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Current evidence describing antimicrobial resistance (AMR) in the context of the Syrian conflict is of poor quality and sparse in nature. This paper explores and reports the major drivers of AMR that were present in Syria pre-conflict and those that have emerged since its onset in March 2011. Drivers that existed before the conflict included a lack of enforcement of existing legislation to regulate over-the-counter antibiotics and notification of communicable diseases. This contributed to a number of drivers of AMR after the onset of conflict, and these were also compounded by the exodus of trained staff, the increase in overcrowding and unsanitary conditions, the increase in injuries, and economic sanctions limiting the availability of required laboratory medical materials and equipment. Addressing AMR in this context requires pragmatic, multifaceted action at the local, regional, and international levels to detect and manage potentially high rates of multidrug-resistant infections. Priorities are (1) the development of a competent surveillance system for hospital-acquired infections, (2) antimicrobial stewardship, and (3) the creation of cost-effective and implementable infection control policies. However, it is only by addressing the conflict and immediate cessation of the targeting of health facilities that the rehabilitation of the health system, which is key to addressing AMR in this context, can progress.

Background: Brucellosis is a zoonosis that occurs worldwide. The disease has been completely eradicated in livestock in Sweden in 1994, and all cases of confirmed human brucellosis are imported into Sweden from other countries. However, due to an increase in the number of refugees and asylum seekers from the middle-east to Sweden, there is a need to improve the current diagnostic methodology for Brucella melitensis. Whilst culture of Brucella species can be used as a diagnostic tool, real-time PCR approaches provide a much faster result. The aim of this study was to set up a species-specific real-time PCR for the detection of all biovars of Brucella melitensis, which could be used routinely in diagnostic laboratories. Methods: A Brucella melitensis real-time PCR assay was designed using all available genomes in the public database of Brucella (N=96) including all complete genomes of Brucella melitensis (N=17). The assay was validated with a collection of 37 Brucella species reference strains, 120 Brucella melitensis human clinical isolates, and 45 clinically relevant non-Brucella melitensis strains. Results: In this study we developed a single real-time PCR for the specific detection of all biovars of Brucella melitensis. Conclusions: This new real-time PCR method shows a high specificity (100%) and a high sensitivity ( 1.25 GE/mu l) and has been implemented in the laboratories of four governmental authorities across Sweden.

Section I: Adult urgent care medicine. Headache and neurologic complaints -- Red eye, eye pain, and vision loss -- Ear, nose, and throat -- Dental and mouth pain -- Cough, shortness of breath, and chest pain -- Abdominal pain, nausea, vomiting, and diarrhea -- Genitourinary complaints -- Gynecologic complaints -- Rashes and skin infections -- Miscellaneous musculoskeletal trauma -- Miscellaneous infectious disease issues -- Section II. Pediatric urgent care medicine. Fever -- Headache -- Eye complaints -- Ear pain, nasal congestion, and sore throat -- Cough -- Neck pain and masses -- Chest pain -- Abdominal pain -- Nausea, vomiting, diarrhea, and dehydration -- Urinary complaints -- Vaginal complaints -- Skin rashes and infections -- Common newborn complaints -- Limp -- Head and neck trauma -- Chest and abdominal trauma -- Extremity trauma -- -- Section III. Sport-related complaints. Acute neck pain -- Evaluation and management of acute sprains and strains -- Acute low back pain -- The acutely swollen knee -- Acute finger and wrist injuries -- Fall on outstretched hand injuries -- When to image for sport-related complaints? -- Environmental emergencies -- The acutely injured shoulder -- Concussion -- Overuse apophyseal injuries -- The acutely limping child -- Ankle sprains -- Acute infectious disease and athletes -- Section IV. Procedures. Wound assessment, burns, and animal bites. Laceration repair -- Fracture and dislocation reductions -- Splinting procedures -- Abscess I & D -- Foreign body removal -- Dental and oral complaints and procedures -- Analgesia and sedation -- Section V. Miscellaneous. Adult emergencies presenting to urgent care centers. Pediatric emergencies presenting to urgent care centers -- Office emergency and disaster preparedness -- Diagnostic ultrasound -- Mental health urgencies -- Travel medicine -- Business of urgent care medicine.

"Since the 2014 Ebola outbreak many public- and private-sector leaders have seen a need for improved management of global public health emergencies. The effects of the Ebola epidemic go well beyond the three hardest-hit countries and beyond the health sector. Education, child protection, commerce, transportation, and human rights have all suffered. The consequences and lethality of Ebola have increased interest in coordinated global response to infectious threats, many of which could disrupt global health and commerce far more than the recent outbreak. In order to explore the potential for improving international management and response to outbreaks the National Academy of Medicine agreed to manage an international, independent, evidence-based, authoritative, multistakeholder expert commission. As part of this effort, the Institute of Medicine convened four workshops in summer of 2015 to inform the commission report. The presentations and discussions from the Workshop on Resilient and Sustainable Health Systems to Respond to Global Infectious Disease Outbreaks are summarized in this report"--Publisher description.

Front Cover -- Board Review in Preventive Medicine and Public Health -- Copyright Page -- Contents -- About the Author -- Preface -- Acknowledgements -- 1. General Public Health -- 1.1 General Public Health Questions -- 1.2 General Public Health Answers -- Bibliography -- 2. Health Policy and Management -- 2.1 Health Policy and Management Questions -- 2.2 Health Policy and Management Answers -- Bibliography -- 3. Epidemiology and Biostatistics -- 3.1 Epidemiology and Biostatistics Questions -- 3.2 Epidemiology and Biostatistics Answers -- Bibliography -- 4. Environmental Medicine -- 4.1 Environmental Medicine Questions -- 4.2 Environmental Medicine Answers -- Bibliography -- 5. Occupational and Aerospace Medicine -- 5.1 Occupational and Aerospace Medicine Questions -- 5.2 Occupational and Aerospace Medicine Answers -- Bibliography -- 6. Clinical Preventive Medicine -- 6.1 Clinical Preventive Medicine Questions -- 6.2 Clinical Preventive Medicine Answers -- Bibliography -- 7. Infectious Disease -- 7.1 Infectious Disease Questions -- 7.2 Infectious Disease Answers -- Bibliography -- 8. Emergency Preparedness -- 8.1 Emergency Preparedness Questions -- 8.2 Emergency Preparedness Answers -- Bibliography -- Index -- Back Cover

Contagion in the commentaries on prophetic tradition -- Contagion as metaphor in Iberian Christian scholarship -- Contagion contested : Greek medical knowledge, prophetic medicine, and the first plague treatises -- Situating scholastic contagion between miasma and the evil eye -- Contagion between Islamic law and theology -- Contagion revisited : early modern Maghribi plague treatises -- Reframing Muslim and Christian views on contagion.

Infectious pancreatic necrosis (IPN) is a highly contagious viral disease of fish causing economic losses in farmed salmonid aquaculture worldwide. This research aimed to elucidate the epidemiological, pathological and genetic factors underlying IPNV infection occurring in farmed fish in Finland. The work was carried out by describing the epidemiology of an IPNV outbreak in Finnish inland waters in 2012–2014 and by characterizing the Finnish IPNV isolates occurring in inland waters using genetic, histopathological and immunological approaches. Furthermore, molecular characterization of Finnish IPNV isolates collected in 2000–2015 was performed. Finally, an infection trial was conducted to gather further information on the pathogenicity of three IPN genogroups in Finnish rainbow trout. IPNV genogroups 2, 5 and 6 have been found to occur in Finland. Of these, genogroup 2 is the most widespread. All three genogroups occur in the sea area. The IPNV epidemic starting in 2012 in inland waters was caused by genogroup 2. Retrospectively, a genetically similar viral strain to that of the inland strains was already found to occur in 2011 in the sea area, making it likely that the epidemic originated from the sea area. Molecular characterization of the isolated IPN viruses revealed little genetic variation within the Finnish genogroup 2 and 5 isolates. Finnish genogroup 2 isolates appeared to form their own subgroup, whereas genogroup 5 isolates formed a more consistent cluster with previously published isolates. Genogroup 6 consisted of two subgroups. The divergence of genogroup 6 IPNV within the aquabirnaviruses was further demonstrated by the sequence data from our studies. Prior to our studies, only partial VP1 genogroup 6 IPNV sequences were available at the NCBI GenBank. In our study, two IPNV genogroup 6 isolates were sequenced for the complete coding regions of viral genome segments A and B (polyprotein sequences). The Finnish IPNV isolates studied demonstrated virulence-associated amino acid patterns in the viral capsid protein (VP2) gene region previously associated with avirulence in genogroup 5, except for IPNV genogroup 6, which exhibits an amino acid pattern that has not been connected in the literature with either virulence or avirulence. In the infection trial, mortalities noted in all the treatment groups were only moderate at most. The highest mortalities were caused by the Finnish IPNV genogroup 5 (10.3% to 38.2%), whereas IPNV genogroup 2 caused variable mortalities (3.5% to 28.3%) and the Norwegian IPNV genogroup 5 virus used as a positive control caused only negligible mortalities. The IPNV genogroup 6 virus was not re-isolated in the infection trial, although some elevated mortalities were seen in one tank (8%), leaving the virulence of this genogroup still uncertain. Finnish inland waters harbour the most IPNV-susceptible life stages of fish, and here, an infection caused by a virulent strain of IPNV would thus potentially have the greatest negative economic impact on Finnish rainbow trout farming. Continuation of the legislative disease control of IPN genogroup 5 in Finnish inland waters is thus supported by this study. In general, IPN is considered a coldwater disease, with a peak in clinical disease and increased mortality at 10 °C. However, in Finland, the occurrence of virus at exceptionally high temperatures, with clinical signs of disease and histopathological changes typical of IPN, was noted at water temperatures as high as 21°C. The occurrence of IPNV in higher water temperatures has economic consequences, as it lengthens the susceptible time period for the disease. Moreover, rising water temperatures and longer warm water periods due to global warming may increase the disease-causing importance of this genogroup in the future. ; Tarttuva haimakuoliotauti IPN (Infectious Pancreatic Necrosis) on akvabirnaviruksen aiheuttama helposti leviävä kalatauti, joka aiheuttaa taloudellisia tappioita viljellyillä lohikaloilla maailmanlaajuisesti. Viruksesta esiintyy nykytietämyksen mukaan seitsemän eri taudinaiheuttamiskyvyltään vaihtelevaa genoryhmää (1–7), joista genoryhmään 5 kuuluvia viruksia on pidetty potentiaalisesti vakavimpina taudinaiheuttajina. Genoryhmän 5 IPN-virustartunta on Suomen sisävesialueilla lakisääteisesti vastustettava, valvottaviin eläintauteihin kuuluva kalatauti. Ruokaviraston Eläintautibakteriologian ja -patologian yksikössä sekä Eläintautivirologian yksikössä vuosina 2014-2021 tehdyssä tutkimuksessa selvitettiin suomalaisten IPN-virustartuntojen epidemiologiaa ja taudinaiheuttamiskykyä sekä viruskantojen geneettisiä ominaisuuksia. Tutkimuksen ensimmäisessä osa-alueessa kuvailtiin sisämaan vesistöissä vuosina 2012-2014 kalanviljelylaitoksilla todettua laajaa IPN-epidemiaa. Tutkimuksessa selvisi, että epidemian aiheutti IPNV genoryhmän 2 virus, joka geneettisen analyysin perusteella on todennäköisesti peräisin merialueelta. Virus aiheutti vähäistä kuolleisuutta, mutta taudille tyypillisiä kliinisiä muutoksia kaloissa. Lisäksi tautia todettiin esiintyvän myös kalojen virustaudeille epätyypillisen korkeissa veden lämpötiloissa, jopa 22 ⁰C. Tutkimuksen toisessa osa-alueessa selvitettiin vuosien 2000-2015 aikana kerättyjen IPN-viruskantojen perimää, etsien mahdollisia muutoksia viruskannoissa. Tutkimuksessa analysoitiin 88 viruskantaa viruskapsidiproteiini VP2 -geenin osalta. Lisäksi suoritettiin kokogenomisekvensointi 11 viruskannasta. Tutkimusten perusteella todettiin Suomessa esiintyvän kolmea IPNV-genoryhmää: genoryhmiä 2,5 ja 6. Genoryhmän 2 virusta esiintyy sisävesialueilla, kun taas merialueella esiintyy kaikkia kolmea genoryhmää. Genoryhmät 2 ja 5 osoittivat ainoastaan vähäistä ryhmien sisäistä perinnöllistä variaatiota, mutta genoryhmässä 6 todettiin kahta eriävää alaryhmää. Genoryhmä 6 suurempi geneettinen eroavuus muista genoryhmistä ilmeni kokogenomisekvensoinnissa. Kaikissa tutkituissa viruskannoissa todettiin sellaisia emäsyhdistelmiä viruksen kapsidiproteiinin (VP2) perimässä, joiden on aiempien tutkimusten perusteella todettu olevan yhteydessä vähäiseen taudinaiheuttamiskykyyn genoryhmän 5 IPN-tartunnoissa. Suomessa todetut genoryhmän 2 viruskannat olivat kuitenkin aiheuttaneet kaloissa IPN-taudin oireita sekä lisääntynyttä kuolleisuutta, ja tutkimuksen viimeisessä osa-alueessa tutkittiinkin tartuntakokeen avulla Suomessa esiintyvien kolmeen eri genoryhmään kuuluvien suomalaisten IPN-viruskantojen taudinaiheuttamiskykyä suomalaiselle kirjolohikannalle. Tartuntakokeessa todettiin genoryhmän 5 virusten aiheuttavan kohtalaista kuolleisuutta ja genoryhmän 2 vaihtelevaa, mutta vähäisempää kuolleisuutta kirjolohella. Genoryhmän 6 virusten taudinaiheuttamiskyky jäi tutkimuksessa epäselväksi. IPN on pääasiassa pienten kirjolohenpoikasten tauti. Suomalaisessa kirjolohenviljelyssä poikastuotanto on pääosin keskittynyt sisämaan kalanviljelylaitoksille. Korkean taudinaiheuttamiskyvyn omaavan viruskannan leviäminen poikaslaitoksille voisi aiheuttaa suuriakin tappioita, joten viruksen leviämisen ennaltaehkäisy on erittäin tärkeää. Taudin leviämisen ehkäisemistä voidaan edistää tehokkailla bioturvallisuustoimilla, lisäksi lakisääteinen genoryhmän 5 IPNV-tartuntojen torjunta on perusteltua myös jatkossa kotimaisen kirjolohen poikastuotannon turvaamiseksi.

This next volume in Research in the Sociology of Health Care covers a variety of important social factors and their relationship to health and health care inequities both in the United States and the rest of the world. The authors of this volume explore issues related to infectious diseases and various chronic health problems. One section focuses on Covid 19 and issues of kidney disease, face masks and social values, pandemic experiences in rural parts of the United States, and in urban India. Other topics that are discussed focus on issues outside the United States such as in Nepal, Ecuador, and broader cross-national comparisons. Several papers focus on health care system issues within the United States including micro hospitals in Texas, evidence-based medicine, and trends in health disparities in the Latina population in the United States. Written from a sociological and broader social science approach, the papers provide important information both about broad trends in the US and other countries and some specific considerations of issues from a social perspective as linked to Covid 19.

Infectious diseases are caused by pathogenic micro-organisms which can be bacteria, viruses, parasites or fungi. The diseases can be spread through many different routes, either directly or indirectly. Military personnel are at high risk of contracting infections, in particular vector-borne and zoonotic infections, during overseas deployments, where they may be exposed to endemic or emerging infections to which they do not have immunity. Additionally, overcrowded settings with poor sanitation are high risks for disease. Genomics is having a transformational impact on medicine. It is enabling advances in accurate diagnosis of infectious disease, development of effective and targeted treatment strategies and opportunities to assess pathogenicity. Further, it supports the detection, surveillance of infectious diseases, the development and assessment of vaccines, as well as the assessment and prediction of anti-microbial resistance. These capabilities are all key military needs to protect personnel in this inter-connected world. The advances in sequencing technologies have resulted in an explosion of genomic data. However, making sense of genomic data requires advances in computational analysis technologies together with crossdisciplinary scientific approaches, skill sets and people. There are extensive reference databases of genomic data. One such open access database is PubMLST.org: it contains well curated genomes for more than 100 microbial species and genera integrated with provenance and phenotype information. All levels of sequence data, from single gene sequences up to and including complete, finished genomes can be accessed on this platform. This data is, however, both large and complex and intractable to analyse and understand using traditional analysis tools. This paper will discuss the challenges of analysing such genomic data for bacterial infections and consider the application of bioinformatics tools and techniques to analyse and communicate microbial genomic data in healthcare.

AbstractThe effect of drug shortages on estimating the infectivity of antiviral‐treatable disease epidemics is evaluated using an illustrative dataset. Simulation‐based analysis shows that a given outbreak can be caused by either (i) a high infectivity parameter even with sufficient and timely supply of medicines, or (ii) a low infectivity parameter and poor supply of medicines. Also, the use of a stand‐alone epidemic model is found to overestimate disease transmissibility. A compartmental epidemic model is integrated with multi‐echelon supply chain models to further investigate the impact of medicine supply chain on the epidemic dynamics. In integrated models, medicine demands for the supply chain are generated from the disease model, and the medicine supply rate controls the recovery rate of patients in the disease model. It is found that supply chain aspects have a significant effect on epidemic dynamics. Some improvement schemes for supply chain management are also highlighted.

Background: This topic is aimed to review the treatment approach in adult patients diagnosed with urosespsis, in order to decrease mortality and to maximize the outcome of the antibiotic stewardship efforts. Methods: We present an approach of antibiotic therapy in urosepsis from an infectious diseases physician perspective, based on the recently published data integrating the epidemiology of the urinary tract infections in a multidisciplinary hospital from Romania. Results: The principles of therapy in urosepsis should have five goals, but not limited to rapid diagnosis, specific intensive care unit treatment, obtaining urine and blood cultures, anti-infective treatment and identifying and correction of underlying risk factors. Due to the higher prognostic value, the antimicrobial therapy in urosepsis should consist in "two steps" regimen: initial antimicrobial therapy, based on "empirical" approach for the first 48 - 72 hours and directed or "definitive" antimicrobial therapy adapted to the susceptibility profile of the isolated pathogens, the penetration into the urinary tract and the patient clinical response. Clinicians should be aware of the different antibiotic susceptibility profile of the bacteria from the hospital compared to the community. Thus, the initial choice of antimicrobial agents depends on several criteria like the severity of illness and the risk factors for multidrug resistant pathogens: the immune status of the patient (age, debilitating chronic illnesses, immunosuppressive treatment or uncontrolled malignancies), broad-spectrum antimicrobial use and health care environment exposures in the previous 3 to 6 months, susceptibility of prior urinary isolates, and local community resistance prevalence of bacteria. Conclusions: Our important messages highlighted the need of a holistic approach of urosepsis, in a multidisciplinary team, with integration of risk factors for AMR, focusing on the first phase of antibiotic treatment as the main driven of the survival rate.