Mechanism of Japanese encephalitis virus genotypes replacement based on human,porcine and mosquito-originated cell lines model

Objective:To examine the multiplication efficiency Japanese encephalitis virus(JEV)genotype Ⅰ(G Ⅰ) and genotype Ⅲ(GⅢ) of different cell lines which originated from human,porcine,mosquitoes in order to prove mechanism of JEV G Ⅰ replacement JEV GⅢ since it emerging in nature recent decades.Methods:The mixture of Gi and GⅢ JEV isolates was inoculated on human rhabdomyosarcoma(RD).pig kidney epithelial(PS) and Aedes albopictus C6/36 clone(C6/36) which originated from human,porcine and mosquitoes,respectively.Plaque assays were performed to calculate virus titer and real-time RT-PCR with GⅠand GⅢspecific primer sets to quantify the number of GⅠ and GUI RNA copies.Results:The highest virus titer reached at the 3rd day of post infection when G Ⅰand GⅢ mixture was inoculated on RD and PS and that of C636 was at the 4^(th)day.JEVs were amplified and maintained by C6/36 cells after 10 passages whereas that by RD and PS only limited within 8 and 6 passages,respectively.GⅠ strain amplified and maintained more efficiently on C6/36 and PS but not RD.whereas GⅢ strain amplified and maintained more efficiently on RD.Conclusions:There is a correlation between the multiplication efficiency of GⅠ and GⅢ JEV strains when these two genotype strains co-infected on different cell lines with the predominance of GⅠstrains in C6/36 and PS and the limited detection of G 1 strains in RD cells proving a possible mechanism of shift JEV genotypes in nature recent decades since GⅠ emerging.

Role of Aedes aegypti and Aedes albopictus during the 2011 dengue fever epidemics in Hanoi, Vietnam

Objective: To record the human cases of dengue fever(DF) and investigate the Aedes mosquito species circulating during the Hanoi 2011 DF epidemics. Methods: 24 different outbreak points were recorded in 8 districts between August and December 2011. Results: 140 patients were hospitalized following dengue diagnostic with a predominance of males(59.3%) and the 15-34 age class. Only DENV-1(11.27%) and DENV-2(88.73%) serotypes were detected in human samples. Mosquito sampling performed in and around patients households revealed the predominance of Aedes aegypti(95.15%) versus Aedes albopictus(4.85%). There is a positive correlation between the population density of Aedes aegypti and the number of human cases and duration of outbreaks. Conclusions: This was not observed for Aedes albopictus. 3 pools of Aedes aegypti were positive with dengue virus, two with DENV-1 and one with DENV-2.

Association between measles antibodies in vaccinated and naturally infected mothers with protective antibodies and the occurrence of measles in their children:A cross-sectional study in the Bavi district of Hanoi

Objective:To determine the concentration and rate of decay of maternal IgG antibodies against measles prevalence in infants of vaccinated or naturally infected mothers and study initial measles immunization occurs in nine-month-old children.Methods:In total,401 pregnant women and the same number of their subsequent newborns were recruited in the Bavi district of Hanoi in 2016-2017;they were divided into two groups:Older women(born before 1985,n=201)and younger women(born after 1990,n=200).Samples were collected at five time-points;week 36 of pregnancy,birth(cord),and 3,6,and 9 months after birth.Measles-specific IgG antibody levels were recorded.Results:In total,77.06% of the 401 pregnant women were seropositive for measles-specific IgG antibodies.A significantly greater proportion of mothers aged 30 and older(88.06%)and their newborn(93.53%)were seropositive compared to the mothers aged 25 and younger(66.00%),and their newborn(72.00%)(P<0.001).The infants of older mothers had significantly higher geometric mean titres(GMT)of measles IgG antibodies than the infants of younger mothers(P<0.001)at all time-points of the study period.The proportion of measles IgG antibodies together with GMT decreased from 82.97%(506.96)at the age of three months to 23.19%(45.22)at the age of nine months.Conclusions:This study provides a profile of maternal antibodies against measles in Vietnamese infants and investigates the early susceptibility to measles in both the infants of vaccinated mothers and mothers with naturally acquired immunity.These data suggest that determining the appropriate age for measles vaccination is paramount for the elimination of measles in Vietnam.

Surveillance of dengue and chikungunya infection in Dong Thap,Vietnam:A 13-month study

Objective:To establish a surveillance in Dong Thap,at the border with Cambodia by assessing the presence of DHNV serotypes and CHIKV among patients hospitalized at Dong Thap general hospital.Methods:Cross-sectional descriptive analysis was conducted on a cohort of 131 patients hospitalized with acute fever and symptoms compatible with dengue or chikungunya.The study was conducted from January 2012 to February 2013.The full clinical picture was established as well as serological and molecular detection.Serological analysis was sequentially performed on blood samples collected on admission and an average of seven days after admission.The detection of IgM antibody to DENV was performed by IgM capture ELTSA and the detection of DENV and CHIKV RNA was done by reverse-transcription multiplex PCR.Results:101 patients out of 131(77%) were confirmed with dengue.All four dengue serotypes were detected with a predominance of DENV2 and DENV4.No chikungunya infection was detected although reported in neighboring Cambodia.A differential efficiency of serological dengue detection was observed.Efficiency was 29%upon admission and 53%after seven days on the same patients.30 patients out of 131(23%) were negative with both DENV and CHIKV.Conclusions:Dengue is at risk of being underestimated and chikungunya is not systematically detected.Changes in detection and surveillance procedures are therefore discussed to increase efficiency of dengue detection and continue the monitoring the emergence of CHIKV in Dong Thap province and in Vietnam.

Food Is Security: The Nexus of Health Security in Fragile and Failed States

Global food security is a major development challenge dictated by state stability, resilience to geopolitical and economic shocks and is linked to health security. Fragile and failed nation-states are at risk of extreme poverty and lead to war and conflict. Fragile states experience, corrupt financial regimes and are influenced by skewed global market systems and reduced equitable market access that decrease food and health security. This qualitative review describes the critical cross sections of food security, the influence of global market systems and state stability and institutions that form the nexus of global health security. We outline how the manipulation of free market systems and decreased state capacity not only decrease food and health security but also contribute to state fragility and failure. Improved public health policy mechanisms, decreased dependence on foreign financial structures and extractive mechanisms are crucial to improving food and health security at present, and to further increase state stability in the future.

Glycated hemoglobin and antidiabetic strategies as risk factors for hepatocellular carcinoma

AIM: To evaluate the relationship between glycemic control [assessed by glycated hemoglobin (HbA1c)], antidiabetic therapies and the risk of hepatocellular carcinoma (HCC).METHODS: We recruited 465 patients with HCC, 618 cases with liver cirrhosis and 490 controls with no liver disease. Among subjects with type 2 diabetes mellitus (DM2), the associations between the antidiabetic strategies and HbA1c level with HCC were determined through 2 series of multivariate logistic regression models using cirrhotic patients and controls as comparison groups. RESULTS: DM2 prevalence was 31.2% in patients with HCC, 23.2% in cirrhotic patients and 12.6% in controls (P < 0.0001). In 86% of study subjects, DM2 had been diagnosed for more than 1 year before the HCC diagnosis. HCC patients with DM2 had a 1.52.5fold increased risk of liver cancer. The HbA1c mean levels were signif icantly higher in DM2 patients with HCC than in cirrhoticand control DM2 patients. Antidiabetic treatment with metformin was more common among cirrhotic and control DM2 subjects than among cases with HCC. In both series of multivariate analyses, treatment with metformin signif icantly reduced the risk of HCC by more than 80% compared with sulphonylureas and insulin therapy. No signif icant differences were seen between sulphonylureas and insulin treatment. Elevated HbA1c levels were positively related to the risk for HCC in diabetic patients, with a 26%50% increase in risk for each 1% increase in HbA1c values.CONCLUSION: In patients with preexisting DM2, the risk of HCC is positively associated with poor chronic glycemic control and significantly decreased by metformin therapy.

Hepatoprotective effect of nitric oxide in experimental model of acute hepatic failure

AIM:To evaluate the effect of nitric oxide(NO)on the development and degree of liver failure in an animal model of acute hepatic failure(AHF).METHODS:An experimental rat model of galactosamine-induced AHF was used.An inhibitor of NO synthase,nitroarginine methyl ester,or an NO donor,arginine,were administered at various doses prior to or after the induction of AHF.RESULTS:All tested groups developed AHF.Following inhibition of the endogenous NO pathway,most liver parameters improved,regardless of the inhibitor dose before the induction of liver damage,and depending on the inhibitor dose after liver damage.Prophylactic administration of the inhibitor was more effective in improving liver function parameters than administration of the inhibitor after liver damage.An attempt to activate the endogenous NO pathway prior to the induction of liver damage did not change the observed liver function parameters.Stimulation of the endogenous NO pathway after liver damage,regardless of the NO donor dose used,improved most liver function parameters.CONCLUSION:The endogenous NO pathway plays an important role in the development of experimental galactosamine-induced AHF.

Environmental risk and risk perception management in public health

When evaluating environmental risk and its perception, psychosocial and psychosomatic factors may be of fundamental importance for public health programming and the promotion of quality of life. This is the case in particular where knowledge of the true health consequences of environmental exposure to given risk factors are incomplete or its action is within the range of values where we do not anticipate the measurable biological effect. This applies not only in the case of the indoor environment related complaints but also to that of non-ionizing electromagnetic radiation and electroionic microclimate, among many others. A serious consequence found in the syndrome of mass hysteria is the fact that due to differently motivated information and disinformation, part of the population can suffer from psychosomatic symptoms and deterioration quality of life for those affected.

Retrospective survey of avian influenza H5N1 infection in Northern Vietnam by using a combinational serologic assay

Outbreaks of highly pathogenic avian influenza H5N1 virus have occurred in Vietnam since 2003. However, how people got avian H5N1 infection in Northern Vietnam is still unclear. We therefore performed a combination of the serologic assays H5N1 ELISA and H5 western blot to detect anti-H5N1 specific antibodies. Sera samples of 149 subjects with suspected H5N1 infection from three provinces of Northern Vietnam were collected from September 2006 to March 2007. Our results indicated that this combinational assay showed high sensitivity (100%) and specificity (95%) when compared with hemagglutinin inhibition (HI) assay. Fifty-one sera samples (34.2%) contained specific antibodies against H5N1 viruses. Poultry raisers (32/77;41.6%) showed higher H5N1 infection rates than slaughterers (12/41;29.3%) and health care workers (7/31;22.6%). Contact history with sick or dead poultry in household or slaughter-house (p < 0.05) and lack of protective equipment use when in contact with dead poultry (p < 0.05) were risk factors found to be associated with H5N1 infection. In this study, we established an alternative serologic assay for H5N1 diagnosis, and we hereby present seroepidemiologic data of H5N1 infection in Northern Vietnam.

Evaluation of Steroid Receptors mRNA Fingerprints in Two Groups of Normozoospermic Patients: Men from Unexplained Infertility Couples vs. Men from Couples with Tubal Factor Infertility

The study of sperm cellular components at molecular level is crucial for the diagnosis of male unexplained infertility. The aim of the study was to compare the molecular profile of steroid receptors and aromatase in spermatozoa obtained from two normozoospermic groups of patients issued from couples treated for infertility. We investigated 46 male patients from unexplained infertility couples and from men, 38 where female partners presented with tubal infertility. Sperm ERs (estrogen receptors: alpha and beta), GPER (G protein-coupled estrogen receptor), AR (androgen receptor) and aromatase mRNA expression levels by TaqMan qPCR were analyzed. AR transcript level was significantly lower in sperm of men from unexplained infertility couples vs. men from couples with tubal factor infertility (P = 0.04). Although the AR mRNA expression level did not had any effect on embryo development and its implantation, a significant correlation between AR mRNA levels and clinical pregnancy in unexplained infertility patients was observed. Taken together, AR transcript presence in ejaculated spermatozoa could be a potential marker for unexplained infertility.

Carbon Monoxide Poisoning: The Culture of Indoor Burning

This patient case report describes a 40-year-old African woman presenting with a classic acute presentation of carbon monoxide poisoning from an unlikely source responding to conventional treatment. This case highlights the classic presenting features of carbon monoxide poisoning and the requirement to maintain a high index of suspicion and immediate use of rapid empirical treatment in the undifferentiated patient, sometimes before diagnostics and definitive diagnosis can be determined. The definitive diagnosis and cause of poisoning are also discussed to educate the emergency physician to new and foreign cultural habits and encourage best medical practices within multicultural societies.

Seasonal and geographical distribution of bacillary dysentery(shigellosis)and associated climate risk factors in Kon Tum Province in Vietnam from 1999 to 2013

Background:Bacillary dysentery(BD)is an acute bacterial infection of the intestine caused by Shigella spp.,with clinical symptoms ranging from fever to bloody diarrhoea to abdominal cramps to tenesmus.In Vietnam,enteric bacterial pathogens are an important cause of diarrhoea and most cases in children under 5 years of age are due to Shigella strains.The serogroups S.flexneri and S.sonnei are considered to be the most common.The main objective of this study was to,for the first time,assess the seasonal patterns and geographic distribution of BD in Vietnam,and to determine the climate risk factors associated with the incidence of BD in Kon Tum Province,where the highest rate of bacillary dysentery was observed from 1999 to 2013.Methods:The seasonal patterns and geographic distribution of BD was assessed in Vietnam using a seasonaltrend decomposition procedure based on loess.In addition,negative binomial regression models were used to determine the climate risk factors associated with the incidence of BD in Kon Tum Province,from 1999 to 2013.Results:Overall,incidence rates of BD have slightly decreased over time(except for an extremely high incidence in 2012 in the north of Vietnam).The central regions(north/south central coast and central highlands)had relatively high incidence rates,whereas the northwest/east and Red River Delta regions had low incidence rates.Overall,seasonal plots showed a high peak in the mid-rainy reason and a second smaller peak in the early or late rainy season.The incidence rates significantly increased between May and October(“wet season”)across the country.In Kon Tum Province,temperature,humidity,and precipitation were found to be positively associated with the incidence of BD.Conclusions:Our findings provide insights into the seasonal patterns and geographic distribution of BD in Vietnam and its associated climate risk factors in Kon Tum Province.This study may help clinicians and the general public to better understand the timings of outbreaks and therefore equip them with the knowledge to plan better interventions(such as improving water,sanitation,and hygiene conditions)during peak seasons.This can,in turn,prevent or reduce outbreaks and onwards transmission during an outbreak.

Viral co-infections among children with confirmed measles at hospitals in Hanoi,Vietnam,2014

Objective:To characterize viral co-infections among representative hospitalized measles cases during the 2014 Hanoi outbreak.Methods:Throat swabs were collected from 54 pediatric patients with confirmed measles,and molecular diagnostics performed for 10 additional viral respiratory pathogens(Influenza A/H1N1pdm09;A/H3N2 and influenza B;Parainfluenza 1,2,3;Respiratory Synctial Virus,RSV;human Metapneumovirus,hM PV;Adenovirus and Picornavirus).Results:Twenty-one cases(38.9%) showed evidence of infection with other respiratory viruses:15 samples contained measles plus one additional virus,and 6 samples contained measles plus 2 additional viruses.Adenovirus was detected as a predominant cause of co-infections(13 cases;24.1%),followed by RSV(6 cases;11.1%),A/H1N1pdm09(3 cases;5.6%),PIV3(3 cases;3.7%),Rhinovirus(3 cases;3.7%) and hM PV(1 case;1.96%).Conclusions:Viral co-infections identified from pediatric measles cases may have contributed to increased disease severity and high rate of fatal outcomes.Optimal treatment of measles cases may require control of multiple viral respiratory pathogens.

Food insecurity: How to orchestrate a global health crisis

In 2007-2008, the world experienced over 1 billion people going hungry. This complex food security and public health crisis have many levels, actors and stakeholders. There lacks equity in access food markets, unbalanced consumption of nutrients and poor state institutions that, all negatively impact food security. Global financial products and regimes can greatly influence food prices, and if not properly regulated, this can lead to whole market manipulation and starvation. This paper discusses the basics of food security in a public health framework and describes the legal and financial mechanisms that lead to food insecurity.

First Masquerading as Gallstones, Pulmonary Hypertension Mimics PE

Patients presenting to emergency and urgent care centers with calf pain after long and short-haul flights are a common presentation throughout Europe. Patients fitting an epidemiological risk profile for cholelithiasis and presenting with right upper quadrant abdominal pain can also be a common presentation fitting of a specific patient profile. However, pulmonary hypertension can present in a nuanced and possible missed chronic and acute presentation. The patient case we present profiles a mildly obese 54-year-old Caucasian woman and recent holiday maker with unilateral calf pain and shortness of breath after traveling on a long-haul flight with tertiary symptoms of indigestion and epigastric discomfort indicative of gastroenteritis. This case highlights the required diligence for emergency physicians to maintain a high index of suspicion and broad differential diagnosis in the undifferentiated patient with seemingly common or classic presentations. We find that a serendipitous definitive diagnosis is made by following a systematic and organized approach.