Global Dilemma and Needs Assessment Toward Achieving Sustainable Development Goals in Controlling Leishmaniasis.

Leishmaniasis is a disease of poverty that imposes a devastating medical, social, and economic burden on over 1 billion people nationwide. To date, no in-depth study to analyze the major global challenges and needs assessment has been carried out. This investigation aimed to explore a comprehensive narrative review of leishmaniasis's main challenges and initially highlight obstacles that might impede the implementation of control measures. Also, we propose a specific list of priorities for needs assessment. The presence of socioeconomic factors, multiple clinical and epidemiological forms, various Leishmania species, the complexity of the life cycle, the absence of effective drugs and vaccines, and the lack of efficient vector and reservoir control make this organism unique and sophisticated in playing a tangled role to react tricky with its surrounding environments, despite extensive efforts and implementation of all-inclusive former control measures. These facts indicate that the previous strategic plans, financial support, and basic infrastructures connected to leishmaniasis surveillance are still insufficient. Strengthening the leishmaniasis framework in a context of accelerated programmatic action and intensification of cross-cutting activities along with other neglected tropical diseases (NTDs) is confidently expected to result in greater effectiveness, cost-benefit, and fruitful management. Sensitive diagnostics, effective therapeutics, and efficacious vaccines are vital to accelerating advancement toward elimination, and reducing morbidity/mortality and program costs. Collective actions devoted by all sectors and policy-makers can hopefully overcome technical and operational barriers to guarantee that effective and coordinated implementation plans are sustained to meet the road map for NTDs 2021- 2030 goals.

A prospective longitudinal study on the elimination trend of rural cutaneous leishmaniasis in southeastern Iran: Climate change, population displacement, and agricultural transition from 1991 to 2021.

Leishmaniasis is a complex disease. Any change in weather conditions affects the humans' social and agricultural expansion and, consequently, the parasite's life cycle in terms of ecology, biodiversity, social stigma, and exclusion. This population-based prospective longitudinal investigation was conducted between 1991 and 2021 in a well-defined CL (cutaneous leishmaniasis) focus in Bam County, southeastern Iran. A robust health clinic and health surveillance system were responsible for the ongoing systematic documentation, detection, identification, and management of CL cases. The exponential smoothing method via the state space model was used in the univariate time series. The TTR, smooth, and forecast packages were used in R software. Landsat satellite images from 1991, 2001, 2011, and 2021 were employed in the physical development. During this period, the temperature increased while the rainfall and humidity decreased. The findings showed a downward trend in the standardized drought index. Also, the results showed that climate warming and ecological changes profoundly affected the area's agricultural patterns and topographical features. Furthermore, the last three decades witnessed an elimination trend for zoonotic CL (ZCL) and the predominance of anthroponotic CL (ACL). The present findings showed that the critical factors in the predominance of ACL and elimination of ZCL were rising temperature, drought, migration, unplanned urbanization, earthquake, and agrarian reform. The wall-enclosed palm tree gardens excluded the primary ZCL reservoir host. They controlled the disease while providing suitable conditions for the emergence/re-emergence of ACL in the newly established settlements and the unplanned ecozone. Therefore, robust health infrastructures, sustained financial support, and evidence-based research studies are crucial to facilitating the necessary surveillance, monitoring, and evaluation to control and eliminate the disease.

An Efficient Electrochemical Sensor Based on NiCo2O4 Nanoplates and Ionic Liquid for Determination of Favipiravir in the Presence of Acetaminophen.

Based on the modification of carbon paste electrode with NiCo2O4 nanoplates and 1-hexyl-3-methylimidazolium tetrafluoroborate, a new electrochemical sensing platform for the sensing of favipiravir (a drug with potential therapeutic efficacy in treating COVID-19 patients) in the presence of acetaminophen was prepared. For determining the electrochemical behavior of favipiravir, cyclic voltammetry, differential pulse voltammetry, and chronoamperometry have been utilized. When compared to the unmodified carbon paste electrode, the results of the cyclic voltammetry showed that the proposed NiCo2O4 nanoplates/1-hexyl-3-methylimidazolium tetrafluoroborate/carbon paste electrode had excellent catalytic activity for the oxidation of the favipiravir in phosphate buffer solution (pH = 7.0). This was due to the synergistic influence of 1-hexyl-3-methylimidazolium tetrafluoroborate (ionic liquid) and NiCo2O4 nanoplates. In the optimized conditions of favipiravir measurement, NiCo2O4 nanoplates/1-hexyl-3-methylimidazolium tetrafluoroborate/carbon paste electrode had several benefits, such as a wide dynamic linear between 0.004 and 115.0 µM, a high sensitivity of 0.1672 µA/µM, and a small limit of detection of 1.0 nM. Furthermore, the NiCo2O4 nanoplates/1-hexyl-3-methylimidazolium tetrafluoroborate/carbon paste electrode sensor presented a good capability to investigate the favipiravir and acetaminophen levels in real samples with satisfactory recoveries.

A New Electrochemical Sensor for the Detection of Ketoconazole Using Carbon Paste Electrode Modified with Sheaf-like Ce-BTC MOF Nanostructure and Ionic Liquid.

An ultrasensitive and selective voltammetric sensor with an ultratrace-level detection limit is introduced for ketoconazole (KTC) determination in real samples using a modified carbon paste electrode with a sheaf-like Ce-BTC MOF nanostructure and ionic liquid. The as-synthesized nanostructure was characterized by several techniques, including energy-dispersive X-ray spectroscopy (EDX), X-ray diffraction (XRD), and field emission scanning electron microscopy (FE-SEM). The electrocatalytic performance of the developed electrode was observed by cyclic voltammetry (CV), differential pulse voltammetry (DPV), linear sweep voltammetry (LSV), and chronoamperometry. The limit of detection (LOD) of the developed sensor for KTC is 0.04 µM, and the response was found to be in the dynamic concentration range of 0.1-110.0 µM in a phosphate buffer solution. The proposed electrode exhibits acceptable electrocatalytic activity for KTC oxidation with a high sensitivity of 0.1342 µA·µM-1. The ability of the fabricated sensor to monitor KTC in real aqueous samples is demonstrated using standard addition data.

Fifty years of struggle to control cutaneous leishmaniasis in the highest endemic county in Iran: A longitudinal observation inferred with interrupted time series model.

Negligible data are available following major social activities and environmental changes on leishmaniasis. Therefore, how interactions between these events influence cutaneous leishmaniasis (CL) risk is not well-known. This longitudinal study was undertaken to explore the impact of interventions conducted between 1971 and 2020 in Bam county, which has had the highest disease burden in Iran. Only confirmed CL cases during this period were taken into account. Data were analyzed by SPSS 22 using the X2 test to assess the significance of the difference between proportions. Moreover, we used interrupted time series (ITS) to assess the impact of three environmental events during this period. Overall, 40,164 cases of CL occurred in the past five decades. Multiple complex factors were among the leading causes that synergistically induced the emergence/re-emergence of CL outbreaks in Bam. The main factors attributed negatively to CL control were cessation of malaria spraying activity, expansion of the city spaces, and a massive earthquake creating new breeding potentials for the vectors. The highest impact on CL incidence during these years was related to the earthquake [coefficient = 17.8 (95% CI: 11.3, 22.7); p-value < 0.001]. Many factors can contribute to CL outbreaks in endemic foci. They also can cause new foci in new areas. Since humans are the single reservoir for CL in this area, early detection and effective management significantly contribute to controlling CL to reduce the disease burden. However, essential evidence gaps remain, and new tools are crucial before the disease can ultimately be controlled. Nevertheless, sustained funding and more trained task forces are essential to strengthen surveillance and case management and monitor the interventions' impact.

A long-lasting emerging epidemic of anthroponotic cutaneous leishmaniasis in southeastern Iran: population movement and peri-urban settlements as a major risk factor.

BACKGROUND: Epidemics of cutaneous leishmaniasis (CL) are occurring more frequently and spreading faster and farther than before in many areas of the world. The present study aimed to assess a long-lasting emerging epidemic (2005-2019) of 5532 cases with anthroponotic CL (ACL) in peri-urban areas of Kerman city in southeastern Iran. METHODS: This descriptive-analytical study was carried out for 15 years in Kerman province, southeastern Iran. The data were passively obtained through the health surveillance system and the Kerman Leishmaniasis Research Center. Every subject was diagnosed using direct smear microscopy. The representative causative agent was further examined by ITS1-PCR, PCR-RFLP, 7SL RNA gene sequencing and phylogenetic analyses. For each subject, a case report form designating demographic and clinical data was recorded. RESULTS: A different pattern of ACL incidence was found in peri-urban areas compared to that in the city of Kerman. The incidence rate of ACL cases has significantly increased (P < 0.001) from 2005 to 2016 in new settlements with a gradual decline after that. The overall average risk of contracting the disease was 7.6 times higher in peri-urban areas compared to Kerman city, an old endemic focus. All isolates consisting of six variants were confirmed to be Leishmania tropica. The overall pattern of the ACL infection indicates that the etiological agent of ACL is propagated and transmitted by the bite of female Phlebotomus sergenti sandflies from person to person from dissimilar clones as reflected by the complexity of the migrants' backgrounds in the province. CONCLUSIONS: The movement of populations and establishment of new settlements in peri-urban areas close to endemic areas are major risk factors for and are directly linked to CL. The underlying factors of this emerging ACL epidemic caused by L. tropica were disasters and droughts, among others. A robust commitment to a multilateral approach is crucial to make improvements in this area. This will require decisive coordinated actions through all governmental factions and non-governmental organizations. Furthermore, active and passive case detection strategies, early diagnosis, and effective treatment could help control the disease.

A Screen-Printed Electrode Modified With Graphene/Co3O4 Nanocomposite for Electrochemical Detection of Tramadol.

In this paper, graphene (Gr)/Co3O4 nanocomposite was synthesized and utilized for the development of a novel electrochemical sensor to detect tramadol. Tramadol determination was examined by linear sweep voltammetry, differential pulse voltammetry, cyclic voltammetry, and chronoamperometry on Gr/Co3O4 nanocomposite-modified screen-printed electrode (Gr/Co3O4/SPE) in phosphate-buffered saline (PBS). Under the optimized condition, the detection limit of tramadol is 0.03 µM (S/N = 3) in the linear ranges of 0.1-500.0 µM. Furthermore, Gr/Co3O4/SPE was satisfactorily utilized to detect tramadol in tramadol tablet and urine specimens.

Comparison five primer sets from different genome region of COVID-19 for detection of virus infection by conventional RT-PCR.

BACKGROUND AND OBJECTIVES: The new beta-coronavirus, which caused Severe Acute Respiratory Coronavirus-2 Syndrome (SARS-CoV-2), a major respiratory outbreak in Wuhan, China in December 2019, is now prevalent in many countries around the world. Identifying PCR-based viruses is a well-known and relatively stable protocol. Unfortunately, the high mutation rates may lead to widespread changes in viral nucleic acid sequences, and so using specific primers for PCR can be recommended. In this study, we evaluated the power of a conventional RT-PCR to detect SARS-CoV-2 RNA among the five set primer sets. MATERIALS AND METHODS: The five genomic regions of the Coronavirus SARS-2 virus including Nucleocapsids (N), Envelope (E), RNA depended RNA Polymerase (RdRp), ORF1ab and Spike (S) were selected for primer designing. A conventional RT-PCR was performed to compare sensitivity, specificity and other analytical characteristics of primers designed against two Real Time PCR commercial kits. RESULTS: The result of the comparative analysis showed that the ORF1ab, N and RdRp primers had a sensitivity, specificity and positive predictive value higher than other primers. A significant difference in the analytical sensitivity between the studied primer sets in RT-PCR kits was observed. CONCLUSION: In this study, the ORF1ab, Nucleocapsid and RdRp regions have the best primers for identifying the SARS-CoV-2 RNA between different genes that have been suggested.

Direct electrochemical detection of clozapine by RuO2 nanoparticles-modified screen-printed electrode.

This study introduces the sensitive electrochemical detection of clozapine with the use of a ruthenium(iv) oxide nanoparticle (RuO2 NP)-modified screen-printed electrode (RuO2 NPs/SPE). The electrochemical behaviors of clozapine at RuO2 NP/SPE have been examined via cyclic voltammetry (CV), differential pulse voltammetry (DPV) and chronoamperometry (CHA). According to the results, the modified electrode has been accompanied by a decreasing over-potential (ca. 170 mV) and enhancement in the peak current (3 times) in comparison with the bare SPE. The results indicated that RuO2 NP/SPE markedly augmented electro-catalytic activities toward clozapine oxidation. In addition, linear responses have been observed in the range between 0.2 and 500.0 µM with a sensitivity of 0.076 µA µM-1 and a limitation of detection of 0.07 µM (3σ). Moreover, the successful application of RuO2 NP/SPE has been seen in detecting clozapine in real samples, which showed satisfied recoveries. Therefore, outputs suggest that RuO2 NP/SPE will be promising for functional utilization.

Fabrication of magnetic iron oxide-supported copper oxide nanoparticles (Fe3O4/CuO): modified screen-printed electrode for electrochemical studies and detection of desipramine.

The present investigation examines a sensitive electrochemical technique to detect desipramine through Fe3O4/CuO nanoparticles (NPs). Fe3O4/CuO NPs were synthesized via a coprecipitation procedure, and the products were characterized via energy disperse spectroscopy, X-ray diffraction, transmission electron microscopy, scanning electron microscopy, and vibrating sample magnetometer. The voltage-current curve and differential pulse voltammetry examinations of Fe3O4/CuO-modified screen-printed electrode (Fe3O4/CuO/SPE) were followed by the determination of electro-catalytic activities toward desipramine oxidation in a phosphate buffer solution (pH = 7.0). In addition, the value of diffusion coefficient (D = 3.0 × 10-6 cm2 s-1) for desipramine was calculated. Then, based on the optimum conditions, it was observed that the currents of the oxidation peak were linearly proportionate to the concentration of desipramine in the broad range between 0.08 and 400.0 µM and LOD of 0.03 µM (S/N = 3). Finally, our new sensor was successfully utilized to detect desipramine in the real samples, with reasonable recovery in the range of 97.2% to 102.7%.

Associated-risk determinants for anthroponotic cutaneous leishmaniasis treated with meglumine antimoniate: A cohort study in Iran.

BACKGROUND: The control of cutaneous leishmaniasis (CL) is facilitated by knowledge of factors associated with the treatment failures in endemic countries. The aim of this evaluation was to identify the potential risk determinants which might affect the significance of demographic and clinical characteristics for the patients with anthroponotic CL (ACL) and the outcome of meglumine antimoniate (MA) (Glucantime) treatment. METHODOLOGY/PRINCIPAL FINDINGS: This current was executed as a cohort spanning over a period of 5 years which centered in southeastern part of Iran. Altogether, 2,422 participants were evaluated and 1,391 eligible volunteer patients with ACL caused by Leishmania tropica were included. Overall, 1,116 (80.2%) patients received MA intraleisionally (IL), once a week for 12 weeks along with biweekly cryotherapy, while 275 (19.8%) patients received MA alone (20 mg/kg/day for 3 weeks) (intramuscular, IM). The treatment failure rate in ACL patients was 11% using IL combined with cryotherapy plus IM alone, whilst 9% and 18.5% by IL along with cryotherapy or IM alone, respectively. Multivariate logistic regression model predicted 5 major associated-risk determinants including male (odds ratio (OR) = 1.54, confidence interval (CI) = 1.079-2.22, p = 0.018), lesion on face (OR = 1.574, CI = 1.075-2.303, p = 0.02), multiple lesions (OR = 1.446, CI = 1.008-2.075, p = 0.045), poor treatment adherence (OR = 2.041, CI = 1.204-3.46, p = 0.008) and disease duration > 4 months (OR = 2.739, CI = 1.906-3.936, p≤0.001). CONCLUSIONS/SIGNIFICANCE: The present study is the original and largest cohort of ACL patients who treated with MA. A comprehensive intervention and coordinated action by the health authorities and policy-makers are crucial to make sure that patients strictly follow medical instructions. Early detection and effective therapy < 4 months following the onset of the lesion is critical for successful treatment of the patients. Since a significant number of patients are still refractory to MA, reducing man-vector exposure and development of new effective alternative drugs are essential measures against ACL due to L. tropica.

Bam Earthquake Survivors' Mental Health Status 12 Years after the Earthquake: A Population-Based Study.

BACKGROUND: Mental health is one of the characteristic benchmarks of public health. This research aimed to evaluate mental health of survivors of the Bam earthquake which occurred in 2003 twelve years after the earthquake in fall of 2015. METHODS: The statistical population of this cross-sectional study were people over 16 years of age who were present at the time of the earthquake in the city of Bam. The sample of the study consisted of 1500 people selected from the survivors by multistage sampling. The general health questionnaire-28 was used as a screening tool for mental disorders. The independent sample test, ANOVA test, Welch test, one-sample t test and the multiple logistic regression test were used to analyze the data. The analysis of data in the current study was carried out using the SPSS-18 software. RESULTS: Using the GHQ Likert scoring method, the results showed 52% of the people surveyed were suspected of having mental disorders (49.93% of men and 54.27% of women). Somatization and anxiety is more frequent than severe depression in respondents. The obtained statistics revealed that the prevalence of mental disorders amplified with loss of close relatives and age (odds ratio [OR] =1.457 and 1.828 respectively). The results also indicated that widows and divorcees (66.66%), illiterates and drop-outs (57.48%) and the elderly (77.12%) had the highest average in terms of having mental disorders. CONCLUSION: The results of this study showed more than half of the Bam earthquake survivors are suspected to be suffering from mental disorders. Since natural disaster-related mental illness effects can last for many years, comprehensive screening programs at regular intervals are required. Mental health services should be available to the elderly and people at risk in order to ensure restoration of mental health after a catastrophe.

The severity of cutaneous leishmaniasis before and after the earthquake in Bam, southeastern Iran.

Cutaneous leishmaniasis (CL) is a major disease with significant public health concerns in Iran. The objective of this study was to compare the severity of CL among the patients before and after the earthquake in the city and suburbs of Bam, southeastern Iran. This study was carried out as a descriptive-analytical manner by house-to-house visits in 2010 in Bam, southeastern Kerman province of Iran, where a massive earthquake has recently occurred. Overall, 1,481 individuals were selected as a cluster random sampling. Suspected lesions were detected by direct smear preparation and X(2) test was used for statistical significance at P < 0.05. Overall, 1,481 individuals (mean age; 25.7 ± 17.6 years) consisting of 51.4 % males and 48.6 % females were randomly selected. 549 individuals showed history of CL; 23.4 % belonged to before and 13.7 % belonged to after the earthquake. When the overall severity in terms of location, number, size and duration of lesions was considered, the lesions were less severe in the time period after the earthquake (P < 0.05) than those before the earthquake. Cutaneous leishmaniasis is currently considered as a growing public health concern worldwide, mainly due to creation of various risk factors particularly after a major natural disaster. Possibly the establishment of the CL health clinic to serve patients and to coordinate various activities had a major role in planning control strategies and thus reduction in severity of the CL disease.

A comprehensive review of cutaneous leishmaniasis in kerman province, southeastern iran-narrative review article.

BACKGROUND: Cutaneous leishmaniasis (CL) remains a serious public health concern in Kerman Province, eastern Iran. This study was aimed to conduct a comprehensive review and highlights various aspects of CL in the province of Kerman. METHODS: This article mainly focuses on the studies published in the past 26 years on CL in the province. Current data for the present status were obtained through the provincial health system. RESULTS: Bam was the most infected district (63.6%), followed by Kerman (24.7%) and other districts to a less extent. Leishmania tropica is the major causative agent (95.5%) of CL in Kerman province, however, L. major accounts for 4.5% of the total cases. Bam, Kerman and southern districts of Kerman province were purely anthroponotic CL (ACL), while Rafsanjan, Baft, and Sirjan showed both ACL and zoonotic CL (ZCL). In contrast, Orzoieh district was merely endemic to ZCL type. Phlebotomus sergenti was the main vector in ACL foci while Ph. papatasi was the major vector in the ZCL district of Orzoieh. Localized CL was the most prevalent form (80%) of the disease, while leishmaniasis recidivans was the most uncommon clinical manifestation (18.7%). CONCLUSION: Due to recent rises in CL disease both in regard of increases in incidence rate and expansion of the disease to new foci, and presence of various risk factors in the province, control measures and health strategies should have high priorities to help treat the existing cases and prevent the expansion of the disease to new areas.

A prospective cohort study of cutaneous leishmaniasis risk and opium addiction in south eastern Iran.

Opium addiction and cutaneous leishmaniasis (CL) are endemic in different parts of Iran, particularly in Bam, where a massive earthquake occurred. This study was designed to compare the incidence rate and severity of CL cases among opium addicted and non-addicted individuals in south-eastern Iran. This study was carried out as a prospective cohort by active house-to-house visits of 1,481 habitants in Bam. CL cases were confirmed by smear and identification of Leishmania species was performed using nested-PCR. The data was analyzed by χ(2) and t-tests, using SPSS software and also Kaplan-Meier survival curve and long-rank test in Stata 11.2 and P<0.05 was considered as significant. A total of 904 individuals consisting of 226 opium addicted and 678 non-addicted individuals were followed-up for a period of seven years. The two cohorts were similar in terms of age, sex and place of residency. A similar pattern of incidence was observed among the two cohort groups. In contrast, the severity of CL in terms of the number, duration and the size of the lesions in opium addicted individuals was significantly (P<0.001) higher than non-opium addicted individuals. In conclusion, the present findings indicate that there is no relationship between the incidence of CL and opium addiction.