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الفونولوجيا المقطعية نحو نظرية توليدية للمقطع
يتناول هذا الكتاب مستوى جديدا في التمثيل الصواتي (مستوى ص مص : مستوى الصامت والمصوت)، وهو مستوى تتحدد بموجبه المواقع الوظيفية داخل المقطع يتناول الكتاب بالدراسة عددا من اللغات (الإنجليزية، والتركية، والفنلندية والفرنسية والإسبانية والدنماركية) وبعض فصوله ترمي إلى تطبيق النظرية على لغة الكلاماث (وهي لغة هندية أمريكية يتكلم بها سكان أوريكون بشمال غرب الولايات المتحدة)
BOOK
A Mathematical Model of Chikungunya Dynamics and Control: The Major Epidemic on Réunion Island
Chikungunya is a re-emerging arboviral disease transmitted by Aedes spp. mosquitoes. Although principally endemic to Africa and Asia, recent outbreaks have occurred in Europe following introductions by returning travellers. A particularly large outbreak occurred on Réunion Island in 2006, the published data from which forms the basis of the current study. A simple, deterministic mathematical model of the transmission of the virus between humans and mosquitoes was constructed and parameterised with the up-to-date literature on infection biology. The model is fitted to the large Réunion epidemic, resulting in an estimate of 4.1 for the type reproduction number of chikungunya. Although simplistic, the model provided a close approximation of both the peak incidence of the outbreak and the final epidemic size. Sensitivity analysis using Monte Carlo simulation demonstrated the strong influence that both the latent period of infection in humans and the pre-patent period have on these two epidemiological outcomes. We show why separating these variables, which are epidemiologically distinct in chikungunya infections, is not only necessary for accurate model fitting but also important in informing control.
Journal Article
Economic burden of multidrug-resistant tuberculosis on patients and households: a global systematic review and meta-analysis
Multidrug-resistant tuberculosis (MDR-TB) is a major health threat worldwide, causing a significant economic burden to patients and their families. Due to the longer duration of treatment and expensive second-line medicine, the economic burden of MDR-TB is assumed to be higher than drug-susceptible TB. However, the costs associated with MDR-TB are yet to be comprehensively quantified. We conducted this systematic review and meta-analysis to determine the global burden of catastrophic costs associated with MDR-TB on patients and their households. We systematically searched five databases (CINHAL, MEDLINE, Embase, Scopus, and Web of Science) from inception to 2 September 2022 for studies reporting catastrophic costs on patients and affected families of MDR-TB. The primary outcome of our study was the proportion of patients and households with catastrophic costs. Costs were considered catastrophic when a patient spends 20% or more of their annual household income on their MDR-TB diagnosis and care. The pooled proportion of catastrophic cost was determined using a random-effects meta-analysis. Publication bias was assessed using visualization of the funnel plots and the Egger regression test. Heterogeneity was assessed using I
2
, and sub-group analysis was conducted using study covariates as stratification variables. Finally, we used the Preferred Reporting Items for Reporting Systematic Review and Meta-Analysis-20 (PRISMA-20). The research protocol was registered in PROSPERO (CRD42021250909). Our search identified 6635 studies, of which 11 were included after the screening. MDR-TB patients incurred total costs ranging from $USD 650 to $USD 8266 during treatment. The mean direct cost and indirect cost incurred by MDR-TB patients were $USD 1936.25 (SD ± $USD 1897.03) and $USD 1200.35 (SD ± $USD 489.76), respectively. The overall burden of catastrophic cost among MDR-TB patients and households was 81.58% (95% Confidence Interval (CI) 74.13–89.04%). The catastrophic costs incurred by MDR-TB patients were significantly higher than previously reported for DS-TB patients. MDR-TB patients incurred more expenditure for direct costs than indirect costs. Social protection and financial support for patients and affected families are needed to mitigate the catastrophic economic consequences of MDR-TB.
Journal Article
Model validation for a knowledge and practices survey towards prevention of soil-transmitted helminth infections in rural villages in Indonesia
The rate of soil-transmitted helminth (STH) infection is estimated to be around 20% in Indonesia. Health promotion and health education are cost-effective strategies to supplement STH prevention and control programs. Existing studies suggest that quantitative tools for knowledge, attitudes and practices (KAP) are important to monitor effective community-based STH interventions. However, evidence is limited regarding the applicability of such tools. This study aims to identify the socio-demographic predictors for STH-related knowledge and practices and validate the quantitative tools in population use. A cross-sectional study design was conducted among residents of 16 villages in Central Java, Indonesia. Adult and child respondents were interviewed to assess general knowledge and practices in relation to STH. Two mixed effects models identified the significant factors in predicting knowledge and practice scores. The model predicted knowledge and practice scores were compared with the observed scores to validate the quantitative measurements developed in this study. Participants’ socio-demographic variables were significant in predicting an individual’s STH-related knowledge level and their hand washing and hygiene practices, taking into account household-level variability. Model validation results confirmed that the quantitative measurement tools were suitable for assessing STH associated knowledge and behaviour. The questionnaire developed in this study can be used to support school- and community-based health education interventions to maximize the effect of STH prevention and control programs.
Journal Article
Spatial clustering of notified tuberculosis in Ethiopia: A nationwide study
Tuberculosis (TB) remains a major health problem worldwide and in Ethiopia. This study aimed to investigate the spatial distributions of notified TB over the whole territory of Ethiopia and to quantify the role of health care access, environmental, socio-demographic, and behavioural factors associated with the clustering of TB.
A spatial analysis was conducted using national TB data reported between June 2016 and June 2017 in Ethiopia. Spatial clustering of TB was explored using Moran's I statistic and the local indicator of spatial autocorrelation (LISA). A multivariate Poisson regression model was developed with a conditional autoregressive (CAR) prior structure and with posterior parameters estimated using Bayesian Markov chain Monte Carlo (MCMC) simulation with Gibbs sampling to investigate the drivers of the clustering.
A total of 120,149 TB cases were reported from 745 districts in Ethiopia during the study period; 41,343 (34%) were bacteriologically confirmed new pulmonary TB and 33,997 (28%) were clinically diagnosed, new, smear-negative pulmonary TB patients. The nationwide annual incidence rate of notified TB was 112 per 100,000 population. The highest incidence was observed in three city administrative regions, namely Dire Dewa (348 cases per 100,000 population), Addis Ababa (262 per 100,000 population) and Harari (206 per 100,000 population), and the lowest incidence was observed in Somali region (51 per 100,000 population). High-high spatial clustering of notified TB was detected at Humera, Gog, and Surima district, and low-low clustering was detected in some districts located in the Somali region. Poor health care access (IRR = 0.78; 95%CI: 0.66, 0.90) and good knowledge about TB (IRR = 0.84; 95%CI: 0.73, 0.96) were negatively associated with the incidence of notified TB.
Substantial spatial clustering of notified TB was detected at region, zone and district level in Ethiopia. Health care access and knowledge about TB was associated with incidence of TB. This study may provide policy makers target hotspot areas, where national control programs could be implemented more efficiently for the prevention and control of TB, and to address potential under-reporting in poor access areas.
Journal Article
Clinical predictors of severe dengue: a systematic review and meta-analysis
Background
Severe dengue is a life-threatening complication; rapid identification of these cases, followed by adequate management is crucial to improve the clinical prognosis. Therefore, this study aimed to identify risk factors and predictors of severe dengue.
Methods
A literature search for studies reporting risk factors of severe dengue among individuals with dengue virus infection was conducted in PubMed, Scopus and Web of Science database from inception to December 31, 2020. Pooled odds ratios (
ORs
) for patients’ demographic characteristics, co-morbidities, and warning signs were estimated using an inverse variance heterogeneity model.
Results
We included 143 articles in the meta-analysis from a total of 13 090 articles retrieved from the literature search. The risk factors of severe dengue were: being a child [
OR
= 1.96; 95% confidence interval (
CI
): 1.22–3.13], secondary infection (
OR
= 3.23; 95%
CI
: 2.28–4.57), and patients with pre-existing diabetes (
OR
= 2.88; 95%
CI
: 1.72–4.81) and renal disease (
OR
= 4.54; 95%
CI
: 1.55–13.31). Warning signs strongly associated with severe disease were increased haematocrit with a concurrent decrease in platelet count (
OR
= 5.13; 95%
CI
: 1.61–16.34), abdominal pain (
OR
= 2.00; 95%
CI
: 1.49–2.68), lethargy (
OR
= 2.73; 95%
CI
: 1.05–7.10), vomiting (
OR
= 1.80; 95%
CI
: 1.43–2.26), hepatomegaly (
OR
= 5.92; 95%
CI
: 3.29–10.66), ascites (
OR
= 6.30; 95%
CI
: 3.75–10.60), pleural effusion (
OR
= 5.72; 95%
CI
: 3.24–10.10) and melena (
OR
= 4.05; 95%
CI
: 1.64–10.00).
Conclusions
Our meta-analysis identified children, secondary infection, diabetes and renal disease(s) as important predictors of severe dengue. Our finding also supports the predictive ability of the WHO warning signs to identify severe dengue. These findings are useful for clinicians to identify severe dengue for management and timely interventions.
Journal Article
Clinical features and outcomes of COVID-19 and dengue co-infection: a systematic review
Background
Dengue is the most common arboviral disease in the tropical and sub-tropical regions of the world. Like other regions, dengue-endemic areas have faced the additional public health and socio-economic impact of the ongoing coronavirus disease 2019 (COVID-19) pandemic. COVID-19 and dengue co-infections have been reported, with complicated patient management and care requirements. This review aimed to collate and synthesise current knowledge on the clinical features and outcomes of COVID-19 and dengue virus co-infection, a potentially important new dimension to be considered in public health management of the COVID-19 pandemic.
Methods
A systematic literature review was conducted using PubMed, Web of Science and Scopus databases from 1st January to 21st November 2020. The key search terms used were “dengue” and “coronavirus”. Descriptive analysis with graphical illustrations were used to present the clinical and laboratory parameters of the co-infection.
Results
Thirteen published papers and four news articles were included in the review. Most studies were case reports with a detailed description of the clinical and laboratory characteristics of the co-infection. All cases were in adults with the exception of a six-year old child. The common symptoms of co-infection were fever, dyspnea, headache, and cough. Common laboratory results included thrombocytopenia, lymphocytopenia, elevated transaminases, and leukopenia. Serious outcomes of co-infection included septic shock, acute respiratory disease syndrome and multi-organ failure, leading to death in some patients.
Conclusions
COVID-19 and dengue co-infection was associated with severe disease and fatal outcomes. The correct diagnosis and treatment of co-infection poses a substantial challenge due to the overlapping clinical and laboratory parameters. Therefore, confirmative diagnostic tests are necessary for accurate and timely diagnosis and patient management.
Journal Article
Application of a Multiplex Quantitative PCR to Assess Prevalence and Intensity Of Intestinal Parasite Infections in a Controlled Clinical Trial
Accurate quantitative assessment of infection with soil transmitted helminths and protozoa is key to the interpretation of epidemiologic studies of these parasites, as well as for monitoring large scale treatment efficacy and effectiveness studies. As morbidity and transmission of helminth infections are directly related to both the prevalence and intensity of infection, there is particular need for improved techniques for assessment of infection intensity for both purposes. The current study aimed to evaluate two multiplex PCR assays to determine prevalence and intensity of intestinal parasite infections, and compare them to standard microscopy.
Faecal samples were collected from a total of 680 people, originating from rural communities in Timor-Leste (467 samples) and Cambodia (213 samples). DNA was extracted from stool samples and subject to two multiplex real-time PCR reactions the first targeting: Necator americanus, Ancylostoma spp., Ascaris spp., and Trichuris trichiura; and the second Entamoeba histolytica, Cryptosporidium spp., Giardia. duodenalis, and Strongyloides stercoralis. Samples were also subject to sodium nitrate flotation for identification and quantification of STH eggs, and zinc sulphate centrifugal flotation for detection of protozoan parasites. Higher parasite prevalence was detected by multiplex PCR (hookworms 2.9 times higher, Ascaris 1.2, Giardia 1.6, along with superior polyparasitism detection with this effect magnified as the number of parasites present increased (one: 40.2% vs. 38.1%, two: 30.9% vs. 12.9%, three: 7.6% vs. 0.4%, four: 0.4% vs. 0%). Although, all STH positive samples were low intensity infections by microscopy as defined by WHO guidelines the DNA-load detected by multiplex PCR suggested higher intensity infections.
Multiplex PCR, in addition to superior sensitivity, enabled more accurate determination of infection intensity for Ascaris, hookworms and Giardia compared to microscopy, especially in samples exhibiting polyparasitism. The superior performance of multiplex PCR to detect polyparasitism and more accurately determine infection intensity suggests that it is a more appropriate technique for use in epidemiologic studies and for monitoring large-scale intervention trials.
Journal Article
Internet-based surveillance systems for monitoring emerging infectious diseases
Emerging infectious diseases present a complex challenge to public health officials and governments; these challenges have been compounded by rapidly shifting patterns of human behaviour and globalisation. The increase in emerging infectious diseases has led to calls for new technologies and approaches for detection, tracking, reporting, and response. Internet-based surveillance systems offer a novel and developing means of monitoring conditions of public health concern, including emerging infectious diseases. We review studies that have exploited internet use and search trends to monitor two such diseases: influenza and dengue. Internet-based surveillance systems have good congruence with traditional surveillance approaches. Additionally, internet-based approaches are logistically and economically appealing. However, they do not have the capacity to replace traditional surveillance systems; they should not be viewed as an alternative, but rather an extension. Future research should focus on using data generated through internet-based surveillance and response systems to bolster the capacity of traditional surveillance systems for emerging infectious diseases.
Journal Article
Co-distribution and co-infection of chikungunya and dengue viruses
Background
Chikungunya and dengue infections are spatio-temporally related. The current review aims to determine the geographic limits of chikungunya, dengue and the principal mosquito vectors for both viruses and to synthesise current epidemiological understanding of their co-distribution.
Methods
Three biomedical databases (PubMed, Scopus and Web of Science) were searched from their inception until May 2015 for studies that reported concurrent detection of chikungunya and dengue viruses in the same patient. Additionally, data from WHO, CDC and Healthmap alerts were extracted to create up-to-date global distribution maps for both dengue and chikungunya.
Results
Evidence for chikungunya-dengue co-infection has been found in Angola, Gabon, India, Madagascar, Malaysia, Myanmar, Nigeria, Saint Martin, Singapore, Sri Lanka, Tanzania, Thailand and Yemen; these constitute only 13 out of the 98 countries/territories where both chikungunya and dengue epidemic/endemic transmission have been reported.
Conclusions
Understanding the true extent of chikungunya-dengue co-infection is hampered by current diagnosis largely based on their similar symptoms. Heightened awareness of chikungunya among the public and public health practitioners in the advent of the ongoing outbreak in the Americas can be expected to improve diagnostic rigour. Maps generated from the newly compiled lists of the geographic distribution of both pathogens and vectors represent the current geographical limits of chikungunya and dengue, as well as the countries/territories at risk of future incursion by both viruses. These describe regions of co-endemicity in which lab-based diagnosis of suspected cases is of higher priority.
Journal Article