The Effect of FOXP3+Regulatory T Cells on Infectious and Inflammatory Diseases

CD4+CD25+FOXP3+regulatory T cells (Tregs) contribute to the maintenance of immune homeostasis and tolerance in the body. The expression levels and functional stability of FOXP3 control the function and plasticity of Tregs. Tregs critically impact infectious diseases, especially by regulating the threshold of immune responses to pathogenic microorganisms. The functional regulatory mechanism and cell-specific surface markers of Tregs in different tissues and inflammatory microenvironments have been investigated in depth, which can provide novel ideas and strategies for immunotherapies targeting infectious diseases.Copyright © 2021. All rights reserved.

19th Seminar on Tropical Pathology and Public Health 12th Biotechnology Week 1st Physical Therapy Week, Virtual, 23-25 November 2022

These proceedings comprise 85 articles spanning diverse fields such as bacteriology, molecular biology, biotechnology, dermatology, infectious and parasitic diseases, epidemiology, physiotherapy, immunology, mycology, parasitology, pathology, collective health, and virology. The articles delve into a wide range of research topics, from repurposing drugs for Mycobacterium abscessus complex infections to utilising artificial intelligence for SARS-CoV-2 diagnosis. In bacteriology, investigations explore the correlation between smoking and Helicobacter pylori infection in gastric adenocarcinoma patients, as well as the resistance profiles of Staphylococcus aureus and Pseudomonas aeruginosa in tracheostomised children. Molecular biology studies focus on gene polymorphisms related to diseases like paracoccidioidomycosis. Biotechnology research emphasises bioactive molecules in species like Croton urucurana and the development of computational models for cytotoxicity prediction. Dermatology articles address stability characterisation in vegetable oil-based nanoemulsions. The section on infectious and parasitic diseases encompasses studies on COVID-19 vaccine response in pregnant women and the impact of infection prevention measures in rehabilitation hospitals. Epidemiology investigations analyse trends in premature mortality, tuberculosis in diabetic patients, and public adherence to non-pharmacological COVID-19 measures. Physiotherapy research covers topics such as telerehabilitation through a developed game and the prevalence of congenital anomalies. Immunology studies explore immune responses in HIV and Leishmaniasis, whilst mycology investigates the biotechnological potential of fungi from the cerrado biome. Parasitology research evaluates treatment efficacy against vectors parasites such as Aedes aegypti and Toxoplasma gondii. Pathology articles discuss intentional intoxication in cattle and the influence of curcumin on acute kidney injury therapy. Collective health studies focus on intervention plan development in healthcare settings and pesticide use in horticulture. Lastly, virology research investigates parvovirus occurrence in hospitalised children during the COVID-19 pandemic, hidden hepatitis B virus infection in inmates, and the prevalence of HPV and HTLV-1/2 infections in specific populations.

Health Benefits, Therapeutic Applications, and Recent Advances of Cirsilineol in the Medicine: Potential Bioactive Natural Flavonoids of Genus Artemisia.

BACKGROUND: Herbal medicine and its derived products have been used in the medicine and nutraceutical sectors for the treatment of human disorders and associated secondary complications. Plant-derived products play an important role in our daily life due to their medicinal properties and pharmacological activities. The attention of scientists to natural products has increased due to their significant biological activities. Flavonoids represent one of the most important phytocompounds present in the higher plants, common fruits, vegetables, herbs, wine, juices, and dried fruits. Flavonoids exert potent antioxidant activity by blocking and scavenging free radicals. Cirsilineol, also called 4',5-dihydroxy-3',6,7-trimethoxyflavone, is an active phytochemical of Artemisia vestita, Artemisia monosperma, Artemisia asiatica, and Agrostis gigantea. METHODS: Medicinal importance and pharmacological activities of cirsilineol have been investigated in the present work with their analytical aspects in order to know the biological importance of cirsilineol in medicine. Literature data on cirsilineol were collected and analyzed in the present work to study its therapeutic potential against various human disorders and associated secondary complications. Scientific data were collected from Google, Google Scholar, PubMed, Science Direct, and Scopus and analyzed in the present work using the term herbal medicine, flavonoid and cirsilineol. RESULTS: Medicinal plants containing a significant amount of cirsilineol have biological applications in medicine due to their pharmacological activities. This present work signifies the biological importance of cirsilineol in medicine as it has anti-proliferative, gastroprotective, anti-Helicobacter pylori, anti-diabetic and anti-oxidant activities. Further therapeutic effectiveness of cirsilineol against different types of cancers, including breast carcinoma and lung carcinoma, has been discussed in the present work. The biological importance of cirsilineol against allergic rhinitis, inflammation, coronavirus, immune system, renal cellular membrane and protein glycation has also been discussed in the present work. However, the importance of analytical methods for the isolation and identification of cirsilineol in medicine has also been analyzed. CONCLUSION: This work aimed to summarize the health-beneficial aspects of cirsilineol in medicine which will be beneficial to explore the further therapeutic effectiveness of cirsilineol for the treatment of various forms of human disorders.

Miscellaneous causes of abdominal pain

FAPDs (Functional Abdominal Pain Disorders) are the most common cause of chronic abdominal pain but are largely diagnoses of exclusion. More specific, but much less common, causes of acute and chronic abdominal pain include COVID-19 (PIMS-TS), Helicobacter pylori infection, Yersinia spp. Infection and Familial Mediterranean Fever. © Springer Nature Switzerland AG 2022. All rights reserved.

Fatal gastritis and enterocolitis due to concurrent Helicobacter pylori and Campylobacter jejuni infection in a captive cheetah (Acinonyxjubatus).

A 3.5-year-old female cheetah (Acinonyx jubatus) died after a 10-day history of anorexia, regurgitation and diarrhoea despite symptomatic therapy. At gross post-mortem examination, the stomach was blood-filled with mucosal thickening and multifocal ulcerations. The intestinal mucosa was thickened and reddened, and the intestinal lumen was filled with dark red to black pasty content. Gastric histological lesions were compatible with gastritis due to Helicobacter infection, which was confirmed by polymerase chain reaction. Histology of the intestines revealed a severe necrotizing neutrophilic enterocolitis with abundant intralesional curved to spiral bacteria, corresponding to Campylobacter jejuni, which were subsequently isolated from both small and large intestinal contents. No other intestinal pathogens were detected despite thorough investigations. These findings suggest that C. jejuni may have played an aetiological role in the enterocolitis. Such an association has not been previously reported in non-domestic felids.

Immunoinformatic prediction of potential immunodominant epitopes from cagW in order to investigate protection against Helicobacter pylori infection based on experimental consequences.

Helicobacter pylori is a leading cause of stomach cancer and peptic ulcers. Thus, identifying epitopes in H. pylori antigens is important for disease etiology, immunological surveillance, enhancing early detection tests, and developing optimal epitope-based vaccines. We used immunoinformatic and computational methods to create a potential CagW epitope candidate for H. pylori protection. The cagW gene of H. pylori was amplified and cloned into pcDNA3.1 (+) for injection into the muscles of healthy BALB/c mice to assess the impact of the DNA vaccine on interleukin levels. The results will be compared to a control group of mice that received PBS or cagW-pcDNA3.1 (+) vaccinations. An analysis of CagW protein antigens revealed 8 CTL and 7 HTL epitopes linked with AYY and GPGPG, which were enhanced by adding B-defensins to the N-terminus. The vaccine's immunogenicity, allergenicity, and physiochemistry were validated, and its strong activation of TLRs (1, 2, 3, 4, and 10) suggests it is antigenic. An in-silico cloning and immune response model confirmed the vaccine's expression efficiency and predicted its impact on the immune system. An immunofluorescence experiment showed stable and bioactive cagW gene expression in HDF cells after cloning the whole genome into pcDNA3.1 (+). In vivo vaccination showed that pcDNA3.1 (+)-cagW-immunized mice had stronger immune responses and a longer plasmid DNA release window than control-plasmid-immunized mice. After that, bioinformatics methods predicted, developed, and validated the three-dimensional structure. Many online services docked it with Toll-like receptors. The vaccine was refined using allergenicity, antigenicity, solubility, physicochemical properties, and molecular docking scores. Virtual-reality immune system simulations showed an impressive reaction. Codon optimization and in-silico cloning produced E. coli-expressed vaccines. This study suggests a CagW epitopes-protected H. pylori infection. These studies show that the proposed immunization may elicit particular immune responses against H. pylori, but laboratory confirmation is needed to verify its safety and immunogenicity.

Helicobacter Pylori and Sars-Cov-2: A Dangerous Pathogenetic Correlation?

Background and aim: The correlation between Covid-19 and nonrespiratory bacteria is mostly unexplored. The following considerations led us to investigate a possible correlation between Hp and SARS-CoV2: both are microbial agents with a very large-scale epidemiology;both can cause GI symptoms;both can persist in the GI tract for long time [Fei Xiao, 2022];patients with pre-existing HP gastric colonization, once infected by SARS-CoV-2, complain more frequently and with greater severity of GI symptoms such as abdominal pain and diarrhea [Balamtekin, 2019];SARS-CoV-2 binds ACE-2 receptors to enter cells, which are widely expressed in the GI tract. In addition, Hp is known to increase the expression of ACE-2 receptors. This study aims to investigate, by C13 Urea BT, the prevalence of Hp infection and the DOB (delta over baseline), in pre-pandemic period (pPP), from Sept. 2017 to Dec. 2019, and during Covid-19 pandemic period (PP), from Jan. 2020 to Apr. 2022, to evaluate whether SARS-CoV-2 and Hp infection association is only due to chance or whether represents a pathogenetic correlation. Material(s) and Method(s): This is a retrospective preliminary study on 1532 randomized patients: 825 and 707 referring respectively to pPP and PP. Result(s): 316 patients underwent C13 Urea BT for the diagnosis of Hp infection: 36 out of 179 (20.11%), and 74 out of 137 (54.01%), respectively in pPP and in PP, tested positive for Hp. The DOB of patients tested during the PP was 40.4+/-17.5, significantly higher when compared to the mean value found in pPP: 17.4+/-16.5 (p=0.0001). [Figure presented] Conclusion(s): Neglecting the search for Hp, also due to difficulties encountered in this period to access BT, represents a risk condition for gastric diseases, especially considering the remarkable elevation of the prevalence and the DOB caused, somehow, by the SARS-CoV-2 virus. Particularly, the higher the DOB, the higher the bacterial load, but, more significantly, the greater the ability of the bacterial strains to produce urease: the strains with the greatest urease-activity are cagA+ strains (those capable of producing the oncogenic protein involved in the process of carcinogenesis) [Moreno-Ochoa, 2020]. Thus, it can be assumed that the higher the DOB, the greater the risk of developing serious gastric problems in the absence of treatment. So, in conclusion, Sars-Cov-2 and HP infection may influence each other. GI morphological and functional alterations due to Sars-Cov-2 infection, which can promote HP colonization and replication, need further investigation.Copyright © 2023. Editrice Gastroenterologica Italiana S.r.l.

New onset chronic spontaneous urticaria post COVID-19 vaccination in South Africa

Background: Chronic spontaneous urticaria (CSU) is a common chronic inflammatory disease. There have been small case series of new onset CSU post COVID-19 infection as well as reports of new onset CSU or worsening of existing CSU post COVID-19 vaccination. Dermatological side effects post COVID-19 vaccine are typically delayed, self-limiting urticaria. We have described the characteristics of patients who have developed new onset CSU post COVID-19 vaccination. Method(s): All patients referred to the UCT Lung Institute Allergy clinic from the initiation of the COVID-19 vaccine roll out (February 2021) were reviewed to identify patients that developed new onset CSU within 12 weeks of receiving a COVID-19 vaccine. Medical history, response to therapy, and available laboratory investigations were reviewed by clinic physicians. Result(s): We identified seven patients that developed CSU post COVID-19 vaccine. The median age of the cohort is 39 (IQR 32-45) and the majority are female (n = 5). The most common vaccine was the Pfizer-BioNTech BNT162b2 mRNA COVID-19 vaccine (n = 6, 85.7%), and one patient received the Jansen Ad26.COV2.S vaccine. No patients had COVID-19 infection prior to vaccination and only one patient contracted COVID-19 post vaccination. The median time to the development of symptoms post vaccination was 14 days (IQR 2;44) and the median time to diagnosis was 90 days (IQR 45;120). Most patients (n = 4) reported angioedema and urticaria, one patient reported isolated angioedema, and two isolated urticaria. The median initial UAS7 score was 37.5 (IQR 24.5;46) and the initial CU-Q2oL score was 72 (IQR 56;76) indicating severe disease activity. All but one patient had a history of atopy with the most common diagnoses being allergic rhinitis (n = 5) and atopic dermatitis (n = 3). All patients had normal eosinophil counts and over half of the patients (n = 4) had an elevated total IgE level (median 26.4 [IQR 9.8;194]). All patients were HIV negative and one patient had positive Helicobacter pylori serology. All had normal serum protein electrophoresis, thyroid function (with negative thyroid autoantibodies), and negative antinuclear antibodies. All patients started on high dose antihistamine therapy with 71.1% having partial or no response to therapy. Conclusion(s): New onset CSU is a rare side effect of COVID-19 vaccination with poor response to high dose antihistamine therapy. It is important that allergists and physicians are aware of the possibility of new onset CSU post COVID-19 vaccine and further research is needed to identify risk factors.

A Comprehensive Review on the Medicinal Benefits of Honey with an Emphasis on Unani Medicine

Background: Honey has been used medicinally in folk medicine since the dawn of civili-zation. It is a necessary component of medicine and food in a wide variety of cultures. It has been used in Unani Medicine for centuries to treat a variety of ailments. Objective(s): This review article aims to explore the medicinal characteristics of honey in view of Unani and modern concepts, highlight its potential in the treatment of the ailments stated in Unani medical literature, and also explore the relevant evidence-based phytochemistry, pharmacological, and clinical data. Method(s): The authors searched classical texts exhaustively for information on the temperament (Mizaj), pharmacological activities, mechanism of action, and therapeutic benefits of honey. Addition-ally, a comprehensive search of internet databases was conducted to compile all available information on the physicochemical, phytochemical, and pharmacological properties of this compound. Result(s): Evidence suggests that honey contains about 180 different types of various compounds, including carbohydrates, proteins, enzymes, flavonoids, and other chemical substances. In Unani classical literature, it exerts important pharmacological actions besides its immense nutritional signifi-cance. Unani physicians advocated many tested/experimented prescriptions and formulations, which still have their relevance in the amelioration of various diseases. Conclusion(s): This analysis concludes that honey has been successfully utilized in Unani medicine for centuries to treat a variety of maladies and is a potential natural source of remedy for a variety of medical disorders. Future research on honey should include a combination of Unani and modern principles.Copyright © 2023 Bentham Science Publishers.

Microorganisms in the Pathogenesis and Management of Immune Thrombocytopenia (ITP)

Immune thrombocytopenia (ITP) represents an immune-mediated condition characterized by isolated thrombocytopenia due to the production of autoantibodies directed at human thrombocytes with a subsequent decrease in the platelet count below 100, 000 platelets/mmc. Microbial pathogens have emerged as key players in the development of ITP and are frequently listed as causes in the development of secondary ITP in adults, alongside autoimmune disorders, immune deficits, blood cancers, and others. This chapter briefly reviews the role of Helicobacter pylori, HIV, HCV, HBV, and SARS-CoV-2 (the viral agent responsible for the development of COVID-19) in the pathogenesis and management of ITP. In addition, the role of the gut microbiota and post-vaccination ITP is discussed. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022.

Migration and spread of infectious diseases: From the origin of Homo sapiens up to the Anthropocene

A typifying characteristic of Homo sapiens is its ability to walk upright, which allowed humans to move about in grasslands, enabling them to leave the forests of central Africa and populate the rest of Africa and later the world, a success story like no other. Africa is the place of origin of Homo sapiens. The first major migration of anatomically modern humans, known as the Out-of-Africa migration, was the first of many migratory events of Homo sapiens that continue up to the current era that shaped the world and society. This article aims to describe the defining role of human migration in spreading infectious diseases from pre-history to the present. In future, infectious diseases will continue to spread through migration. However, by contrast, the spread of diseases will be exacerbated due to the opportunities provided in the Anthropocene epoch and will become progressively more challenging. Migration is a term that encompasses the simultaneous movement of large numbers or groups of people away from their original place of living and for a specific reason. The main reasons for migration are emigration/immigration, forced displacement, slavery, migrant labour, asylum seeking and refugees. In addition, war, conflict, and environmental disasters such as droughts, famine and overpopulation are other common causes of migration. Migration is usually unplanned;it happens without warning or advanced planning and is accompanied by a large-scale disruption in the socio-economic structure, health, and well-being of the migrants and/or other affected groups. Such major disruptions to individuals' normal living can weaken the immune system, leading to increased susceptibility to infectious diseases. In addition, temporary housing during migration can often also result in humanitarian disasters that increase opportunities for the transmission of infectious diseases. Migrants are also at risk of contracting new or previously-unencountered diseases prevalent in their chosen resettlement area. Conversely, migrants can carry with them microorganisms absent in the resettlement area. An example of this is the smallpox virus that was brought to South America by the Spanish colonisers. At that stage, poxvirus was absent in this continent, and the indigenous populations had no immunity to the pathogen. The transmission of the poxvirus by colonizers to indigenous populations almost destroyed the indigenous populations of the time. A form of migration that emerged more recently is travel. Travel migration is defined as the large number of unrelated individuals who travel simultaneously across the globe for work or pleasure. Travel migration has been enabled by advances in the speed by which air and train travel takes place. This results in large numbers of individuals being transported across the globe in a short period and over long distances. Travel by water, air and land resulted in the world's population being highly interconnected through the mingling of large numbers of people from geographically remote places but in a relatively short period. Travelling connects people and diseases across the globe. Examples of pathogens that spread through migration and that cause major infectious diseases include the smallpox virus, the human immuno-deficiency virus (HIV), and coronaviruses that cause Middle Eastern respiratory syndrome (MERS), coronavirus disease 2019 (COVID-19) and severe acute respiratory syndrome (SARS). Mycobacterium tuberculosis, the cause of tuberculosis, and Helicobacter pylori, which can cause gastric ulcers, are among the oldest known bacteria that infect humans and were already present in humans when the Out-of-Africa migration occurred. These two pathogens were carried with humans as they migrated and populated new areas of the world, and both have been present in large numbers of humans over millennia. These two organisms can only spread through very close contact between humans and have no host outside the body;therefore, they are great examples of how migration distributes infectious diseases across the world Mycobacterium tuberculosis is exceptionally well-adapted to spread and cause disease among individuals with lower immunity, such as migrants. Poor housing conditions and crowding, which invariably result from migration due to humanitarian disasters, advance the transmission of pathogens such as tuberculosis. Major lifestyle changes of humans occurred from the Paleolithic to the Neolithic after the Out-of-Africa migration, which directly or indirectly benefited the transmission of diseases. During the Neolithic, animals were domesticated, and agriculture started, allowing people to settle down and establishing the first towns and cities. The domestication of animals created an opportunity for pathogens to cross from animals to humans and adapt to the new host to cause new infectious diseases in humans, called zoonosis. The Anthropocene dawned when deforestation, mining, farming, and other human activities left their mark. As a result, the Anthropocene offers unique opportunities for the emergence and spread of infectious diseases: firstly, by zoonosis or the transmission of diseases from animals to humans, and secondly, the spread of the diseases through migration. Furthermore, changes in the weather and climate can lead to environmental migration. This occurs when people need to abandon their normal place of living because of severe weather events such as droughts and ice ages. Labour migration was responsible for the spread of HIV from its place of origin in Africa. This virus initially landed in humans through inter-species cross-over from primates to humans in the 1950s from eating semi-cooked bush meat. As a result, it became established in the indigenous populations of Africa. HIV is a sexually transmitted disease amongst humans, and migratory labourers from Haiti were infected with the virus while working in the Congo, where they transmitted the virus to people in Haiti upon their return. The MERS and SARS coronaviruses became human pathogens due to bat-human species cross-over, probably due to eating bush meat. However, the rapid distribution of these two viruses to other areas of the world was enabled through travel migration and the highly connected world population. Similarly, the extremely rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) upon its discovery in December 2019 was partly due to travel migration. In future, the negative impact of infectious diseases can be prevented by having disaster preparedness plans to protect the health and well-being of migrants and resident populations. However, events that can potentially be disastrous are difficult to pre-empt: the world was largely unprepared on how to respond to the rapid spread of SARS-CoV-2 and how to control the ensuing pandemic. Other recent examples of similar unforeseen events are the Ukraine-Russian conflict that started in March 2022, which caused many people from Ukraine to flee to other countries for safety. The second example is the heavy rain of April 2022 in the KwaZulu-Natal Province of South Africa, which caused massive destruction of houses and infrastructure, resulting in affected people being displaced. In both cases, the reasons for migration can have a detrimental impact on the health of the affected people, which renders them susceptible to disease transmission. © 2022 South African Academy for Science and the Arts. All rights reserved.

Migration and spread of infectious diseases: From the origin of Homo sapiens up to the Anthropocene

A typifying characteristic of Homo sapiens is its ability to walk upright, which allowed humans to move about in grasslands, enabling them to leave the forests of central Africa and populate the rest of Africa and later the world, a success story like no other. Africa is the place of origin of Homo sapiens. The first major migration of anatomically modern humans, known as the Out-of-Africa migration, was the first of many migratory events of Homo sapiens that continue up to the current era that shaped the world and society. This article aims to describe the defining role of human migration in spreading infectious diseases from pre-history to the present. In future, infectious diseases will continue to spread through migration. However, by contrast, the spread of diseases will be exacerbated due to the opportunities provided in the Anthropocene epoch and will become progressively more challenging. Migration is a term that encompasses the simultaneous movement of large numbers or groups of people away from their original place of living and for a specific reason. The main reasons for migration are emigration/immigration, forced displacement, slavery, migrant labour, asylum seeking and refugees. In addition, war, conflict, and environmental disasters such as droughts, famine and overpopulation are other common causes of migration. Migration is usually unplanned;it happens without warning or advanced planning and is accompanied by a large-scale disruption in the socio-economic structure, health, and well-being of the migrants and/or other affected groups. Such major disruptions to individuals' normal living can weaken the immune system, leading to increased susceptibility to infectious diseases. In addition, temporary housing during migration can often also result in humanitarian disasters that increase opportunities for the transmission of infectious diseases. Migrants are also at risk of contracting new or previously-unencountered diseases prevalent in their chosen resettlement area. Conversely, migrants can carry with them microorganisms absent in the resettlement area. An example of this is the smallpox virus that was brought to South America by the Spanish colonisers. At that stage, poxvirus was absent in this continent, and the indigenous populations had no immunity to the pathogen. The transmission of the poxvirus by colonizers to indigenous populations almost destroyed the indigenous populations of the time. A form of migration that emerged more recently is travel. Travel migration is defined as the large number of unrelated individuals who travel simultaneously across the globe for work or pleasure. Travel migration has been enabled by advances in the speed by which air and train travel takes place. This results in large numbers of individuals being transported across the globe in a short period and over long distances. Travel by water, air and land resulted in the world's population being highly interconnected through the mingling of large numbers of people from geographically remote places but in a relatively short period. Travelling connects people and diseases across the globe. Examples of pathogens that spread through migration and that cause major infectious diseases include the smallpox virus, the human immuno-deficiency virus (HIV), and coronaviruses that cause Middle Eastern respiratory syndrome (MERS), coronavirus disease 2019 (COVID-19) and severe acute respiratory syndrome (SARS). Mycobacterium tuberculosis, the cause of tuberculosis, and Helicobacter pylori, which can cause gastric ulcers, are among the oldest known bacteria that infect humans and were already present in humans when the Out-of-Africa migration occurred. These two pathogens were carried with humans as they migrated and populated new areas of the world, and both have been present in large numbers of humans over millennia. These two organisms can only spread through very close contact between humans and have no host outside the body;therefore, they are great examples of how migration distributes infectious diseases across the world Mycobacterium tuberculosis is exceptionally well-adapted to spread and cause disease among individuals with lower immunity, such as migrants. Poor housing conditions and crowding, which invariably result from migration due to humanitarian disasters, advance the transmission of pathogens such as tuberculosis. Major lifestyle changes of humans occurred from the Paleolithic to the Neolithic after the Out-of-Africa migration, which directly or indirectly benefited the transmission of diseases. During the Neolithic, animals were domesticated, and agriculture started, allowing people to settle down and establishing the first towns and cities. The domestication of animals created an opportunity for pathogens to cross from animals to humans and adapt to the new host to cause new infectious diseases in humans, called zoonosis. The Anthropocene dawned when deforestation, mining, farming, and other human activities left their mark. As a result, the Anthropocene offers unique opportunities for the emergence and spread of infectious diseases: firstly, by zoonosis or the transmission of diseases from animals to humans, and secondly, the spread of the diseases through migration. Furthermore, changes in the weather and climate can lead to environmental migration. This occurs when people need to abandon their normal place of living because of severe weather events such as droughts and ice ages. Labour migration was responsible for the spread of HIV from its place of origin in Africa. This virus initially landed in humans through inter-species cross-over from primates to humans in the 1950s from eating semi-cooked bush meat. As a result, it became established in the indigenous populations of Africa. HIV is a sexually transmitted disease amongst humans, and migratory labourers from Haiti were infected with the virus while working in the Congo, where they transmitted the virus to people in Haiti upon their return. The MERS and SARS coronaviruses became human pathogens due to bat-human species cross-over, probably due to eating bush meat. However, the rapid distribution of these two viruses to other areas of the world was enabled through travel migration and the highly connected world population. Similarly, the extremely rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) upon its discovery in December 2019 was partly due to travel migration. In future, the negative impact of infectious diseases can be prevented by having disaster preparedness plans to protect the health and well-being of migrants and resident populations. However, events that can potentially be disastrous are difficult to pre-empt: the world was largely unprepared on how to respond to the rapid spread of SARS-CoV-2 and how to control the ensuing pandemic. Other recent examples of similar unforeseen events are the Ukraine-Russian conflict that started in March 2022, which caused many people from Ukraine to flee to other countries for safety. The second example is the heavy rain of April 2022 in the KwaZulu-Natal Province of South Africa, which caused massive destruction of houses and infrastructure, resulting in affected people being displaced. In both cases, the reasons for migration can have a detrimental impact on the health of the affected people, which renders them susceptible to disease transmission. © 2022 South African Academy for Science and the Arts. All rights reserved.

SARS-CoV-2 and Helicobacter pylori and some hematological parameters: A case-control study

Background: The SARS-CoV-2 associated with bacterial infection represents a serious public health challenge. Recently, there is a remarkable increase in the number of researches that confirms the effect of Helicobacter pylori on pulmonary diseases. Aim(s): The goal of this research was to see how H. pylori affected the presentation of COVID-19 infections as a prospective risk factor. Material(s) and Method(s): This research was conducted in Babylon, Iraq, from January 1, 2022, to March 5, 2022. A total of 180 people were engaged in this study, with 90 patients identified with SARS-CoV-2 by polymerase chain reaction testing and 90 people serving as a control group. Antibody screening assays on blood samples were used to look for antibodies against H. pylori. The samples were processed for complete blood count and ABO blood group. Result(s): COVID-19 infection was more frequent in females than in males, especially between 31 and 45 years. When compared to healthy people, COVID-19 patients had a higher white blood cell count (P = 0.0001) and a lower lymphocyte count (P = 0.0001). H. pylori and COVID-19 have been found to have a strong relationship, especially in females. When comparing patients to healthy people, blood group A is the most common. Conclusion(s): People with H. pylori infections are considerably more sensitive to COVID-19 than people without H. pylori infections (P = 0.011). In combination with SARS-CoV-2, IgG for H. pylori might be a risk factor.Copyright © 2023 Journal of Medical Society Published by Wolters Kluwer-Medknow.

Large-scale, national, family-based epidemiological study on Helicobacter pylori infection in China: the time to change practice for related disease prevention.

BACKGROUND AND AIMS: Current practice on Helicobacter pylori infection mostly focuses on individual-based care in the community, but family-based H. pylori management has recently been suggested as a better strategy for infection control. However, the family-based H. pylori infection status, risk factors and transmission pattern remain to be elucidated. METHODS: From September 2021 to December 2021, 10 735 families (31 098 individuals) were enrolled from 29 of 31 provinces in mainland China to examine family-based H. pylori infection, related factors and transmission pattern. All family members were required to answer questionnaires and test for H. pylori infection. RESULTS: Among all participants, the average individual-based H. pylori infection rate was 40.66%, with 43.45% for adults and 20.55% for children and adolescents. Family-based infection rates ranged from 50.27% to 85.06% among the 29 provinces, with an average rate of 71.21%. In 28.87% (3099/10 735) of enrolled families, there were no infections; the remaining 71.13% (7636/10 735) of families had 1-7 infected members, and in 19.70% (1504/7636), all members were infected. Among 7961 enrolled couples, 33.21% had no infection, but in 22.99%, both were infected. Childhood infection was significantly associated with parental infection. Independent risk factors for household infection were infected family members (eg, five infected members: OR 2.72, 95% CI 1.86 to 4.00), living in highly infected areas (eg, northwest China: OR 1.83, 95% CI 1.57 to 2.13), and large families in a household (eg, family of three: OR 1.97, 95% CI 1.76 to 2.21). However, family members with higher education and income levels (OR 0.85, 95% CI 0.79 to 0.91), using serving spoons or chopsticks, more generations in a household (eg, three generations: OR 0.79, 95% CI 0.68 to 0.92), and who were younger (OR 0.57, 95% CI 0.46 to 0.70) had lower infection rates (p<0.05). CONCLUSION: Familial H. pylori infection rate is high in general household in China. Exposure to infected family members is likely the major source of its spread. These results provide supporting evidence for the strategic changes from H. pylori individual-based treatment to family-based management, and the notion has important clinical and public health implications for infection control and related disease prevention.

Evolution of Helicobacter pylori Resistance to Antibiotics: A Topic of Increasing Concern.

Antibiotic resistance among Helicobacter pylori strains is the major cause of eradication failure. Resistance prevalence is dynamic and can greatly vary among countries over the years. We revealed H. pylori resistance trends for five antibiotics in 14 countries through articles predominantly published in 2018-2022, since the latest data can best show the most recent trends in resistance evolution. Amoxicillin resistance generally exhibited no evolution, yet it increased in Bulgaria, Iran, China, and Vietnam. Metronidazole resistance exhibited different trends, including an increase, a decrease and no evolution in six, three, and five studies, respectively. Clarithromycin resistance increased in Australia, Belgium, Bulgaria, Italy, Iran, and Taiwan, but remained stable in France, Spain, Russia, China, Chile, and Colombia. Tetracycline resistance was low and stable except in Iran. Levofloxacin resistance increased in four European and six other countries/regions, without significant increases in France, Spain, and Chile. In Chile, triple resistance also increased. In countries such as France and Spain, resistance to most antibiotics was stabilized, while in Bulgaria, Belgium, Iran and Taiwan, resistance to three or more agents was reported. Use of non-recommended regimens, national antibiotic consumption, patient's compliance, host factors, strain virulence, migrations, and azithromycin overuse during the COVID-19 pandemic can influence resistance evolution. New drugs, eradication regimens and diagnostic methods, such as next-generation sequencing can improve H. pylori infection control.

Duodenal Stricture as a Rare, Possible Complication of Eosinophilic Gastrointestinal Disease (Egid)

EGID is a recently described condition with an unknown etiology and pathogenesis. There are three case reports of duodenal stricture associated with EGID: one in an adult requiring pancreaticoduodenectomy due to the suspicion of malignancy and 2 cases in a child and a young adult, who responded to oral steroids. We report the case of a 10-year-old who presented to A&E with a 9-month history of epigastric abdominal pain and 1 episode of haematemesis, on a background of asthma. He was treated for Helicobacter pylori, based on a positive stool antigen. Abdominal pain and vomiting persisted, therefore an oesophago-gastro-duodenoscopy (OGD) was performed. This identified widespread white plaques throughout the oesophagus, erythema and nodularity of the gastric antrum and white nodules in the first part of the duodenum. Histology revealed changes of EGID and eosinophilic oesophagitis (EOE) and patient was commenced on Montelukast, oral viscous Budesonide (OVB), Cetirizine and continued proton pump inhibitor (PPI). After the allergy workup identified house dust mites, cat sensitisation and fish allergy, a 6-food elimination diet was initiated. During the next 2 years, symptoms subsided, and endoscopy changes improved, with only mild signs of active EOE while on OVB, PPI and diary/egg/fish free diet. However, the patient relapsed due to poor compliance to treatment. He became more unwell during the Covid pandemic with recurrent vomiting and static weight. A trial of dupilumab was considered, however his reassessment OGD had to be delayed due to restricted access to theatre. He was treated empirically with a reducing course of oral prednisolone, with temporary response. The endoscopic assessment performed subsequently showed erythema, erosions and white plaques in the distal oesophagus and gastric antrum with narrowing between the first and the second part of the duodenum (D2), that could not be entered. Histology identified mild upper oesophagitis (4 eosinophils (eos)/HPF), active middle and lower oesophagitis (20 eos/HPF and 12 eos/HPF, respectively), chronic gastritis (80 eos/HPF) and nonspecific reactive changes of the proximal duodenum. A barium meal confirmed a duodenal stricture. At this stage, we recommended a sloppy diet and a second weaning course of oral prednisolone, along with Montelukast. He was subsequently commenced on azathioprine for maintenance of remission. A repeat barium study and small bowel MRI performed post course of steroids and on azathioprine revealed stable appearances of the proximal duodenal stricture, excluding the presence of further strictures. While the patient has responded to the course of oral steroids and azathioprine, a repeat upper GI endoscopy is currently planned to dilate the duodenal stricture. The challenges posed by this case were the rarity of the condition, limited treatment options and access to endoscopy during the Covid pandemic and the fact that unlike previous case reports a sustained remission could not be obtained on steroids, and a maintenance immunosuppressive medication was required. We can conclude that this subgroup of patients should be monitored closely for signs of bowel obstruction and will require more intense treatment, including immunomodulators, endoscopic dilatation and or surgery.

Helicobacter pylori eradication rates using clarithromycin and levofloxacin-based regimens in patients with previous COVID-19 treatment: a randomized clinical trial.

BACKGROUND: Helicobacter pylori (H. pylori) is affecting half of the globe. It is considered a main causative organism of chronic gastritis, peptic ulcer disease, and different gastric maliganacies. It has been also correlated to extraintestinal diseases, including refractory iron deficiency anaemia, vitamin B12 deficiency, and immune thrombocytopenic purpura. The misuse of antibiotics during the coronavirus diseases 2019 (COVID-19) pandemic time can affect H. pylori eradication rates. Our aim was to compare the efficacy of clarithromycin versus levofloxacin-based regimens for H. pylori treatment in naïve patients after the COVID-19 pandemic misuse of antibiotics. METHODS: A total of 270 naïve H. pylori infected patients with previous treatment for COVID-19 more than 3 months before enrolment were recruited. Patients were randomized to receive either clarithromycin, esomeprazole, and amoxicillin, or levofloxacin, esomeprazole, and amoxicillin. RESULTS: A total of 270 naïve H. pylori infected patients with previous treatment for COVID-19 more than 3 months before enrolment were included, 135 in each arm. In total, 19 patients in the clarithromycin group and 18 patients in the levofloxacin group stopped treatment after 2-4 days because of side effects or were lost for follow-up. Finally, 116 subjects in the clarithromycin group and 117 in the levofloxacin group were assessed. The eradication rates in intention to treat (ITT) and per protocol (PP) analyses were: group I, 55.56% and 64.66%; and Group II, 64.44% and 74.36% respectively (p = 0.11). CONCLUSION: As COVID-19 pandemic has moved forward fast, high resistance rates of H. pylori to both clarithromycin and levofloxacin were developed after less than two years from the start of the pandemic. Molecular & genetic testing is highly recommended to identify antimicrobial resistance patterns. Strategies to prevent antibiotic misuse in the treatment of COVID-19 are needed to prevent more antibiotic resistance. TRIAL REGISTRATION: The trial was registered on Clinicaltrials.gov NCT05035186. Date of registration is 2-09-2021.