Amal Saif Al-Maani: tackling drug-resistant pathogens.

Amal Saif Al-Maani talks to Andréia Azevedo Soares about antimicrobial resistance and the need for multisectoral approaches to mitigating its development.

[125 Years German Central Committee for the Fight against Tuberculosis (DZK)]. / 125 Jahre Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK).

The German Central Committee for the Fight against Tuberculosis (DZK) celebrates this year its 125th birthday. On this occasion, the DZK as one of the oldest TB organizations worldwide is looking back on the development during its history and records the results in a comprehensive book, summarized in this article. In the book, the various political changes with their impact on the DZK are mirrored, starting with the German Empire, the Weimar Republic, the so-called "Third Reich", the two German states separated after the Second World War and the current FRG. Tuberculosis (TB) was the dominant widespread disease in the 19th century, today it is the leading infectious disease worldwide. As a consequence of migration, this affects also Germany. After meanwhile - in particular in 2015/16 - risen numbers of new cases (especially of those not born in Germany, which in 2019 accounted for 72 % of all cases), the impact of drug-resistant tuberculosis (in 2019, 11.4 % of all new cases had some resistance (384 cases), including 87 cases of MDR-TB, and of these 8 cases of XDR-TB and 27 cases of pre-XDR-TB), as well as the high proportion (81,5 %) - in 2019 - of open and thus very infectious pulmonary TB among new TB cases in Germany, impressively show that TB continues to be a health problem that should not be underestimated and that is increasingly concentrated in risk groups (socially disadvantaged persons, people from high-prevalence countries, homeless people, drug addicts, alcoholics, HIV-infected persons). The DZK therefore continues to play an important role in TB control as a link between the national and international organizations responsible for combating TB.

El Alamein: the battle in the battle. How infectious disease management changed the fate of one of the most important battle of the World War II.

El Alamein, on Egypt's Mediterranean coast, was the theater of war for one of the most important and decisive battles of the Second World War. The Allied victory in November 1942 opened the end of the Western Desert Campaign. The battle revived the morale of the Allies, being the first big success against the Axis since Operation Crusader in late 1941. The German threat to Egypt, the Suez Canal and the Middle Eastern and Persian oil fields was eliminated and the doors for Mediterranean advance were opened. Fighting in the desert under extreme human conditions exposed all the involved armies to health hazards going beyond those arising from common battle injuries. The outcome of the battle was influenced by a gap in morbidity and mortality derived from different approaches in infectious disease management between armies. The attention of the British for medical research, pharmacological experimentation, hygiene strategies and prevention may have been as important as warfare strategies in deciding the fate of the battle. Examples of some of these advances include wound nursing, control of endemic diseases, surveillance of difficult hygienic conditions, prevention of faecal-oral transmission diseases. During El Alamein Battle soldiers on both fronts where engaged in two wars: the first one, vertical, was against the enemy uniform; the second one, horizontal, was against invisible enemies called pathogens. Only surviving the horizontal war meant preserve enough units and morale in order to win El Alaman Battle.

[To what extent Africa can limit the impact of the COVID-19 pandemic?] / Jusqu'où l'Afrique peut-elle limiter l'impact de la pandémie de COVID-19 ?

Following the onset of the global COVID-19 pandemic and the alerts issued by the World Health Organization, for several months attention has been focused on Africa as a potentially severely endangered continent. A sizable number of African countries, mainly low and middle income, suffer from limited available resources, especially in critical care, and COVID-19 is liable to overwhelm their already fragile health systems. To effectively manage what is shaping up as a multidimensional crisis, the challenge unquestionably goes beyond the necessary upgrading of public health infrastructures. It is also a matter of anticipating and taking timely action with regard to factors that may mitigate the propagation of SARS-CoV2 and thereby cushion the shock of the pandemic on the African continent. While some of these factors are largely unmanageable (climate, geography…), several others (socio-cultural, religious, audio-visual, and potentially political…) could be more or less effectively dealt with by African governments and populations.

COVID-19 and Other Pandemics: How Might They Be Prevented?

Pandemics such as influenza, smallpox, and plague have caused the loss of hundreds of millions of lives and have occurred for many centuries. Fortunately, they have been largely eliminated by the use of vaccinations and drugs. More recently, Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and now Coronavirus Disease 2019 (COVID-19) have arisen, and given the current absence of highly effective approved vaccines or drugs, brute-force approaches involving physical barriers are being used to counter virus spread. A major basis for physical protection from respiratory infections is eye, nose, and mouth protection. However, eye protection with goggles is problematic due to "fogging", while nose/mouth protection is complicated by the breathing difficulties associated with non-valved respirators. Here, we give a brief review of the origins and development of face masks and eye protection to counter respiratory infections on the basis of experiments conducted 100 years ago, work that was presaged by the first use of personal protective equipment, "PPE", by the plague doctors of the 17th Century. The results of the review lead to two conclusions: first, that eye protection using filtered eye masks be used to prevent ocular transmission; second, that new, pre-filtered, valved respirators be used to even more effectively block viral transmission.

Smallpox vaccination in the German Empire. Vaccination between biopolitics and moral economy / La vacuna contra la viruela en el imperio alemán. La vacunación entre biopolítica y economía moral

After a smallpox epidemic in Germany in the early 1870s in the wake of the Franco-German War, smallpox vaccination became compulsory by Imperial Law in 1874. The act was hotly debated in parliament and in public and earlier resistance against vaccination developed into a political anti-vaccination movement. For this reason, the German government adopted a number of safety measures. The current article describes, firstly, vaccination practices, regulations and policies in the German states up to the 1870s and the biopolitical developments that led to the Imperial Law on compulsory smallpox vaccination in 1874. Secondly, the article sketches the public debate and critique regarding vaccination asking why compulsory vaccination succeeded in Germany. The article describes the measures implemented by the German government to promote compulsory vaccination and acceptance of the Imperial Law: initially, smallpox vaccines were manufactured by state-run production sites and supervised by local authori­ties. Empire-wide statistics were collated documenting the success of vaccination as well as related side-effects. From a government perspective, these precautions could be interpreted as a technology of trust

Después de una epidemia de viruela en Alemania a principios de la década de 1870 a raíz de la guerra francoalemana, la vacuna antivariólica se hizo obligatoria por Ley Imperial en 1874. La ley se debatió acaloradamente en el parlamento y en pú­blico, y la resistencia ya existente contra la vacunación se convirtió en un movimiento político antivacunas. Por ello, el gobierno alemán adoptó una serie de medidas de seguridad. El artículo actual describe, en primer lugar, las prácticas, regulaciones y políti­cas de vacunación en los estados alemanes hasta la década de 1870, y los desarrollos biopolíticos que llevaron a la Ley Imperial sobre la vacunación antivariólica obligatoria en 1874. En segundo lugar, se esbozan el debate público y la crítica sobre la vacunación, preguntando por qué la vacunación obligatoria tuvo éxito en Alemania. Se describen las medidas aplicadas por el gobierno alemán para promover la vacunación obligatoria y la aceptación de la Ley Imperial: inicialmente, las vacunas contra la viruela se fabricaban por centros de producción estatales supervisados por las autoridades locales. Se recopilaban estadísticas de todo el imperio que documentaban el éxito de la vacunación, así como los efectos secundarios relacionados. Desde la perspectiva del gobierno, estas precauciones podrían interpretarse como una tecnología de confianza

The past, present and future impact of HIV prevention and control on HPV and cervical disease in Tanzania: A modelling study.

BACKGROUND: Women with HIV have an elevated risk of HPV infection, and eventually, cervical cancer. Tanzania has a high burden of both HIV and cervical cancer, with an HIV prevalence of 5.5% in women in 2018, and a cervical cancer incidence rate among the highest globally, at 59.1 per 100,000 per year, and an estimated 9,772 cervical cancers diagnosed in 2018. We aimed to quantify the impact that interventions intended to control HIV have had and will have on cervical cancer in Tanzania over a period from 1995 to 2070. METHODS: A deterministic transmission-dynamic compartment model of HIV and HPV infection and natural history was used to simulate the impact of voluntary medical male circumcision (VMMC), anti-retroviral therapy (ART), and targeted pre-exposure prophylaxis (PrEP) on cervical cancer incidence and mortality from 1995-2070. FINDINGS: We estimate that VMMC has prevented 2,843 cervical cancer cases and 1,039 cervical cancer deaths from 1995-2020; by 2070 we predict that VMMC will have lowered cervical cancer incidence and mortality rates by 28% (55.11 cases per 100,000 women in 2070 without VMMC, compared to 39.93 with VMMC only) and 26% (37.31 deaths per 100,000 women in 2070 without VMMC compared to 27.72 with VMMC), respectively. We predict that ART will temporarily increase cervical cancer diagnoses and deaths, due to the removal of HIV death as a competing risk, but will ultimately further lower cervical cancer incidence and mortality rates by 7% (to 37.31 cases per 100,000 women in 2070) and 5% (to 26.44 deaths per 100,000 women in 2070), respectively, relative to a scenario with VMMC but no ART. A combination of ART and targeted PrEP use is anticipated to lower cervical cancer incidence and mortality rates to 35.82 and 25.35 cases and deaths, respectively, per 100,000 women in 2070. CONCLUSIONS: HIV treatment and control measures in Tanzania will result in long-term reductions in cervical cancer incidence and mortality. Although, in the near term, the life-extending capability of ART will result in a temporary increase in cervical cancer rates, continued efforts towards HIV prevention will reduce cervical cancer incidence and mortality over the longer term. These findings are critical background to understanding the longer-term impact of achieving cervical cancer elimination targets in Tanzania.

Can Chinese Medicine Be Used for Prevention of Corona Virus Disease 2019 (COVID-19)? A Review of Historical Classics, Research Evidence and Current Prevention Programs.

OBJECTIVE: Since December 2019, an outbreak of corona virus disease 2019 (COVID-19) occurred in Wuhan, and rapidly spread to almost all parts of China. This was followed by prevention programs recommending Chinese medicine (CM) for the prevention. In order to provide evidence for CM recommendations, we reviewed ancient classics and human studies. METHODS: Historical records on prevention and treatment of infections in CM classics, clinical evidence of CM on the prevention of severe acute respiratory syndrome (SARS) and H1N1 influenza, and CM prevention programs issued by health authorities in China since the COVID-19 outbreak were retrieved from different databases and websites till 12 February, 2020. Research evidence included data from clinical trials, cohort or other population studies using CM for preventing contagious respiratory virus diseases. RESULTS: The use of CM to prevent epidemics of infectious diseases was traced back to ancient Chinese practice cited in Huangdi's Internal Classic (Huang Di Nei Jing) where preventive effects were recorded. There were 3 studies using CM for prevention of SARS and 4 studies for H1N1 influenza. None of the participants who took CM contracted SARS in the 3 studies. The infection rate of H1N1 influenza in the CM group was significantly lower than the non-CM group (relative risk 0.36, 95% confidence interval 0.24-0.52; n=4). For prevention of COVID-19, 23 provinces in China issued CM programs. The main principles of CM use were to tonify qi to protect from external pathogens, disperse wind and discharge heat, and resolve dampness. The most frequently used herbs included Radix astragali (Huangqi), Radix glycyrrhizae (Gancao), Radix saposhnikoviae (Fangfeng), Rhizoma Atractylodis Macrocephalae (Baizhu), Lonicerae Japonicae Flos (Jinyinhua), and Fructus forsythia (Lianqiao). CONCLUSIONS: Based on historical records and human evidence of SARS and H1N1 influenza prevention, Chinese herbal formula could be an alternative approach for prevention of COVID-19 in high-risk population. Prospective, rigorous population studies are warranted to confirm the potential preventive effect of CM.

Técnicas e procedimentos de controle de infecções de cateteres venosos em onco-hematologia infantil: aspectos clínico-epidemiológicos e microbiológicos e prevalência de Corynebacterium spp. - Instituto Nacional de Câncer, RJ / Techniques and procedures central line infections control in childhood cancer patients: clinical and epidemiological aspects, microbiological and prevalence of Corynebacterium spp. - Instituto Nacional de Câncer, RJ

Estudo descritivo retrospectivo realizado no Instituto Nacional do Câncer José Alencar Gomes da Silva, HCI-Rio de Janeiro, Brasil, (INCA-HCI-RJ), no qual foram avaliadas infecções relacionadas aos acessos venosos para tratamento oncológico, nos setores Onco-Hematológicos pediátricos. A infecção representa uma importante complicação em pacientes oncológicos em tratamento. Devido ao tratamento oncológico que envolve: procedimentos cirúrgicos muitas vezes mutilantes, tratamento com quimioterápicos que ocasionam períodos de imunossupressão e neutropenia, e tratamento radioterápico com radiação e lise celular. O uso de dispositivos venosos associados a períodos de imunossupressão pode levar a infecção da corrente sanguínea e outras complicações (por exemplo trombose). No presente estudo foram investigados aspectos clínico-epidemiológicos das infecções e da susceptibilidade antimicrobiana em amostras clínicas obtidas de processos infecciosos associados ao uso de cateteres venosos de longa permanência no tratamento oncológico em pacientes do Hospital do Câncer José de Alencar Gomes da Silva, HCI/INCA, Rio de Janeiro Brasil. Foram avaliadas: a) prevalência das espécies diversas relacionadas aos quadros infecciosos identificados nestes pacientes oncológicos; b) prevalência de casos de complicações e outras infecções invasivas relacionadas ao uso de cateteres de longa permanência; c) perfis de susceptibilidade a antimicrobianos e ocorrência de multirresistência. O desenvolvimento deste projeto de pesquisa possibilitou a observação análise e validação da evolução dos processos envolvidos nos quadros de infecções nosocomiais em pacientes oncológicos pediátricos na prevenção de complicações que envolvem todo o sistema de saúde, além de contribuir na escolha de antimicrobianos e estratégias terapêuticas mais efetivas para o tratamento de infecções em cateteres por espécies multirresistentes de Corynebacterium.

Retrospective descriptive study conducted at the National Cancer Institute José Alencar Gomes da Silva, INCA / HCI-Rio de Janeiro, Brazil, (INCA-HCI-RJ). Infection represents an important complication in cancer patients. This group is more prone to infections due to the cancer treatment that involves: surgical procedures often mutilating, treatment with chemotherapy that cause periods of immunosuppression even with neutropenia, and radiotherapy treatment with radiation and cell lysis. The vascular devices associated with these periods can lead to bloodstream infection besides others complication as thrombosis. The number of reports of infections in hospitalized cancer patients increases morbidity and mortality rates. In the present study clinical and epidemiological aspects of infections were identified and antimicrobial susceptibility were investigated in clinical exams and samples from blood patients and venous catheter in children oncological patients at the José de Alencar Gomes da Silva, HCI / INCA, Rio de Janeiro Brazil. It was possible evaluate a) prevalence of various species infections in cancer patients; b) prevalence of cases of complications and other invasive infections related to the use of long-term catheters; c) antimicrobial susceptibility profiles and occurrence of multidrug resistance. The development of this research project in nosocomial infections in pediatric cancer patients was enabled analysis and validation of some process involved to prevent vascular complications that involve entire health system. In addition to contributing to the choice of antimicrobials and the most effective therapeutic strategies for the treatment of multi-resistant Corynebacterium sp.

Hallmarks of amputation surgery.

PURPOSE: To highlight the most important innovations and milestones in the historical evolution of amputation and disarticulation surgery through the ages, from the early antiquity until the modern era. METHOD: A thorough search of the literature was undertaken in PubMed and Google Scholar as well as in physical books in libraries to summarize current and classic literature on the hallmarks of the history of amputation surgery in the course of medical history. RESULTS: Amputation of a limb is one of the oldest surgical procedures. Initially, it was fraught with complications and dismal outcome of the patients because of hemorrhage and infection. Due to lack of analgesics and narcotics the operation had to take only a few minutes. Obtaining experience, the surgeons evolved the operative technique and refined the procedure, anesthesia and perioperative analgesia was introduced, instruments were developed, and rehabilitation has enabled functional and social reintegration of amputees. CONCLUSION: From the Hippocratic era until currently, the surgical approach to amputation has changed little. However, the indications for amputations have changed a lot and had been refined, especially in diabetic patients and in those with severe chronic peripheral vascular disease. An exponential decrease in mortality for an operation once fraught with complications was due to the development of the tourniquet, proper vessel ligation and repair, antisepsis, and anesthesia.

A review of isolation practices and procedures in healthcare settings.

The notion of 'isolation' in infectious diseases refers to the possibility of people known or suspected to be infected from the wider population, and has historically been used to control and prevent the spread of infectious diseases. Isolation practices in healthcare settings evolved over the 20th century resulting in a focus on the disruption of known routes of potential transmission. There was renewed attention to infection prevention and control (IPC) in the UK at the turn of the 20th century after high-profile reports acknowledged the importance of IPC as a key indicator of high-quality clinical care, and the impact of healthcare-acquired infections. There has been a shift away from isolation wards towards isolation in single rooms on general wards. For infections that are spread by the airborne, droplet or contact routes, placing the patient in single-room isolation is considered to be an important component of transmission-based precautions (TBPs). However, in practice isolation is complex and a number of challenges are involved in implementing IPC procedures.

[One hundred years later, recalling how BMJ and JAMA reported the 1918-1919 influenza pandemic]. / Cien años después, recordando cómo BMJ y JAMA comunicaron la pandemia de gripe de 1918-1919.

The influenza pandemic that ravaged the planet in 1918-1919 is, undoubtedly, the most virulent and lethal infectious disease that the human species has ever overcome. This essay was to evaluate the medical interpretation of this phenomenon and the response given by doctors in terms of diagnostic and therapeutic technology based on the data published in the medical literature of two of the most important journals of the time, BMJ (The British Medical Journal) and JAMA (The Journal of the American Medical Association). It was found that the arsenal of knowledge, diagnosis and therapeutics of the time offered very few tools to address clinical management and curb contagion and mortality. However, the difficulties that clinicians and health authorities had to overcome were a solid incentive to make significant progress in the understanding and management of infectious diseases, particularly of viral etiology, in a short period of time.

La pandemia de gripa que en 1918-1919 asoló el planeta, es sin duda el evento de enfermedad masivo de mayor virulencia y letalidad que la especie humana ha sorteado a lo largo de la historia. Este ensayo se centró en evaluar, a partir de lo publicado en la literatura médica de dos de las más importantes revistas de la época, (BMJ) The British Medical Journal y (JAMA)The Journal of the American Medical Association, la interpretación que desde la medicina se hizo de este fenómeno y de la respuesta que en términos de tecnología diagnóstica y terapéutica se dio por parte de los médicos. Se encontró que el arsenal de conocimientos, diagnóstico y terapéutica de la época ofrecía muy pocas herramientas para abordar el manejo clínico y frenar los contagios y mortalidad. No obstante, las dificultades que debieron sortear los clínicos y autoridades sanitarias de la época se constituyeron en un sólido aliciente para que en poco tiempo se avanzara significativamente en la comprensión y manejo de las enfermedades infecciosas, particularmente de etiología viral.

[Next-generation vector control]. / La lutte contre les vecteurs : quel avenir ?

Vector control is a cornerstone of vector-borne infectious disease control, a group of emerging and re-emerging diseases of major public health concern at a global scale. The history and evolution of mosquito disease vectors control, mainly based on the use of chemical insecticides, is emblematic of the successes, failures, lessons learned and experiences gained in setting-up and implementing vector control, and of the challenges that pave the way to sustainable disease vector management. This paper provides a non-exhaustive and non-exclusive overview of some of the most promising cutting-edge technical and strategic innovations that are committed to this endeavour, assessing the strength of scientific evidences for proof of concept, perspectives for scaling-up, and expected impact and outcomes in a rapidly changing world.