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Primary care and travel medicine services should offer assessments for older adults, optimising chronic disease management, ensuring recommended vaccinations are administered, and advising on hydration, heat risks, and mobility challenges.4589 Educational sessions and leaflets can empower older attendees with knowledge to navigate risks proactively and have contact information to seek help early if needed. The NHS and global public health systems must educate healthcare providers and adopt structured follow-up care for older people returning from overseas gatherings.8 Clinicians at all points of healthcare should routinely inquire about recent travel and mass gathering attendance when evaluating older patients with new or vague symptoms for early detection which can prevent prolonged morbidity and hospital admissions. 40151592 7 Pillay J Gaudet LA Saba S. Falls prevention interventions for community-dwelling older adults: systematic review and meta-analysis of benefits, harms, and patient values and preferences.

Tuberculosis (TB) is the most common cause of death from infectious disease worldwide. A substantial proportion of patients presenting with extrapulmonary TB have urogenital TB (UG-TB), which can easily be overlooked owing to non-specific symptoms, chronic and cryptic protean clinical manifestations, and lack of clinician awareness of the possibility of TB. Delay in diagnosis results in disease progression, irreversible tissue and organ damage and chronic renal failure. UG-TB can manifest with acute or chronic inflammation of the urinary or genital tract, abdominal pain, abdominal mass, obstructive uropathy, infertility, menstrual irregularities and abnormal renal function tests. Advanced UG-TB can cause renal scarring, distortion of renal calyces and pelvic, ureteric strictures, stenosis, urinary outflow tract obstruction, hydroureter, hydronephrosis, renal failure and reduced bladder capacity. The specific diagnosis of UG-TB is achieved by culturing Mycobacterium tuberculosis from an appropriate clinical sample or by DNA identification. Imaging can aid in localizing site, extent and effect of the disease, obtaining tissue samples for diagnosis, planning medical or surgical management, and monitoring response to treatment. Drug-sensitive TB requires 6–9 months of WHO-recommended standard treatment regimens. Drug-resistant TB requires 12–24 months of therapy with toxic drugs with close monitoring. Surgical intervention as an adjunct to medical drug treatment is required in certain circumstances. Current challenges in UG-TB management include making an early diagnosis, raising clinical awareness, developing rapid and sensitive TB diagnostics tests, and improving treatment outcomes.

The Middle East respiratory syndrome coronavirus (MERS-CoV) is a lethal zoonotic pathogen that was first identified in humans in Saudi Arabia and Jordan in 2012. Intermittent sporadic cases, community clusters, and nosocomial outbreaks of MERS-CoV continue to occur. Between April 2012 and December 2019, 2499 laboratory-confirmed cases of MERS-CoV infection, including 858 deaths (34·3% mortality) were reported from 27 countries to WHO, the majority of which were reported by Saudi Arabia (2106 cases, 780 deaths). Large outbreaks of human-to-human transmission have occurred, the largest in Riyadh and Jeddah in 2014 and in South Korea in 2015. MERS-CoV remains a high-threat pathogen identified by WHO as a priority pathogen because it causes severe disease that has a high mortality rate, epidemic potential, and no medical countermeasures. This Seminar provides an update on the current knowledge and perspectives on MERS epidemiology, virology, mode of transmission, pathogenesis, diagnosis, clinical features, management, infection control, development of new therapeutics and vaccines, and highlights unanswered questions and priorities for research, improved management, and prevention.

Furthermore, using a unique study design the authors controlled for demographic, biological, economic, and environmental variables associated with COVID-19 outcomes, including age, seasonality, population density, income, and health risks to identify contextual factors subject to policy control. [...]the level of trust in governments, interpersonal trust, and less government corruption were directly proportional to fewer infections and higher vaccination rates in high-income and middle-income countries. [...]GBD researchers have brought to light important knowledge gaps due to varying quality and quantity of data from across the world.

[...]whether these events are due to change in monkeypox virus transmission properties or increased virulence remains unknown. Compared with RNA viruses, the monkeypox virus is a large DNA virus, which makes itself more stable and efficient than RNA viruses at detecting and repairing mutations. [...]it is unlikely that the virus has evolved to increase human transmission. The unprecedented manifold increase in monkeypox cases seen in the past 3 weeks outside Africa yet again highlights that developing effective capacity at source is crucial for effective global public health preparedness and surveillance for zoonotic threats to global health security.1,2 Rapid garnering of financial and political support for this is required to fuel reassurance, rather than fear and stigmatisation. iStock/Biod AZ, NH, DA, FN, and RK are members of the Pan-African Network for Rapid Research, Response, Relief and Preparedness for Infectious Diseases Epidemics funded by the European and Developing Countries Clinical Trials Partnership, which is supported by Horizon 2020, the EU's Framework Programme for Research and Innovation.

Middle East respiratory syndrome (MERS) is a highly lethal respiratory disease caused by a novel single-stranded, positive-sense RNA betacoronavirus (MERS-CoV). Dromedary camels, hosts for MERS-CoV, are implicated in direct or indirect transmission to human beings, although the exact mode of transmission is unknown. The virus was first isolated from a patient who died from a severe respiratory illness in June, 2012, in Jeddah, Saudi Arabia. As of May 31, 2015, 1180 laboratory-confirmed cases (483 deaths; 40% mortality) have been reported to WHO. Both community-acquired and hospital-acquired cases have been reported with little human-to-human transmission reported in the community. Although most cases of MERS have occurred in Saudi Arabia and the United Arab Emirates, cases have been reported in Europe, the USA, and Asia in people who travelled from the Middle East or their contacts. Clinical features of MERS range from asymptomatic or mild disease to acute respiratory distress syndrome and multiorgan failure resulting in death, especially in individuals with underlying comorbidities. No specific drug treatment exists for MERS and infection prevention and control measures are crucial to prevent spread in health-care facilities. MERS-CoV continues to be an endemic, low-level public health threat. However, the virus could mutate to have increased interhuman transmissibility, increasing its pandemic potential.

All three coronaviruses induce excessive and aberrant non-effective host immune responses that are associated with severe lung pathology, leading to death.2–4 Similar to patients with SARS-CoV and MERS-CoV, some patients with 2019-nCoV develop acute respiratory distress syndrome (ARDS) with characteristic pulmonary ground glass changes on imaging. In most moribund patients, 2019-nCoV infection is also associated with a cytokine storm, which is characterised by increased plasma concentrations of interleukins 2, 7, and 10, granulocyte-colony stimulating factor, interferon-γ-inducible protein 10, monocyte chemoattractant protein 1, macrophage inflammatory protein 1 alpha, and tumour necrosis factor α.2–6 In those who survive intensive care, these aberrant and excessive immune responses lead to long-term lung damage and fibrosis, causing functional disability and reduced quality of life.7,8 Specific drugs to treat 2019-nCoV will take several years to develop and evaluate. Infection with 2019-nCoV appears to be initially associated with an increased Th2 response,4 which might reflect a physiological reaction to curb overt inflammatory responses, a clinical phenomenon that guided the optimal timing of interferon treatment in patients with sepsis, resulting in increased survival.14 Interleukin 17 blockade might benefit those patients who have a 2019-nCoV infection and increased plasma concentration of interleukin 17.

A novel coronavirus (MERS-CoV) was recently identified as the cause of severe respiratory disease. In this report from Saudi Arabia, a family cluster of infection over a 6-week period is described, suggesting possible limited person-to-person transmission. MERS-CoV was first reported in September 2012 in samples obtained from a Saudi Arabian businessman who died from acute respiratory and renal failure. 1 As of May 28, 2013, a total of 49 cases of human MERS-CoV infection with 26 deaths have been reported to the World Health Organization (WHO). MERS-CoV is the first betacoronavirus belonging to lineage C that is known to infect humans. 2 It belongs to the Coronaviridae family, a group of large, enveloped single-stranded RNA viruses that are known for their genomic plasticity and their ability to cause a range of infections in mammalian and avian hosts. MERS-CoV . . .

A novel coronavirus (MERS-CoV) is causing severe disease in the Middle East. In this report on a hospital outbreak of MERS-CoV infection, 23 confirmed cases and evidence of person-to-person transmission were identified. The median incubation period was 5.2 days. Respiratory viruses are an emerging threat to global health security and have led to worldwide epidemics with substantial morbidity, mortality, and economic consequences. Since the severe acute respiratory syndrome (SARS) pandemic in 2003–2004, 1 – 3 two additional human coronaviruses — HKU-1 and NL-63 — have been identified, both of which cause mild respiratory infection and are distributed worldwide. 4 , 5 In September 2012, the World Health Organization (WHO) reported two cases of severe community-acquired pneumonia caused by a novel human β-coronavirus, subsequently named the Middle East respiratory syndrome coronavirus (MERS-CoV). 6 – 8 Since then, MERS-CoV has been identified as the cause of pneumonia . . .