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http://www.webmedcentral.com/images/Header_Logo.giftext/html2011-03-29T09:01:18+01:00http://www.webmedcentral.com/Dr. Kadriye Kart YasarProlonged Herpes Simplex Virus Encephalitis in a Patient with Mental Retardation and Epilepsy
http://www.webmedcentral.com/article_view/1803
Herpes simplex virus (HSV) is a leading cause of severe encephalitis which is related with high mortality and morbidity. This report describe a successfully treated HSV encephalitis (HSVE) with prolonged course in a patient with mental retardation and chronic convulsion. Diagnosis was made by using cerebrospinal fluid (CSF) examination, cranial MRI signs and CSF polymerase chain reaction for HSV. The patient was treated with intravenous acyclovir (ACV) for three weeks which gave a favorable outcome.text/html2021-07-30T05:00:28+01:00http://www.webmedcentral.com/Dr. Deepak GuptaKissing HPV or Kissing It Goodbye: Time To Reinvent Mass Media Strategy To Increase Acceptance Of HPV Vaccination Among Parents And Their Young Wards
http://www.webmedcentral.com/article_view/5731
As physicians, some of us first encountered the plight of human papillomavirus (HPV) among their patients once they moved across the continents. Surprisingly, those first observed episodes were among toddlers and even infants presenting for surgical management of recurrent respiratory/laryngeal papillomatosis under anesthesia [1]. This observed vertical transmission of HPV did not rattle much until the exposure to HPV vaccination promotion to counter cervical and other genital cancers [2-5]. Then came the awakening that some parents may be baffled by whether HPV vaccination among minor wards will promote precocious promiscuity among their wards [6] unless HPV vaccination among wards makes them accept their pubertal and sexual growth as the undeniable fact of life. Anyhow, the bottom line is that for parents to wholeheartedly accept HPV vaccination among their minor wards, the narrative in the mass media has to change and be outright open that kissing itself may transmit HPV considering that 15 years as the age for first kiss [7-10] is socially acceptable even among the parents abhorring at the idea of their wards exploring sexual activity before attaining the legal age of maturity. After the age of maturity, it will be up to the wards themselves as young adults whether they want to constantly worry about infection control against HPV during their sexual lives by remaining unvaccinated against HPV or whether they want to embrace HPV vaccination at the first moment of turning legally mature if their parents could not muster up courage to accept their minor wards' needing HPV vaccination even if they are engaging only in socially acceptable kissing and making out before attaining the legal age of maturity. There is no better time than the current time to reinvent mass media strategy to increase acceptance of HPV vaccination among parents and their young wards because for the first time, there seems to be decline in genital cancers but increase in oral cancers as related to HPV due to changing sexual practices among the newer generations mistakenly believing that sexually transmitted diseases are only transmitted genitally and not orally [11-14]. In this regard, a counterintuitive movie scene from a Bollywood movie comes to the mind wherein lead female character from India objects to lead male character from Italy kissing her while mistakenly worrying that she may get pregnant just by kissing [15]. That is not true but sexually transmitted diseases can and do spread orally including kissing [16-18] whereby parents may be more amenable to get their wards vaccinated to prevent HPV spread by kissing rather than vaccinating their sexually active wards against HPV. Essentially, the bottom line is that parents and their young wards have to ensure that the young wards not only not end up carrying the disease burden of HPV but also not end up transmitting their disease burden vertically to wards' future wards.
To further investigate into awareness about HPV vaccination, we personally bought targeted responses [19] with SurveyMonkey audience (n=130). All respondents were full-time students at four-year colleges across all the regions in the United States wherein almost 96% were aged 18-29 years and almost 53% were females. These respondents responded to the following two open-ended questions:
1. In your view, why do some parents NOT get their teenage children vaccinated against human
papillomavirus (HPV)?
2. In your view, why do some young adults NOT get themselves vaccinated against human papillomavirus (HPV)?
Although only one of these 130 respondents viewed absence of sexual activity among young adults as the reason for the absence of HPV vaccination among young adults, as many as eight out of the same 130 respondents viewed absence of sexual activity among teenage children as the reason for the absence of HPV vaccination by parents among their teenage children. Interestingly, respondents open-ended responses did not elaborate in detail (a) why they were unsure about the parents’ and young adults’ reasons for absent HPV vaccination, (b) why parents and young adults feel HPV vaccination as unnecessary, (c) why parents and young adults do not educate themselves about HPV vaccination and its side-effects, and (d) why parents and young adults are non-believers about HPV vaccination and thus anti-vaxxers. As many as 10% of 130 respondents seemed disinterested in the questions and thus non-responsive.
Summarily, it is time to broaden awareness about HPV and HPV vaccination by broadening the minds of parents and young adults whereby they have to realize that they can either kiss HPV or kiss it goodbye with HPV vaccination.text/html2010-10-13T11:01:16+01:00http://www.webmedcentral.com/Dr. Christian ObirikorangSerum Lipid Profiling In Highly Active Antiretroviral Therapy-naive HIV Positive Patients In Ghana; Any Potential Risk?
http://www.webmedcentral.com/article_view/987
Background
In recent years serum lipid profile alterations have been described from an early stage of human immunodeficiency virus (HIV) infection and more importantly in the progression of the disease. The aim of this study was to find out if any correlation existed between serum lipid profile and the progression of HIV infection and the potential risks it poses to patients who were about to enroll on highly active antiretroviral therapy (HAART) in Ghana.
Methods
One hundred and fifty (150) confirmed HAART naïve People Living with HIV/AIDS who consented to this study were recruited from the Central Regional Hospital, Ghana between May to December 2008. One hundred (100) sex and age matched healthy HIV-seronegative individuals were used as controls. Fasting blood samples were taken from all the study subjects and analyzed for serum total cholesterol, triglycerides, high density lipoprotein cholesterol (HDL) and CD4 lymphocyte count. Low density lipoprotein cholesterol (LDL) was calculated using the Friedewald’s equation
Results
Apart from serum triglycerides (p<0.01) which showed a significant increase in the subjects compared to the control group, serum total cholesterol (p<0.001), HDL-cholesterol (p<0.001) and LDL- cholesterol (p<0.001) showed significant decreases compared to the control group. HDL-C in subjects with CD4 <200 mm-3 was significantly reduced when compared to the control group while HDL-C in subjects with CD4 between 200-499 mm-3 and CD4 ≥500 showed no statistically significant difference in comparison to the control group. From the correlation analysis, serum total cholesterol (R=0.67), HDL-cholesterol (R=0.27) and LDL- cholesterol (R=0.27) showed a positive significant correlation to the CD4 count. Serum triglycerides (R=-0.27) correlated negatively to CD4 count.
Conclusion
In conclusion, lipid profile changes in patients with HIV infection are related to disease progression. An increase in serum Triglycerides and decreases in serum Cholesterol, HDL and LDL cholesterol could be useful in assessing disease progression, risk for myocardial infarction and the clinical management of Ghanaian HIV-infected patients before introduction of HAART.text/html2011-02-21T20:32:22+01:00http://www.webmedcentral.com/Dr. Christian ObirikorangSerum Lipid Profiling In Highly Active Antiretroviral Therapy-Naïve HIV Positive Patients In Ghana; Any Potential Risk?
http://www.webmedcentral.com/article_view/1558
The human immunodeficiency virus (HIV) was unknown until the early 1980's and has since infected millions of persons in a worldwide pandemic. HIV infection results in relentless destruction of the immune system leading to the onset of acquired immunodeficiency syndrome (AIDS). The AIDS epidemic has resulted in the deaths of over half of its victims [1] with its etiologic agent, the human immunodeficiency virus (HIV) being one of the commonest lethal infections worldwide. The total number of infections in sub-Saharan Africa continues to increase because of poor resource availability and awareness regarding the disease [2].
The first reported cases of HIV infection in Ghana were recorded in 1986, mainly among women who had travelled outside the country. By the end of December 1999, a cumulative total of 37,298 cases had been recorded. Nearly 90% of the cumulative AIDS cases from 1986-1999 are between the age group of 15-49 years, with 63% of all reported cases being females. The female-to-male HIV/AIDS infection ratio is gradually attaining parity; changing from 6:1 in 1987 to approximately 2:1 in 1998. According to the 2007 HIV Sentinel Survey and National HIV Prevalence AIDS Estimates Reports, an estimated 264,481 people are living with HIV/AIDS out of which 110,666 are males and 153, 815 are females [3].
The primary target of HIV infection is CD4+ lymphocyte because of the affinity of the virus to the CD4+ surface marker. HIV infection leads to progressive impairment of cellular functions, characterised by a gradual decline in peripheral blood CD4+ lymphocyte levels resulting in an increasing susceptibility to a wide range of opportunistic infections and certain malignancies [4].
Secondary infectious acute diseases have more evidently been associated with lipid abnormalities. These acute diseases can produce dyslipemia independent of the infective agent [5,6] and are mediated by different cytokines that regulate the immunological response to infection [7]. Hypertriglyceridaemia was the first dyslipidaemia to be reported in HIV infected patients with other lipid abnormalities such as hypocholesterolaemia or hypo HDL-cholesterolaemia also being reported [4]. Disorders of lipid metabolism have been described in patients with HIV infection before the introduction of HAART, including increased serum triglyceride (TG) levels and decreased cholesterol levels observed at various stages of HIV infection [8].
Considering the increasing incidence of HIV infection in Ghana and the fact that a number of infected patients will be put on HAART medication, this study was carried out to ascertain if any relationship existed between lipid profile and the different clinical stages of HIV infection and the potential risks, if any, it might pose to patients who were about to be enrolled on HAART medication.text/html2011-03-14T22:07:04+01:00http://www.webmedcentral.com/Dr. Li LiDifferential Functions of CCR9- or CXCR3-Expressing Microglia
http://www.webmedcentral.com/article_view/1727
Underlying mechanisms by which how microglia accomplishes a destructive or constructive role in central nervous system remain to be fully studied. We have established different mouse models by intracranially infection and re-challeng with Toxoplasma gondii (T. gondii) or infection and re-challeng with lymphocytic choriomeningitis virus (LCMV). The neurotoxic CCR9+Irg1+ (immunoresponsive gene 1) microglia are high frequent in the brain in the mice infected and re-challenged with T. gondii. These cells possess resistance to apoptosis and TNF-a-biased. The neurosupportive CXCR3+Irg1- microglia are high frequent in the brain in the mice infected and re-challenged with LCMV. These cells are sensitive to apoptosis and IL-10- and TGF-b-biased. Moreover, the brain-derived neurotrophic factors (BDNF) express in similar pattern in different CCR9+Irg1+ or CXCR3+Irg1- microglia. CCL25/CCR9 induces Irg1 phosphorylation in neurotoxic CCR9+Irg1+ microglia ex vivo. These data plus our previous report indicate that there are two different subsets of microglia, which have neurotoxic or neurosupportive function. The study provide with a number of novel evidences on involvement of microglia in neurodegenerative and neuroinflammatory diseases.text/html2011-04-21T14:14:27+01:00http://www.webmedcentral.com/Dr. Filiz PehlivanogluRelapse After Five Years in a Chronic Carrier Patient with Salmonellosis
http://www.webmedcentral.com/article_view/1887
S. Typhi is a bacteria, of which the sole resevoir is humans. The carrier state was shown to persist for many years in patients. Treatment is difficult and time-consuming. If there is an anatomical defect, treatment of the carrier state with antibiotics is not successful. We report a case of S.Typhi bacteremia and bacteriuria in a 53 years old male patient with recurrent infections within five years.text/html2010-09-20T16:28:28+01:00http://www.webmedcentral.com/Prof. Parvaiz A Koul Adult Hemophagocytic Lymphohistiocytosis: A 25-Year Experience at a Tertiary Care Hospital
http://www.webmedcentral.com/article_view/674
Five patients of acquired Hemophago Lymphohistiocytosis (HLH) were seen in a tertiary care hospital over a period of 25 years. Three of the patients had a culture proved Salmonella typhi infection and one had evidence of Epstein Barr virus infection. The three patients with Enteric fever were managed with antibiotic therapy and the one with EBV associated HLH received etoposide, cyclosporine and steroids. The other patient was treated with pulsed steroid therapy. One patient died of sepsis during his relapse. HLH must be considered in patients with fever with prolonged cytopenias.text/html2010-10-05T21:54:30+01:00http://www.webmedcentral.com/Dr. Marc EgethSneeze-vector And Sexually Transmitted Vaccines
http://www.webmedcentral.com/article_view/899
Intra-nasal vaccine delivery (e.g. Flumist) has become a popular alternative to injections: just as naturally occurring viruses can enter the body through the respiratory system, so can artificially attenuated or inactivated viruses, or vaccines. The ability of vaccine strains to act effectively after entering the body through the mouth or nose raises the possibility that vaccines could also spread, like natural viruses, from person to person. If so, then we have potential new mechanisms for inoculating populations: sneeze-vector vaccines. A sexually transmitted vaccine would represent an alternate transmission pathway. For example, retransmittable vaccines could be given to individuals who come to clinics with respiratory and sexually transmittable viruses. The effect would be to introduce the vaccine to social networks of people who would otherwise have received virus.Developing optimal re-transmittable vaccines would require overcoming various engineering problems. However, a person might already, in principle, be able to inoculate another by sneezing after receiving Flumist, simply through mechanical transmission. In addition, vaccinia, the naturally occurring virus used as a smallpox vaccine, may already be able to cause several generations of accidental contagious inoculations [1]. To optimize the process of deliberate vaccine retransmission, vaccine strains might be crafted, to the extent possible, to be virile (alive and reproducing) but not virulent (disease-causing). Overall, the cost-benefit ratio for broadcasted immunization must be favorable with respect to infecting non-consenting and immunocompromised individuals with even a weakened version of a virus.Bioengineering, epidemiological, and sociological problems of re-transmittable vaccines might or might not be able to be overcome. But, in cases where a harmful virus threatens a large population of individuals who have poor access to vaccines, the idea of inoculating a few individuals with a vaccine that can spread like a virus might be nothing to sneeze at.text/html2010-10-07T19:48:29+01:00http://www.webmedcentral.com/Dr. Mario P ChinInfluenza: The 2009 H1N1 Pandemic And Antiviral Treatment Options
http://www.webmedcentral.com/article_view/916
Purpose. To provide an overview of the 2009 H1N1 influenza pandemic and antiviral treatment options for influenza.
Summary. Influenza infection causes significant morbidity and mortality every year. The high mutation rate and segmented nature of influenza virus genome gives rise to high genetic variability which enables the virus to escape antiviral and vaccine interventions. A novel H1N1 strain of influenza virus known as the swine-origin influenza virus has emerged and established itself recently in the population. The result has been the first influenza pandemic to develop in the 21st century. This new H1N1 virus is resistant to the M2 ion channel inhibitors (amantadine and rimantadine), one of the two classes of anti-influenza drugs. Neuraminidase (NA) inhibitors (oseltamivir and zanamivir) became the only treatment options for the novel H1N1 virus. NA inhibitors work by interfering with the cleavage of sialic acid and preventing the release of viruses, thereby preventing further infection. However, an oseltamivir-resistant H1N1 pandemic strain has been identified in patients. Thus, the emergence of antiviral resistance and the limited treatment options available highlight the urgent need for developing new antiviral agents to combat H1N1 infection. In response to this urgent call, the unapproved investigational drug intravenous peramivir was authorized by the FDA for emergency use. In addition, several new drugs for influenza treatment are currently under development.
Conclusion. Understanding the origin, pathogenicity, resistance potentials of influenza viruses, and the availability of new treatment options is crucial for influenza pandemic preparedness.text/html2010-10-19T21:39:15+01:00http://www.webmedcentral.com/Dr. Christian ObirikorangAntioxidant Therapy- A Relevant Therapeutic Adjunct For Antiretroviral Therapy In Plwhas In Ghana
http://www.webmedcentral.com/article_view/1039
Background: Reactive Oxygen Species (ROS) has been implicated in the stimulation of replication and progression of HIV infection. This study was aimed at investigating the levels of oxidative stress and the relevance of antioxidant therapy as an adjunct for highly active antiretroviral therapy (HAART) in people living with HIV/AIDS (PLWHA) in Ghana.
Methods: Two hundred and twenty-eight (228) people living with HIV/AIDS (PLWHAs) were recruited from an established HIV/ART centre in Ghana. The subjects were placed in three groups according to their CD4 counts: CD4+ counts Group 1: ≥ 500 cell mm-3; Group 2: 200-499 cells mm-3; and Group 3: <200 cells mm-3. One hundred (100) sex, age-matched and healthy HIV-seronegative individuals were used as control. Venous blood samples was taken and analyzed for CD4+ count and markers of oxidative stress which included Malondialdehyde (MDA), Ferric Reducing Ability of Plasma (FRAP), Vitamin C and E, Superoxide Dismutase (SOD) and Glutathione Peroxidase (GPx).
Results: The mean MDA concentrations in Group 1 (2.68±0.09 mmol L-1), Group 2 (2.77±0.10 mmol L-1) and Group 3 (3.17±0.13 mmol L-1) were significantly elevated when compared to the control group (1.54±0.04 mmol L-1) (p<0.0001). The mean FRAP concentrations in Group 1 (563.4±17.70 μmol L-1), Group 2 (463.3±13.28 μmol L-1) and Group 3 (342.0±9.93 μmol L-1) were significantly decreased when compared to the control group (923.3±36.91 μmol L-1) (p<0.0001). Significant decreases in the levels of SOD (p<0.0001), GPx(p<0.0001), Vitamin C and E (p<0.0001) was observed in the patient group compared to the control group.
Conclusions: Results from this study clearly show that, severe oxidative stress occurs in the HIV seropositive patients in comparison with healthy controls and increases significantly disease progression. Adverse effects of ROS might therefore be alleviated with antioxidant therapy as a combination therapy with antiretroviral drugs at cellular level and this might lead to a concomitant improvement in the general health status of PLWHAs.text/html2011-01-14T13:11:23+01:00http://www.webmedcentral.com/Prof. Jeanne Adiwinata Pawitan2009 Pandemic H1N1 Influenza: Previous Infection May Cause Severe And Fatal Cases?
http://www.webmedcentral.com/article_view/1469
Since 10 August 2010 we are in the post pandemic period of 2009 H1N1 influenza pandemics. However, it does not mean that the 2009 pandemic virus was eradicated, as past pandemics experiences revealed that a pandemic influenza virus will take on the behavior of a seasonal influenza and will continue to circulate
An intriguing fact is that some severe and fatal cases occurred in previously healthy individuals. One of the possible risk factors in those cases is previous infection with another type of influenza virus. Therefore, this article addressed the issues that are related i.e. the role of innate and specific immune response and possible role of antibody dependent enhancement in H1N1 influenza, and evaluation of vaccination effect. text/html2011-03-12T13:49:40+01:00http://www.webmedcentral.com/Dr. Bassem ToemaSalmonella Typhi Associated Hemophagocytic Lymphohistiocytosis in a Previously Healthy 23 Years Old Woman
http://www.webmedcentral.com/article_view/1751
A previously healthy 23 years old female was admitted with fever. All the clinical and laboratory findings of the patient are summarized in Table 1. Blood culture revealed Salmonella typhi. Bone marrow aspirate showed hemophagocytosis (figures 1 and 2). The patient received fluoroquinolone, intravenous pentaglobulins for 4 days and intravenous dexamethasone for 8 days. There was marked clinical and biochemical improvement (graphs 1, 2 and 3).
Suggestive evidence linking Hemophagocytic Lymphohistiocytosis (HLH) to Typhoid fever include:
1. Differentiating HLH from similar blood diseases
According to the Histiocyte Society guidelines, five out of eight criteria should be fulfilled for establishing diagnosis of HLH. The history of persistent high grade fever, physical examination and CT scans that revealed hepatosplenomegaly, pancytopenia, associated transaminitis, hypofibrinogenemia and elevated Lactate dehydrogenase and ferritin levels supported the evidence for HLH besides the histopathological confirmation of hemophagocytosis by bone marrow examination. Peripheral smear didn’t show fragmentation or schistocytes excluding thrombotic thrombocytopenic purpura. [1]
2. Exploring other possible causes of HLH
Complete viral screen for Cytomegalovirus, Epstein Barr virus, Hepatitis B and C Viruses, and Human Immunodeficiency Viruses 1 and 2 was negative. Antinuclear antibody, Double stranded DNA antibody, Rheumatoid Factor and Anti Neutrophil Cytoplasmic Antibody were negative ruling out the macrophage activation syndrome.
3. Positive temporal relationship and biological plausibility
Hemophagocytosis is non-specific frequent pathologic finding in the active proliferative stage of typhoid fever which coincides with the second week of infection. [2]
4. Recognized association with Gram negative aerobic bacilli
Brucella is a genus of Gram negative, non motile, non spore-forming bacilli. In a pivotal case-control study, 16 patients (5.8%) out of 276 pediatric cases of brucellosis seen over a 7-year period were found to have pancytopenia. Fourteen out of these 16 patients (87.5%) had positive blood and / or bone marrow cultures for Brucella melitensis. Also hemophagocytosis was observed in 14 out of these 16 patients (87.5%). [3]
Typhoid fever is rarely associated with HLH. In one study the bone marrow of four cases (out of fifteen cases of culture proven typhoid fever) was examined and showed infection associated Hemophagocytic syndrome. In another study, the bone marrow examinations of five patients with Typhoid fever associated with pancytopenia revealed histiocytic hyperplasia with marked phagocytosis of platelets, leukocytes and red blood cells in those affected individuals. [4][5]
5. Identification of Salmonella typhi with blood culture.
In conclusion, in areas where typhoid fever prevalence is high, hemophagocytic findings should be considered Salmonella typhi associated HLH until proven otherwise.text/html2011-04-26T19:33:49+01:00http://www.webmedcentral.com/Dr. Kadriye Kart YasarEmerging Antibiotic Resistance in Psedomonas and Acinetobacter Strains Isolated from ICU Patients: Comparison of Years 1999, 2006 and 2009
http://www.webmedcentral.com/article_view/1898
Objectives: Pseudomonas and Acinetobacter spp. which are usually resistant to many antibiotics, are the most important infectious pathogens in intensive care units (ICUs). The aim of this study was to determine the antibiotic resistance patterns of these agents and to follow variation in resistance among the years of 1999, 2006 and 2009.
Methods: The resistance rates of various antibiotics for 21, 38 and 54 acinetobacter and 26, 44 and 66 pseudomonas bacteria which were isolated from blood cultures of ICU patients in years 1999, 2006 and 2009 respectively were compared with Fischer’s qui square test statistically.
Results: The most effective antibiotics were amikacin (88%), cephaperazone-sulbactam (85%), piperacillin-tazobactam (85%), ceftazidim (75%) and imipenem (75%) for Pseudomonas spp. and imipenem (76%),cephaperazone-sulbactam (71%), ciprofloxacin (52%) and amikacin (48%) for Acinetobacter spp. in 1999. Decreasing sensivities to amikacin (76%), cephaperazone-sulbactam (53%), piperacillin-tazobactam (71%), ceftazidim (53%) and imipenem (64%) for Pseudomonas spp. and decreasing sensivities to imipenem (28%), cephaperazone-sulbactam (37%), ciprofloxacin (13%) and amikacin (17%), piperacillin for Acinetobacter spp in 2009 were significant (p<0,05).
Conclusions: These results suggested that significant resistance development for imipenem, cephaperazone-sulbactam and ciprofloxacin occurred against acinetobacter strains and for cephaperazone-sulbactam, amikacin and ceftazidime against pseudomonas strains. Increased resistance in our ICU is significant in Acinetobacter spp. The usage of some antibiotics have been limited and multidrug-resistant or pan-resistant strains have been monitorized by infection control committee of our hospital. Protective measures like good hand hygiene, strict contact isolation and control strategies for rational antibiotic usage may be effective factors for infection control caused by these pathogens in ICUs.text/html2011-07-02T13:55:49+01:00http://www.webmedcentral.com/Mr. Thijs VeenstraRisk Factors for Q Fever in the Netherlands
http://www.webmedcentral.com/article_view/2006
Background - Living close to an infected farm has been established as a risk factor for human Q fever during the large, ongoing epidemic in the Netherlands. The aim of the present study was to identify other individual-level risk factors for Q fever, with an emphasis on outdoor activities.Methods - In a case control study, cases were notified Q fever patients within a municipal health region in the south of the Netherlands and controls were recruited via a newspaper advertisement that contained a link to a web-based questionnaire.
Results - Male gender, living in an area within 1 km of the nearest affected goat farm and smoking were strong risk factors for acquiring Q fever. Contrary to what was expected, we found that contact with animal or farm waste products or having visited nature areas had a protective effect.
Conclusion – We did not find an increased risk for Q fever associated with outdoor activities. However, our control group may have included people with an earlier unnoticed seroconversion who were protected against clinical acute Q fever around the time of the study. Despite this methodological problem, the present study confirms the increased risk associated with living close to an infected goat farm.text/html2011-10-18T12:25:50+01:00http://www.webmedcentral.com/Prof. Parvaiz A ShahEnteric Fever Presenting as Hemophagocytic Lymphohistiocytosis (Macrophage Activation Syndrome)
http://www.webmedcentral.com/article_view/2331
Macrophage Activation Syndrome is a rare, fatal disease which needs to be considered in patients with a SIRS(systemic inflammatory response syndrome) like clinical presentation. Here,we report a case of enteric fever masquerading as hemophagocytic syndrome for its rarity and unusual presentation.text/html2011-11-22T06:51:03+01:00http://www.webmedcentral.com/Dr. Emeka E OjiyiThe Influence of Occupation on Genital Tract Infections
http://www.webmedcentral.com/article_view/2497
Background: Genital tract infections such as Gardnerella vaginalis vaginosis, trichomoniasis and candidiasis have continued to assume importance because of the particular unique features of their main causative organisms- Gardnerella vaginalis, Trichomonas vaginalis and Candida albicans, and myriads of clinical and pathological changes in affected persons.Aim: To study the association between occupation and genital tract infectionsMethods: The subjects were 450 randomly selected sexually active women attending antenatal, postnatal, gynecology and family planning clinics in the Department of Obstetrics and Gynecology of the University of Maiduguri Teaching Hospital from April 2001 to May 2002. The Pap smear of these patients were examined microscopically for the evidence of Candida albicans, Garnerella vaginalis and Trichomonas vaginalis. A questionnaire assessing the occupations of the patients was administered.Results: Sixty-six (66) of the 459 patients studied had specific infections giving a prevalence rate of 14.7%. Candida albicans, Gardnerella vaginalis, Trichomonas vaginalis and Candida albicans in conjunction with Gardnerella vaginalis contributed 7.1%, 5.15%, 2.4% and 1.8% respectively to this overall prevalence. Their ages ranged between 15 and 64 years, with a mean of 26± 3 years.Conclusion: Students and those not currently employed are at increased risk of acquiring genital tract infections and should be the target in sporadic or organized sexually transmitted infections screening without discriminating other sexually active women.text/html2011-12-18T05:42:40+01:00http://www.webmedcentral.com/Ms. Zhe Y ChengSexually Transmitted Disease (STD)
http://www.webmedcentral.com/article_view/2611
Sexually transmitted disease (STD) can be infected through sexual contacts. Some of the common STDs are syphilis, gonorrhea and chlamydia. Different STDs have different transmission mechanism, signs and symptoms, complications, diagnosis and treatments. This review article focuses on the mechanism of disease transmission, bacterial resistance and type of antibacterial drugs used for three commonly known STDs which are syphilis, gonorrhea and chlamydia. It is found that syphilis is usually treated with penicillin with no bacterial resistance shown. Third generation of Cephalosporins is now usually used as the antibacterial agent for gonorrhea due to the bacterial resistance towards penicillin, tetracycline and earlier generations of cephalosporins. Azithromycin is found to be a more effective antibacterial agent compared to doxycycline for treating chlamydia. STDs can usually be effectively treated if early diagnosis and treatment seeking behaviour are present. These STDs can also be avoided if the proper prevention steps are followed.text/html2011-12-19T15:42:58+01:00http://www.webmedcentral.com/Ms. Fatin A Mohd ZainTuberculosis Among Diabetic Patient
http://www.webmedcentral.com/article_view/2696
Tuberculosis is the leading killer among bacterial disease worldwide and World Health Organization (WHO) suspects that TB control is being undermined by the growing number of patients with diabetes mellitus in the world. Diabetes depresses the immune response, which in turn facilitates infection with Mycobacterium Tuberculosis. Diabetes patient has two or three times risk toward the tuberculosis compared to others who do not have diabetes. Signs and symptoms of active Tb include a persistent cough, night sweats, breathlessness or pain while breathing, weight loss, loss of appetite and fever while the signs and symptoms of diabetes are severe frequent thirst, lack of energy, fatigue and blurred vision. The problem of this disease is the clinicians do not routinely screen for this disease and they are unaware of this essential link. Some of the diabetic drugs to treat diabetes are insulin, sulfonylureas, metformin and many more whereas drugs that use to treat tuberculosis are isoniazid, rifampin, pyrazinamide and ethambutol. There are fist line drugs. When diabetes is diagnosed with tuberculosis, the probability of drug interactions between anti-diabetic drug and anti-tuberculosis drug will occur. Drug interaction occurs when isoniazid is given to patient who taking metformin. This will lower hypoglycemic metformin with interrupting the control of blood glucose. There are many effective ways in preventing the infection of TB such as not always to get close to people who are coughing or wear a mask. The Bacillus Calmette-Guerin (BCG) vaccination can provides protection against TB. Patient who has diabetic and tuberculosis can cause death if they are not treated immediately so to prevent it from happen, patients have to go through treatment to stop the tuberculosis. People are advised to take serious precaution about this disease to make sure they are not infecting with TB that can cause fatal to those who get it.text/html2011-12-19T15:41:32+01:00http://www.webmedcentral.com/Ms. Ro-zanne LeanLeprosy
http://www.webmedcentral.com/article_view/2701
Leprosy is a chronic infectious disease caused by a rod-shaped bacillus, Mycobacterium Leprae. This disease was used to be considered incurable. This disease will cause patients suffering from it to have skin lesions at the extremities, having physical deformities of the fingers, toes and also face. Diagnosis of this disease is hard because the bacillus have a long incubation period. The signs and symptoms will only show a few months or maybe years after infection. However, once the disease is diagnosed, chemotherapy by multidrug therapy of dapsone, rifampicin, clofazimine and other chemotherapy drugs will be given to treat the disease. The treatment will be long term ranging from six months to two years, depending on the seriousness of disease. Single dose of chemotherapy drug or Bacillus Calmette-Guerin (BCG) vaccination can be used as prophylaxis against leprosy.text/html2011-12-19T15:36:21+01:00http://www.webmedcentral.com/Mr. Tee D LiangH1N1 Influenza: A Viral Infection
http://www.webmedcentral.com/article_view/2736
The outbreak of Influenza H1N1 on 11 June 2009 caught attention worldwide. H1N1 influenza is a subtype of Influenza A. There are several serious outbreaks of H1N1 influenza which occurred in the history in 1918, 1957, 1968 and 2009. H1N1 influenza is caused by influenza viruses, which are small RNA that will infect many mammals, including humans, birds, and swine. The deadly virus contains two types of protein on its surface which are hemagglutinin (H) and neuraminidase (N). Hemagglutinin binds to its receptor, sialic acid on the host cell surface. Neuraminidase cleaves the sialic acid receptor and then release progeny virus from the cell surface that has been infected by the virus. The common symptoms of patients with H1N1 influenza are difficulties in breathing, cough, headache, tiredness, sore throat, vomiting and diarrhoea. The preventive measures that can be taken for H1N1 influenza include getting vaccinated, practising proper and frequent hand washing, avoiding close contact with sick people, wearing a facemask, and practising a healthy lifestyle. The treatment of the H1N1 influenza involves drugs such as Tamiflu® (oseltamivir) and Relenza® (zanamivir).text/html2011-12-19T15:32:03+01:00http://www.webmedcentral.com/Ms. Hui M LaiManagement of Side Effects and Drug Interactions of Anti-mycobacterial in Tuberculosis
http://www.webmedcentral.com/article_view/2749
Background: Tuberculosis is a communicative disease caused by Mycobacterium tuberculosis that may cause death if it is left untreated. The incidence of tuberculosis has decreased since the introduction of anti-tubercular drugs. Undesirable side effects and drug-drug interaction of anti-tubercular drugs will results in discontinuation or substitution of other drugs. This may influence patient’s response and compliance. It also may increase the risk of treatment failure.
Purpose: The purpose of this assignment is to study the side effects and drug interactions of anti-tubercular drugs as well as the way to manage them.
Literature Review: Journals related to anti-tubercular agents are referred to accomplish this assignment. Databases such as Science Direct and PubMed are used to search for these journals.
Discussion: Patients with tuberculosis are with treated anti-tubercular agents, either in monotherapy or in combination. The anti-tubercular drugs will bring adverse effects to the patients if not managed properly such as hepatotoxicity and rashes due to hypersensitivity. The anti-tubercular drugs will also interact with other medications such as antiretroviral drugs as well as among themselves. The negative effects from these interactions have to be managed.
Conclusion: Tuberculosis treatment will bring positive effects as well as negative effects due to side effects and drug interactions of the anti-tubercular dugs. Therefore, the side effects of as well as the interactions of the anti-tubercular drugs have to be managed to prevent treatment failure or even worse, death in the tuberculosis patient.text/html2011-12-20T17:37:33+01:00http://www.webmedcentral.com/Ms. Jennie K LimA Case Study: Leptospirosis In Malaysia
http://www.webmedcentral.com/article_view/2764
Leptospirosis is one of the common re-emerging zoonotic diseases transmitted from infected animals to humans. It is a bacterial infection caused by a species of pathogenic leptospiragenus called Spirochaetes. The very first case of human leptospirosis in Malaysia was discovered by Fletcher in the year 1925. Pathogenic leptospires can spread through the urine of carrier animals to the environment. Flu-like symptoms such as severe headache, sudden fever of 39°C and above, eyes inflammation, muscle aches, diarrhea, fatigue, nausea and vomiting, chills, rigors and maculopapular rashes can be observed. Several antibiotics that are used to treat this disease are ampicillin, ceftriazone, doxycycline and penicillin. A good prevention for the spread of leptospirosis is by practicing good sanitation and avoiding any direct contact with urine - contaminated soil and water.The recurrence of leptospirosis infection in the recent years proves to be a source for concern. Malaysian government should continue to work out measures to tackle this infection.text/html2011-12-21T15:26:30+01:00http://www.webmedcentral.com/Mr. Ahmad Ikhwan FayadhThe Overview of Meningitis and its Treatment
http://www.webmedcentral.com/article_view/2767
Meningitis is generally an infection involving the inflammation of the meninges which is becoming an increasingly common non-infectious disease. Patients with meningitis must be given treatment within a rapid period of time as delay in treatment causes various serious complications. Studies have shown that meningitis has a high mortality rate in most countries and therefore, in our research paper, we aim to discover and explore more about the causative agents of meningitis, both classic signs and uncommon symptoms of meningitis, ways to diagnose infection of meningitis, risk factors for meningitis and also the therapies available to combat meningitis. In order to achieve the objectives above, we took several approaches to gain answers and explanations to our questions. First of all, we derived many research journals from the internet that were related to the field of our study. We analyzed the findings of these medical journals and focused on the selected topics we were assigned to. Also, we searched for related information from other published medical books. Upon completion of all the procedures, we found that meningitis could be classified into several groups based on their causative microorganisms. We also discovered that the empiric therapy for most meningitis cases were mostly third generation antibiotics as they could penetrate the CSF. Lumbar puncture may also be conducted to discover the causative agent of meningitis in a patient. Also, there were many drugs in the market available for the treatment of meningitis. This discovery enables us to determine the drugs for empirical therapy of meningitis and the specific drugs used after the causative agent of meningitis has been identified. In conclusion, this research study has increased our understanding of meningitis.text/html2011-12-22T17:52:53+01:00http://www.webmedcentral.com/Ms. Hui Yi LeowLeptospirosis
http://www.webmedcentral.com/article_view/2772
Background: Leptospirosis disease has been recognized for decades, particularly in resource-poor, developing countries.Outbreaks have been associated with flooding and natural disasters. Leptospirosis is transmitted by direct or indirect contact with urine of infected animals. Other sources of exposure include blood, fluids, or tissues of parturition of infected animals. Diagnosis requires a high manifestation of suspicion based on clinical presentation associated with epidemiological exposure. Affected individuals can present with an extensive spectrum of clinical manifestations ranging from subclinical illness to renal and hepatic failure and pulmonary haemorrhages. Disease can be presented in two phases, the initial phase and the immune phase. Treatment of disease includes usage of antibiotics such as penicillin-G and Doxycycline along with supportive therapy. Alternative therapeutic agents include Cephalosporins and traditional medicines. Prevention and controls of Leptospirosis should be targeted at the source of infection, the route of transmission between infection sources and the human host; or infection of disease in the human host. Personal and environmental hygiene should be emphasised by the high risk groups where preventive measures should be taken.Conclusion: The studies of etiology and epidemiology of Leptospirosis has led to the development of effective preventive strategies. Recent advances in the molecular biology of Leptospires offer the prospect of more rapid progress in the future.text/html2011-12-23T18:19:14+01:00http://www.webmedcentral.com/Ms. Sok Teng NgEmergence of Vancomycin-Resistant Staphylococcus Aureus (VRSA)
http://www.webmedcentral.com/article_view/2787
Background: Staphylococcus aureus is one of the bacteria under the genus Staphylococcus which is a gram-positive coccus. It is microscopically observed as individual organisms, in pairs and in irregular, grapelike clusters. S. aureus is non-motile and non-spore forming bacteria. It is one of the most common community and nosocomial pathogen. It mainly causes skin and soft tissue infections as it is the normal flora on human skin.Discussion: Infections caused by S. aureus are treated with benzylpenicillin, methicillin and others. It is difficult to treat infections caused by S. aureus as it destroys neutrophils and shows high antibiotic resistant. MRSA emerged and causes methicillin to be ineffective against them. Thus, vancomycin becomes the drug of choice to be used. Vancomycin acts by inhibiting the biosynthesis of cell wall of S. aureus. However, some strains of S. aureus developed resistance to vancomycin as well, by increasing the quantities of peptidoglycan and alter the terminal peptide of D-Ala-D-Ala to D-Ala-D-Lac. As a result, hetero-VRSA, VISA and VRSA strains emerged.Conclusion: Emergence of VRSA is due to the reduced susceptibility of S. aureus to vancomycin as S. aureus has developed resistant to vancomycin. Normally, antibiotic combination therapy is used to treat infections caused by VRSA. Hygiene precautions should be taken to avoid the transmission of infections caused by S. aureus.text/html2011-12-31T10:34:41+01:00http://www.webmedcentral.com/Prof. Jayendra R GohilDiphtheria
http://www.webmedcentral.com/article_view/2594
Necrotic patch visible as white membrane on left tonsil and a grey patch on the inner pillar of right tonsil in a 7 year boy suffering from DIPHTHERIA. The swelling over left angle of mandible and near right tragus suggest beginning of lymphnode enlargement which can grow large enough to be called 'bull neck'.Membrane may extend down to glottis causing stridor and respiratory obstruction requiring tracheostomy. Exotoxins reach myocardium and invariably cause myocarditis simultaneuosly. Cardiac markers are elevated. This child was not immunised with diphtheria (DPT) vaccine. The serious symptoms like respiratory obstruction and stridor are not seen in this child perhaps due to partial immunity from previous asymptomatic infections.Neurological complications like muscle paralysis, nasal voice or post infectious polyneuropathy (GBS- Gullian Barry syndrome) can occur after 2 weeks to 6 months later.Therefore, not giving a vaccine leads to complications that are life treatening (tracheal obstruction, myocarditis), require expensive treatment like ventilator and/or immunoglobulins.Other causes of white membrane in oral cavity are infectious mononucleosis, streptococci, candida, submucus fibrosis and lichen planus (due to tobacco chewing), poor oral toilet esp with tonsilar cleft.text/html2012-03-29T15:57:38+01:00http://www.webmedcentral.com/Dr. Aditya S BeradEpidemiological Study of Reproductive Tract Infections in Rural Area of Indore District.
http://www.webmedcentral.com/article_view/3205
Research Question:What is the burden of Reproductive Tract Infections in Women of reproductive age group in rural Indore?Objective:1) To find out the magnitude of problem of RTIs in women aged 15-44 years in villages of Double Chowki PHC of Indore District, Madhya Pradesh.2) To study the epidemiological determinants of RTIs.Design:Cross-sectional study. Setting: 7-subcentre villages comming under Double Chowki PHC of Indore district.Material and Methods:The study was conducted in 7 subcentre villages. The study included all women in the age group of 15-44 years. The sample size was calculated as 421 women taking 5% allowable error. The number of women studied in each village was selected by probability proportional to size (PPS) sampling technique. In the second stage the primary unit of survey was selected using systematic random sampling at each village level. The cases were identified using Syndromic approach and were referred to the subcentre for further clinical examination and treatment.Results:The proportion of RTIs symptomatics was found to be 18.7%. Among 79 RTIs symptomatic women, majority (49.3%) of women had only vaginal discharge followed by 37.9% women had vaginal discharge with lower abdominal pain. 1.3% of them had only other symptoms of RTIs which includes genital ulcer, mucopus from cervix and inguinal lymphadenopathy, 5.1% were having vaginal discharge with other symptoms of RTIs and 6.4% had pain in lower abdomen with other symptoms of RTIs.Conclusion:There was significant association between RTIs symptomatics and age, age at menarche, age at marriage, age at first conception. The proportion of RTIs symptomatics did not differ significantly with education, occupation, socioeconomic status, religion, parity, history of abortion, use of IUCD, and hygienic practices during menstrual period.text/html2012-04-09T14:40:08+01:00http://www.webmedcentral.com/Dr. Gentian VyshkaStreptococcus (GAS) as Cause of Necrotizing Fasciitis Associated with Septic Shock and Multiorgan Dysfunction
http://www.webmedcentral.com/article_view/3224
Necrotizing fasciitis is a rare infection caused by microorganisms called “flesh eating bacteria”. It is characterized by rapid tissue destruction along superficial fascia, systemic signs of toxicity and high mortality. The most common etiologic agents are gram positive and gram negative species or/and anaerobes. The authors present the successful treatment of a 71 years old woman with necrotizing fasciitis due to Group A Streptococcus (GAS), complicated with severe septic shock in a subject with chronic malnutrition. No skin lesion was found to serve as a portal of entry for infection. The successful outcome was due to the early treatment with antibiotics and massive debridement of necrotic tissue two days after hospitalization.text/html2012-05-08T20:32:25+01:00http://www.webmedcentral.com/Mr. Muhammed R SiddiquiEmerging and Re-emerging Infectious Diseases: Hepatitis C
http://www.webmedcentral.com/article_view/3342
Aim: To explore new developments in anti-viral therapy used to treat hepatitis C.Background: Hepatitis C is a blood-borne virus currently affecting 175 million people worldwide. Infection with the virus can predispose to chronic infection, cirrhosis and hepatocellular carcinoma. The virus can be contracted through exposure with a hepatitis C infected person’s blood. Intravenous drug use is the most common mode of transmission. Those infected with the virus may experience vague symptoms such as malaise and fatigue, or they may show symptoms of liver disease or any other complications of the infection. As symptoms may be non-specific and are not often detected in the early stages of infection the hepatitis C virus (HCV) is in this sense known as a silent killer, as the liver may be extensively damaged before infection with the virus is detected. Anti-viral therapy for treating chronic hepatitis C currently remains the only option in preventing cases of liver cirrhosis and hepatocellular carcinoma. Currently no vaccines have been developed.Method: An insight and understanding of HCV was gained by using books, journals and the internet. Electronic databases used were used to conduct a literature search for articles regarding the development of anti-viral drugs; the outcome of this is shown in the results table. An inclusion and exclusion criteria was applied to the articles generated and the most suitable articles were selected for discussion.Results: The results of almost all of the anti-viral drugs researched were successful in attaining a decrease in the HCV RNA levels and achieving a sustained viral response.Conclusion: The results of the clinical trials researched show some promise for future developments in anti-viral therapy. A successful treatment regime which can eliminate the hepatitis C virus is in great demand, given the substantial amount of morbidity and mortality caused by the virus.text/html2013-08-09T06:28:16+01:00http://www.webmedcentral.com/Dr. Murtaza A CalcuttawalaNon Tuberculous Mycobacterial soft tissue swelling in an immunocompetent Patient.
http://www.webmedcentral.com/article_view/4361
The Non Tuberculous Mycobacteria (NTM) include those Mycobacterium species that are not members of the Mycobacterium tuberculosis complex; hence the use of the terms ‘‘Non Tuberculous Mycobacteria'' and ‘‘Mycobacteria other than Tuberculosis.'' Although the pathogenic potential of NTM was reported throughout the 20th century, widespread appreciation of the clinical syndromes caused by NTM began during the 1980s in association with the AIDS pandemic and the consequent dramatic increase in disseminated Mycobacterium Avium complex infections. (1,2) However, the epidemiology of NTM disease in patients without Human Immunocompetent Virus infection remains somewhat difficult to determine. NTM disease is relatively uncommon.(3) We present a case of Non Tuberculous Mycobacterial soft tissue infection, in an immunocompetent 18 year old male.
text/html2018-05-15T07:41:04+01:00http://www.webmedcentral.com/Dr. Deepak GuptaLet There Be Guideline For Being Too Clean
http://www.webmedcentral.com/article_view/5460
As interestingly brought to light by Svanes et al (2018) [1] and others [2-3], the time has been ripe for eliciting a discussion about the consequences of cleaning when with time, being too clean has been slowly replacing being too dirty [4-5]. To my limited understanding, the mechanical agents may elicit harm within moments and thus resolution against them may be successful within moments; the chemical agents may elicit harm within hours and thus their resolution may need more time; the biological agents may elicit harm within days and thus their recognition and thereafter their resolution may take longer times; and finally, the idiopathic (potentially psychological) agents may elicit harm within unknown time frames and consequently their recognition and resolution may spread over periods unknown. Hereafter, we can assume that workplaces like airports and hospitals [6-10], which may have been prone to be the most dangerous places in terms of transmitting diseases (biological agents) among the massive turnover of visitor populations' traffic harboring all types of contagions from all over the world, may have ended up achieving the tag of being the cleanest workplaces with the chemical agents (cleaning solutions) replacing the biological agents [11] at various points of contacts which are prone to be involved in humans-to-fomites-to-humans transmissions. Moreover, it may NOT be as much as the dusting off component of vacuum based often wet-cleaning but rather the spraying component of the cleaning solutions often "sitting on" (adhering to) the fomites waiting to be absorbed or adsorbed on to the next host body and in turn finding more often than not the bodies of cleaning solutions' dispersers (the cleaners) themselves. Even though the cleaning solutions' sprays may be replaced with cleaning solutions' sponges with the limitations and restrictions to be used only while donning the gloves along with the N95 respirators (masks) preventing the inhalation of 95% of small size inhalants [12] which are potentially evaporating while the recently cleansed surfaces are drying and turning/becoming to be odor-vapor-free, the human tendency to involuntarily touch mucosal surfaces of their faces with their hands [13] and contributing to transmissions of infectious agents (biological agents) may NOT differentiate much when translocating cleaning solutions (chemical agents) from their hands (even if they are gloved) to the mucosal surfaces of their faces and may thereafter raise the question whether it's time to re-explore if hot water or even cold water [14-15] cleansing may be sufficient enough for some surfaces to reduce humans' exposures to chemical agents as replacements for biological agents in the modern much more clean though much more chemicalized existence for humans [16-17]. Interestingly, the cleaning additives which used to need hot water for better dissolution are no longer needing water to be heated up thus raising the question whether the chemical agents in cleaning additives have become more powerful (and potentially more harmful) when they are no longer needing water's heat for dissolution/homogenization to make them work more effectively unless the cleaning additives irrespective of their affinity for cold or hot water may never be as harmless (and some may say pointless) as plain water itself. Summarily, the issues covertly inducted into readers' minds by Svanes et al (2018) [1] should bring modern society more into action like some [18] wherein as simple an action as cleaning houses or offices may be evolving as detrimental to cleaners' health warranting the need for guidelines about how to be safe without being too clean unless the society is sleeping while waiting to be shaken/awakened by overzealous/zealot litigating entities getting drawn on behalves of our insured healthcare costs and our protected occupational healthcare costs into these potentially lucrative avenues thus forcing our innocent hands into changing our cleaning practices and skills whether we are ourselves cleaning or are expecting others to clean our homes expectantly/domestically or our offices contractually/professionally.text/html2018-05-15T07:41:00+01:00http://www.webmedcentral.com/Dr. Deepak GuptaVideo Phone Communication With Patients In Isolation
http://www.webmedcentral.com/article_view/5461
The most stringent isolation precautions (airborne precautions) warrant the most commonly used N95 respirators to be worn by healthcare providers in negative pressure rooms caring for patients suspected or confirmed to be harboring airborne pathogens. However, although N95 respirators aim to protect healthcare providers by filtering out at least 95% airborne pathogens, their use can be discomforting leading to impaired functioning of healthcare providers. Therefore, it may be worthwhile to explore videophone communication with patients in isolation so that total duration of discomforting N95 respirators' use can be limited while unmasked faces may ensure improved in-hospital experience due to more fulfilling communication on videophones and reduced in-room traffic enhancing patient safety among "isolated" patients.text/html2018-05-15T07:40:42+01:00http://www.webmedcentral.com/Dr. Deepak GuptaSave The Hands While Saving From Hands
http://www.webmedcentral.com/article_view/5459
There has been escalating stress on hand hygiene to ensure prevention of disease-transmission. However, it is time to concurrently give due consideration to counter-concerns inherent with hand hygiene precautions and hereafter, possibly suggest an alternative solution. Although gloves have been in use as barrier method, in the absence of technological advancement to aseptically wear on the clean gloves and then to aseptically tear off the dirty gloves, personnel are not able to do away with hand washing and/or hand rubbing prior to wearing on gloves as well as after tearing off gloves. The possible solution can be auto-glove dispenser and auto-glove remover that can prevent disease-transmission due to hands while avoiding wet-work-exposure dermatitis of the hands due to repetitive hand washing and/or hand rubbing.text/html2018-06-15T04:55:44+01:00http://www.webmedcentral.com/Dr. Haruna I AdamuRelationship between Caregivers\' Socio-Economic Status and Childhood Tuberculosis in Bauchi State, Northeastern Nigeria
http://www.webmedcentral.com/article_view/5487
Background:Childhood tuberculosis (CTB), remains a neglected aspect of the TB epidemic despite accounting for 10% of the global TB burden and being responsible for 210,000 deaths in 2016. Furthermore, TB research, prevention, and control worldwide has predominantly focused on adults, neglecting children 0-14 years old. In Nigeria, there is paucity of research studies examining the relationship between reporting of CTB and caregivers’ socio-economic status (SES).
Study Design:Observational study
Methods:This quantitative cross-sectional study examined the relationship between caregivers’ socioeconomic status (SES) and the reporting of TB in children aged 0-14 years. Using the abridged version of World Health Organization’s (WHO) QOL tool, the WHOQOL-BREF, data were collected individually in a face-to-face setting from caregivers (n= 47) whose children had been diagnosed with TB in Bauchi State, Northeastern Nigeria, over a 5-year period. Data were collected in the same manner from another set of caregivers of children without TB (n= 47) within the same period and setting.
Results:Logistic regression revealed a statistically insignificant relationship (p>0.05) between the caregivers’ SES and the reporting of childhood TB.
Conclusion:This study should be repeated with an additional validated tool that measures SES across diverse, resource-limited settings like Nigeria. text/html2018-11-12T07:08:00+01:00http://www.webmedcentral.com/Dr. Robert A LodderSetting Starting Level for a Trial of a Biofilm-Disrupting Adjuvant
http://www.webmedcentral.com/article_view/5521
Combination therapy is beneficial treatment modality for multiple diseases. Cinnamon oil may be an advantageous agent in a number of combination therapies as cinnamon oil has antibacterial activity. Cinnamon oil has also been shown to be effective against biofilm cultures of Streptococcus mutans and Lactobacillus plantarum. Cinnamomum osmophloeum inhibits planktonic cultures of many gram-positive and gram-negative bacteria, including MRSA (methicillin-resistant Staphylococcus aureus). Subjecting S. epidermidis to cinnamon oil eliminates planktonic cells or staphylococci in biofilms. Cinnamon oil is an essential oil used throughout the food industry because of its pleasant and distinctive aroma. The purpose of this study is to estimate the amount of exposure to cinnamon through selected foods in the United States in order to propose an initial target level for pharmacokinetic studies of a novel combination drug.
A complete version of this article is available on BioRXiv as BIORXIV/2018/447607.text/html2018-11-12T07:08:12+01:00http://www.webmedcentral.com/Dr. Robert A LodderComparison of Analytical Techniques for Thermal Stability Analysis of Beta-Cyclodextrin for an Ebola Virus Infection Treatment
http://www.webmedcentral.com/article_view/5520
Each New Drug Application filed with the Food and Drug Administration (FDA) must include the analytical procedures to ensure the identity, strength, quality, purity, and potency of a drug substance and drug product. The BSN389 drug product (being developed to treat Ebola virus infections) includes beta cyclodextrin. Evidence must be provided that the analytical procedures used in testing BSN389 meet proper standards of accuracy, sensitivity, specificity, and reproducibility and are suitable for their intended purpose. The Bootstrap Error-adjusted Single-Sample Technique (BEST) software was used to compare the quantitative and qualitative power of IR and 1H NMR to differentiate new and partially decomposed samples of beta cyclodextrin, and the best assay will be incorporated into the thermal stability protocol for BCD.
The complete version of this paper with figures is available on BioRXiv as BIORXIV/2018/448928. text/html2019-09-04T07:42:14+01:00http://www.webmedcentral.com/Dr. Esther Una CidonThe birth of antibiotics: cutting a long story short. Part 1
http://www.webmedcentral.com/article_view/5591
Nowadays we are so used to the antibiotics that we take them for granted. However, there was a time were common bacterial infections were at ease and minor scratches or simple cuts were fatal.
All started when syphilis, although known for centuries, became the 19th century version of today’s Aids epidemic. This sexually transmitted disease infected and killed millions worldwide. Mercury had been used to treat it but unsuccessfully and with a high risk of poisoning.
In 1880, Robert Koch found a way of staining bacteria to identify them. Paul Ehrlich, a member of his team, took this idea further. He thought that a dye could be used not just to stain the bacteria, but hopefully to kill them (and not the patient) as well. He began experimenting with several arsenic compounds in treating syphilis in rabbits. In 1909 and after trying 606 chemicals, he and his assistant Sahachiro Hata, a Japanese bacteriologist, experienced success with the compound 606, later called Salvarsan, or the “magic bullet”. This was highly toxic and in 1912 Ehrlich created Neo-salvarsan, safer than its ancestor and this became the standard treatment for syphilis until replaced by penicillin.
It was in 1928 when a scottish scientist, Alexander Fleming returned from a holiday trip to discover that a mold had accidentally contaminated Petri dishes containing cultures of the bacteria Staphylococcus. He realised that no bacteria grew up near the mold. Further tests showed that other bacteria died as well after being exposed to the mold known as Penicillium notatum. This seemed to contain an agent that inhibited the growth of bacteria initially called “mold juice”, later penicillin. Fleming wrote: “When I woke up just after dawn on September 28, 1928, I certainly didn’t plan to revolutionize all medicine by discovering the world’s first antibiotic, or bacteria killer. But I guess that was exactly what I did.” But sad news, he could not successfully isolate pure penicillin from the mold juice and the experiments stopped in 1931.
Other researchers were working to find the “second magic bullet”. This was a red dye called Prontosil which killed bacteria causing “blood poisoning”. Gerhard Domagk in 1932 injected mice with a lethal dose of a streptococcal infection and then with Prontosil, which cured them. He also cured his daughter when she became seriously ill with the same infection.
Further investigations showed that the active ingredient of Prontosil was a sulphonamide and this led to the cure of gonorrhoea, pneumonia, scarlet fever and reduced mothers post-birth mortality from 20% to 4.7%.text/html2020-08-17T07:57:38+01:00http://www.webmedcentral.com/Dr. Deepak GuptaCan COVID-19 Pandemic Invent Redesigned Electric Microcars To Be Parked Inside Workplaces As Mask-Vacation Pods?
http://www.webmedcentral.com/article_view/5619
Non-physiological in-mask microclimates may require mask-vacation pods as safe-spaces for workers to break away from masks during COVID-19 pandemic.text/html2020-09-23T04:55:17+01:00http://www.webmedcentral.com/Dr. Deepak GuptaCan Bat-Gown, Bat-Sack, Bat-Box Protection Counter Bat-Human Contraption? An Envisaged Idea Triplet
http://www.webmedcentral.com/article_view/5643
Dose of exposure cannot be downplayed whether it is the dose of inanimate chemicals, animate bacteria or viruses somewhere-in-between therein. Therefore, as high infectivity of clinical scenarios unravel during COVID-19 pandemic, Bat-Gown, Bat-Sack and Bat-Box as envisaged idea triplet may play a role to counter Bat-Human contraption like SARS-CoV-2 in the healthcare environments. text/html2020-10-07T04:51:37+01:00http://www.webmedcentral.com/Dr. Deepak GuptaNOT Hate Masks; Just Investigate Them Regarding: Fungal Rhino-Sinusitis, Catabolic Myo-Arthralgia, Schoolchildren\'s Cognition, Sclerosis\'s Temperature And Disability Sabbatical
http://www.webmedcentral.com/article_view/5654
Love and hate are powerful words which are often overused to make or break the case for what we love or what we hate. Personally, I have never loved masks even when they now seem “therapeutic” to me against pathogens like SARS-CoV-2 [1-2]. However, I cannot hate their non-physiological micro-environments [3] because the stakes are too high when daily so many are losing lives globally. Therefore, I can only make the case for investigating masks to find the common middle ground for my love-hate relationship with masks because masks may not go away even after pandemic is over. The global population may get acclimatized to the new-normal safety, seemingly provided by masks not only against SARS-CoV-2 but also against other pathogens like seasonal influenza and pathogens causing healthcare associated infections like surgical site infections [4-5].text/html2020-12-27T08:17:38+01:00http://www.webmedcentral.com/Dr. Deepak GuptaWorth Investigating: Sunbathing (Sunfacial) With Masks On (SUMA) For Cleansing \"Cold\" Viruses
http://www.webmedcentral.com/article_view/5672
It is my opinion that as SARS-CoV-2 is mutating into new variants complicating the ongoing raging pandemic, it remains to be seen whether transmissibility of mutating viruses makes their virulence irrelevant when determining their pathogenic potential considering that globally human bodies have had already developed too many co-morbidities before the pandemic to make them potentially vulnerable to complications of highly contagious viruses irrespective of their virulence with flourishing globalization and exuberant mobilization providing susceptible populations across the free-spirited world while potentially halting or reversing virulence-transmission trade-offs [1-11]. Although consistently controlling SARS-CoV-2 transmission may appear difficult in the long haul due to innately free-spirited and easily fatigued human behavior, it is my opinion that it may be important to realize that viruses may adapt to chemicals and antibodies by mutating into variants but it may be difficult for them to adapt to non-conducive micro-environments like in-mask heat and humidity complemented with outdoor/indoor sunlight whereby imperfect masks may be facilitating development of immunity by blocking “lethal” doses of virulent viruses while allowing just “homeopathic” doses of immunogenic antigens across them [12-14].
Therefore, contrary to my strong affliction due to masks prior to pandemic [15], I have developed strong affection for masks since pandemic. This flip of affliction to affection has evolved secondary to my personal subjective experience and objective observation of unnatural heat and humidity under my masks which led me to coin the hypothesized "therapeutic" role of masks against "cold" viruses [16-18]. The report from United States, Department of Homeland Security, Science and Technology, demonstrating ambient modalities for surface and airborne decay of SARS-CoV-2 has further encouraged my thinking process [19-20]. Similar documentations about inactivation of influenza with sunlight, heat and humidity have strengthened my resolve to pursue my hypothesized theory [21-22]. Therefore, I am hereby sharing my envisaged protocol regarding combination of sunbathing and masking (SUMA) as a cleansing protocol - a non-pharmacological "therapy" - against "cold" viruses like influenza and SARS-CoV-2 [23].text/html2021-01-31T05:34:42+01:00http://www.webmedcentral.com/Dr. Deepak GuptaMy In-Mask Micro-Climate\'s Hot And Humid Efficiency
http://www.webmedcentral.com/article_view/5693
Since the dawn of COVID-19 pandemic, I have been personally exploring my masks’ ambiance. After documenting in-mask heat and humidity objectively determined with Hygrochron iButton DS1923 in my face covering [1], I had been wondering whether my in-mask micro-climate will differ (A) if simple mask vs. valved mask vs. N95 mask, and (B) if indoor vs. outdoor. Hereby, image (A) is my in-mask micro-climate over one-hour period on day-(A) with simple mask, valved KN95 mask, and surgical N95 mask, worn for 20 minutes each. Subsequently, image (B) is my in-mask micro-climate over one-hour period on day-(B) with simple mask covering surgical N95 mask (dual mask) worn while indoor with no air changes, indoor with some indeterminate air changes, and outdoor, for 20 minutes each. Irrespective of mask type or ambient environment, images (A-B) demonstrate variable but definite in-mask increases in temperature and relative humidity as measured by Hygrochron iButton DS1923 and absolute humidity as calculated by online calculator [2]. Moreover, based on variabilities in entrapped heat and humidity under mask and such microclimates’ corresponding efficacy to potentially inactivate SARS-CoV-2 [3-5], I can hypothesize that my hypothesized “therapeutic” effect of in-mask micro-climate against “cold” viruses may have variable onset and effectiveness according to mask type [6]. However, it remains to be seen if (and how) barometer readings change under mask, indoor vs. outdoor, considering barometric pressure’s effect on calculated absolute humidity [2], because as noted while outdoor (B), calculated absolute humidity did not budge much as compared to indoor even when measured relative humidity increased in response to decreasing temperature outdoor as compared to indoor. A point worth noting may be that, during heated and dried indoors during winters, the problem may be the low absolute humidity created by cold outdoors whereby heating the indoors further drastically decreasing indoor relative humidity due to the low absolute humidity therein to begin with. However, this problematically low absolute humidity too may somewhat get countered by the somewhat stability in the absolute humidity exhaled by bodies within the masks’ enclosed microclimates irrespective of ambient climates’ labile temperature, labile barometric pressure and labile humidity, outdoors or indoors [7].
FIGURE A-B
text/html2021-04-06T03:20:14+01:00http://www.webmedcentral.com/Dr. Deepak GuptaDirty Urinals/Toilets And Urinary Tract Inflammation/Infection: Worth Investigating If It Can Be True Due To Urinary Aerosols In Urinals/Toilets
http://www.webmedcentral.com/article_view/5699
Since current pandemic dawned, we have been wearing masks and avoiding infectious aerosols even in the urinals/toilets, especially when using the shared urinals/toilets. Although masks can curtail the inhalation of aerosols generated in urinals/toilets, the aerosols contaminating the perineum cannot be avoided, especially when the urinals/toilets are unclean, dirty or clogged. Although the chemically cleansed urinals/toilets may generate chemicalized aerosols which may create non-infectious contaminations and complications, especially when the urinals/toilets are flushed powerfully with water [1-3] as similar to when the fomites/surfaces are transferring the infectious and non-infectious agents by contact [4], the question we often overlook is whether we are exposing our perineal areas to the infectious and non-infectious agents while urinating sitting on or standing over standard or compost urinals/toilet bowls. Therefore, as inspired from global researchers' investigation into imaging aerosols generated by simulated raindrops falling on soil [5-10], the research question that is worth investigating is whether aerosols generated while urinating can be imaged with ultra-high speed cameras [11-12] to quantify the aerosols generated depending on the position while urinating and depending on urinal/toilet bowl where urinating. This envisaged investigating may prove or disprove whether aerosol generation while urinating differs (a) between the sexes, (b) as urinary stream falls on smooth bowl surface or textured bowl surface, or (c) between the sawdust filled compost urinal/toilet and the water-filled standard urinal/toilet. text/html2021-05-28T05:44:24+01:00http://www.webmedcentral.com/Dr. Deepak GuptaIs It Apophenic Bet on Bats to Search for SARS-CoV-0 as Prequel and Prepare for SARS-CoV-X as Sequel to COVID-19 Pandemic?
http://www.webmedcentral.com/article_view/5725
My imagination has always run wild but it is running amok since COVID-19 pandemic. Currently, the question bugging me is “if pandemic had started with bat-consumption [1-2], will pandemic end with bat-consumption too?” as if lyrics penned by Qateel Shifai and sung by Jagjit Singh that translate as “He/She/It who/that has given this pain will also give medicine” [3-4] seem apt in my theoretical and non-conspiratorial search for SARS-CoV-0, the prequel to pandemic. Therefore, I am betting on bats not just as a blame for our global suffering during pandemic but as a theoretical understanding into our global differences in terms of complications and deaths during pandemic. This may help us innovate better for future pandemics originating from bats for which bats may play a role as a futuristic medicine just like it may have played a role in natural immunity among human populations who have been consuming bats or at least have been routinely exposed to bats since unknown times in the past [5-16]. These bat-consuming (or bat-exposed) human populations may have kept bat-consuming (or bat-exposed) geographical regions better equipped to deal with constant evolution of bat-viruses as parallel to bats becoming strongly immune to viruses [17-18] hosted by them when constant exposure to these bat-viruses inducing development of immunity over time not only among bats but also among bat-consuming (or bat-exposed) geographical regions’ humans too. It is unclear if SARS-CoV itself back in early 2000s may have been as detrimental as SARS-CoV-2 if globalization rates of transregional movements in 2010s have evolved way earlier in the 2000s itself [19-28]. Similarly, it is unclear if SARS-CoV-0 may have been prevalent and undetected as endemic in the bat-consuming (or bat-exposed) regions which may have been globally secluded, physically as well as informationally, before 2000s. The similar trend can be seen in the search for HIV that was christened in 1980s but has now been traced back to 1920s [29-30]. As the globalization trends are here to stay because of humanity evolving the need for exponential connectedness as an innate need for itself, this connectedness can be used to fight the cause by turning the cause into the medicine. Globally, human population may not start consuming bats as staple diet but medicines may have to be extracted from bats just like honey from bees by the Big Pharma only if and only after Big Pharma’s thorough scientific investigations in the future irrefutably prove it to be a non-apophenic bet on bats so that human population globally is having hormesis with wild life without consuming them as meat but in the form of extracted medicine. Experts may say that the bat-consuming (or bat-exposed) regions should abandon consumption of (or exposure to) bats [1]. That may be one option but viruses like HIV and SARS will find another intermediate animal host which some human populations somewhere in the world relish or are cozy with to become inadvertently immune as if naturally vaccinated to those evolving viruses and yet ending up transmitting those evolving viruses to the naïve world as Disease X, thus creating future pandemics.
The soul-searching questions by 21st-century humans must delve into foregone 20th-century humans’ history to prepare ourselves as 22nd-century humans.
Is there any other more plausible biological theory [31-36] for bat-consuming (or bat-exposed) geographical regions beating COVID-19 pandemic so effectively?
Is there any evidence for the conspiratorial theory about the under-reported SARS-CoV-2 cases and COVID-19 deaths from bat-consuming (or bat-exposed) geographical regions?
Isn’t it conspiratorial to believe that bat-consuming (or bat-exposed) geographical regions’ humans have innately become better disciplined over generations so as to enable stringent enforcement and maintenance of stricter lockdowns for containing and mitigating COVID-19 pandemic?
Isn’t it conspiratorial to envision real-life in bat-consuming (or bat-exposed) geographical regions as an extension of a plot from science fiction wherein bat-consuming (or bat-exposed) geographical regions have been envisioned to have had experimented with population therapies, hitherto unknown, on the lines of en masse covert variolation vaccination (as similar to historical methods of variolation [37-38]) among the unknowing humans inhabiting those bat-consuming (or bat-exposed) geographical regions?
Is it even feasible that sexualized revolution of late 20th-century evolving into virtual sexuality to contain HIV can make the case for globalized revolution of early 21st-century to evolve into virtual globalization to contain SARS and any future Disease X?
Has humanity ever completely abandoned its habits regarding food, mating and travel except when it is temporarily adapting them to the changing times which may sometimes imprint those changes as permanent ones thus evolving as the new normal from that point onwards?
Although small pox [39-40] did NOT evolve due to eating animals because small pox has had no animal vector since more than hundreds of thousands of years ago, did humanity being a vector itself stop traveling despite deaths due to small pox happening across the continents until recently?
Can humans stop eating plants once they discover that plant-viruses too are jumping into humans [41-47]?
Essentially, I am envisioning with a straight face that, futuristically, globe-trottering humans may have to metaphorically evolve hormesis with over-the-counter “bat-soups” or prescription “bat-syrups” as their controlled exposure to develop bat-like immunity over generations against future SARS-CoV-X irrespective of whether or not they inhabit bat-consuming (or bat-exposed) geographical regions, unless this is no longer my imagination running wild or amok but evolving into a delusional unimaginably non-conspiratorial hallucinations as similar to potentially dead-end scientific explorations into cow-urine distillates [48-49].text/html2021-09-15T07:30:53+01:00http://www.webmedcentral.com/Dr. Deepak GuptaAntibiosis: \"Dear Microbiome, Are You Dead Yet?\" Probiosis: \"Maybe Never, Must Be Never.\"
http://www.webmedcentral.com/article_view/5739
Since watching movie "Kiss the Ground" [1], it has been fascinating personal enterprise to foresee personal "Poop in the Loop" [2]. However, neither the ground has been kissed nor the poop has been looped. Henceforth, the deeds which could not be completed are being documented as the deeds which should have been accomplished because even when the act of defecation is considered soiling, the feces are no longer returned to soil as soilage because they are left to trot as sewage. It is a shame that a natural animal product has been converted into a modern human waste due to the needs of urbanized humanity wherein it is convenient to flush out feces and even urine with available water [3-4] because it is difficult to find the land to plant feces and even urine [5-7].text/html2022-07-18T10:39:43+01:00http://www.webmedcentral.com/Dr. Deepak GuptaSurgical Site Infections (SSIs): Can Clear Anesthesia Screen Drape Be Suppressing Self-Infection (SSI)?
http://www.webmedcentral.com/article_view/5785
Since the onset of pandemic, it has been anecdotally observed that incidence of surgical site infections (SSIs) may be coming down [1-6]. One of the explanations thought to be underlying this presumed reduction in SSIs is sterner as well as more complete use of personal protective equipment (PPE) not only by providers and staff in the perioperative areas as well as postoperative areas but also by patients and their families too [7-14]. Now the question arises whether incidence of SSIs will crop up again once the pandemic mitigating practices are loosened not only outside operating rooms but also inside them. There may be research investigators looking for answers and waiting for evidence. However, it may appear common sense to expect providers and staff continue pandemic mitigating practices as SSIs mitigating practices in the post-pandemic era as sternly and as completely as during pandemic. If that becomes difficult to incorporate and regulate, the microbiological evidence can be created by matching the bacterial genome (predominantly Staphylococcus aureus [15-20]) causing SSIs in patients to the bacterial genome harbored (predominantly in noses) within providers and staff in the operating rooms. If that turns out to be inconclusive [21-25], the evidence can search to match Staphylococcus aureus genome causing SSIs in patients to Staphylococcus aureus genome in their own noses and their families' noses. If that turns out to be true, it may make the case for patients and their families to continue pandemic mitigating practices as SSIs mitigating practices in the post-pandemic era as sternly and as completely as during pandemic. If that remains difficult, there may be few options at least in the operating rooms besides the administration of increasing number of gut microbiome-suppressing [26] perioperative antibiotics to patients after futuristically protocolizing and policing for perioperatively decolonizing and decontaminating not only patients' noses and their nasal microbiomes [27-30] but also their personal caregivers' noses and their nasal microbiomes as well as professional caregivers' noses and their nasal microbiomes including healthcare providers' noses and their nasal microbiomes as well as healthcare staff's noses and their nasal microbiomes. In the interim, the surgical site preps [31-32] can be delayed until after the patients' airways have been intubated and secured so that their aerosols do not get deposited on to their surgical sites after preps have been done. If the patients are undergoing procedures under sedation, the patients can be made to have oxygen mask covering their faces to reduce their droplets directly depositing onto the surgical sites after they have been prepped. However, unless the surgical sites and airways are common and one and the same, the best option in all the cases may be placing a clear anesthesia screen drape [33] as SSI (suppressing self-infection [34]) screen drape before the surgical site is prepped so that even awake patients during Cesarean sections [35-47] can be free to talk, laugh, cough, burp and vomit without soiling the being prepped surgical sites with their droplets from their mouths and noses. It may not be too much to ask and too much to do considering that providers and staff are always expected to re-prep the surgical sites when they inadvertently touch and thus contaminate the prepped surgical sites. Moreover, it can be envisioned for future clinical microbiological research investigators to decipher that not only bacterial genomes but also viral genomes may be discovered not only from prepped surgical sites but also from SSI screen drapes to outline whether SSIs are the reflection of patients as reservoirs [48] or their personal or professional caregivers as reservoirs with portal of exit being their mouths and noses and modes of transmission being breathing, talking, laughing, coughing, burping, vomiting without protecting prepped surgical sites as portal of entry by covering their noses and mouths with stern and complete PPE and clear SSI screen drapes as additional barriers in-between.text/html2022-08-31T02:11:05+01:00http://www.webmedcentral.com/Dr. Deepak GuptaIs Pandemic Teaching Gut Biome Maybe Holding The Key With Us Carrying Our Answers In Our Gut?
http://www.webmedcentral.com/article_view/5789
Just like global epidemiology of HIV had its onset among men having sex with men, global epidemiology of monkeypox is following the same onset. However, just as HIV did not limit itself to men having sex with men, monkeypox too may evolve a similar pattern. Therefore, the question arises as to why so. Is it the absence of vulvo-vagino-cervical intercourse among men having ano-rectal and/or oro-pharyngeal intercourse with men [1]? Thence comes the question whether it is oro-pharyngeal intercourse or ano-rectal intercourse that is increasing this vulnerability to these diseases among men having sex with men. If oro-pharyngeal intercourse is not increasing this vulnerability to these diseases among all others yet, the preponderance of ano-rectal intercourse among men having sex with men may be the primary route of spread. However, as ano-rectal intercourse is not limited to men having sex with men as aptly elaborated by Gana and Hunt in their opinion [2], the question arises as to how ano-rectal intercourse predisposes to this exaggerated vulnerability. One of the most common documented reasons is the differently evolved mucosa and surrounding layers of tissue wherein unlike ano-rectum and oro-pharynx, vulvo-vagino-cervix as receptive organ may have evolved with more frequent exposures over millenniums to penis as insertive organ thus allowing vulvo-vagino-cervix much more opportunity to acquire and mature its armamentarium to fight back mechanical, chemical and biological exposures during this coevolutionary arms race with penis [3]. Although ano-rectum and oro-pharynx may have lagged in this coevolutionary arms race, they may be catching up. However, during these catch-up times, the unexpected consequences of mechanical, chemical and biological exposures may get expressed while ano-rectum and oro-pharynx are acquiring and maturing their armamentarium to fight back as effectively as vulvo-vagino-cervix. In the interim, there is an avenue to investigate and maybe affect outcomes in currently evolving diseases like monkeypox. Although not available at the onset of HIV pandemic [4-7], theory and testing for gut biomes are currently available and may be explored in all known and suspected monkeypox cases if not in all susceptible populations. Such surveillance data comparing biodiversity of gut biomes may be able to provide information about gut ecosystems differentially favoring not only current pathogens but also future pathogens evolving to potentially mutate first among those engaging in ano-rectal intercourse irrespective of their gender and orientation before mutating further in such reservoir populations' ano-rectum to spread beyond and across all human populations. Concurrently, evolving eating and purging habits among humans may have to be taken in account too when deciphering whether eating and purging habits are being physiologically warranted per sexual habits. Henceforth, gut biome surveillance may provide a summated data of what humans are or are not getting exposed to mechanically, chemically and biologically per their eating, purging and sexual habits so that they can accordingly make informed decisions for-or-against overcompensating biodiversity of their gut biomes by bettering it nutritionally with addition of prebiotic-probiotic foods and/or iatrogenically with addition of corresponding over-the-counter prescriptions.