous hydration or symptomatic drugs in 96 (36%), 252 (94.4%) were discharged after telemedicine assessment, and only 15 (5.6%) were referred to immediate face-to-face medical evaluation. No adverse events were recorded. Conclusion: Telemedicine medical assessment of low-to-moderate risk patients with dengue previously screened by nursing triage is effective in replacing the face-to-face evaluation in a field hospital. Telemedicine may be reinforced in epidemiological outbreak scenarios as a cost-effective strategy for the initial assessment of acute patients.

Background: Tinea capitis (TC) is a superficial mycoses infection of hair follicles and hair shaft caused by dermatophytes of the genus Trichophyton and Microsporum. Tinea capitis can cause hair loss and scales with varying degrees of inflammatory response. The incidence varies depending on geographical location and factors that affect the incidence rate. It is important to know the incidence also the clinical and cure profile of tinea capitis to provide benefits in the prevention, diagnosis, and treatment. Purpose: To evaluate the clinical and cure profile of TC patients at the Dermatology and Venereology Outpatient Clinic of Dr. Soetomo General Academic Hospital Surabaya from January 2019 to January 2020. Methods: A retrospective descriptive study based on medical records with a total sampling technique. Result: Of the 10 TC patients, who were the research subjects, TC predominantly affected males and at 5–11 years age group. The highest risk factor was a history of contact with cats. Scales were the most common clinical feature. Microsporum canis was the most common causative species, ectothrix arthrospores was revealed during the direct microscopic examination, Wood lamp's fluorescence was mostly yellow-green, and cigarette-shaped hair was the most common dermoscopic finding. Eighty percent of subjects were diagnosed with gray patch type. Conclusion: The diagnosis of TC was established based on the patient's history, clinical examination, and supporting examination.

Currently, Chagas disease, or human American trypanosomiasis, affects around 900 people in Portugal, mostly Brazilian immigrants, the main foreign population residing in the country. This article presents a historical inquiry on the first receptions of the Brazilian discovery of Chagas disease in Portugal, a country that had scientists interested in the study of tropical diseases, namely sleeping sickness, or African trypanosomiasis, which affected epidemic in the African colonies of Angola and the island of Príncipe. The time frame of this study is limited between 1909, the date of Carlos Chagas' scientific discovery, and 1924, the year in which the already internationally renowed Brazilian physician, then traveling through Europe, was invited by Portuguese colleagues to give a lecture on American trypanosomiasis in Lisbon. In methodological terms, this article was written based on the work of scrutinizing publications in scientific periodicals, inaugural theses defended in medical schools and Portuguese press news.

Background: Tinea capitis (TC) is common infection caused by dermatophytes on the scalp. Cat contact is one of the TC risk factors. Microsporum canis is the most abundant fungi in cats and humans as a zoophilic infection. Cats and carrier cats can infect humans, mostly children. Purpose: To evaluate cat contact as a risk factor for TC patients at the Dermatology and Venereology Outpatients Unit of Dr. Soetomo General Academic Hospital Surabaya in January 2017 - December 2018. Methods: A retrospective study by observation and recording data. The results obtained as a result of the data recap were then processed using tabulation to obtain conclusions. Result: The results obtained from TC cases in 2017 and 2018 are 20 patients. The results were cat contact in 9 patients (45%), aged > 5 years (55,6%), male (55,6%), and lived in Surabaya (88,9%), hair loss (88,9%), crust (100%), M. canis in culture (55,6%), Grey patch type (55,6%), combination of oral Griseofulvin and Ketoconazole 2% scalp solution (88,9%), and patients’ follow up (44,4%). Discussion: More people keeping cats will increase the risk of being infected with feline dermatophytosis. Combination therapy is the best treatment for M. canis. It is important to educate parents to be careful with pet cats that can become carriers. Conclusion: Cat contact was positive in almost half patients, mostly in a male and > 5 years old. The most common signs and symptoms were crust and hair loss, and grey patch.

Memnoniella is a fungal genus from which a wide range of diverse biologically active compounds have been isolated. A Memnoniella dichroa CF-080171 extract was identified to exhibit potent activity against Plasmodium falciparum 3D7 and Trypanosoma cruzi Tulahuen whole parasites in a high-throughput screening (HTS) campaign of microbial extracts from the Fundación MEDINA's collection. Bioassay-guided isolation of the active metabolites from this extract afforded eight new meroterpenoids of varying potencies, namely, memnobotrins C-E (1–3), a glycosylated isobenzofuranone (4), a tricyclic isobenzofuranone (5), a tetracyclic benzopyrane (6), a tetracyclic isobenzofuranone (7), and a pentacyclic isobenzofuranone (8). The structures of the isolated compounds were established by (+)-ESI-TOF high-resolution mass spectrometry and nuclear magnetic resonance spectroscopy. Compounds 1, 2, and 4 exhibited potent antiparasitic activity against P. falciparum 3D7 (EC50 0.04–0.243 μM) and T. cruzi Tulahuen (EC50 0.266–1.37 μM) parasites, as well as cytotoxic activity against HepG2 tumoral liver cells (EC50 1.20–4.84 μM). The remaining compounds (3, 5–8) showed moderate or no activity against the above-mentioned parasites and cells. [ABSTRACT FROM AUTHOR]

Copyright of Akofena is the property of Universite Felix Houphouet Boigny and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)