COVID-19 pandemic and antimicrobial resistance in developing countries

Modifying cellulose fibres with carbon dots: a promising approach for the development of antimicrobial fibres

This study focuses on the development of antimicrobial fibres for use in medical and healthcare textile industries. Carbon dots (CDs) were designed with boronic acid groups for the attachment to cellulose fibres found in cotton textiles and to enhance their attachment to glycogens on bacterial surfaces. Boronic acid-based and curcumin-based CDs were prepared and characterized using various techniques, showing a nanoscale size and zeta potential values. The CDs inhibited the growth of both Staphylococcus epidermidis and Escherichia coli bacteria, with UV-activated CDs demonstrating improved antibacterial activity. The antimicrobial activity of the CDs was then tested, revealing strong adherence to cellulose paper fibres with no CD diffusion and potent inhibition of bacterial growth. Cytotoxicity assays on human cell lines showed no toxicity towards cells at concentrations of up to 100 µg ml-1 but exhibited increased toxicity at concentrations exceeding 1000 µg ml-1. However, CD-modified cellulose paper fibres showed no toxicity against human cell lines, highlighting the antimicrobial properties of the CD-modified cellulose fibres are safe for human use. These findings show promising potential for applications in both industrial and clinical settings.

Antibiotic resistance and the COVID-19 pandemic: A dual crisis with complex challenges in LMICs

Background and Aims

Antimicrobial resistance (AMR), a global health crisis of mounting urgency, has been further complicated by the ongoing COVID-19 pandemic. The intricate relationship between these two phenomena is especially pronounced in low- and middle-income countries (LMICs) due to the distinct obstacles encountered by their healthcare systems and policy structures. This study aims to explore the complex challenges arising from the coexistence of these two crises in LMICs and proffer specific recommendations for holistic management.

Methods

An exhaustive bibliographic survey was executed, employing search queries in specialized databases such as PubMed, SCOPUS, and Web of Science's SCI-EXPANDED index. The timeframe for the literature search extended from January 2020 to January 2023. The search strategy employed key terms including antibiotic resistance, AMR, COVID-19 pandemic, low- and middle-income countries, SARS-CoV-2, and LMICs.

Results

The pandemic has aggravated various drivers of AMR in LMICs, including limited capabilities, weak frameworks, and socioeconomic factors. New challenges have emerged, such as disruptions in the antibiotic supply chain and an increased risk of healthcare-associated infections. The interaction between these drivers presents a complex problem that demands a coordinated response. Specific recommendations include strengthening health systems, funding research and innovation, and enhancing infection prevention control measures.

Conclusion

The coexistence of AMR and the COVID-19 pandemic in LMICs demands an integrated approach involving multiple stakeholders. Emphasis must be placed on constructing aligned regulatory frameworks, nurturing regional collaborations, and focusing on accessible therapeutic options. The study underscores the necessity for actionable strategies to achieve sustainable access to clean water and sanitation and also highlights the importance of long-term planning, funding, and specialized expertise in emerging modalities like phage therapy.

Classics of infectious diseases: A bibliometric analysis of the 100 most cited articles

In our study, the 100 most cited publications in the field of "Infectious Diseases" in the WOS database were evaluated bibliometrically. "Web of Science" database "advanced mode" feature was used. A search was made in the field of "Infectious Diseases." The top 100 most cited publications were determined. The total number of citations of the publications, the annual number of citations, the authors, the information of the study and the journal were analyzed. There were a total of 552,828 publications in the field of "Infectious Diseases" in the WOS between 1975 and 2023. The total citation average of the 100 most cited publications was 2246.02 ± 2165.35 and the annual citation average was 208.04 ± 215.00. The first 3 subjects in the first hundred articles were listed as antibiotic resistance (21%), coronavirus disease 2019 (COVID-19) (17%) and gram positive agents (10%). The first 3 journals in which the studies were published the most were determined as "Clinical Infectious Diseases" (33%), "Lancet Infectious Diseases" (20%), and "Emerging Infectious Diseases" (9%). A significant relationship was found between the subject of the study, the quarter (Q) category of the journal, the continent of authors and publisher, the funding status, the year of publication, the open access status and the number of citations per year (P < .0001). Our study is the first to analyze the top 100 most cited studies in the field of "Infectious Diseases" in the literature and their citation characteristics. Most of the most cited studies on the subject were on antibiotic resistance. The study subject, author, journal, publisher and publication access features, funding status and publication year affect the number of citations per year.

Antibiotics Resistant Pattern of Bacteria Isolated from Spoiled Avocado Fruit Sold in Sokoto Metropolis

Consuming fruit contaminated with bacteria remains a crucial route of foodborne infection in developing countries and creates a severe public health burden. The research aimed to determine the antibiotic-resistant pattern of bacteria associated with the spoilage of Avocado pear (Persea americana) sold in the Sokoto metropolis. Twenty spoilt avocado fruits were obtained from market three in Sokoto Metropolis. The bacteriological analysis was carried out using the pour plate method. The antibiotic resistance pattern was determined using the Kirby-Bauer disk diffusion method. A total of five species of bacteria were isolated and identified in this study. The mean and standard error of total viable bacterial counts of avocado samples across three different locations ranged from 4.20±5.77 to 8.43±33.49 (x 104CFU/g). A total of 19 bacterial isolates were identified from avocado samples. Staphylococcus aureus had the highest frequency of occurrence, 16 (29.2%), while Klebsiella sp. had the lowest frequency of occurrence, 7 (12.7%). Among all antibiotics tested against bacterial species, Escherichia coli isolates were found to have 10 (91%) and 9 (82%) resistance against ciprofloxacin and streptomycin, respectively. Pseudomonas sp. was found to be 100% resistant to chloramphenicol and Septrin (cotrimoxazole). However, S. aureus was found to have 12 (72%) resistance to pefloxacin. Similarly, Klebsiella spp. were found to be 7 (100%) resistant to Septrin. Isolation of these bacterial species, especially E. coli from avocado samples analyzed, is of public health significance, especially the presence of antibiotic resistance species.

Descriptive analysis of deaths associated with COVID-19 in Fiji, 15 April to 14 November 2021

Objective

There is limited published information about deaths due to coronavirus disease 2019 (COVID-19) in Fiji, the World Health Organization's Western Pacific Region and low- and middle-income countries. This report descriptively analyses deaths directly associated with COVID-19 in Fiji by age group, sex, ethnicity, geographical location, vaccination status and place of death for the first 7 months of the 2021 community outbreak.

Methods

A retrospective analysis was conducted of deaths directly associated with COVID-19 that occurred from 15 April to 14 November 2021 in Fiji. Death rates per 100 000 population were calculated by using divisional population estimates obtained from medical zone nurses in 2021.

Results

A total of 1298 deaths relating to COVID-19 were reported, with 696 directly associated with COVID-19 and therefore included in the analysis. Of these, 71.1% (495) were reported from the Central Division, 54.6% (380) occurred among males, 75.6% (526) occurred among people of indigenous (iTaukei) ethnicity and 79.5% (553) occurred among people who were unvaccinated. Four deaths were classified as maternal deaths. The highest percentage of deaths occurred in those aged ³70 years (44.3%, 308), and the majority of deaths (56.6%, 394) occurred at home.

Discussion

At-risk populations for COVID-19 mortality in Fiji include males, iTaukei peoples, and older (³70 years) and unvaccinated individuals. A high proportion of deaths occurred either at home or during the first 2 days of hospital admission, potentially indicating both a reluctance to seek medical care and a health-care system that was stressed during the peak of the outbreak.

COVID-19 incidence, severity, medication use, and vaccination among dentists: survey during the second wave in Brazil

Objective

This cross-sectional study with dentists in Brazil assessed the COVID-19 incidence and severity, its vaccination status, and the level of confidence in vaccines in May 2021 (COVID-19 second wave). The medications used to prevent or treat COVID-19, including controversial substances (vitamin D, ivermectin, zinc, and chloroquine), were analyzed.

Methodology

Dentists were recruited by email and responded to a pretested questionnaire until May 31, 2021. Bivariate and multivariate regression analyses were performed (α=0.05). Prevalence ratios were calculated for the association between professional characteristics and two outcomes: SARS-CoV-2 infection and use of controversial substances.

Results

In total, 1,907 responses were received (return rate of 21.2%). One third of dentists reported intermediate levels of confidence in the safety and efficacy of COVID-19 vaccines, but 96% had received at least one vaccine dose, mainly CoronaVac. The effect of the pandemic on dental practice was classified as lower/much lower, in comparison with the first wave, by 46% of participants. Moreover, 27% of dentists had already tested positive for SARS-CoV-2 and about 50% had relatives or friends who had been hospitalized or died from COVID-19. At least one medication was used by 59% of participants and 43% used two or more substances. Vitamin D (41%), ivermectin (35%), and zinc (29%) were the most frequent substances. More experienced dentists (≥21 years of professional experience) were 42% more likely to use controversial substances than less experienced dentists. The prevalence of use of controversial substances was 30% higher among dentists with residency or advanced training, such as postgraduate degrees, in comparison with participants holding MSc or PhD degrees. Participants with low confidence in vaccines were 2.1 times more likely to use controversial substances than participants with a very high confidence.

Conclusion

The results of this study show the high severity of the COVID-19 pandemic in Brazil and raised questions about the use of scientific evidence by dentists in their decision to use controversial substances.