Over the past decades,rapid diagnostic tests (RDTs) have become the most widely deployed diagnostic tool,enabling timely treatment in resource-limited and remote settings[1]. Their reliability,however,depends on rigorous quality assurance frameworks,with the World Health Organization (WHO)-endorsed quality control panels serving as the cornerstone for monitoring RDT performance and ensuring diagnostic fidelity across diverse epidemiological landscapes[2].Quality control panels are standardized,parasite-based reference materials used to evaluate antigen detection by RDTs under controlled conditions. They play an essential role in detecting lot-to-lot variations,guiding procurement decisions,and safeguarding programmatic confidence in RDTs[3]. Despite this centrality,the practical and operational realities of quality control panel preparation in malaria-endemic regions remain underexplored.
Objective:To analyze the prevalence and risk factors of drug-resistant tuberculosis(DR-TB)among Indonesian children. Methods:This study analyzed data from the 2023 Indonesian Health Survey,which included children aged 0-14 years and household heads nationwide.Binary logistic regression was used to identify factors associated with DR-TB. Results:A total of 423 participants were included in the final analysis.The national prevalence of pediatric DR-TB was 15.9%,with substantial variation across provinces.In the multivariable logistic regression analysis,rural residence(aOR 2.68;95%CI 1.23-5.84),poor TB treatment adherence(a OR 17.353;95%CI 3.098-97.206),and household TB contact(a OR 5.628;95%CI 1.113-28.450)were independently associated with higher odds of DR-TB.Wealth index was significantly associated with DR-TB overall(P=0.018),but no significant differences were observed between individual wealth categories after adjustment.Household TB contact was associated with higher odds of DR-TB(aOR 5.628;95%CI 1.113-28.450). Conclusions:Pediatric DR-TB in Indonesia has a substantial prevalence and marked geographic variation.Rural residence,poor TB treatment adherence,and household TB contact were key factors associated with DR-TB,highlighting the need to strengthen treatment adherence,household contact investigation,and targeted interventions.
Objective:To identify tuberculosis preventive treatment nonadherence mechanisms via the Capability,Opportunity,Motivation,and Behavior(COM-B)framework for latent tuberculosis infection patients. Methods:This study was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines.Relevant literature reporting factors associated with tuberculosis preventive treatment discontinuation or completion was included.Identified determinants were synthesized and mapped across the COM-B domains. Results:Twenty-seven studies were included.Treatment discontinuation rates varied widely(2.0%-66.8%),with consistently higher rates observed in longer regimens(6 months of isoniazid,and 9 months of isoniazid)compared with shorter regimens(3 months of isoniazid plus rifapentine,3 months of isoniazid plus rifampin,and 4 months of rifampin).Adverse drug reactions,particularly hepatotoxicity,emerged as the most consistent predictor of discontinuation,reflecting impaired physical capability.Opportunity-related factors included healthcare system fragmentation,transportation challenges,and limited access to services.Reduced motivation was associated with stigma,low risk perception,and negative treatment beliefs.Interventions such as shorter regimens,patient-centered care,healthcare worker supervision,and digital adherence technologies were associated with improved treatment completion.These findings suggest that treatment discontinuation results from dynamic interactions between treatment-related burden,healthcare accessibility,and patient motivation. Conclusions:Clinical tolerance,structural and behavioral factors interact to cause latent tuberculosis infection discontinuation.COM-B guides targeted interventions:shorter regimens,adverse drug reaction management,and improved access and motivation.
Objective:To assess the prevalence of mortality and factors associated with prolonged length of hospital stay(LOS)among dengue fever(DF)patients who were admitted at Kassala Hospital,eastern Sudan,during the ongoing war. Methods:This hospital-based cross-sectional study of 129 hospitalized DF patients was conducted in 2025.Data on sociodemographics,clinical outcomes(recovery or death),LOS,and hematological parameters were collected using standardized methods.Univariate and multivariate Poisson regression analyses were used to identify factors associated with prolonged LOS among the recovered patients. Results:Of the 129 hospitalized patients,67(51.9%)were males and their median age was 32 years.The median LOS was 4(interquartile range,IQR 3-6)days.Twelve patients(9.3%)died and they had significantly longer LOS,elevated white blood cell(WBC),and neutrophil counts compared to recovered patients.In multivariate analysis of recovered patients,higher WBC(adjusted risk ratio,aRR 1.020;95%CI 1.005-1.035),neutrophil(aRR 1.029;95%CI 1.008-1.050),and lymphocyte(aRR 1.044;95%CI 1.009-1.080)were positively associated with prolonged LOS.Other positive associations included being female sex(aRR 1.24;95%CI 1.05-1.46),married(aRR 1.29;95%CI 1.02-1.74),less educated(aRR 1.20;95%CI 1.01-1.44),being a local resident(non-internally displaced person)(a RR 1.44;95%CI 1.20-1.74),having dengue hemorrhagic fever(aRR 1.53;95%CI 1.27-1.85),and pre-existing morbidity(aRR 2.18;95%CI 1.71-2.78).Younger age(aRR 0.980;95%CI 0.980-0.990),and infection with DF serotype 2(aRR 0.72;95%CI 0.61-0.86)or serotype 3(aRR 0.51;95%CI 0.30-0.87)were negatively associated. Conclusions:The mortality rate among hospitalized dengue patients was high.Among those who recovered,prolonged LOS was associated with various clinical and sociodemographic factors.These findings highlight the need for enhanced surveillance and targeted clinical management strategies for vulnerable dengue patients in conflict-affected settings.
Objective:To evaluate the knowledge,attitudes,and practices(KAP)on chikungunya disease among healthcare workers in Ho Chi Minh City,Vietnam. Methods:A cross-sectional study was conducted from September to December 2025 at two hospitals in Ho Chi Minh City using convenience sampling.Data were collected through face-to-face interviews using a structured questionnaire covering socio-demographic factors and KAP on chikungunya prevention based on the Health Belief Model(HBM).Knowledge scores were classified as"good knowledge"(≥9/13)or"poor knowledge"(<9/13).Logistic regression was used to identify factors associated with preventive practices. Results:A total of 481 of 531 healthcare workers enrolled in the study were included in the final analysis.The rates of good knowledge,positive attitudes,and sufficient practices were 70.89%,62.37%,and 71.93%,respectively.The primary sources of information on the disease were books,newspapers,or social media.While general knowledge was high,gaps were noted in clinical recognition and diagnostic awareness.Multivariate analysis revealed that sufficient practices were significantly associated with having previously heard of the disease(a OR 0.31;95%CI 0.14-0.70,P=0.005)and positive attitudes(aOR 4.21;95%CI 2.65-6.68,P<0.001). Conclusions:Despite moderate overall KAP levels,important gaps remain,particularly in clinical knowledge and risk perception of chikungunya.
Objective: To compare the efficacy and safety of levornidazole and levornidazole disodium phosphate in women with pelvic inflammatory disease. Methods: Women from 12 hospitals in China received a 14-day treatment course comprising 7 days of intravenous therapy followed by 7 days of oral sequential therapy: intravenous levornidazole 0.5 g twice daily (Group A, n =49), levornidazole disodium phosphate 1.0 g once daily (Group B, n =49), or levornidazole disodium phosphate 0.5 g twice daily (Group C, n =46), followed by oral levofloxacin plus ornidazole for 7 days. Results: Of the 144 patients in the full analysis set (FAS), 131 (91.00%) were included in the per-protocol set and 38 (29.00%) were microbiologically valid. In the FAS, clinical cure rates at day 14 were 77.55%, 83.67%, and 82.61% for Groups A, B, and C, respectively ( P =0.745). Bacteriological clearance rates were 76.47%, 93.75%, and 100.00%, respectively ( P =0.248). Drug-related adverse events occurred less frequently in Group B than in Group A (38.78% vs . 61.22%; P =0.025). Conclusions: Daily administration of levornidazole disodium phosphate achieved clinical and bacteriological efficacy comparable to twice-daily levornidazole in women with pelvic inflammatory disease and was associated with significantly fewer drug-related adverse events.
Objective: To evaluate the effect of statin therapy on biomarkers of vascular inflammation in people living with HIV (PLWH). Methods: We conducted a living systematic review of randomized controlled trials (RCTs). We searched Scopus, PubMed, Cochrane Library, and Scilit up to April 4, 2025, with a predefined plan for ongoing evidence surveillance and updating. Nine RCTs involving 1 721 participants were included. Data were extracted on changes in key biomarkers, including interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), soluble CD14 (sCD14), soluble CD163 (sCD163), oxidized LDL (oxLDL), and lipoprotein-associated phospholipase A 2 (Lp-PLA 2 ). The Cochrane Risk of Bias (RoB 2) tool was used for quality assessment. This review is not intended to be retired from the living mode at this stage. Results: Statin therapy significantly reduced key biomarkers of monocyte activation and vascular inflammation, particularly IL-6 and sCD14, with effects being most consistent and pronounced with pitavastatin. Pitavastatin also demonstrated greater efficacy in reducing oxLDL and Lp-PLA 2 compared to other statins. Reductions in hs-CRP were inconsistent across studies. A critical finding was that treatment duration was a major modifier of effect, with interventions lasting ≥12 months yielding substantially greater anti-inflammatory benefits. The mechanistic profile suggests statins specifically target the LPS-sCD14 pathway of innate immune activation, which is highly relevant to HIV pathogenesis. Conclusions: Pitavastatin emerges as the most effective statin for reducing vascular inflammation in PLWH, offering a targeted strategy to mitigate cardiovascular disease risk in this population. These findings, derived from the current iteration of a living systematic review, support the use of long-term pitavastatin therapy for PLWH with evidence of residual inflammation and highlight the need for its inclusion in future clinical guidelines as new evidence continues to emerge.
Objective: To study assessed factors associated with mass drug administration (MDA) noncompliance for lymphatic filariasis in urban and rural Indonesian communities. Methods: A cross-sectional analysis was conducted using a subset of nationally representative data from the 2023 Indonesian Health Survey (Survei Kesehatan Indonesia, SKI). Participants were classified as residing in urban ( n =469 549) and rural ( n =407 982) and interviewed regarding anti-filarial drugs intake over the past 5 years. Logistic regression models were constructed to identify factors associated with MDA noncompliance. Results: A total of 877 531 individuals from 284 177 households across 514 districts in 38 provinces were included in the study. Among them, 136 526 (15.56%) took anti-filarial drugs in five years; of these, 27 113 (19.86%) never complied fully, revealing significant urban-rural disparities. In urban areas, noncompliance with MDA was associated with pre-working age group (a OR 1.58; 95% CI 1.21-2.07) and those with self-reported LF (a OR 1.47; 95% CI 1.13-1.91). Awareness of health facilities was protective against noncompliance (a OR 0.29; 95% CI 0.11-0.77). In contrast, rural noncompliance was associated with transportation cost barriers (a OR 1.55; 95% CI 1.21-1.99), children aged 2-5 years (a OR 1.43; 95% CI 1.08-1.87), mobile phone ownership (a OR 1.40; 95% CI 1.12-1.75), and self-reported LF (a OR 1.47; 95% CI 1.19-1.82). Conclusions: Distinct demographic, socioeconomic, and accessibility factors influence MDA noncompliance in Indonesia. Targeted behavioral interventions in urban areas and improved communication and access in rural regions are essential for LF elimination.
Rationale: The emergence of fluoroquinolone-resistant Salmonella enterica serovar Typhi has become increasingly prevalent across South Asia, Southeast Asia, and sub-Saharan Africa, with resistance rates exceeding 90% in some regions. Hepatobiliary complications, particularly cholangitis and Mirizzi syndrome, are rare manifestations. Patient concerns: A 13-year-old male developed high-grade fever, progressive jaundice, upper abdominal pain, and multiple episodes of non-bilious vomiting for 8 days. Diagnosis: Fluoroquinolone-resistant Salmonella typhi complicated with acute gangrenous cholecystitis, Mirizzi syndrome and cholangitis. Treatment: Emergency cholecystectomy and subsequent endoscopic retrograde cholangiography with biliary drainage were performed. Blood and bile cultures isolated a fluoroquinolone-resistant Salmonella enterica subspecies enterica serovar Typhi . The patient responded to intravenous ceftriaxone. Outcomes: The patient was discharged after 9 days of admission, and the common bile duct stent was removed after 8 weeks following discharge. Lessons: This case emphasizes the critical importance of culture-based diagnosis over serological testing in endemic areas and a multidisciplinary approach in complicated invasive salmonellosis.
Objective: To evaluate the clinical characteristics, risk factors, antimicrobial susceptibility profiles, and outcomes of bloodstream infections caused by rare Gram-negative bacteria in a tertiary pediatric center. Methods: A retrospective analysis was conducted on pediatric patients (0-18 years) with rare Gram-negative bloodstream infections growth in blood cultures between 2016 and 2023. Common pathogens (Escherichia coli, Klebsiella pneumoniae, Pseudomonas spp., and Acinetobacter spp.) were excluded to focus on unusual isolates. Results: A total of 394 patients were included in the study. Their median age was 21.5 months and 237 (60.2%) were male. The cohort had a high prevalence of chronic underlying diseases (94.0%) and a median hospital stay of 27 (16, 49) days. Central venous catheters (35.8%) and recent blood product transfusions (35.8%) were the most frequent predisposing factors. The most prevalent isolates were Serratia spp. (20.1%), Stenotrophomonas maltophilia (17.5%), and Enterobacter spp. (15.2%). High rates of intrinsic and acquired resistance were observed: 100% of Serratia isolates were resistant to trimethoprim/sulfamethoxazole, and Elizabethkingia meningoseptica demonstrated extensive carbapenem resistance. Resistance to co- trimoxazole in Stenotrophomonas maltophilia was 0%. All-cause mortality was 13.7%, whereas infection-related mortality was 1.1%, specifically associated with Aeromonas spp. (10.0%), Comamonas testosteroni (25.0%), and Enterobacter spp (3.3%). Conclusions: Rare Gram-negative bacteria bloodstream infections in children represent a significant diagnostic and therapeutic challenge due to unpredictable resistance patterns. Our data suggest that empirical therapy for high-risk pediatric patients should be periodically reviewed to include coverage for these emerging pathogens, especially in those with indwelling devices and chronic comorbidities.
The global incidence of dengue continues to escalate,posing a significant public health burden,particularly in Southeast Asia[1].
It is estimated that at least two million women of childbearing age in Latin America are chronically infected with Trypanosoma(T.)cruzi,representing a persistent risk of congenital transmission[1].Vertical transmission has been associated with maternal immune dysfunction,which may compromise foetal development and increase the risk of adverse outcomes[2].
Objective:To investigate the prevalence, species distribution, temporal trends, and associated demographic and clinical factors of intestinal parasitic infections (IPIs) among symptomatic patients attending a tertiary hospital in Tizi-Ouzou Province, North-central Algeria, over a seven-year period (2018-2024).Methods:A retrospective analysis was conducted using laboratory records of 2568 stool examinations performed at the Parasitology-Mycology Laboratory of the Nedir Mohamed University Hospital Center. Parasitological diagnoses had been established using standard techniques, including direct wet mount, formol-ether concentration, and Scotch tape test. Prevalence rates were calculated, and associations with sex, age, hospital status, and hospital unit were evaluated using Chi-square or Fisher's exact tests.Results:The overall prevalence of IPIs was 28.4% (95% CI 26.7-30.2). Infection rates were higher in males (30.8%) than females (24.9%), in adults compared with children (30.8% vs. 21.9%), and in outpatients compared with inpatients (30.3% vs. 19.9%). Protozoa predominated (94.4%), with Blastocystis spp. as the most frequently detected parasite, increasing from 7.3% in 2018 to 22.2% in 2024. Dientamoeba fragilis also showed a rising trend (2.2% to 7.2%). Co-infections were observed in 5.3% of cases, mainly involving Blastocystis spp. A decline in prevalence was noted in 2020, likely related to COVID-19 hygiene measures.Conclusions:IPIs remain highly prevalent among symptomatic patients in this region, with emerging protozoan species representing a growing public health concern. further prospective, multicenter studies incorporating molecular diagnostics and environmental investigations are essential to better understand the transmission dynamics of IPIs and validate these findings across diverse geographical regions and healthcare settings.
To the Editor:Alibudbud[1]calls attention to rising HIV infections among young people in the Philippines and increasing access to preexposure prophylaxis (PrEP),an effective,preventative medication. The Philippines has the fastest-growing HIV epidemic in the Asia-Pacific,and about one-third of newly diagnosed cases in early 2025 were among people ages 15-24 years[2,3],highlighting the article's importance.
Rationale: Mycotic aortic aneurysm (MAA) is uncommon, accounting for 1%-3% of all aortic aneurysms. Delayed treatment carries a high risk of rapid enlargement, rupture, and death. MAA may spread contiguously from an abdominal aortic source to the adjacent vertebrae and psoas, resulting in spondylodiscitis and psoas abscess. MAA is an uncommon but life-threatening condition. The simultaneous presentation of an MAA with both spondylodiscitis and an iliopsoas abscess (IPA) represents an exceedingly rare and fatal triad of complications from invasive non-typhoidal Salmonella infection. Patient concerns: A 59-year-old male presented with progressive low back pain and intermittent fever for about 6 six weeks. Imaging revealed multiple infrarenal mycotic aortic aneurysms, an L3-L4 spondylodiscitis, and extensive bilateral IPAs. Blood and abscess cultures identified Salmonella group D1. Diagnosis: Salmonellosis associated with mycotic aortic aneurysm. Intervention: The endovascular stent-graft repair was implanted combined parenteral antibiotics, with initial clinical improvement after surgical debridement for abscess. Outcome: He represented with recurrent Salmonella bacteremia three months later and subsequently expired. Lessons: Physician must keep a high index of suspicion for an underlying MAA in patients presenting with spondylodiscitis or IPA. It tragically illustrates the significant risk of treatment failure with endovascular stent-graft repair, emphasizing that rigorous long-term surveillance is essential for patients managed with this approach.
Objective: To evaluate the clinical efficacy of albendazole in pediatric toxocariasis. Methods: This interventional study was conducted over a 6-month period, enrolling 117 children aged 3-15 years between 2023 and 2024 in Ho Chi Minh City, Vietnam. All patients received oral albendazole at a dosage of 15 mg/kg/day, divided into two daily doses, for five consecutive days. Treatment efficacy was assessed at 6 months based on the following criteria: (1) resolution or marked improvement of clinical symptoms; (2) negative ELISA serology; (3) normalization or significant reduction of eosinophil (EOS) counts to within the normal range; and (4) normalization or significant reduction of total IgE levels. Results: After six months, significant reductions were observed in white blood cell (WBC) count, neutrophil (NEU) count, mean corpuscular hemoglobin (MCH), mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), platelet (PLT) count, EOS count, ELISA optical density (OD), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and creatinine levels (all P<0.05). Age-stratified analysis revealed that children aged 3-11 years showed statistically significant improvements in OD levels and EOS counts compared to baseline (P<0.05). The overall treatment recovery rate was 28%. Conclusions: The cure rate for pediatric toxocariasis following a five-day albendazole regimen remains modest. Further research is required to optimize treatment durations and regimens to improve clinical outcomes in children.
Objective: To assess the prevalence of post COVID-19 conditions, functional disability impacting daily living, and associated sociodemographic determinants. Methods: In this cross-sectional door-to-door survey, post COVID-19 conditions were identified. Functional impairment was assessed using EuroQoL five-dimension five-level (EQ-5D-5L) questionnaire. Relative risk of symptoms in the COVID-19 positive group as compared to the symptoms in the COVID-19 negative group was calculated. Chi-square test with subsequent Bonferroni's correction was performed to analyze the association of symptoms with age categories, sex and severity of infection. P value <0.05 was considered to be statistically significant. Results: Out of 57610 persons surveyed, COVID-19 test reports were available for 34602 (1799 positive and 32 803 negative) respondents. Post COVID-19 complaints were significantly more prevalent in infected individuals, including loss of taste (RR 8.82, 95% CI 4.77-16.31, P<0.01), loss of smell (RR 7.29, 95% CI 3.7414.22, P<0.01), fatigue (RR 2.97, 95% CI 2.56-3.44, P<0.01), muscle pains (RR 1.86, 95% CI 1.59-2.18, P<0.01). EQ-5D-5L scores reflected greater difficulty in mobility, self-care, daily activities, and mental health among the infected group, especially in moderate to severe cases. Conclusions: The survey highlights a significantly higher burden of post COVID-19 complaints and functional limitations among COVID-19 positive individuals. These findings underscore the necessity for long-term management strategies to mitigate the burden of post COVID-19 conditions and poor functional status.
