Frequency of exposure to Toxoplasma gondii in COVID-19 patients: a systematic review and meta-analysis.

BACKGROUND: Toxoplasmosis is a chronic protozoan parasitic infection that affects nearly one-third of the global population. During the COVID-19 pandemic, cases were observed in patients with COVID-19 and toxoplasmosis. Therefore, this systematic review and meta-analysis aimed to determine the frequency of Toxoplasma gondii exposure in patients with COVID-19. METHODS: A literature search was conducted in six databases or search tools (PubMed, Scopus, Embase, Web of Science, ScienceDirect, and Google Scholar) until March 3, 2024. Study selection, quality assessment, and data extraction were performed independently by three investigators. Statistical analysis was performed using R version 4.3, applying a random-effects model. The quality of the included observational studies was assessed using the "JBI-MAStARI". RESULTS: A total of 5,936 studies were retrieved, 13 of which were included in the final meta-analysis. The sample included a total of 2,947 patients with COVID-19 from four countries, of whom approximately 43.3% were men and 49.4% were women. Among the patients, 1,323 showed evidence of exposure to T. gondii through IgG detection, while 1,302 COVID-19 patients were explicitly examined for T. gondii by IgM detection, and 36 positive cases were identified. The frequency of exposure to T. gondii, determined by the presence of IgG in patients with COVID-19, reached 49% (95% CI: 34-63%; 2,947 participants; 13 studies; I2 = 98%, p < 0.01). In addition, the frequency of exposure to T. gondii, evaluated by IgM presence in patients with COVID-19, was 2% (95% CI: 0-6%; 1,302 participants; 6 studies; I2 = 94%, p < 0.01). CONCLUSION: It was shown that almost half of COVID-19 patients had previous exposure to T. gondii through the presence of IgG, and a small percentage, 2%, showed active infection through IgM detection. Although the results indicate a possible correlation between exposure to T. gondii and the presence of COVID-19, it is essential to note that this study is based on observational research, which precludes establishing a causal relationship. Consequently, further research is required to deepen understanding of the interaction between the two conditions. TERMS USED: The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI), Prospective International Registry of Systematic Reviews (PROSPERO), and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

The resurgence of monkeypox: Epidemiology, clinical features, and public health implications in the post-smallpox eradication era.

The recent global resurgence of Mpox (formerly monkeypox), primarily transmitted via close contact and respiratory droplets, highlights a significant shift in its epidemiology, particularly among men who have sex with men (MSM). This resurgence underscores the need for robust public health responses and improved surveillance. This comprehensive review of current literature focuses on recent outbreaks, virology, and available treatments. Epidemiological data were gathered from various international health reports and analysed to understand transmission dynamics and outbreak patterns. Mpox, characterised by symptoms like fever and rash, has shown variable clinical presentations, particularly among immunocompromised individuals. Recent outbreaks have prompted the development of new diagnostic methods and treatments, including antivirals like Tecovirimat and vaccines such as MVA-BN. Studies have demonstrated the effectiveness of these vaccines in preventing infection, which is crucial for outbreak containment. The global response to the Mpox resurgence requires integrated strategies combining vaccination, antiviral treatments, and public health policies tailored to high-risk populations. Future efforts should focus on vaccine distribution equity and enhancing diagnostic capabilities to effectively manage and mitigate the impact of Mpox.

Cross-sectional study of factors associated with caregiver's burden in patients diagnosed with psychotic disorders in urban India.

Pharmacotherapy has deinstitutionalized the patients with psychotic disorder. This has led to the transfer of the caregiving burden from hospitals to family members of the patients. This study aimed to assess the caregivers' burden and the factors associated with it objectively. This was a cross-sectional survey conducted amongst 143 caregivers of patients diagnosed with psychotic disorders reporting to a psychiatric outpatient department. The investigative tool used was a 12-item ZARIT Burden Interview (ZBI) questionnaire. The frequency of schizophrenia amongst patients with psychotic disorder was 68.5%. The median age of caregivers was 50 years in the "high burden" group, 40 years in the "moderate burden" group, and 34 years in the "no/mild burden" group. The mean score of burden experienced by the caregiver was 27.5 ±â€…9.7. The degree of burden was high in 66% of caregivers. The caregivers were generally more females, married, less educated, and mainly parents. A high degree of burden was associated with variables viz. female gender (OR 1.77 [0.88, 3.57], P = .043), low education status (OR 2.31 [1.09, 4.91] P = .002), unemployed status (OR 2.32 [1.12, 4.78] P = .027) and, increasing age of caregiver. No significant association was found between the degree of burden and variables, viz. marital status of caregivers, duration of caregiving, and duration of patient's illness. The current study identifies variables that can predict caregiver's burden. These results also suggest the implementation of psycho-educational, community-based programs which can address the core issues associated with caregiving.

Adverse pregnancy outcomes in maternal malarial infection: A systematic review and meta-analysis.

Background: Malaria in pregnancy is a critical public health issue that can lead to severe adverse outcomes for both mother and fetus. This systematic review and meta-analysis evaluated the prevalence of adverse birth outcomes in malaria-infected pregnancies and examines their association with the condition. Method: We searched databases up to January 30, 2024, for observational studies on pregnant women with malaria. Data were analyzed using a random-effects model to calculate pooled prevalence rates and risk ratios (RRs) for adverse outcomes, with statistical support from R software version 4.3. Results: Thirty-one studies were included, showing high prevalence of low birth weight (LBW; 17.4 %), preterm birth (17.9 %), and small for gestational age (SGA; 16.1 %) in malaria-affected pregnancies. Infected mothers were significantly more likely to have LBW infants (RR = 1.755), preterm births (RR = 1.484), and SGA infants (RR = 1.554). The risk of stillbirth was not significantly increased (RR = 1.238). Conclusion: Malaria in pregnancy significantly elevates the risk of LBW, preterm birth, and SGA, underscoring the need for effective malaria prevention and treatment strategies in endemic regions. Future research should aim to refine and implement these strategies to enhance maternal and neonatal health outcomes.

Effectiveness of a single dose of JYNNEOS vaccine in real world: A systematic review and meta-analysis.

Background: Mpox infection is a zoonotic illness that resembles smallpox. Vaccination is widely regarded as a vital effective method of preventing mpox, however, there is lack of consensus of effectiveness of a single dose of mpox vaccine in the current 2022-2023 outbreak. We pooled data from real-world studies to evaluate the efficacy of the JYNNEOS vaccination given as a single dosage. Method: We carried out a thorough literature search in PubMed, Web of Science, and Scopus up until August 2023. We estimated the pooled vaccine effectiveness (VE) for mpox using inverse variance method in a random-effects meta-analysis. We expressed the results as VE, 95% confidence interval (95% CI), and 95% prediction interval (95% PI) using R v4.3.0. We assessed influence, heterogeneity contribution, and influence of studies using several tests and conducted sensitivity analysis accordingly. We used Doi plot and Luis Furuya-Kanamori (LFK) index to evaluate publication bias. Results: With a total sample size of 35,326 individuals, we involved 11 studies in the meta-analysis. The VE of a single dose of JYNNEOS vaccine was 78.23% (95% CI: 62.79%-87.27%) by pooling data of 24,784 individuals over seven studies. The findings were heterogenous with a 95% PI of -32.14% to 96.41% depicting the expected range of VE in similar settings. Notably, VE increased to 83.02% (74.62%-88.64%) with a prediction interval of (44.67%-94.79) after sensitivity analysis by leaving out outliers. The results were robust in light of several sensitivity analyses. An asymmetric Doi plot with LFK index of -2.25 showed potential publication bias. Pooled prevalence of mpox infection among vaccinated individuals (breakthrough infection) in six studies was 2.19% (0.37%-5.32%). Conclusion: The present findings provide compelling evidence that a single dose of JUNNEOS vaccine can protect recipients from mpox infection. With a 78.23% estimated efficacy rate, the vaccine is thought to be a useful tool in preventing further spread of mpox. However, more research and ongoing surveillance are required to fully understand the reasons behind breakthrough infections and to improve immunization strategies for better protection against mpox.

Mpox virus infection in women and outbreak sex disparities: A Systematic Review and Meta-analysis.

BACKGROUND: Although the recent literature indicates that mpox (monkeypox) primarily affects men, there are also multiple reports in women. Estimates of the sex distribution of mpox patients and patterns will enable a better understanding of the ongoing mpox outbreak. METHODS: In this systematic review and meta-analysis, seven databases were searched for studies published in English up to January 4th, 2023. The proportion of women with mpox was the primary outcome. A random-effects model was fitted for the primary outcome, and a sensitivity analysis was performed to check possible outliers in the studies. RESULTS: Here we screened 470 articles and included 60 studies for qualitative synthesis. 42 studies with 3125 women out of 47,407 confirmed cases were found suitable for meta-analysis. The pooled proportion of female patients is 17.22% (95% CI: 10.49-25.11; I2 = 98.86%). Subgroup analyses reveal higher proportion before 2022 [44.09% (42.93-46.86] than 2022 onwards [2.40% (1.17-3.98)], and in endemic countries [43.13% (37.63-48.72)] than in nonendemic countries [6.15% (2.20-11.65)]. CONCLUSIONS: There is considerable caseload (17.22%) amongst women, which must be seen in the context of a much higher proportion (44.09%) in studies prior to 2022 compared to 2.40% in the 2022 outbreak indicating an epidemiological shift. Data on disease characteristics among women with mpox disease are scarce. Further studies should focus on these aspects to better understand the disease in women and empower epidemiologists and clinicians to make evidence-based decisions for this vulnerable group.

Mpox (formerly known as monkeypox) is an infection caused by the monkeypox virus. While it is known to affect men more commonly than women, there are also reports of this infection in women. We have searched the literature to find out how frequently mpox affected women. We found that 17% of mpox patients were female. However, this number was 44% before 2022, and has reduced to 2% from 2022 onwards. This indicates changes in mpox disease characteristics and in the ability to infect different sexes. Further studies are needed to better understand the disease in women and empower epidemiologists and clinicians to make evidence-based decisions for this group.

Multi-organ clinical manifestations of Mpox: an umbrella review of systematic reviews.

BACKGROUND: Mpox is a severe viral zoonosis that has emerged as a public health concern due to its potential for human-to-human transmission and severe illness. Understanding its clinical manifestations is crucial for effective management and control. Several systematic reviews have assessed various manifestations of Mpox. This umbrella review synthesizes evidence on Mpox's manifestations across different organ systems. METHOD: We conducted an umbrella review, adhering to Joanna Briggs Institute (JBI) methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, focusing on systematic reviews of Mpox manifestations. We performed a literature search up to 25th September 2023, in databases like PubMed, Embase, and Web of Science. We included systematic reviews of observational studies, case reports, case series, or RCTs reporting any manifestations of Mpox in humans, focusing on a global scope. AMSTAR 2 was used to evaluate the quality of systematic reviews, and data has been synthesized in narrative and tabular manners. RESULTS: A total of 25 systematic reviews were included, uncovering diverse manifestations of Mpox, such as cutaneous, cardiovascular, oral, ophthalmic, gastrointestinal, respiratory, and pregnancy-related. Cutaneous manifestations (up to 100%) were the most prevalent, featuring lesions and rashes. Constitutional symptoms of viral illness were reported in ~ 60% to > 85% of the cases. Significant respiratory symptoms were present in ~ 50% of cases overall. Headaches were the leading neurological symptom present in > 30%. Symptoms of gastrointestinal involvement ranged from 39% (oral lesions) with decreasing frequency to low diarrhea at ~ 5%, with proctitis percentages ranging from high teens to mid-twenties. Ophthalmic manifestations (6% but with wide variations among studies). Many primary studies included in the systematic reviews consisted of case reports and case series. A wide range of manifestations across different organ systems was observed. Negative outcomes for pregnancies were reported, but evidence is limited. Adverse cardiovascular and neurological outcomes were identified, though only a few studies provided insights into these findings. CONCLUSION: Mpox exhibits diverse manifestations, impacting multiple organ systems, with substantial variations. The findings highlight the importance of ongoing, nuanced, and region-specific research and management strategies for Mpox. The reliance on case reports and series underscores the need for more high-quality, long-term studies to deepen our understanding and management of this significant public health concern.

Control strategies for emerging infectious diseases: Crimean-Congo hemorrhagic fever management.

Background and Aims: Crimean-Congo Hemorrhagic Fever (CCHF) is a significant public health concern transmitted by ticks. This study seeks to thoroughly grasp the epidemiology and transmission patterns of CCHF, which is caused by the CCHF virus (CCHFV), a member of the Nairovirus genus in the Bunyaviridae family. Methods: The study investigates the global distribution and endemicity of CCHF, its mortality rates, modes of transmission (including tick bites, contact with infected animal blood, and limited person-to-person transmission), and factors influencing its prevalence across different regions. Genetic diversity within CCHFV and its impact on transmission dynamics are explored, along with efforts to control the disease through tick prevention, antiviral treatment, and the development of vaccines and diagnostics. Results: CCHFV exhibits widespread distribution, particularly in the Middle East, Africa, Asia, and Eastern Europe, with an overall mortality rate of approximately 30% and a case fatality rate ranging from 10% to 40%. Transmission occurs primarily through tick bites and contact with infected animal blood, with limited person-to-person transmission. Livestock workers, slaughterhouse employees, and animal herders in endemic areas are most affected by their frequent interaction with sick animals and ticks. Genetic diversity within CCHFV contributes to variations in transmission dynamics, complicating control efforts. Antiviral ribavirin shows efficacy in treating CCHF infection. Conclusion: This study underscores the importance of further research to understand the enzootic environment, transmission routes, and genetic diversity of CCHFV for effective control measures, including the development of vaccines, treatment options, and diagnostics.

Knowledge and attitude towards mpox: Systematic review and meta-analysis.

BACKGROUND: The increase in mpox incidence underscores the crucial need to understand and effectively address prevention, early detection, and agile response to this disease. Therefore, the present study aims to determine the knowledge and attitude towards mpox. METHODS: A systematic review and comprehensive literature meta-analysis were conducted using prominent databases such as PubMed, Scopus, Web of Science, Embase, and ScienceDirect, with an updated search until June 25, 2023. The quality of the included observational studies was assessed using the Joanna Briggs Institute's Statistical Meta-Analysis Review Instrument. The collected data were recorded in a Microsoft Excel spreadsheet, and analyses were conducted using R software version 4.2.3. Additionally, Cochran's Q statistics were applied to assess the heterogeneity of the included studies. RESULTS: A total of 299 articles were retrieved from 5 databases. This study included 27 cross-sectional articles with a total sample of 22,327 participants, of which 57.13% were women. The studies were conducted in 15 countries through an online survey. All studies had a moderate level of quality. The combined prevalence of a good level of knowledge about mpox was 33% (95% CI: 22%-45%; 22,327 participants; 27 studies; I2 = 100%), and the combined prevalence of a positive attitude towards mpox was 40% (95% CI: 19%-62%; 2,979 participants; 6 studies; I2 = 99%). Additionally, as a secondary outcome, the combined prevalence of the intention to vaccinate against mpox was 58% (95% CI: 37%-78%; 2,932 participants; 7 studies; I2 = 99%). CONCLUSION: Good knowledge and a positive attitude towards mpox were found to be low. The findings of this study highlight the need to identify gaps and focus on implementing educational programs on mpox. TERMS USED: Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI), Prospective International Registry of Systematic Reviews (PROSPERO), and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Chikungunya virus vaccine: a decade of progress solving epidemiological dilemma, emerging concepts, and immunological interventions.

Chikungunya virus (CHIKV), a single-stranded RNA virus transmitted by Aedes mosquitoes, poses a significant global health threat, with severe complications observed in vulnerable populations. The only licensed vaccine, IXCHIQ, approved by the US FDA, is insufficient to address the growing disease burden, particularly in endemic regions lacking herd immunity. Monoclonal antibodies (mAbs), explicitly targeting structural proteins E1/E2, demonstrate promise in passive transfer studies, with mouse and human-derived mAbs showing protective efficacy. This article explores various vaccine candidates, including live attenuated, killed, nucleic acid-based (DNA/RNA), virus-like particle, chimeric, subunit, and adenovirus vectored vaccines. RNA vaccines have emerged as promising candidates due to their rapid response capabilities and enhanced safety profile. This review underscores the importance of the E1 and E2 proteins as immunogens, emphasizing their antigenic potential. Several vaccine candidates, such as CHIKV/IRES, measles vector (MV-CHIK), synthetic DNA-encoded antibodies, and mRNA-lipid nanoparticle vaccines, demonstrate encouraging preclinical and clinical results. In addition to identifying potential molecular targets for antiviral therapy, the study looks into the roles played by Toll-like receptors, RIG-I, and NOD-like receptors in the immune response to CHIKV. It also offers insights into novel tactics and promising vaccine candidates. This article discusses potential antiviral targets, the significance of E1 and E2 proteins, monoclonal antibodies, and RNA vaccines as prospective Chikungunya virus vaccine candidates.