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National action plans enumerate many interventions as potential strategies to reduce the burden of bacterial antimicrobial resistance (AMR). However, knowledge of the benefits achievable by specific approaches is needed to inform policy making, especially in low-income and middle-income countries (LMICs) with substantial AMR burden and low health-care system capacity. In a modelling analysis, we estimated that improving infection prevention and control programmes in LMIC health-care settings could prevent at least 337 000 (95% CI 250 200–465 200) AMR-associated deaths annually. Ensuring universal access to high-quality water, sanitation, and hygiene services would prevent 247 800 (160 000–337 800) AMR-associated deaths and paediatric vaccines 181 500 (153 400–206 800) AMR-associated deaths, from both direct prevention of resistant infections and reductions in antibiotic consumption. These estimates translate to prevention of 7·8% (5·6–11·0) of all AMR-associated mortality in LMICs by infection prevention and control, 5·7% (3·7–8·0) by water, sanitation, and hygiene, and 4·2% (3·4–5·1) by vaccination interventions. Despite the continuing need for research and innovation to overcome limitations of existing approaches, our findings indicate that reducing global AMR burden by 10% by the year 2030 is achievable with existing interventions. Our results should guide investments in public health interventions with the greatest potential to reduce AMR burden.

Primaquine and tafenoquine are the only licensed drugs with activity against Plasmodium vivax hypnozoites but cause haemolysis in patients with glucose–6–phosphate dehydrogenase (G6PD) deficiency. Malaria also causes haemolysis, leading to the replacement of older erythrocytes with low G6PD activity by reticulocytes and young erythrocytes with higher activity. Aim of this study was to assess the impact of acute malaria on G6PD activity. Selected patients with uncomplicated malaria were recruited in Bangladesh (n = 87), Indonesia (n = 75), and Ethiopia (n = 173); G6PD activity was measured at the initial presentation with malaria and a median of 176 days later (range 140 to 998) in the absence of malaria. Among selected participants (deficient participants preferentially enrolled in Bangladesh but not at other sites) G6PD activity fell between malaria and follow up by 79.1% (95%CI: 40.4 to 117.8) in 6 participants classified as deficient (<30% activity), 43.7% (95%CI: 34.2 to 53.1) in 39 individuals with intermediate activity (30% to <70%), and by 4.5% (95%CI: 1.4 to 7.6) in 290 G6PD normal (≥70%) participants. In Bangladesh and Indonesia G6PD activity was significantly higher during acute malaria than when the same individuals were retested during follow up (40.9% (95%CI: 33.4–48.1) and 7.4% (95%CI: 0.2 to 14.6) respectively), whereas in Ethiopia G6PD activity was 3.6% (95%CI: -1.0 to -6.1) lower during acute malaria. The change in G6PD activity was apparent in patients presenting with either P . vivax or P . falciparum infection. Overall, 66.7% (4/6) severely deficient participants and 87.2% (34/39) with intermediate deficiency had normal activities when presenting with malaria. These findings suggest that G6PD activity rises significantly and at clinically relevant levels during acute malaria. Prospective case-control studies are warranted to confirm the degree to which the predicted population attributable risks of drug induced haemolysis is lower than would be predicted from cross sectional surveys.

PURPOSE: The purpose of this study is to review the humanitarian work done by KSrelief to support the healthcare sector in Yemen during the COVID-19 crisis, and to assess its impacts on the seroprevalence rate of anti-SARS-CoV-2 antibodies among healthcare workers (HCWs) in Yemen.DESIGN/METHODOLOGY/APPROACH: Data related to the KSrelief humanitarian efforts, particularly the medical aid to the healthcare sector in Yemen, over the 3-year period from 2020 to 2022 was analysed. In addition, a cross-sectional study was conducted among 404 HCWs in Lahj and AL-Dhalea hospitals from 1 June-30 September 2022. A self-administered questionnaire was distributed to all voluntary HCWs. A blood test for the presence of anti-nucleocapsid (anti-N) antibodies by anti-SARS-CoV-2 immunoassay using an electrochemiluminescence technique was taken. The impact of the aid efforts on the seroprevalence rate was assessed and correlated, and the lessons learned and what needs to be done to improve the utilisation of the aid efforts are discussed.STUDY FINDINGS: Up to December 2022, KSrelief implemented 764 projects with budget of US$1,130,771,135. These projects were executed through the Yemeni Ministry of Public Health and covered more than 12 governorates of Yemen. The projects included a vaccination programme, the provision of personal protection equipment (PPE) and other protective gear for HCWs, RT-PCR devices and accessories, and medical and laboratory devices and equipment. The seroprevalence test revealed 94.0% of the healthcare workers with Anti-SARS-CoV-2 antibodies.RESEARCH LIMITATIONS/IMPLICATIONS: To the best of our knowledge, this is the first study that compares the impact of the humanitarian assistance provided by KSrelief in Yemen during the COVID-19 crisis with the level of seroprevalence of COVID-19 among HCWs in Lahj and AL-Dhalea governorates in Yemen. It is also the first study documenting the seropositivity of SARS-CoV-2 antibodies in HCWs in Yemen. The findings among HCWs in different healthcare settings in the country are non-general; this is because only 2 governorates out of 22 were selected that could be reported among the findings’ limitations. In addition, there are some potential information recall biases such as in reporting of previous infection with SARS-CoV-2, the use of PPE, and infection prevention and control (IPC) training.PRACTICAL IMPLICATIONS: Although the KSrelief efforts are directed at all governorates of Yemen, the impact of these efforts on the seroprevalence rate in other regions needs to be assessed to get an overall view of the correlation between the two. This study revealed that the ultimate great humanitarian assistance and relief measures provided by KSrelief to the healthcare sector in Yemen in the form of medical equipment and supplies to fight the COVID crisis set a true example of universal brotherhood; this can be replicated by other organisations working to decrease human suffering from natural or man-made disasters. Vaccination and reinforcement of IPC measures and training activities for imparting knowledge and appropriate implementation of the IPC protocol are key to preventing morbidity and mortality among HCWs.ORIGINALITY/VALUE: The lessons learned from the correlation of the seroprevalence study with the aid efforts can be used as a guide by KSrelief themselves as well as by the other organisations working to deliver medical aid to the conflict-ridden countries, to better manage the precious resources and to identify any lacunae’s that may hinder full utilisation of the relief efforts. Although humanitarian assistance to Yemen has been provided by KSrelief since the beginning of the political turmoil, the relief measures were increased exponentially to counter the challenges of the COVID-19 pandemic and the social and economic deprivation due to the ongoing war. This seroprevalence survey was the first to document the seropositivity of SARS-CoV-2 antibodies in HCWs in Yemen after the fifth global COVID-19 wave.

Abstract A 65-year-old male presented with a left renal mass and a retained common bile duct stent from a previous endoscopic retrograde cholangiopancreatography 2 years ago for choledocholithiasis. Imaging confirmed a lower pole renal lesion with features of renal cell carcinoma (RCC) and dilated biliary tree with sludge and a retained stent. The patient underwent single-stage surgery—left radical nephrectomy and open choledochoduedenotomy—for removal of the stent and biliary clearance through midline approach. Histopathology confirmed chromophobe RCC. This case illustrates the feasibility of patient-centred manner simultaneous surgical treatment for dual-system pathologies in a low resource setting and.

Primaquine radical cure is used to treat dormant liver-stage parasites and prevent relapsing Plasmodium vivax malaria but is limited by concerns of haemolysis. We undertook a systematic review and individual patient data meta-analysis to investigate the haematological safety of different primaquine regimens for P vivax radical cure. For this systematic review and individual patient data meta-analysis, we searched MEDLINE, Web of Science, Embase, and Cochrane Central for prospective clinical studies of uncomplicated P vivax from endemic countries published between Jan 1, 2000, and June 8, 2023. We included studies if they had active follow-up of at least 28 days, if they included a treatment group with daily primaquine given over multiple days where primaquine was commenced within 3 days of schizontocidal treatment and was given alone or coadministered with chloroquine or one of four artemisinin-based combination therapies (ie, artemether–lumefantrine, artesunate–mefloquine, artesunate–amodiaquine, or dihydroartemisinin–piperaquine), and if they recorded haemoglobin or haematocrit concentrations on day 0. We excluded studies if they were on prevention, prophylaxis, or patients with severe malaria, or if data were extracted retrospectively from medical records outside of a planned trial. For the meta-analysis, we contacted the investigators of eligible trials to request individual patient data and we then pooled data that were made available by Aug 23, 2021. The main outcome was haemoglobin reduction of more than 25% to a concentration of less than 7 g/dL by day 14. Haemoglobin concentration changes between day 0 and days 2–3 and between day 0 and days 5–7 were assessed by mixed-effects linear regression for patients with glucose-6-phosphate dehydrogenase (G6PD) activity of (1) 30% or higher and (2) between 30% and less than 70%. The study was registered with PROSPERO, CRD42019154470 and CRD42022303680. Of 226 identified studies, 18 studies with patient-level data from 5462 patients from 15 countries were included in the analysis. A haemoglobin reduction of more than 25% to a concentration of less than 7 g/dL occurred in one (0·1%) of 1208 patients treated without primaquine, none of 893 patients treated with a low daily dose of primaquine (<0·375 mg/kg per day), five (0·3%) of 1464 patients treated with an intermediate daily dose (0·375 mg/kg per day to <0·75 mg/kg per day), and six (0·5%) of 1269 patients treated with a high daily dose (≥0·75 mg/kg per day). The covariate-adjusted mean estimated haemoglobin changes at days 2–3 were –0·6 g/dL (95% CI –0·7 to –0·5), –0·7 g/dL (–0·8 to –0·5), –0·6 g/dL (–0·7 to –0·4), and –0·5 g/dL (–0·7 to –0·4), respectively. In 51 patients with G6PD activity between 30% and less than 70%, the adjusted mean haemoglobin concentration on days 2–3 decreased as G6PD activity decreased; two patients in this group who were treated with a high daily dose of primaquine had a reduction of more than 25% to a concentration of less than 7 g/dL. 17 of 18 included studies had a low or unclear risk of bias. Treatment of patients with G6PD activity of 30% or higher with 0·25–0·5 mg/kg per day primaquine regimens and patients with G6PD activity of 70% or higher with 0·25–1 mg/kg per day regimens were associated with similar risks of haemolysis to those in patients treated without primaquine, supporting the safe use of primaquine radical cure at these doses. Australian National Health and Medical Research Council, Bill & Melinda Gates Foundation, and Medicines for Malaria Venture.

Glucose-6-Phosphate dehydrogenase (G6PD) deficiency is the most common enzymopathy worldwide, no reliable bedside diagnostic tests to quantify G6PD activity exist. This study evaluated two novel quantitative G6PD diagnostics. Participants with known G6PD activity were enrolled in Bangladesh. G6PD activity was measured by spectrophotometry, Biosensor (BS; AccessBio/CareStart, USA) and STANDARD G6PD (SG; SDBiosensor, ROK). G6PD activity was measured repeatedly in a subset of samples stored at room temperature and 4°C. 158 participants were enrolled, 152 samples tested by BS, 108 samples by SG and 102 samples were tested by all three methods. In comparison to spectrophotometry BS had sensitivity and specificity of 72% (95%CI: 53-86) and 100% (95%CI: 97-100) at 30% cut off respectively, while SG had a sensitivity of 100% (95%CI: 88-100) and specificity of 97% (95%CI: 91-99) at the same cut off. The sensitivity and specificity at 70% cut off activity were 71% (95%CI: 59-82) and 98% (95%CI, 92-100) respectively for BS and 89% (95%CI: 77-96) and 93% (95%CI: 83-98) respectively for SG. When an optimal cut-off was applied the sensitivity of the BS at 70 cut off rose to 91% [95%CI: 80-96] and specificity to 82% [95%CI: 83-89]; a diagnostic accuracy comparable to that of the SG (p = 0.879). G6PD activity dropped significantly (-0.31U/gHb, 95%CI: -0.61 to -0.01, p = 0.022) within 24 hours in samples stored at room temperature, but did not fall below 90% of baseline activity until day 13 (-0.87U/gHb, 95%CI: (-1.11 to -0.62), p<0.001). BS and SG are the first quantitative diagnostics to measure G6PD activity reliably at the bedside and represent suitable alternatives to spectrophotometry in resource poor settings. If samples are stored at 4°C, G6PD activity can be measured reliably for at least 7 days after sample collection.

Retrocaval ureter is a rare congenital vascular anomaly with an incidence of 0.13%, leading to the passage of the right ureter behind the inferior vena cava and then turning around it to attain its lateral position. The condition is usually associated with obstruction in the right kidney and proximal ureter leading to symptoms like dull aching pain in the flanks, recurrent episodes of urinary tract infections, and recurrent stone formation. The patient presented with recurrent episodes of burning micturition and pain in the right flank for the past 6 months. A contrast-enhanced computed tomography kidney–ureter–bladder was done to diagnose the condition. The patient was managed by open pelviureteric anastomosis lateral to the inferior vena cava, thus eliminating the obstruction on the ureter. The patient has had an uneventful postoperative follow-up. Retrocaval ureter is a rare condition and should be clinically suspected in cases of hydronephrosis where other causes have been ruled out. Different approaches can be used to correct the anomaly. In this case report, an open transperitoneal intraabdominal approach has been used.

Glucose-6-phosphate dehydrogenase (G6PD) activity is dependent upon G6PD genotype and age of the red blood cell (RBC) population, with younger RBCs having higher activity. Peripheral parasitemia with Plasmodium spp. induces hemolysis, replacing older RBCs with younger cells with higher G6PD activity. This study aimed to assess whether G6PD activity varies between individuals with and without malaria or a history of malaria. Individuals living in the Chittagong Hill Tracts of Bangladesh were enrolled into 3 complementary studies: (i) a prospective, single-arm clinical efficacy trial of patients (n = 175) with uncomplicated malaria done between 2014 and 2015, (ii) a cross-sectional survey done between 2015 and 2016 (n = 999), and (iii) a matched case-control study of aparasitemic individuals with and without a history of malaria done in 2020 (n = 506). G6PD activity was compared between individuals with and without malaria diagnosed by microscopy, rapid diagnostic test (RDT), or polymerase chain reaction (PCR), and in aparasitemic participants with and without a history of malaria. In the cross-sectional survey and clinical trial, 15.5% (182/1,174) of participants had peripheral parasitemia detected by microscopy or RDT, 3.1% (36/1,174) were positive by PCR only, and 81.4% (956/1,174) were aparasitemic. Aparasitemic individuals had significantly lower G6PD activity (median 6.9 U/g Hb, IQR 5.2-8.6) than those with peripheral parasitemia detected by microscopy or RDT (7.9 U/g Hb, IQR 6.6-9.8, p < 0.001), but G6PD activity similar to those with parasitemia detected by PCR alone (submicroscopic parasitemia) (6.1 U/g Hb, IQR 4.8-8.6, p = 0.312). In total, 7.7% (14/182) of patients with malaria had G6PD activity < 70% compared to 25.0% (248/992) of participants with submicroscopic or no parasitemia (odds ratio [OR] 0.25, 95% CI 0.14-0.44, p < 0.001). In the case-control study, the median G6PD activity was 10.3 U/g Hb (IQR 8.8-12.2) in 253 patients with a history of malaria and 10.2 U/g Hb (IQR 8.7-11.8) in 253 individuals without a history of malaria (p = 0.323). The proportion of individuals with G6PD activity < 70% was 11.5% (29/253) in the cases and 15.4% (39/253) in the controls (OR 0.7, 95% CI 0.41-1.23, p = 0.192). Limitations of the study included the non-contemporaneous nature of the clinical trial and cross-sectional survey. Patients with acute malaria had significantly higher G6PD activity than individuals without malaria, and this could not be accounted for by a protective effect of G6PD deficiency. G6PD-deficient patients with malaria may have higher than expected G6PD enzyme activity and an attenuated risk of primaquine-induced hemolysis compared to the risk when not infected.

Employee voice behavior has attained significant attention in contemporary research due to its positive consequences for both workers and employers. Drawing on the social exchange theory, this study examined the mediating role of job satisfaction and psychological empowerment on the relationship between transformational leadership and employee’s voice behavior. Data were collected through survey questionnaires by utilizing a three-wave time-lagged study design from employees from diverse private and public sector organizations in Pakistan. The parallel multiple mediation is tested through Hayes’s process macro. The results indicate that job satisfaction and psychological empowerment partially mediate the relationship between transformational leadership and employee’s voice behavior. Further analysis depicts that both job satisfaction and psychological empowerment leveraged under transformational leadership act as parallel mediators and have no statistical significant difference between them. The theoretical and managerial implications are discussed.

Groundwater supplies approximately half of the total global domestic water demand. It also complements the seasonal and annual variabilities of surface water. Monitoring of groundwater fluctuations is mandatory to envisage the composition of terrestrial water storage. This research provides an overview of traditional techniques and detailed discussion on the modern tools and methods to monitor groundwater fluctuations along with advanced applications. The groundwater monitoring can broadly be classified into three groups. The first one is characterized by the point measurement to measure the groundwater levels using classical instruments and electronic and physical investigation techniques. The second category involves the extensive use of satellite data to ensure robust and cost-effective real-time monitoring to assess the groundwater storage variations. Many satellite data are in use to find groundwater indirectly. However, GRACE satellite data supported with other satellite products, computational tools, GIS techniques, and hydro-climate models have proven the most effective for groundwater resources management. The third category is groundwater numerical modeling, which is a very useful tool to evaluate and project groundwater resources in future. Groundwater numerical modeling also depends upon the point-based groundwater monitoring, so more research to improve point-based detection methods using latest technologies is required, as these still play the baseline role. GRACE and numerical groundwater modeling are suggested to be used conjunctively to assess the groundwater resources more efficiently.