Leading Role of Sofosbuvir/Daclatasvir in Achieving Hepatitis C Elimination in Egypt

Chronic hepatitis C virus (HCV) management has historically been challenging, particularly in Egypt, the country with the highest global disease prevalence. The introduction of direct-acting antivirals (DAAs) has revolutionised treatment, providing high rates of sustained virologic response (SVR) with fewer adverse events compared to previous therapies. In Egypt, the locally produced generics of sofosbuvir/daclatasvir (SOF/DAC) have been integral to the national HCV elimination programme, treating millions effectively and affordably, demonstrating similar efficacy and safety to brand-name drugs. Although not currently present in most international guidelines, this cost-effective regimen offers a viable option for large-scale elimination programmes similar to Egypt's successful experience. This review synthesises real-world Egyptian data and highlights the efficacy and safety of the SOF/DAC combination in various population groups. High sustained virological response (SVR) rates were observed across diverse patient populations, including those with advanced liver disease. However, limitations regarding long-term follow-up, especially HCC surveillance, were identified, underscoring the need for further research. Additionally, the review underscores the success of local Egyptian pharmaceutical policies in reducing treatment costs and securing access for all infected individuals. The Egyptian experience offers valuable insights into the potential for replicating its success, particularly in other high-burden regions.

Acute rheumatic fever

Acute rheumatic fever (ARF) is an autoimmune disorder resulting from Group A Streptococcus (GAS) pharyngitis or impetigo in children and adolescents, which may evolve to rheumatic heart disease (RHD) with persistent cardiac valve damage. RHD causes substantial mortality and morbidity globally, predominantly among socioeconomically disadvantaged populations, with an interplay of social determinants of health and genetic factors determining overall risk. ARF diagnosis is based on a constellation of clinical and laboratory features as defined by the 2015 Jones Criteria, although advances in molecular point-of-care testing and the ongoing search for ARF biomarkers offer the potential to revolutionise diagnostics. There are persistent gaps in ARF pathophysiology with little progress in therapeutics over the last several years. The greater focus towards primordial, primary, and secondary prevention such as advances in GAS vaccine development, innovations in digital health technology, improved antibiotic formulations for secondary prevention, and decentralised programmatic implementation to improve health-care delivery offer feasible solutions towards reducing future ARF burden globally.

Assessing the efficiency and effectiveness of community-based voluntary counseling and testing for HIV in Turin: insights from the fast-track cities initiative - a cross-sectional study

BACKGROUND

This study evaluated the efficiency and effectiveness of Community-Based Voluntary Counseling and Testing (CBVCT) for HIV in Turin as part of the Fast-Track Cities initiative. It aimed to understand demographic characteristics and risk behaviors to identify factors associated with routine testing. The findings can help to better tailor interventions for reducing HIV transmission and improving public health outcomes.

METHODS

A cross-sectional design was employed, utilizing anonymous questionnaires administered throughout 2022. Participants were individuals attending rapid serological testing sessions for HIV organized by third-sector associations in Turin, Northern Italy. The sample comprised 795 participants who attended HIV testing sessions. Data were collected via paper-based questionnaires (n = 495), later digitized for analysis. Descriptive statistics, univariate, and logistic regression analyses were conducted to examine socio-demographic characteristics, risk behaviors, and testing outcomes. Cost-effectiveness was evaluated using a Markov model stratifying patients by CD4 + levels to assess QALYs and direct healthcare costs.

RESULTS

The study achieved a high HIV testing rate of 99.9%, with a positivity rate of 0.5%. All individuals with reactive tests were successfully linked to care. Syphilis testing had a lower uptake (76.7%) and identified a positivity rate of 0.7%. Significant demographic and behavioral differences were found: previously tested participants are more likely to be older (p < 0.001, OR = 1.15) than first-time testers, more likely to be MSM (Men who have Sex with Men) than MSF (Men who have Sex with Female) and FSM (Female who has Sex with Male) (p < 0.001, OR = 0.132; p < 0.001, OR = 0.183); and are more likely to have had a history of sexually transmitted infections (STIs)(p = 0.003, OR = 0.128). Immediate HIV diagnosis and access to antiviral therapy reduce healthcare costs by €3,841 per patient, with total savings of €23,808 due to lower treatment expenses before immunodeficiency onset.

CONCLUSIONS

CBVCT programs in Turin demonstrated high feasibility and effectiveness in engaging the target population and ensuring linkage to care. However, syphilis testing requires greater integration. The findings highlight the need for targeted interventions to address disparities in testing behaviors and reinforce the economic sustainability of early HIV diagnosis and treatment.

Epidemiology and diagnostic challenges of fever of unknown origin (FUO) among adults: A multicenter retrospective study in Northern Italy

BACKGROUND

Fever of Unknown Origin (FUO) is broadly defined as a fever with an unidentified cause despite a minimum set of diagnostic investigations. The variability of FUO etiologies across geographic areas, age groups, and decades makes diagnosis challenging and complicates the adoption of a standardized diagnostic approach. Global warming and changing interactions between humans, animals, and the environment are contributing to the emergence and re-emergence of zoonotic infections. Emerging Vector-Borne Disease (VBD) pathogens circulate in Northern Italy, but their prevalence and impact on febrile illnesses remain poorly understood. This study investigated FUO epidemiology, diagnosis, and treatment in three hospitals in Emilia-Romagna (northeastern Italy).

METHODS

The medical records from 652 patients who were discharged with the International Classification of Diseases, Ninth Revision (ICD-9) codes "780.6 Fever of unknown origin" and "087.9 Relapsing fever, unspecified" between January 2017 and December 2023 were analysed.

RESULTS

Among patients discharged with FUO between 2017 and 2023, the mean age was 58 years, and 45 % older than 65 years. Comorbidities were present in 75 %, and 26 % had active cancer. A diagnostic hypothesis was present in 32 % of cases. Diagnostic tests were mainly laboratory-based; 5.9 % had confirmed infections. Antibiotics were used in 62 % of patients mostly penicillin/beta-lactamase inhibitors. FUO discharges peaked in summer.

CONCLUSION

Active hospital-based surveillance are crucial to deepen our current understanding on FUO epidemiology and possible contribution of VBD pathogens while refining the use of antibiotics in the clinical practice.

Prevalence of H. Pylori in inflammatory bowel disease patients and its association with severity

INTRODUCTION

One key area of interest in gastroenterology research is the relationship between Helicobacter pylori (H. pylori) and Inflammatory bowel disease (IBD). Several studies have shown varying results regarding the prevalence of H. pylori in IBD patients and its impact on disease progression, severity, and overall outcome.

METHOD

This is a prospective cohort study conducted at King Fahad University Hospital in Al Khobar, Saudi Arabia from November 2023 to May 2024 to determine the prevalence of H. pylori in IBD patients and its association with severity. The study included 2 arms for comparison which are IBD patients and control group, IBD will be further classified to CD and UC. Prevalence of H. pylori infection and severity of the disease was compared between these groups.

RESULTS

A total of 360 patients were included in the study which were divided equally into IBD group and control group. The IBD was subdivided into CD with 91 cases and UC with 89 cases. H. Pylori was significantly higher in control group (23.3%) compared with UC cases (13.2%) p value: 0.048. H. pylori infection was significantly high in smokers p value = < 0.0001. The presence of autoimmune disease was significantly associated with H. Pylori infection (16.4%) p value: 0.023.

CONCLUSION

H. pylori infection was significantly higher in the control group in comparison to IBD group. In addition, smoking and autoimmune disease were significantly associated with H. pylori infection. Finally, the overall association between severity of CD, UC and medication use with H. Pylori were insignificant.

Time required to achieve optimum viral load suppression with Ravidasvir/sofosbuvir in chronic hepatitis C patients with or without compensated cirrhosis

A study indicated that ravidasvir (RDV) has excellent safety and tolerability when used with sofosbuvir (SOF) to treat chronic HCV infection. The aim of this study was to determine the time taken by RDV/SOF to achieve optimum viral load suppression in chronic hepatitis C patients with or without compensated cirrhosis. Data from the open-label, multicentre, single-arm, phase II/III clinical trial (STORM-C-1) were utilized. Time‒to-event analysis via Kaplan-Meier curves was performed to determine the time required to achieve optimum viral load suppression in both the cirrhotic and noncirrhotic groups. Multivariate logistic regression analyses were performed to identify potential predictors of achieving suppression within four and eight weeks. The time to achieve optimum viral load suppression ranged from six to 85 days and from five to 148 days among noncirrhotic and cirrhotic patients, respectively. Among noncirrhotic patients, 80.6% achieved optimum viral load suppression within 4 weeks, and 92.6% achieved this within 8 weeks. Among cirrhotic patients, 76.1% and 90.4% achieved optimum viral load suppression within 4 and 8 weeks, respectively. Notably, optimum viral load suppression differs from sustained virological response (SVR12), which is defined as undetectable HCV RNA 12 weeks after treatment completion. While the study demonstrates promising early viral suppression, it does not evaluate the efficacy of a shortened regimen. Further research is needed to assess whether shorter treatment durations maintain high SVR12 rates without compromising treatment success.

TeleHCV: A single-visit protocol and minimal passive remote monitoring are sufficient to achieve high SVR with a sofosbuvir-velpatasvir regimen

AIM

Chronic Hepatitis-C Virus (HCV) treatment has evolved significantly in recent years with Direct-Acting Antivirals (DAAs). The traditional care cascade includes several steps that limit its impact, and simplification protocols have emerged. Therefore, the authors explore a simplified treatment strategy for HCV in a healthcare system with limited access to specialized care.

SUBJECT AND METHODS

Chronic HCV, DAA-naïve patients waiting for in-person specialized care were invited to a single-arm non-inferiority trial to evaluate a simplified treatment protocol with a single face-to-face appointment and minimal monitoring of antiviral therapy. The unique visit consisted of an HCV presentation followed by individual medical consultation, blood tests, and delivery of sofosbuvir-velpatasvir pills for a 12-week treatment. Patients were remotely monitored without scheduled on-treatment appointments or phone calls. After treatment, teleconsultation using video was offered. The primary outcome was Sustained Virological Response (SVR) 12-weeks post-treatment. It was analyzed with Intention-To-Treat (ITT) and Per-Protocol (PP) approaches.

CLINICALTRIALS

gov: NCT04039698.

RESULTS

The authors included 144 patients, of which 54.2 % were male, mean age was 52 years. Most individuals (84.7 %) had an APRI score < 1. All patients received at least one dose of DAA, 139 completed antiviral therapy, and 131 had SVR evaluation. The ITT SVR rate was 90.3 % (130/144 patients; 95 % CI 84.2 %‒94.6 %), and the PP SVR was 99.2 % (130/131 patients; 95 % CI 95.8 %‒100 %). Eighty-three adverse events were reported, and 93 % were handled with remote care.

CONCLUSION

This simplified strategy achieved a high SVR rate in a population with restricted access to specialized care. Telehealth tools and minimal monitoring are promising components for policies aimed at HCV elimination.

Elements in the 5' Untranslated Region of Viral RNA Important for HIV Gag Recognition and Cross-Packaging

During retrovirus assembly, Gag packages unspliced viral RNA as the virion genome. Genome packaging is usually specific with occasional exceptions of cross-packaging RNA from distantly related retroviruses. For example, HIV-1 Gag can efficiently package HIV-2 RNA. To better understand how HIV-1 Gag selects packaging substrates, we defined elements in the HIV-2 5' untranslated region (UTR) that are important for this process. Although sharing little homology, both HIV-1 and HIV-2 5' UTRs have unpaired guanosines essential for packaging by their own Gag. Simultaneously substituting guanosines of nine sites in the HIV-2 5' UTR caused severe defects in HIV-1 Gag-mediated packaging. Two of the nine sites are particularly important, mutating each one impaired HIV-1 Gag-mediated packaging, whereas the other sites required mutations in multiple sites to produce similar effects. Additionally, we identified one site that impacts HIV-1 Gag but is dispensable for HIV-2 Gag selective packaging. Furthermore, combining mutations has an additive effect on packaging defects for HIV-1 Gag, in contrast to the previously reported synergistic effects for HIV-2 Gag. Our study demonstrates that Gag proteins from two different retroviruses recognize and use mostly the same set of cis-acting elements to mediate RNA packaging and provide the mechanistic basis for genome cross-packaging.

Hepatitis B virus infection after immunization: How serious it is? An updated review

Infection with hepatitis B virus (HBV) is one of the significant challenges worldwide. Despite the availability of antiviral drugs against this virus, the most critical strategy to prevent HBV infection is HB vaccination. Basically, despite widespread conventional HB vaccination, due to various reasons, including waning of hepatitis B surface antibody (HBsAb) titer after vaccination, the emergence of vaccine-escape mutants, failure to respond to the vaccine due to viral and host factors, levels of response in high-risk individuals and non-responders to conventional HB vaccination remains a major, unsolved and severe concern. This review focuses on the underlying reasons for conventional hepatitis B vaccination failures. It also suggests solutions to overcome these failures by highlighting significant advances in vaccination, including hepatitis B third-generation vaccines and adjuvanted hepatitis B vaccines as efficient alternatives to second-generation vaccines. Potentially, these new strategies will compensate for the shortcomings caused by second-generation vaccines. Adherence to these denouements has a significant role in preventing the circulation of HBV among individuals and reducing the global burden of HBV-related diseases.

Analysis of Processing, Post-Maturation, and By-Products of shRNA in Gene and Cell Therapy Applications

Short hairpin RNAs (shRNAs) are potent tools for gene silencing, offering therapeutic potential for gene and cell therapy applications. However, their efficacy and safety depend on precise processing by the RNA interference machinery and the generation of minimal by-products. In this protocol, we describe how to systematically analyze the processing of therapeutic small RNAs by DROSHA and DICER1 and their incorporation into functional AGO complexes. Using standard small RNA sequencing and tailored bioinformatic analysis (QuagmiR), we evaluate the different steps of shRNA maturation that influence processing efficiency and specificity. We provide guidelines for troubleshooting common design pitfalls and off-target effects in transcriptome-wide profiling to identify unintended mRNA targeting via the miRNA-like effect. We provide examples of the bioinformatic analysis that can be performed to characterize therapeutic shRNA. Finally, we provide guidelines for troubleshooting shRNA designs that result in suboptimal processing or undesired off-target effects. This protocol underscores the importance of rational shRNA design to enhance specificity and reduce biogenesis by-products that can lead to off-target effects, providing a framework for optimizing the use of small RNAs in gene and cell therapies.

Point-of-care nucleic acid testing - a step forward in controlling the HIV epidemic: A review

INTRODUCTION

The HIV/AIDS epidemic, with 85.6 million infections and 40.4 million AIDS-related deaths globally, remains a critical public health challenge. Current diagnostic methods, primarily fourth-generation immunoassays, have limitations due to their long window periods, and most viral load assays require centralized testing protocols that result in delays, especially in remote regions.

NUCLEIC ACID TESTING

Point-of-care (POC) nucleic acid amplification testing (NAAT) presents a transformative approach by reducing the window period for detection to one week and significantly shortening turnaround times for viral load monitoring.

DISCUSSION

This review highlights the clinical utility of POC NAAT for acute HIV infection diagnosis, its role in timely combination antiretroviral therapy adjustments, and its potential to reduce the basic reproduction number (R0), a critical threshold for suppressing the epidemic.

CONCLUSION

By improving early detection and facilitating faster clinical decisions, POC NAAT enhances the effectiveness of HIV prevention and treatment programmes, particularly in high-risk and remote communities, and supports the global effort to achieve the ambitious UNAIDS 95-95-95 targets.

The Impact of Recreational Diving to a Depth of 40 m on Selected Intracellular DAMPs

Increasingly popular, recreational diving is a physical activity that takes place under extreme environmental conditions, which include hyperoxia, hyperbaria and exposure to cold water. The effects of these factors on the human body induce increased levels of reactive oxygen and nitrogen species in divers' bodies, which may modulate damage-associated molecular pattern (DAMPs), their receptors and the antioxidant response. This study involved 21 divers who descended to a depth of 40 metres. Determinations of selected intracellular DAMPs (high-mobility group box protein 1,HMGB1, S100 calcium-binding proteins A9 and A8, S100A8 and S100A9, heat shock protein family A member 1A, HSPA1A (Hsp70), heat shock protein family B, (small) member 1, HSPB1(Hsp27), thioredoxin, TXN), their receptors (Toll-like receptor 4, TLR4 and receptors for advanced glycation end products, RAGE), nuclear factor-κB (NF-κB) and antioxidant defence markers were performed before, after and 1 h after the dive. A significant transient reduction in HMGB1 expression was observed immediately after the dive at both the mRNA and protein levels. We noted an increase in S100A9 expression, which occurred 1 h post-dive compared to the post-dive time point, and a post-dive decrease in TLR4 expression only at the mRNA level. Diving also influenced the expression of genes encoding key enzymes associated with glutathione synthesis, (glutamate-cysteine ligase, catalytic subunit, GCLC and glutathione synthetase, GSS), and reduced plasma glutathione levels. However, no significant changes were observed in the expression of NF-κB, nitric oxide synthase 2 (NOS2) or circulating DAMP receptors (TLR4 and RAGE). The findings suggest an adaptive response to diving-induced oxidative stress, which appears to be a protective mechanism against an excessive inflammatory response. To our knowledge, this is the first study to analyse the role of intracellular DAMPs in recreational divers.

Mathematical Modelling of the First HIV/ZIKV Co-infection Cases in Colombia and Brazil

This paper presents a mathematical model to investigate the co-infection with human immunodeficiency virus (HIV) and Zika virus (ZIKV) in Colombia and Brazil, where the first cases were reported in 2015. The model considers the sexual transmission dynamics of both viruses and vector-host interactions. We begin by exploring the qualitative behaviour of each model separately. We then analyze the dynamics of the co-infection model using the thresholds and results defined separately for each model. The model also considers the impact of intervention strategies, such as personal protection, antiretroviral therapy (ART), and sexual protection (condom use). Using available and assumed parameter values for Colombia and Brazil, the model is calibrated to investigate the long-term co-infection dynamics, the influence of specific parameters, and the potential effect of implementing these intervention strategies on co-infection spread. The study's results revealed that the duration of Zika infection is a critical factor influencing the burden of co-infection cases. Additionally, bed nets and use of condoms are essential for disease control, while ART is less emphasized due to the cost-effectiveness of condom use.

Comparative structural insights and functional analysis for the distinct unbound states of Human AGO proteins

The four human Argonaute (AGO) proteins, critical in RNA interference and gene regulation, exhibit high sequence and structural similarity but differ functionally. We investigated the underexplored structural relationships of these paralogs through microsecond-scale molecular dynamics simulations. Our findings reveal that AGO proteins adopt similar, yet unsynchronized, open-close states. We observed similar and unique local conformations, interdomain distances and intramolecular interactions. Conformational differences at GW182/ZSWIM8 interaction sites and in catalytic/pseudo-catalytic tetrads were minimal. Tetrads display conserved movements, interacting with distant miRNA binding residues. We pinpointed long common protein subsequences with consistent molecular movement but varying solvent accessibility per AGO. We observed diverse conformational patterns at the post-transcriptional sites of the AGOs, except for AGO4. By combining simulation data with large datasets of experimental structures and AlphaFold's predictions, we identified proteins with genomic and proteomic similarities. Some of the identified proteins operate in the mitosis pathway, sharing mitosis-related interactors and miRNA targets. Additionally, we suggest that AGOs interact with a mitosis initiator, zinc ion, by predicting potential binding sites and detecting structurally similar proteins with the same function. These findings further advance our understanding for the human AGO protein family and their role in central cellular processes.

Epidemiology, Natural History, and Treatment of Inflammatory Bowel Disease in Africa: A Scoping Review

BACKGROUND & AIMS

Inflammatory bowel diseases (IBD), Crohn's disease and ulcerative colitis, are global diseases. There is a paucity of knowledge about the burden and epidemiology of IBD in Africa. We performed a scoping review of the published literature on IBD in Africa to identify burden, risk factors, and outcomes as well as knowledge gaps.

METHODS

A comprehensive search was conducted in MEDLINE, Embase, Web of Science, AIM, Africa Wide, Cochrane, and ClinicalTrials.gov in November 2024. Studies were screened and selected based on predefined inclusion criteria. Data extraction was conducted using Covidence. Literature was summarized focusing on the incidence and prevalence, environmental factors, diagnosis, outcomes, and management of IBD.

RESULTS

Of 6896 references identified, a total of 268 studies met inclusion criteria. This included data from 21,089 patients with IBD (10,426 Crohn's disease; 7956 ulcerative colitis; 329 unspecified IBD; 2378 uncategorized IBD). There were few studies examining temporal incidence of IBD; in the sparse available data, a similar increase was notable as seen in the West. Studies of genetics and environment revealed many shared findings from known associations from Western cohorts (such as environmental hygiene) but highlight some differences as well. Use of biologic or advanced therapy was sparse.

CONCLUSION

We identified a paucity of publications regarding the risk factors, burden, and outcomes of IBD in Africa. There were few prospective studies and regional variations in representation. There is a need for more prospective data to inform our knowledge and management strategies accurately.

Structural insights into RNA cleavage by PIWI Argonaute

Argonaute proteins are categorized into AGO and PIWI clades. Across most animal species, AGO-clade proteins are widely expressed in various cell types, and regulate normal gene expression1. By contrast, PIWI-clade proteins predominantly function during gametogenesis to suppress transposons and ensure fertility1,2. Both clades use nucleic acid guides for target recognition by means of base pairing, crucial for initiating target silencing, often through direct cleavage. AGO-clade proteins use a narrow channel to secure a tight guide-target interaction3. By contrast, PIWI proteins feature a wider channel that potentially allows mismatches during pairing, broadening target silencing capability4,5. However, the mechanism of PIWI-mediated target cleavage remains unclear. Here we demonstrate that after target binding, PIWI proteins undergo a conformational change from an 'open' state to a 'locked' state, facilitating base pairing and enhancing target cleavage efficiency. This transition involves narrowing of the binding channel and repositioning of the PIWI-interacting RNA-target duplex towards the MID-PIWI lobe, establishing extensive contacts for duplex stabilization. During this transition, we also identify an intermediate 'comma-shaped' conformation, which might recruit GTSF1, a known auxiliary protein that enhances PIWI cleavage activity6. GTSF1 facilitates the transition to the locked state by linking the PIWI domain to the RNA duplex, thereby expediting the conformational change critical for efficient target cleavage. These findings explain the molecular mechanisms underlying PIWI-PIWI-interacting RNA complex function in target RNA cleavage, providing insights into how dynamic conformational changes from PIWI proteins coordinate cofactors to safeguard gametogenesis.

Are Treatment Adherence Factors Apparent in Patients with Asthma and to Physicians? Results from the APPaRENT 3 Survey

INTRODUCTION

Patient adherence to regular controller medication is critical for improving clinical outcomes in asthma, which is consistently associated with underlying pathophysiological inflammation. This survey aimed to identify types of treatment nonadherence and associated factors, including patient characteristics that predict poor adherence, in patients with asthma.

METHODS

This cross-sectional online survey involved patients with asthma and physicians managing such patients from Southeast Asia (Indonesia, Malaysia, Philippines, Thailand and Vietnam) and the Middle East (Saudi Arabia and United Arab Emirates) included in the Asthma Patients' and Physicians' Perspectives on the Burden and Management of Asthma (APPaRENT) 3 study. Patients and physicians shared their attitudes and beliefs regarding treatment and adherence in asthma management.

RESULTS

Most patients (82%, 1108/1354) reported having ever received treatment with daily controller inhalers, whereas 38% used inhaled relievers at least once daily for symptomatic relief. Among those prescribed maintenance and reliever therapy, 93% were prescribed a separate inhaled reliever, with significant variation by country (P < 0.01). Erratic nonadherence (primary definition) was exhibited by 55% (462/845) of patients including those who reported at least sometimes forgetting inhaler use, with its prevalence increasing with worsening asthma severity. Nonerratic nonadherence was exhibited by 49% (415/847) of patients including those who reported using controller inhalers less than once daily. Physicians reported that 73% of patients adhered to the prescribed regular medication. Regression analysis examining both erratic (primary definition) and nonerratic nonadherence revealed that current inhaled reliever used was the only significant predictor of poor adherence (P = 0.04). Sensitivity analyses revealed that the predictors of poor adherence to controller inhaler varied depending on the definition of nonadherence employed in the study.

CONCLUSION

This study revealed high rates of erratic and nonerratic nonadherence to regular controller inhalers in patients with asthma as well as discordance between adherence rates reported by patients and physicians.

Identification of Acanthopanax trifoliatus (L.) Merr as a Novel Potential Therapeutic Agent Against COVID-19 and Pharyngitis

Individuals infected with COVID-19 often experience the distressing discomfort of pharyngitis. Thus, it is crucial to develop novel drugs to improve therapeutic options. In this study, we investigated the interaction between bioactive compounds isolated from Acanthopanax trifoliatus (L.) Merr and proteins associated with COVID-19 and pharyngitis through in silico analysis. Several molecules demonstrated high affinities to multiple targets, indicating significant potential for alleviating pharyngitis and other COVID-19-related symptoms. Among them, rutin and isochlorogenic acid C, two major components in Acanthopanax trifoliatus (L.) Merr ethanol extracts, were further experimentally demonstrated to exhibit strong inhibitory effects against SARS-CoV-2 and to possess significant anti-inflammatory activities. Inhibition of over 50% in several key genes was observed, demonstrating the efficacy of in silico methods in identifying high-affinity target binders. Our findings provide a theoretical foundation for the development of Acanthopanax trifoliatus (L.) Merr as a novel multi-target therapeutic agent for both COVID-19 and pharyngitis.

Revealing viral hepatitis epidemiology in the Democratic Republic of Congo: insights from yellow fever surveillance reanalysis

BACKGROUND

Yellow fever surveillance systems are designed to identify cases of acute febrile jaundice, a clinical syndrome used to monitor the emergence of yellow fever outbreaks. However, this syndrome has diverse etiologies, particularly viral hepatitis. This study investigates the seroepidemiology of viral hepatitis A (HAV), B (HBV), C (HCV), and E (HEV) among cases initially suspected to be yellow fever, aiming to elucidate the epidemiology of viral hepatitis in the Democratic Republic of Congo (DRC) and provide insights for improving public health interventions.

METHODS

A retrospective cross-sectional study was conducted using serum samples collected between 2017 and 2018 through national yellow fever surveillance in the DRC. Samples from individuals testing negative for yellow fever were tested for IgM antibodies against HAV, HBc, HCV, and HEV and HBs antigen using validated ELISA kits. Acute HBV infection was defined by both HBc IgM and HBs antigen positivity. Multivariable logistic regression was used to assess the association of demographic, geographic, and environmental factors with each hepatitis type.

RESULTS

Among 1239 participants (58.8% male; median age: 16 years), seroprevalence was 16.1, 11.2, 5.0, and 3.1% for HAV, HBV, HCV and HEV, respectively. HAV prevalence was highest in the youngest age group and rural residents. In contrast, the youngest group was most protected from HBV. HCV prevalence was highest in the oldest age groups. HEV exhibited higher prevalence during the dry season and in a humid subtropical climate. Several provinces were identified as hotspots of HAV, HCV and HEV.

CONCLUSIONS

Viral hepatitis is a major cause of acute febrile jaundice in the DRC with notable geographic and seasonal trends. National yellow fever surveillance is a valuable resource for understanding hepatitis epidemiology, though careful interpretation is necessary. Tailored interventions are required for mitigating the burden of viral hepatitis in each province.

Epigenetic regulation in female reproduction: the impact of m6A on maternal-fetal health

With the development of public health, female diseases have become the focus of current concern. The unique reproductive anatomy of women leads to the development of gynecological diseases gradually become an important part of the socio-economic burden. Epigenetics plays an irreplaceable role in gynecologic diseases. As an important mRNA modification, m6A is involved in the maturation of ovum cells and maternal-fetal microenvironment. At present, researchers have found that m6A is involved in the regulation of gestational diabetes and other reproductive system diseases, but the specific mechanism is not clear. In this manuscript, we summarize the components of m6A, the biological function of m6A, the progression of m6A in the maternal-fetal microenvironment and a variety of gynecological diseases as well as the progression of targeted m6A treatment-related diseases, providing a new perspective for clinical treatment-related diseases.

Knowledge, attitudes, and practices (KAP) of animal health staff and farmers towards brucellosis control in sheep and goat in China: A cross-sectional study

BACKGROUND

In China, brucellosis has resurfaced recently with a discernible spatial distribution, particularly affecting dairy herds and small ruminant populations. However, limited dissemination of knowledge, attitudes, and practices (KAP) for brucellosis control exists among farmers and animal health staff. This study aimed to assess the KAP of brucellosis control and prevention in animal health staff and farmers, with the goal of educating the public regarding the application of efficient brucellosis control and prevention strategies.

METHODS

We conducted a cross-sectional survey involving 1,468 participants, comprising farmers (n = 1,067) and animal health staff (n = 401) based on their significant density of sheep and goat population. They completed a questionnaire targeting a specific group of farmers and animal health staff through face-to-face interviews. The KAP scores were then categorized as either satisfactory or unsatisfactory based on a cutoff set at ≥80% of the total score for satisfactory. Binary logistic regression was used to identify the association between KAP and geographical information.

RESULTS

The results indicated satisfaction with KAP among farmers (57.7%, 75.8% and 87.0%) and animal health staff (80.5%, 84.5%, and 78.3%) at ≥ 80% cut-off point of total score. The primary concern of farmers is involved in the understanding of the route of transmission and handwashing practices after contacting animals. Predictors of higher knowledge and positive attitude included province of residence and age. The factors linked to satisfactory practice levels consist of province of residence, educational level, and a history of family members' infections (p < 0.05). Among animal health staff, the primary factor associated with KAP was province of residence, sex, level of education, and history of family members infection (p < 0.05). Additionally, brucellosis information primarily originated from traditional promotional materials and veterinarians.

CONCLUSIONS

This study emphasized that the KAP scores for both animal health staff and farmers were satisfactory, except for a suboptimal knowledge score among farmers. To proactively control future brucellosis outbreaks, it is imperative to develop targeted educational resources aimed at enhancing the understanding of brucellosis, particularly among farmers. Ensuring the availability and accessibility of informative materials for the effective prevention and control of brucellosis in livestock animals.

Animal Brucellosis in Egypt: Review on Evolution, Epidemiological Situation, Prevalent Brucella Strains, Genetic Diversity, and Assessment of Implemented National Control Measures

Brucellosis is a neglected zoonotic disease that has a significant economic and public health impact, especially in endemic countries. This review delves deeply into brucellosis's current epidemiological situation and potential sources of livestock infection in Egypt during the last two decades. MLVA-16 and Whole Genome Sequencing based on core-genome SNP analyses confirm the presence of different B. abortus and B. melitensis outbreak strains, both older widely disseminated Brucella strains and newly introduced ones. Despite implementing the test-and-slaughter control strategy over forty years, the disease is still endemic, and different Brucella species circulate among several animal species. The raising of mixed animal species in the same households or farms, exposure to aborted animals, and lack of public awareness about brucellosis transmission are among the main risk factors for increasing livestock brucellosis prevalence in Egypt. Young animals' voluntary vaccination, lack of a nationwide animal identification system, and uncontrolled animal movement stand beyond the ineffectively applied control strategy and may be subdued by applying mass vaccination to decrease disease prevalence dramatically and target imported camels, domestic pigs, and dogs (housed and stray) in the national control surveillance. Increasing awareness through educational campaigns is compulsory to reduce brucellosis transmission risk to livestock/humans.

Febrile neutropenia in an immunocompetent patient with brucellosis: a case report and literature review

Introduction and importance

Brucellosis is a zoonotic disease that can affect various organs, with symptoms like fever, lymphadenopathy, and arthritis. Hematologic complications, including febrile neutropenia, are rare. This report highlights the diagnostic and therapeutic challenges of brucellosis with febrile neutropenia.

Case presentation

A 36-year-old man presented with a 3-week history of fever, polyarthralgia, and night sweats. Examination showed febrile symptoms, joint swelling, and cervical lymphadenopathy. Laboratory tests revealed neutropenia and elevated inflammatory markers. Imaging was unremarkable, and blood cultures were negative, but brucellosis was confirmed by serology. Treatment with doxycycline and rifampicin led to clinical improvement.

Clinical discussion

Brucellosis diagnosis can be challenging due to nonspecific symptoms and requires high suspicion, especially in non-endemic areas. In this case, early identification and targeted therapy led to symptom resolution. This case underlines the importance of considering zoonotic diseases in febrile neutropenia with inconclusive initial findings.

Conclusion

Brucellosis with febrile neutropenia is rare but manageable with timely diagnosis and treatment, leading to favorable outcomes.

A Case Report of Meningitis Caused by Brucella melitensis Biovar 3

Background

Brucellosis, a major endemic disease in northern China, is contracted by zoonosis of Brucella. We report a case of meningitis caused by Brucella melitensis biovar 3.

Case Presentation

A 46-year-old man was hospitalized at a local medical facility due to symptoms of fever, soreness, and weakness on April 16, 2021. The local hospital improved the relevant examinations, and the serum tube agglutination test (SAT) for Brucella was positive. The patient underwent a week of anti-infective symptomatic treatment with doxycycline and rifampicin, however, his symptoms continued. Subsequently, he was hospitalized in our facility following convulsions and altered consciousness. We conducted several examinations, and the lumbar puncture revealed abnormal cerebrospinal fluid (CSF) protein levels along with a positive culture. Biochemical and polymerase chain reaction (PCR) tests (based on IS711 gene) identified the pathogen as B. melitensis biovar 3. Following treatment involving with moxifloxacin hydrochloride, doxycycline, rifampin, cefatriaxone, mannitol, and dexamethasone the patient's body temperature stabilized, leading to gradual improvements in his clinical status. After two months of the oral anti-infective regimen, the condition is continuing to alleviate and the laboratory indicators returned to normal. The follow-up maintained two years, the patient with no symptomatic recurrences or sequel.

Conclusion

We showed that in epidemic areas of brucellosis, patients with unexplained neurological symptoms should first be examined for neurobrucellosis. Early treatment with corticosteroids and a combination of antibiotics is beneficial for the relief and satisfactory prognosis of neurological symptoms.

Evaluation of exposure to volatile organic compounds (BTEX) and Polycyclic Aromatic Hydrocarbons (PAHs) in gas station workers and oxidative stress assessment in Karaj city

Gas stations are one of the sources of benzene, toluene, ethylbenzene and xylene (BTEX) and polyromantic hydrocarbons (PAHs). The present study was conducted with the aim of evaluating the level of breathing exposure of gas station workers to BTEX, PAHs and oxidative stress caused by exposure to these compounds in Karaj city. Oxidative stress and reactive oxygen species (ROS) is one of the mechanisms involved in the toxicity caused by exposure to gas vapors. In this study, all 25 gas stations in the city of Karaj were investigated. Personal sampling and analysis of BTEX and PAHs was done according to National Institute for Occupational Safety and Health (NIOSH) 1501 and 5515 methods, respectively. Finally, oxidative stress markers were investigated in 25 gas station workers and 25 control group. The results showed that the mean age and employment history of gas station workers are 39.96 ± 9.55 and 12.84 ± 6.92, respectively. Also, no significant difference was reported between gas station workers and control subjects in terms of oxidative stress parameters including the level of ROS, oxidized glutathione (GSSG) content, malondialdehyde (MDA) and reduced glutathione (GSH) content. The concentration values of personal exposure of gas station workers to BTEX and PAHs are lower than the occupational exposure limits (OEL). Although the level of oxidative stress parameters in gas station workers is higher than the control group, this difference is not statistically significant (p>0.05). It is recommended to take personal protection measures in case of chronic exposure.

Investigating the effects of co-exposure to noise and benzene on serum oxidative stress in rat

Occupational exposures are generally complex, workers are exposed with more than one hazardous agent in work environment. Combined exposure to noise and benzene is common in occupational environments. Sub-acute exposure to benzene vapors can induce oxidative stress in serum. Additionally, noise exposure leads to non-auditory effects, such as oxidative stress. However, In the authors' research scope, a study aimed at investigating the effect of co-exposure to noise and benzene on the oxidative stress of rat serum has not been found. The purpose of this study is to investigate the effect of co-exposure to noise and benzene on oxidative stress. In this study, 24 Wistar albino male rats were divided into four groups: the control group (1), the group exposed to white noise with an intensity of 100 dB and a frequency of 250-8KHz (2), the group exposed to benzene vapors with a concentration of 300 PPM (3), and the group co-exposed to white noise with an intensity of 100 dB and benzene vapors with a concentration of 300 PPM. Oxidative stress induced was investigated by serum oxidative stress indices, including lipid peroxidation (MDA), total oxidative capacity (TOS), and antioxidant activity indices (SOD) and (GSH), as well as total antioxidant capacity (TAC).The results showed that exposure to noise and benzene, both separately and combined, can lead to oxidative stress in rat serum, increasing serum oxidant indices MDA and TOS while decreasing serum antioxidant indices TAC, SOD, and GSH was detected in groups exposed to noise and benzene. The findings indicate that the serum oxidative stress caused by the co- exposure to noise and benzene is significantly higher than separate exposure to noise or benzene, also Co-exposure to noise and benzene can have an almost additive effect on increasing serum oxidative stress in rats. This study highlights the importance of studying co-exposure to physical and chemical hazardous agents in the work environment.

The burden and trend of intestinal parasitosis among women at Berekum, Ghana: a 9-year retrospective study

BACKGROUND

Intestinal parasitic infections (IPIs) are serious global public health issues, especially in low and middle-income countries. These parasites can cause high morbidity and mortality, especially in immunocompromised individuals, and can easily be transmitted by consumption of contaminated food or water or by penetration of skin and mucous membranes.

METHODS

We retrospectively analyzed all archived data from stool examination reports at the Parasitology Unit of Precise Health Diagnostic Services, Berekum for the prevalence and trends of parasitic infections spanning a period of 9 years (2013-2021). The data was retrieved and exported to IBM SPSS v.26 for statistical analysis. Descriptive data was summarized as proportions and presented in tables and charts. Pearson Chi-Square test (χ2) or Fisher's exact test was used to test for a statistical association between demographic factors and intestinal parasitic infections. P value was significant at < 0.05.

RESULTS

A total of 9,217 records of stool examinations were retrieved. Almost half (48.45%) of the data were from patients aged between 20 and 29 years. An overall prevalence of intestinal parasitic infections of 21.20% was observed in this study. Patients aged 70 to 79 had the highest prevalence of the IPIs (44.44%). The parasites recovered in this study were intestinal flagellates, Entamoeba coli, Hookworm, Entamoeba histolytica/dispar, Ascaris lumbricoides, Enterobius vermicularis, Strongyloides stercoralis and Hymenolepis nana. The intestinal flagellates had the highest prevalence (98.31%) compared to the other intestinal parasites recovered. Intestinal parasitic infections had the highest prevalence in the year 2020 (28.56%) and lowest in 2018 (11.78%).

CONCLUSION

An overall prevalence of 21.20% of intestinal parasitic infection was found. The majority of the parasites reported were intestinal flagellates (98.31%). The trend analysis revealed that the overall prevalence fluctuated across the entire period from 2013 to 2021.

A three-layer perspective on miRNA regulation in β cell inflammation

MicroRNAs (miRNAs) are noncoding RNA molecules that regulate gene expression post-transcriptionally and influence numerous biological processes. Aberrant miRNA expression is linked to diseases such as diabetes mellitus; indeed, miRNAs regulate pancreatic islet inflammation in both type 1 (T1D) and type 2 diabetes (T2D). Traditionally, miRNA research has focused on canonical sequences and offers a two-layer view - from expression to function. However, advances in RNA sequencing have revealed miRNA variants, called isomiRs, that arise from alternative processing or modifications of canonical sequences. This introduces a three-layer view - from expression, through sequence modifications, to function. We discuss the potential link between cellular stresses and isomiR biogenesis, and how this association could improve our knowledge of islet inflammation and dysfunction.

Efficacy of 8-week daclatasvir-sofosbuvir regimen in chronic hepatitis C: a systematic review and meta-analysis

BACKGROUND

The high rates of the sustained virologic response 12 weeks after treatment (SVR12) in real world settings provoked the adoption of shortened courses of the costly direct-acting antivirals (DAAs) regimens. This study provides, to our knowledge, the first systematic review and meta-analysis for the efficacy of the shortened 8-week course of sofosbuvir (SOF) plus daclatasvir (DCV), the most accessible DAAs in the low-middle income countries (LMICs).

METHODS

We performed a proportion meta-analysis to determine a reliable rate of SVR12 by pooling all studies that evaluated the results of the 8-week regimen of DCV + SOF. In addition, we applied sensitivity analyses using two imputation paradigms: a conservative approach, and a pragmatic approach to avoid overestimating the efficacy of the 8-week regimen in studies that followed a response-guided treatment (RGT) approach.

RESULTS

Six studies with a total of 159 patients were included. The pooled SVR12 rate ranged from 91 to 97% in the included scenarios. The pragmatic scenario showed that the pooled SVR12 was 97% (95% confidence interval (CI) 91%; 100%) with lower variability as assessed by the prediction interval. The conservative approach revealed an SVR12 of 93% (95% CI 84%; 95%).

CONCLUSION

The 8-week course of 60 mg DCV with SOF provided a comparable SVR12 to the standard 12-week regimen in treatment-naïve, non-HIV co-infected patients with a minimum estimated efficacy of 90%.

The effects of underwater diving on the lung function of divers in coastal areas of tourism destinations: A cross-sectional study in North Sulawesi Province, Indonesia

North Sulawesi is renowned for its captivating underwater tourism, attracting SCUBA divers and traditional divers. Given the potential impact of diving activities on lung function, this study aims to explore differences in lung function among self-contained breathing apparatus (SCUBA) diving tourism workers, traditional divers utilizing breathing air compressors and air lines, and non-divers within the coastal areas of tourism destinations in North Sulawesi. Employing a descriptive comparative study with a cross-sectional approach, 90 subjects were categorized into three groups, and selected through simple random sampling. Spirometry was utilized for data collection, and Analysis of Variance (ANOVA) was employed for comparisons, with post hoc analysis for specific differences. The ANOVA analysis revealed significant variations in FVC Predicted, FVC Measured, FEV1, and obstruction and restriction values among SCUBA divers, traditional divers, and non-divers with a level of significance of p < 0.05. Post hoc analysis exhibited noteworthy distinctions in FVC Predicted, FVC Measured, and FEV1 between traditional divers and non-divers, and between SCUBA divers and traditional divers (p < 0.00). Obstruction values showed differences between SCUBA divers and traditional divers (p = 0.012), while restriction values indicated disparities between traditional divers and non-divers (p = 0.019). In conclusion, there were significant variations in lung function among SCUBA diving tourism workers, traditional divers using compressors and air lines, and non-divers within the coastal areas of tourism destinations in North Sulawesi.

Ginger and its constituents in asthma: a mini-review

OBJECTIVE

The primary objective of this review is to focus on research findings that aim to determine the immunomodulatory action of ginger's active components and the molecular mechanisms that reduce asthma. The study aims to provide an overview of the scientific literature available on ginger's efficacy in treating allergic asthma.

DATA SOURCE

The mouse model of asthma has been used to investigate the actions of ginger and its active compounds on allergies and asthma. Various studies and scientific literature on ginger's health-improving qualities and its traditional use have been examined.

RESULTS

The findings indicate that ginger and its active ingredients have anti-asthmatic features and a suppressive impact on mast cell production of histamine. Animals given ginger and compounds derived from ginger demonstrate a notable reduction in allergic response, suggesting a significant role in lowering the allergic reaction.

CONCLUSION

While ginger shows promise as a potential treatment for allergies and asthma due to its anti-inflammatory, antibacterial, antidiabetic, anticancer, and antioxidant effects, further examination, extrapolation, and confirmation of these results are necessary before utilizing ginger and its active components in human treatments. This review highlights the need for additional research and provides an overview of the current scientific literature on ginger's efficacy in treating allergic asthma.

Target cleavage and gene silencing by Argonautes with cityRNAs

TinyRNAs (tyRNAs) are ≤17-nt guide RNAs associated with Argonaute proteins (AGOs), and certain 14-nt cleavage-inducing tyRNAs (cityRNAs) catalytically activate human Argonaute3 (AGO3). We present the crystal structure of AGO3 in complex with a cityRNA, 14-nt miR-20a, and its complementary target, revealing a different trajectory for the guide-target duplex from that of its ∼22-nt microRNA-associated AGO counterpart. cityRNA-loaded Argonaute2 (AGO2) and AGO3 enhance their endonuclease activity when the immediate 5' upstream region of the tyRNA target site (UTy) includes sequences with low affinity for AGO. We propose a model where cityRNA-loaded AGO2 and AGO3 efficiently cleave fully complementary tyRNA target sites unless they directly recognize the UTy. To investigate their gene silencing, we devised systems for loading endogenous AGOs with specific tyRNAs and demonstrated that, unlike microRNAs, cityRNA-mediated silencing heavily relies on target cleavage. Our study uncovered that AGO exploits cityRNAs for target recognition differently from microRNAs and alters gene silencing.

Burden and Temporal Trends of Valvular Heart Disease-Related Heart Failure From 1990 to 2019 and Projection Up to 2030 in Group of 20 Countries: An Analysis for the Global Burden of Disease Study 2019

BACKGROUND

The aim of this study was to characterize the burden of valvular heart disease (VHD)-related heart failure (HF) in Group of 20 (G20) countries.

METHODS AND RESULTS

Using data from the 2019 Global Burden of Disease Study, we estimated VHD-related HF burdens (cases, age-standardized prevalence rates, and years lived with disabilities rates) in G20 countries from 1990 to 2019 by age, sex, and sociodemographic index. The burden of VHD-related HF increased in G20 countries from 1990 to 2019, exhibiting heterogeneity across VHD subtypes. In 2019, Italy, the United States, and the Russian Federation had the highest age-standardized prevalence rates of nonrheumatic VHD-related HF, whereas India, Brazil, and Mexico had the lowest. Rheumatic VHD-related HF was most prevalent in China, India, and Italy, whereas the Republic of Korea, Brazil, and Turkey had the lowest. Nonrheumatic VHD-related HF prevalence peaked among G20 countries in individuals ≥85 years of age, whereas rheumatic VHD-related HF peaked in those 75 to 84 years of age in several countries, including China, India, the Russian Federation, Mexico, Argentina, and Turkey. Age-standardized prevalence rates of nonrheumatic VHD-related HF showed a decreasing trend, more pronounced in women, whereas rheumatic VHD-related HF increased in both sexes, with a lower increase in men. Nonrheumatic VHD-related HF burden correlated with age and sociodemographic index, whereas rheumatic VHD-related HF burden was highest in middle sociodemographic index countries for those <75 years of age. Years lived with disabilities rates for VHD-related HF represented about 9.0% of the overall burden across populations.

CONCLUSIONS

The increasing burden of VHD-related HF in G20 countries highlights the need for timely interventions to mitigate this growing public health challenge.

Pravastatin prevents colitis-associated carcinogenesis by reducing CX3CR1high M2-like fibrocyte counts in the inflamed colon

Colorectal cancer (CRC) resulting from chronic inflammation is a crucial issue in patients with inflammatory bowel disease (IBD). Although many reports established that intestinal resident CX3CR1high macrophages play an essential role in suppressing intestinal inflammation, their function in colitis-related CRC remains unclear. In this study, we found that colonic CX3CR1high macrophages, which were positive for MHC-II, F4/80 and CD319, promoted colitis-associated CRC. They highly expressed Col1a1, Tgfb, II10, and II4, and were considered to be fibrocytes with an immunosuppressive M2-like phenotype. CX3CR1 deficiency led to reductions in the absolute numbers of CX3CR1high fibrocytes through increased apoptosis, thereby preventing the development of colitis-associated CRC. We next focused statins as drugs targeting CX3CR1high fibrocytes. Statins have been actively discussed for patients with IBD and reported to suppress the CX3CL1/CX3CR1 axis. Statin treatment after azoxymethane/dextran sulfate sodium-induced inflammation reduced CX3CR1high fibrocyte counts and suppressed colitis-associated CRC. Therefore, CX3CR1high fibrocytes represent a potential target for carcinogenesis-preventing therapy, and statins could be safe therapeutic candidates for IBD.

Artificial Neural Networks to Predict Metabolic Syndrome without Invasive Methods in Adolescents

Background/Objectives: The prevalence of metabolic syndrome (MetS) is increasing worldwide, and an increasing number of cases are diagnosed in younger age groups. This study aimed to propose predictive models based on demographic, anthropometric, and non-invasive clinical variables to predict MetS in adolescents. Methods: A total of 2064 adolescents aged 18-19 from São Luís-Maranhão, Brazil were enrolled. Demographic, anthropometric, and clinical variables were considered, and three criteria for diagnosing MetS were employed: Cook et al., De Ferranti et al. and the International Diabetes Federation (IDF). A feed-forward artificial neural network (ANN) was trained to predict MetS. Accuracy, sensitivity, and specificity were calculated to assess the ANN's performance. The ROC curve was constructed, and the area under the curve was analyzed to assess the discriminatory power of the networks. Results: The prevalence of MetS in adolescents ranged from 5.7% to 12.3%. The ANN that used the Cook et al. criterion performed best in predicting MetS. ANN 5, which included age, sex, waist circumference, weight, and systolic and diastolic blood pressure, showed the best performance and discriminatory power (sensitivity, 89.8%; accuracy, 86.8%). ANN 3 considered the same variables, except for weight, and exhibited good sensitivity (89.0%) and accuracy (87.0%). Conclusions: Using non-invasive measures allows for predicting MetS in adolescents, thereby guiding the flow of care in primary healthcare and optimizing the management of public resources.

MMTV RNA packaging requires an extended long-range interaction for productive Gag binding to packaging signals

The packaging of genomic RNA (gRNA) into retroviral particles relies on the specific recognition by the Gag precursor of packaging signals (Psi), which maintain a complex secondary structure through long-range interactions (LRIs). However, it remains unclear whether the binding of Gag to Psi alone is enough to promote RNA packaging and what role LRIs play in this process. Using mouse mammary tumor virus (MMTV), we investigated the effects of mutations in 4 proposed LRIs on gRNA structure and function. Our findings revealed the presence of an unsuspected extended LRI, and hSHAPE revealed that maintaining a wild-type-like Psi structure is crucial for efficient packaging. Surprisingly, filter-binding assays demonstrated that most mutants, regardless of their packaging capability, exhibited significant binding to Pr77Gag, suggesting that Gag binding to Psi is insufficient for efficient packaging. Footprinting experiments indicated that efficient RNA packaging is promoted when Pr77Gag binds to 2 specific sites within Psi, whereas binding elsewhere in Psi does not lead to efficient packaging. Taken together, our results suggest that the 3D structure of the Psi/Pr77Gag complex regulates the assembly of viral particles around gRNA, enabling effective discrimination against other viral and cellular RNAs that may also bind Gag efficiently.

Transcription start site choice regulates HIV-1 RNA conformation and function

HIV-1, the causative agent of AIDS, is a retrovirus that packages two copies of unspliced viral RNA as a dimer into newly budding virions. The unspliced viral RNA also serves as an mRNA template for translation of two polyproteins. Recent studies suggest that the fate of the viral RNA (genome or mRNA) is determined at the level of transcription. RNA polymerase II uses heterogeneous transcription start sites to generate major transcripts that differ in only two guanosines at the 5' end. Remarkably, this two-nucleotide difference is sufficient to alter the structure of the 5'-untranslated region and generate two pools of RNA with distinct functions. The presence of both RNA species is needed for optimal viral replication and fitness.

Protective Effects of Berberine on Nonalcoholic Fatty Liver Disease in db/db Mice via AMPK/SIRT1 Pathway Activation

OBJECTIVE

Berberine (BBR) has emerged as a promising therapeutic agent for nonalcoholic fatty liver disease (NAFLD). This study aims to elucidate the underlying molecular mechanisms.

METHODS

In this study, db/db mice were chosen as an animal model for NAFLD. A total of 10 healthy C57BL/6J mice and 30 db/db mice were randomly allocated to one of 4 groups: the normal control (NC) group, the diabetic control (DC) group, the Metformin (MET) therapy group, and the BBR therapy group. The total cholesterol (TC), triacylglycerol (TG), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels in the serum were measured. The glutathione peroxidase (GSH-Px), glutathione (GSH), malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), interleukin (IL)-1β, tumor necrosis factor (TNF)-α and monocyte chemotactic protein 1 (MCP-1) levels in liver tissue were measured. Hematoxylin and eosin (H&E), acid-Schiff (PAS) and TUNEL stanning was performed for histopathological analysis. Western blotting and immunohistochemistry were conducted to detect the expression levels of key proteins in the AMPK/SIRT1 pathway.

RESULTS

BBR could improve lipid metabolism, attenuate hepatic steatosis and alleviate liver injury significantly. The excessive oxidative stress, high levels of inflammation and abnormal apoptosis in db/db mice were reversed after BBR intervention. BBR clearly changed the expression of AMP-activated protein kinase (AMPK)/Sirtuin 1 (SIRT1), and their downstream proteins.

CONCLUSION

BBR could reverse NAFLD-related liver injury, likely by activating the AMPK/SIRT1 signaling pathway to inhibit oxidative stress, inflammation and apoptosis in hepatic tissue.

Sexual behaviors and HIV-related knowledge among GBMSM: evidence from 2011 to 2021 in Hangzhou, China

INTRODUCTION

Considering that many new HIV infections are transmitted by homosexual behaviors, gay, bisexual, and other men who have sex with men (GBMSM) are more likely to be infected with HIV than other groups due to the higher risk associated with unprotected anal intercourse. It is important to explore the changes in sexual behaviors and HIV-related knowledge among GBMSM in the last 10 years, which could provide evidence for improving public health interventions to reduce HIV infections.

OBJECTIVES

The study sought to explore the changes of 3 sexual behaviors and HIV knowledge among men who have sex with men from 2011 to 2021.

METHODS

Data were collected from national HIV sentinel surveillance among GBMSM in Hangzhou conducted between 2011 and 2021. Univariate and multivariate logistic regression were used to analyze the associated factors of sexual behaviors. The variation trend of variables was evaluated based on the linear trend test in the regression model.

RESULTS

A total of 5111 GBMSM with an average age of 32.00 years were incorporated in the analysis. From 2011 to 2021, the HIV-related knowledge score of GBMSM ranged from 6 to 7.5, and it increased significantly (P trend < .001). The rate of homosexual sex in the past 6 months remained at a high level (75.06%-82.75%). Homosexual behavior was associated with a higher HIV-related knowledge score (P = .004). Heterosexual sex was associated with an increase in the old age, married persons, and domicile outside the province (P < .05). Commercial sex was associated with an increase in drug users (P <.001).

CONCLUSIONS

In the past 10 years, HIV-related knowledge of GBMSM increased and the rate of unprotected sex was at a high level among GBMSM, especially in heterosexual behaviors. Moreover, the likelihood of having homosexual behaviors is raised with the increasing HIV-related knowledge. Conducting precise behavioral interventions for GBMSM are crucial for preventing HIV infection.

Health effects of air pollutant mixtures (volatile organic compounds, particulate matter, sulfur and nitrogen oxides) - a review of the literature

The health risks associated with individual air pollutant exposures have been studied and documented, but in real-life, the population is exposed to a multitude of different substances, designated as mixtures. A body of literature on air pollutants indicated that the next step in air pollution research is investigating pollutant mixtures and their potential impacts on health, as a risk assessment of individual air pollutants may actually underestimate the overall risks. This review aims to synthesize the health effects related to air pollutant mixtures containing selected pollutants such as: volatile organic compounds, particulate matter, sulfur and nitrogen oxides. For this review, the PubMed database was used to search for articles published within the last decade, and we included studies assessing the associations between air pollutant mixtures and health effects. The literature search was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A number of 110 studies were included in the review from which data on pollutant mixtures, health effects, methods used, and primary results were extracted. Our review emphasized that there are a relatively small number of studies addressing the health effects of air pollutants as mixtures and there is a gap in knowledge regarding the health effects associated with these mixtures. Studying the health effects of air pollutant mixtures is challenging due to the complexity of components that mixtures may contain, and the possible interactions these different components may have.

Sexual behavior is linked to changes in gut microbiome and systemic inflammation that lead to HIV-1 infection in men who have sex with men

Pathogenic changes in gut microbial composition precede the onset of HIV-1 infection in men who have sex with men (MSM). This process is associated with increased levels of systemic inflammatory biomarkers and risk for AIDS development. Using mediation analysis framework, in this report we link the effects of unprotected receptive intercourse among MSM prior to primary HIV-1 infection to higher levels of proinflammatory cytokines sCD14 and sCD163 in plasma and a significant decrease in the abundance of A. muciniphila, B. caccae, B. fragilis, B. uniformis, Bacteroides spp., Butyricimonas spp., and Odoribacter spp., and a potential increase in the abundance of Dehalobacterium spp. and Methanobrevibacter spp. in stools of MSM with the highest number of sexual partners. These differences in microbiota, together with a reduction in the pairwise correlations among commensal and short-chain fatty acid-producing bacteria with a number of sexual partners, support an increase in gut dysbiosis with the number of sexual partners. These results demonstrate the interconnectedness of sexual behavior, immune response, and microbiota composition, notably among MSM participating in high-risk sexual behaviors.

Target-specific requirements for RNA interference can arise through restricted RNA amplification despite the lack of specialized pathways

Since double-stranded RNA (dsRNA) is effective for silencing a wide variety of genes, all genes are typically considered equivalent targets for such RNA interference (RNAi). Yet, loss of some regulators of RNAi in the nematode Caenorhabditis elegans can selectively impair the silencing of some genes. Here, we show that such selective requirements can be explained by an intersecting network of regulators acting on genes with differences in their RNA metabolism. In this network, the Maelstrom domain-containing protein RDE-10, the intrinsically disordered protein MUT-16, and the Argonaute protein NRDE-3 work together so that any two are required for silencing one somatic gene, but each is singly required for silencing another somatic gene, where only the requirement for NRDE-3 can be overcome by enhanced dsRNA processing. Quantitative models and their exploratory simulations led us to find that (1) changing cis-regulatory elements of the target gene can reduce the dependence on NRDE-3, (2) animals can recover from silencing in non-dividing cells, and (3) cleavage and tailing of mRNAs with UG dinucleotides, which makes them templates for amplifying small RNAs, are enriched within 'pUG zones' matching the dsRNA. Similar crosstalk between pathways and restricted amplification could result in apparently selective silencing by endogenous RNAs.

Assessing the knowledge, attitude, and practice of frontline physicians in Egyptian university hospitals regarding pharyngitis and acute rheumatic fever: a cross-sectional study that calls for action

BACKGROUND

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain major public health issues. Although the primary and secondary prevention of RHD through appropriate management of bacterial pharyngitis and ARF are well-described in the literature, few studies address the knowledge, attitude, and practice (KAP) of developing countries. We aimed to evaluate the KAP of the frontline physicians in Egyptian university hospitals regarding pharyngitis and ARF.

METHODS

We employed a cross-sectional design between September 1st, 2022, and January 31st, 2023 using a self-administered questionnaire in 21 Egyptian universities. The questionnaire was developed based on previous studies and recent guidelines and included four domains: sociodemographic data, knowledge, attitude, and practice regarding pharyngitis and ARF. We utilized both online (Google Forms) and paper surveys. Frontline physicians, including interns, residents, and assistant lecturers, were conveniently invited to participate. Furthermore, with the help of participating phycisians in recruiting their colleagues, we utilized the snowball method. Data were analyzed using IBM SPSS version 27 software.

RESULTS

The final analysis included 629 participants, of whom 372 (59.1%) were males and 257 (40.9%) had direct contact with ARF patients. Most participants (61.5%) had a fair knowledge level while 69.5% had a fair level of practice regarding ARF and pharyngitis. Higher satisfactory knowledge levels were noted regarding pharyngitis (17.1% vs. 11.3%; p-value: 0.036) and ARF (26.8% vs. 18%; p-value: 0.008) among physicians dealing directly with ARF cases compared to physicians in departments not dealing directly with ARF cases. Physicians in Cairo region universities had significantly higher levels of satisfactory knowledge about ARF compared to Delta and Upper Egypt region universities (p = 0.014). Delta region universities showed significantly lower levels of practice compared to Cairo and Upper Egypt region universities (p = 0.027). The most frequently recognized barriers against health promotion were low socioeconomic status (90.3%) and lack of adequate public education (85.8%).

CONCLUSIONS

Despite the fair knowledge and practice levels towards bacterial pharyngitis and ARF among participants, many gaps were still identified that might contribute to RHD prevalence. Educational interventions should be implemented by updating the local guidelines in Egypt for diagnosis and management based on the most recent guidelines.

HIV-1 Gag Compact form Stabilized by Intramolecular Interactions is Crucial for Infectious Particle Production

HIV-1 Gag polyprotein plays a pivotal role in assembly and budding of new particles, by specifically packaging two copies of viral gRNA in the host cell cytoplasm and selecting the cell plasma membrane for budding. Both gRNA and membrane selections are thought to be mediated by the compact form of Gag. This compact form binds to gRNA through both its matrix (MA) and nucleocapsid (NC) domains in the cytoplasm. At the plasma membrane, the membrane competes with gRNA for Gag binding, resulting in a transition to the extended form of Gag found in immature particles with MA bound to membrane lipids and NC to gRNA. The Gag compact form was previously evidenced in vitro. Here, we demonstrated the compact form of Gag in cells by confocal microscopy, using a bimolecular fluorescence complementation approach with a split-GFP bipartite system. Using wild-type Gag and Gag mutants, we showed that the compact form is highly dependent on the binding of MA and NC domains to RNA, as well as on interactions between MA and CA domains. In contrast, Gag multimerization appears to be less critical for the accumulation of the compact form. Finally, mutations altering the formation of Gag compact form led to a strong reduction in viral particle production and infectivity, revealing its key role in the production of infectious viral particles.

Use of telerehabilitation platforms for delivering patient education among patients with asthma: a scoping review

OBJECTIVE

Use of tele-technology for monitoring symptoms, functional parameters, and quality-of-life of people with asthma is essential. Delivering this information among patients is mandated for a better outcome and made possible via patient education (PE). This review aims to summarize the types of telerehabilitation modalities, dosage, and outcome measures used to assess the effectiveness of PE among people with asthma.

METHODS

We adopted a scoping review methodology. Thematic analysis was used to synthesize the data. The Preferred Reporting System for Meta-Analysis for Scoping Reviews (PRISMA-ScR) was followed during the review process.

RESULTS

PubMed, Embase, and Scopus were searched, with 34 studies meeting inclusion criteria. Results are presented in three themes: telerehabilitation platforms used to deliver PE among patients with asthma; content, duration, and frequency of the PE administered; and patient-reported outcome measures used to evaluate the effectiveness of PE.

CONCLUSION

This scoping study detailed the types of telerehabilitation modalities, dosage, and outcome measures used to assess the effectiveness of PE in people with asthma. This review will be especially beneficial to those considering where additional research or implementation of telerehabilitation for asthma patients is required. The studies emphasized the involvement of several healthcare experts, emphasizing the significance of a multidisciplinary approach to efficient PE delivery and possible improvements in asthma management through telerehabilitation. Although a range of telerehabilitation platforms were generally accepted, hybrid models that integrate online and in-person sessions could further enhance patient satisfaction and quality-of-life. Comprehensive economic analyses are also required, and solving technology issues is essential to maximizing the efficacy of these initiatives.

TLR4 inhibitors through inhibiting (MYD88-TRIF) pathway, protect against experimentally-induced intestinal (I/R) injury

Intestinal ischemia/reperfusion (I/R) injury is a serious condition that causes intestinal dysfunction and can be fatal. Previous research has shown that toll-like receptor 4 (TLR4) inhibitors have a protective effect against this injury. This study aimed to investigate the protective effects of TLR4 inhibitors, specifically cyclobenzaprine, ketotifen, amitriptyline, and naltrexone, in rats with intestinal (I/R) injury. Albino rats were divided into seven groups: vehicle control, sham-operated, I/R injury, I/R-cyclobenzaprine (10 mg/kg body weight), I/R-ketotifen (1 mg/kg body weight), I/R-amitriptyline (10 mg/kg body weight), and I/R-naltrexone (4 mg/kg body weight) groups. Anesthetized rats (urethane 1.8 g/kg) underwent 30 min of intestinal ischemia by occluding the superior mesenteric artery (SMA), followed by 2 h of reperfusion. Intestinal tissue samples were collected to measure various parameters, including malondialdehyde (MDA), nitric oxide synthase (NO), myeloperoxidase (MPO), superoxide dismutase (SOD), TLR4, intercellular adhesion molecule-1 (ICAM-1), nuclear factor kappa bp65 (NF-ĸBP65), monocyte chemoattractant protein-1 (MCP-1), tumor necrosis factor-α (TNF-α), macrophages CD68, myeloid differentiation factor 88 (MYD88), and toll interleukin receptor-domain-containing adaptor-inducing interferon β (TRIF). The use of TLR4 inhibitors significantly reduced MDA, MPO, and NO levels, while increasing SOD activity. Furthermore, it significantly decreased TLR4, ICAM-1, TNF-α, MCP-1, MYD88, and TRIF levels. These drugs also showed partial restoration of normal cellular structure with reduced inflammation. Additionally, there was a decrease in NF-ĸBP65 and macrophages CD68 staining compared to rats in the I/R groups. This study focuses on how TLR4 inhibitors enhance intestinal function and protect against intestinal (I/R) injury by influencing macrophages CD86 through (MYD88-TRIF) pathway, as well as their effects on oxidation and inflammation.

Recognition of HIV-1-infected fibrocytes lacking Nef-mediated HLA-B downregulation by HIV-1-specific T cells

Fibrocytes were reported to be host cells for HIV-1, but the immunological recognition of HIV-1-infected fibrocytes has not been studied. Here, we investigated the recognition of HIV-1-infected fibrocytes by HIV-1-specific CD8+ T cells. CD8+ T cells specific for five HIV-1 epitopes (HLA-A*24:02-restricted, HLA-B*52:01-restricted, and HLA-C*12:02-restricted epitopes) produced IFN-γ and expressed CD107a after coculture with HIV-1-infected fibrocytes. HIV-1-infected fibrocytes were effectively killed by HIV-1-specific CD8+ T cells. Although it is well known that HIV-1 Nef-mediated downregulation of HLA-A and HLA-B critically affects the T cell recognition of HIV-1-infected CD4+ T cells and HIV-1-infected macrophages, Nef downregulated HLA-A, but not HLA-B, in HIV-1-infected fibrocytes. These findings suggested that HIV-1-specific CD8+ T cells could recognize HIV-1-infected fibrocytes more strongly than HIV-1-infected CD4+ T cells or HIV-1-infected macrophages. HIV-1-infected fibrocytes were also recognized by HIV-1-specific HLA-DR-restricted T cells, indicating that HIV-1-infected fibrocytes can present HIV-1 epitopes to helper T cells. Collectively, these findings suggest that fibrocytes have an important role as antigen-presenting cells during HIV-1 infection. The present study demonstrates effective recognition of HIV-1-infected fibrocytes by HIV-1-specific T cells and suggests possible roles of fibrocytes in the induction and maintenance of HIV-1-specific T cells.

IMPORTANCE

Fibrocytes were identified as unique hematopoietic cells with the features of both macrophages and fibroblasts and were demonstrated to be host cells for HIV-1. However, T cell recognition of HIV-1-infected fibrocytes has not been studied. We investigated the recognition of HIV-1-infected fibrocytes by HIV-1-specific T cells. HIV-1-infected fibrocytes were effectively recognized and killed by CD8+ T cells specific for HIV-1 epitopes presented by HLA-A, HLA-B, or HLA-C and were recognized by HIV-1-specific HLA-DR-restricted CD4+ T cells. HIV-1 Nef-mediated downregulation of HLA-A and HLA-B was found in HIV-1-infected CD4+ T cells, whereas Nef did not downregulate HLA-B in HIV-1-infected fibrocytes. These results suggest that HIV-1-specific CD8+ T cells recognize HIV-1-infected fibrocytes more strongly than HIV-1-infected CD4+ T cells. The present study suggests the importance of fibrocytes in the induction and maintenance of HIV-1-specific T cells.

Overview of Hepatitis B Vaccine Non-Response and Associated B Cell Amnesia: A Scoping Review

BACKGROUND

The advent of the hepatitis B vaccine has achieved tremendous success in eradicating and reducing the burden of hepatitis B infection, which is the main culprit for hepatocellular carcinoma-one of the most fatal malignancies globally. Response to the vaccine is achieved in about 90-95% of healthy individuals and up to only 50% in immunocompromised patients. This review aimed to provide an overview of hepatitis B vaccine non-response, the mechanisms involved, B cell amnesia, and strategies to overcome it.

METHODS

Databases, including Google Scholar, PubMed, Scopus, Cochrane, and ClinicalTrials.org, were used to search and retrieve articles using keywords on hepatitis B vaccine non-response and B cell amnesia. The PRISMA guideline was followed in identifying studies, screening, selection, and reporting of findings.

RESULTS

A total of 133 studies on hepatitis B vaccine non-response, mechanisms, and prevention/management strategies were included in the review after screening and final selection. Factors responsible for hepatitis B vaccine non-response were found to include genetic, immunological factors, and B cell amnesia in healthy individuals. The genetic factors were sex, HLA haplotypes, and genetic polymorphisms in immune response markers (cytokines). Non-response was common in conditions of immunodeficiency, such as renal failure, haemodialysis, celiac disease, inflammatory bowel disease, hepatitis C co-infection, and latent hepatitis B infection. Others included diabetes mellitus and HIV infection. The mechanisms involved were impaired immune response by suppression of response (T helper cells) or induced suppression of response (through regulatory B and T cells).

DISCUSSION

A comprehensive and careful understanding of the patient factors and the nature of the vaccine contributes to developing effective preventive measures. These include revaccination or booster dose, vaccine administration through the intradermal route, and the use of adjuvants in the vaccine.

Long way up: rethink diseases in light of phase separation and phase transition

Biomolecular condensation, driven by multivalency, serves as a fundamental mechanism within cells, facilitating the formation of distinct compartments, including membraneless organelles that play essential roles in various cellular processes. Perturbations in the delicate equilibrium of condensation, whether resulting in gain or loss of phase separation, have robustly been associated with cellular dysfunction and physiological disorders. As ongoing research endeavors wholeheartedly embrace this newly acknowledged principle, a transformative shift is occurring in our comprehension of disease. Consequently, significant strides have been made in unraveling the profound relevance and potential causal connections between abnormal phase separation and various diseases. This comprehensive review presents compelling recent evidence that highlight the intricate associations between aberrant phase separation and neurodegenerative diseases, cancers, and infectious diseases. Additionally, we provide a succinct summary of current efforts and propose innovative solutions for the development of potential therapeutics to combat the pathological consequences attributed to aberrant phase separation.