Selected topics in public health - Editorial.

In 2019, there were several new epidemics of diseases around the world, which would only be known from old medical books. Conspiracy and antivax movements around the world have raised important issues about public health, its safety, prevention and the media. The importance of public health is increasing more than ever. That is why we are very pleased that we have succeeded in collecting enough quality articles to present a collection of papers this year again. We have a great need for quality data to combat disinformation, hoaxes and lies. But we also have a greater need to deliver this information to medically untrained people. We - doctors, nurses and medical workers - have lost our ability to talk to people, talk to them in ways they can actually understand us. This, and lack of time for patients, has brought us to this situation and only patience, good data and easily understandable language can give us success. We also have an important task to renew people's trust in doctors and to humanize modern medicine. So, together with the fight against epidemics, setting new standards for occupational safety or ensuring healthy habits for children, adults and the elderly, we should not forget to communicate in the first place. We are grateful for the opportunity to provide you with this supplemental issue of Neuroendocrinology Letters, where support for public health issues has always been strong.

Anaphylaxis in Public Health.

The increasing number of patients with anaphylactic reactions is a modern challenge for healthcare professionals in clinical practice and public health professionals. It remains difficult to determine the prevalence or incidence of anaphylaxis in the population due to the long absence of a consensus definition, the fact that analyses are performed on various population groups and the use of different data collection methodologies. In the United States, anaphylaxis mortality ranges from 0.63 to 0.76 cases per million inhabitants, with 58% of these deaths due to drug anaphylaxis. The risk factors for anaphylaxis are ramipril and metoprolol use, which is common in patients with cardiovascular disease. Also, a higher level of gliadin following excess gluten intake is associated with a higher incidence of anaphylaxis. Drugs, food and insect stings have long been known as anaphylaxis inductors. In diagnosis, determination of serum tryptase concentration is used. In patients with normal tryptase concentration, it is appropriate to screen other inflammatory mediators. The authors of this article present new findings on anaphylaxis in the literature and recommended practices of professional societies in the context of public health.

The Health Impact of Mineral Dust Air Pollution on the Global and Local Scale (on the example from Slovakia).

BACKGROUND: A significant proportion of anthropogenic dust particles are present in the atmosphere. In particular, these include industrial and municipal dust, black carbon from fossil fuels and biomass. Mineralogical research of dust particles in the air is important for knowing their impact on public health in hazardous work environments (not only in Slovakia). In the recent past (in 2000-2010), research of dust fallouts from mining and processing of mineral resources was carried out. Specifically, it was focused on the Lubeník and Jelsava area, where the environment and population were adversely affected by mining activities and magnesite (MgCO3) processing treatment. METHODS: The dust obtained from the plastic containers at the sampling stations was filtered in distilled-water wash. Afterwards the dust dispersion, respirable fraction and chemical composition were determined by analytical methods. The mineralogical characteristics of the particles were determined by X-ray powder diffraction (XRD) and their morphology by Scanning electron microscopy (SEM). RESULTS: The exposure to dust particles and associated contaminants can cause pulmonary diseases with a significant impact on the inhabitants health and quality of life. The most destructive action of the mineral dust particles comes after their penetration into the alveolar parts of the lungs. Pulmonary dusting, Pneumoconiosis, occurs, when the fibrogenic dust particles smaller than 2.5 µm passes through the alveolar wall into the interstitial space. Insoluble or sparingly soluble minerals are referred to as active, they initiate and activate fibrosis. In the samples from Jelsava-Lubeník, the dominant mineral phases include magnesite occurring as crystals and their fragments and periclase present as irregular allotriomorphic grains, aggregates and masses. According to dusting monitoring, a trend of decreasing in the periclase proportion was observed. CONCLUSIONS: Mineral composition and morphology of dust fallouts in the air from mining areas directly affects the health of the population and contributes to the increased incidence of respiratory diseases in the region, even several years after closing the mines or after the change of filters in mineral processing plants. Reducing unwanted air pollution should be a priority for relevant ministries (of health, environment etc.), as well as a challenge for public health professionals.

Lithium intoxication in the pre-hospital care with stroke symptoms - Case report.

Lithium is widely used in psychiatry to treat bipolar affective disorders since 1970 but little is known about the incidence, clinical course and associated factors of acute lithium intoxication. Moderate and severe cases of lithium intoxication are rare. This case reports a patient with acute lithium intoxication (serum level of 3.7 mmol/L) with neurological symptoms imitating stroke, which affects the differential diagnosis in the pre-hospital and hospital care. Patient was treated with forced diuresis and dismissed 21 days after admission.

Misdiagnosing of malaria as RTI decreased after introduction of RDTs in rural areas of Kenya.

BACKGROUND: Clinical presentation of malaria is highly variable and can be mistaken for number of other diseases, including respiratory tract diseases, which are associated with significant morbidity and mortality. However, presumptive management of fever as malaria can result in significant overdiagnosis, even in high-risk areas. Quality microscopy services for the diagnosis of malaria are not widely available in rural areas of Sub-Saharan Africa as well as in substandard conditions of low-income settings and the accuracy of microscopy is usually poor. MATERIAL AND METHODS: The aim of the study was to determine how introduction of RDTs influenced diagnostics of malaria in high risk area of Eldoret, Kenya. Documentation of every patient was screened for data of current disease and diagnostic tools used. In patients with suspected malaria, either microscopy, or RDT or both were done to confirm the diagnosis. RESULTS: Initially, incidence of malaria was very high, about 50-70% of all visits in OPD due to any infectious condition. In 2010, when rapid diagnostic tests became available in Eldoret, decrease in incidence of malaria from 49% (2010) to 29% (2011) and further to 5.3% (2016) was noted. At the same time, increased incidence of upper and especially lower respiratory tract infections was noted. CONCLUSION: Results suggest that upper and lower respiratory tract infections were formerly diagnosed and treated as malaria. Other contributing factors, such as improvement of infrastructure and malaria preventive and treatment programs also play a role in decreasing malaria incidence in rural areas of Kenya, however, RDTs play a key role in proper diagnostics of malaria.

The role of implementation and communication of MANTRA Water, sanitation and hygiene program in improving public health in Odisha state (India).

BACKGROUND: Provision of safe drinking water is the main strategy to reduce the number of water-borne diseases. The Government of India has declared its commitment towards achieving Sustainable Development Goals and universal sanitation coverage in the country by the year 2022. Indian NGO Gram Vikas offers a solution to this task through its flagship WASH program MANTRA. It focuses on water and sanitation as an entry point for integrated village development. METHODS: The case study from Haradango village (Odisha state, India) investigates the effectiveness of MANTRA program by identifying key principles of this Gram Vikas' flagship programme and by analysing an impact of its implemenation and communication on public health of Haradango villagers. Based on field research key principles were identified (100 % inclusion, Gender equity, Social equity, Cost-sharing, Sustainability). RESULTS: Thanks to the application of the principles, reduction of nearly 80 % of water borne diseases was recorded and diarrhea incidence has been less than 2 %. CONCLUSIONS: Gram Vikas' community-driven development approach towards improvement of public health and sustainable rural development can be labeled as successful model for local, as well as national projects. Information, education and communication activities need to persist in order to overcome the cultural practice of open defecation within communities..

Tropical neuroinfections in south sudanese rural hospitals - analysis of 8,709 patients.

OBJECTIVE: Infections involving the central nervous system have very serious consequences and affect thousands of people in Africa. Despite the availability of new antibiotics and vaccines, neuroinfections act as dangerous and life-threatening conditions. The most frequent neuroinfections which are of the greatest importance for public health systems are viral diseases (such as HIV, encephalitis, poliomyelitis, rabies), bacterial diseases (bacterial meningitis, neurological complications of leprosy and tuberculosis) and parasitic infections (cerebral malaria, sleeping sickness, trypanosomiasis, schistosomiasis, toxoplasmosis etc.). METHODS: A descriptive study to assess the occurrence of neuroinfections in two rural hospitals in Sudan (Mapuordit in Yirol and Gordim in Aweil) was performed in two periods of two years: (i) 2005-2006 and (ii) 2010-2011. We obtained data on patients from Mapuordit and from Gordim by studying their medical records. RESULTS: Several cases of neuroinfections were observed during both periods; those were represented by tetanus, meningococcal meningitis, leprosy with neuropathy (altogether 442 patients) in Mapuordit. Also in Gordim, severe neuroinfections such as cerebral malaria were very rare (1 case), as well as tetanus (1 case), meningococcal meningitis (8 cases) and sleeping sickness (9 cases). However, the incidence of neuroinfections decreased from 44/1000 in 2005-2006 to 2/1000 in 2010-2011. CONCLUSIONS: Decreased incidence of serious neuroinfections (cerebral malaria, sleeping sickness, meningococcal meningitis) in Sudan may be related to improvement of effective therapeutic options, represented by (i) intermittent preventive therapy (IPT) for malaria, (ii) by suppression of sleeping sickness vectors and (iii) by better accessibility of antibiotics.