GENETIC DETERMINANTS OF ANTIBIOTIC RESISTANCE AND VIRULENCE IN Staphylococcus aureus ISOLATES FROM HOSPITAL SURFACES IN HIGH-RISK AREAS OF LOJA, ECUADOR

Background: Staphylococcus aureus is a microorganism associated with nosocomial infections, characterized by its high pathogenicity and antibiotic resistance, posing a critical risk in hospital environments. This study aims to determine its presence, antibiotic susceptibility, and the detection of virulence, adhesion, and regulatory genes on hospital surfaces using phenotypic and molecular methods. Materials and Methods: A total of 200 surface samples were collected from a secondary-level hospital, including clinical wards, ICU, and emergency areas. S. aureus was isolated using phenotypic techniques (mannitol, coagulase, DNase) and genotypic methods (detection of nucA and femB). Antimicrobial susceptibility was evaluated using the Kirby-Bauer method. Polymerase Chain Reaction (PCR) was employed to identify resistance and virulence genes. Results: S. aureus was detected in 7.5% of the samples analyzed, with higher prevalence in Clinic I and Emergency areas. The most contaminated surfaces included door handles, tables, and keyboards, identified as critical transmission points. Among the isolated strains, 66.6% were resistant to penicillin, while 100% were sensitive to methicillin and vancomycin. Virulence genes (tst, sea) were present in 26.6% and 13.3% of the strains, respectively. Regarding regulatory genes, agrI (73.3%) was the most common, followed by agrIII. For adhesion factors, icaD and icaC were the most frequently detected genes. Conclusion: These findings highlight the pathogenic potential of S. aureus and its ability to persist on inert surfaces, representing a significant risk for infection transmission

RETROSPECTIVE ANALYSIS OF MORTALITY DETERMINANTS IN COVID-19 PATIENTS BASED ON CLINICAL DIAGNOSES PRIOR TO DEATH AT A NATIONAL REFERRAL HOSPITAL IN INDONESIA

Background: Mortality in COVID-19 patients is often the result of multiple overlapping clinical complications rather than a single cause. Understanding these patterns is essential for improving clinical outcomes and supporting accurate forensic evaluation.  Aim: This study aimed to identify the clinical conditions contributing to death in COVID-19 patients and to assess the association between the number of co-occurring conditions and patient outcomes.  Methods: A retrospective observational study was conducted on 100 confirmed COVID-19 patients admitted to a national referral hospital in Indonesia. Data on demographic characteristics, comorbidities, clinical severity, and outcomes were collected from medical records. Clinical causes of death were recorded and categorized by the number of co-occurring conditions. Unadjusted and adjusted odds ratios (ORs) for mortality were calculated using logistic regression, adjusting for age, sex, BMI, comorbidities, and disease severity.  Results: The most frequently documented clinical conditions contributing to death were acute respiratory distress syndrome (68%), respiratory failure (55%), and septic shock (34%). Among patients, 30% had one condition, 45% had two, and 25% had three or more. Compared to patients with a single condition, those with two conditions had an adjusted OR of 2.41 (95% CI: 1.16–4.41), and those with three or more conditions had an adjusted OR of 19.4 (95% CI: 10.73–32.23).  Conclusion: Mortality in COVID-19 is significantly associated with the number of co-occurring clinical conditions. Early detection and integrated management of overlapping complications are essential for reducing fatal outcomes and improving diagnostic accuracy in clinical and forensic settings.

PHENOTYPIC ANTIBIOTIC RESISTANCE PROFILES OF GRAM-NEGATIVE BACTERIA IN CLINICAL SAMPLES PRE AND DURING COVID-19 PANDEMIC AT ZONAL REFERRAL HOSPITAL NORTHERN TANZANIA

Background: COVID-19 has aggravated antimicrobial use owing to limited treatment options, raising concerns about antimicrobial resistance, which was previously estimated to potentially cause 10 million global deaths within 30 years. This study evaluated the potential impact of the COVID-19 pandemic on antibiotic resistance in referral hospitals. Material and Methods: A cross-sectional study at Kilimanjaro Christian Medical Centre analyzed clinical bacterial samples from pre-COVID-19 (2018) and during COVID-19 (2020, 2023). Two hundred isolates from 2018 and 2020, and 121 samples from 2023, were examined. Bacterial isolates were identified using API 20E for Enterobacteriaceae (bioMérieux) and standard biochemical tests, while antimicrobial susceptibility was assessed using the disc diffusion method. Results: During the COVID-19 pandemic, antibiotic resistance among bacteria has increased significantly. Resistance to ampicillin 113 (95.8%, p=0.018), ceftriaxone 102 (74.5%, p=0.043), and ciprofloxacin 119 (68.8%, p=0.003) increased. Conversely, resistance to chloramphenicol 19 (16.1%, p=0.021) and amoxicillin-clavulanic acid decreased to 62 (52.5 %, p = 0.007). Klebsiella pneumoniae showed decreased resistance to chloramphenicol 11(20.8%, p=0.004) and amoxicillin-clavulanic acid 27(50.9%, p=0.034). Acinetobacter species also showed a significant increase in ceftriaxone resistance 18(94.7%, p=0.018). Among the 233 isolates, ESBL-producing bacteria were identified in 101 (43.4%), and Klebsiella pneumoniae and Escherichia coli showed the highest frequencies at 40 (39.6%) and 54 (53.5%), respectively. Conclusion: During COVID-19, ampicillin, ciprofloxacin, and ceftriaxone resistance significantly increased, whereas restricted antibiotics, such as meropenem, showed lower resistance. The extensive and uncontrolled use of antibiotics during the pandemic has aggravated antimicrobial resistance, necessitating intensified and coordinated efforts to combat it

DOES COVID-19 PANDEMIC AFFECT THE ELIMINATION OF TUBERCULOSIS? LESSONS LEARNED FROM INDONESIA

Background: Tuberculosis is one of the tropical diseases which still exist in the tropical country specifically Indonesia. This study aims to investigate the recent epidemiology of tuberculosis before and during the pandemic of COVID-19. Materials and Methods: Data were collected from East Java Health Profile 2019 and 2020 which was provided by East Java Health Officer. Data were extracted and analyzed by statistical software SPSS and QGIS Application for the geographical map interpretation. Results: This study shows that the total cases of tuberculosis in 2019 was 606,985 cases, while in 2020 was decreased to 384,752 cases. The incidence rate of tuberculosis in 2019 was 224.98 per 100,000 populations, while in 2020 was 134.58 per 100,000 populations. The province with the highest amount of tuberculosis in 2019 was West Java with 143,935 cases, and also in 2020 with 90,905 cases. The province with the lowest number of tuberculosis was North Kalimantan with 2,113 cases, while in 2020 were 985 cases.  The highest incidence rate of tuberculosis in 2019 was found in Jakarta which was 443,47 per 100,000 population, while in 2020 was found in Papua which was 279.92 per 100,000 population. The lowest incidence rate in 2019 was found in Bali Province which was 102.72 per 100,000 population, while in 2020 was 67.43 per 100,000 population. Conclusion: There was a decrease in TB cases before the COVID-19 pandemic (2019) compared to during the COVID-19 pandemic (2020).

The THE RELATIONSHIP BETWEEN SCHOOL ENVIRONMENT CONDITION AND DENGUE HEMORRHAGE FEVER INCIDENCE AT PUBLIC ELEMENTARY SCHOOL

Background: Dengue cases in Indonesia remain a significant public health concern, with incidence rates increasing over the years. The school environment, including lighting, humidity, temperature, and ventilation, plays a crucial role in the spread of Dengue Hemorrhagic Fever (DHF). This study aims to analyze the relationship between school environmental conditions and DHF incidence. Materials and Methods: This was an analytical observational study with a cross-sectional design. The sample consisted of 157 individuals selected using simple random sampling. Data collection was conducted from August to October 2023 using a validated questionnaire assessing school environmental conditions and DHF incidence. Statistical analysis was performed using chi-square and logistic regression tests with a significance level of p < 0.05. Results: School environmental factors significantly associated with DHF incidence included lighting (p = 0.008, PR = 1.82), humidity (p = 0.008, PR = 1.75), temperature (p = 0.045, PR = 1.498), and screen ventilation (p = 0.000, PR = 2.26). Logistic regression analysis identified humidity (OR = 7.16; 95% CI, 2.09–38.37) and ventilation (OR = 18.12; 95% CI, 3.36–56.70) as the most influential factors. Conclusion: The incidence of DHF is closely related to school environmental conditions. Preventive measures focusing on environmental cleanliness and improved ventilation could significantly reduce the risk of dengue transmission among school children

MEAN DIFFERENCE OF ZINC AND SELENIUM LEVELS AND TUBERCULOSIS OUTCOMES IN CHILDREN RECEIVING TREATMENT IN INDONESIA

Background: Tuberculosis (TB) remains a significant health issue, particularly among children in TB-endemic regions. Micronutrient deficiencies, such as zinc and selenium, may influence TB treatment outcomes. However, the relationship between these micronutrients and TB outcomes in children is not well-established in Indonesia. This study aimed to investigate the mean difference of zinc and selenium levels on TB treatment outcomes in children receiving treatment in Padang, Indonesia.  Materials and Methods: A cross-sectional study was conducted at the district level hospitals in Padang City, Indonesia, from April to October 2024. The study included children aged 1–14 years diagnosed with TB and receiving treatment. Serum zinc and selenium levels were measured using Chemiluminescent Immunoassay (ECLIA). The treatment outcomes were categorized as success (cured and completed treatment) or failure (death, treatment failure, or default).  Results: Zinc levels were significantly lower in the failure group (71.61±8.18 ng/mL) compared to the success group (79.72±8.12 ng/mL) (P<0.05). Similarly, selenium levels were lower in the failure group (89.56±23.47 ng/mL) compared to the success group (115.09±17.86 ng/mL) (P<0.05).  Conclusion: The study found a significant association between lower zinc and selenium levels and unsuccessful TB treatment outcomes in children. These findings suggest that addressing micronutrient deficiencies may play an important role in improving TB treatment outcomes in pediatric populations. Further research is needed to explore potential interventions to improve micronutrient status in TB patients

BLOOD URINE POSITIVITY RATE DIPSTICK METHOD ON THE INCIDENCE OF ANEMIA IN URINARY TRACT INFECTION PATIENTS

Background: The prevalence of anemia in children suffering from urinary tract infections with positive hematuria is very high. UTI is confirmed by a complete urine examination including macroscopic, chemical and microscopic examinations. Chemical examination can be carried out using the dipstick method, while urine microscopy involves looking at the image of the urine sediment. One of the parameters on the dipstick is blood. Examination with a reagent strip (dipstick) function to detect erythrocytes, free hemoglobin and myoglobin. So, the presence of erythrocytes, myoglobin or hemoglobin in the urine will give a positive result on the urine blood dipstick parameters, which means hematuria occurs. Materials and Methods: This is a cross-sectional analytical observational method, namely by comparing the results of blood urine examination using the dipstick method, with the results of the erythrocyte index and hemoglobin levels on the incidence of anemia in UTI patients. Result: The results of the blood urine dipstick examination obtained the highest positive value of 3. The average values for Hb, MCV, MCH, MCHC were respectively 10.9 g/dL, 83.3 fL, 28.5 pg, and 34.24%. Conclusion: The results of the Pearson correlation test obtained a degree of relationship of -0.363 which indicates a weak correlation. Blood urine is negatively related to the incidence of anemia (Hb levels), so that the higher the positive blood urine value, the lower the Hb value

EXPLORING INFECTION PREVENTION AND CONTROL MEASURES USED BY TRADITIONAL PRACTITIONERS IN RWANDA

Background: Traditional Practitioners (TPs) serve as primary healthcare providers in Rwanda, offering culturally relevant healing methods. Despite their importance, there's a lack of understanding regarding their infection prevention and control practices. Materials and Methods: The study conducted in-depth interviews with Traditional Practitioners (TPs) in four Rwandan districts. Results: Four main themes emerged from 50 interviews in this study. 1) Many day-to-day traditional medicine procedures pose risks of infection to Traditional Practitioners. 2) TPs' concepts and understanding of infection are often basic and not evidence based. 3) TPs' beliefs and attitudes toward infection prevention and control may not prioritize patient-centered care. 4) TPs employ various IPC measures, including some scientifically questionable or incorrect practices. Discussion: Challenges such as lack of formal medical training and resources hinder effective IPC practices among Traditional Practitioners (TPs). Addressing the gaps in IPC practices among Traditional Practitioners (TPs) is crucial for promoting patient safety and public health in Rwanda. Improving IPC knowledge and practices, providing comprehensive training, and institutionalizing traditional medicine are recommended. Additionally, more research is needed to support the effectiveness and safety of traditional healing practices

EMILIA PRAETERMISSA MILNE-REDHEAD (ASTERACEAE): PHYTOCHEMICAL PROFILING AND CYTOTOXIC POTENTIAL

Background: Emilia praetermissa Milne-Redhead, is a fast growing herb that is native to west and central Africa, the leaf is use in the treatment of ulcer, hernia, pain and tumor by traditional healers in these regions. It is explored in this study for its phytochemicals and cytotoxic activities. Materials and Methods: The powdered leaf was screened for phytochemicals using standard methods, while profiling of the methanol extract was done by both Gas Chromatography-Mass Spectrometry (GCMS) and High Pressure Liquid Chromatography (HPLC). Cytotoxic potential was evaluated using Raniceps raninus (Tadpole-fish) at varying doses (20-320 µg/mL) of the extract (methanol) and fractions (ethylacetate and dichloromethane). Results: Tannins, flavonoids, steroids, glycosides, alkaloids and saponins were revealed by the phytochemical screening. The GC-MS analysis identified thirty-three compounds, which include aziridine, benzaldehyde, benzofuran, carbazole, hydroquinone, isopropylidine, indole, piperidine, piperazine, pyrazole, pyridine, pyrrolidine and tetrazole derivatives. Twelve compounds were identified and quantified from the HPLC analysis; coumaric acid (10.2385 µg/ml), cresol (25.7350 ppm), ellagic acid (3.9547 µg/ml), ferulic acid (8.9514 µg/mL), isoflavone (22.7694 ppm), naringenin (14.1526 µg/mL), naringin (5.6179 µg/ml), pyrogallol (12.5850 µg/g), resveratrol  (3.8639 ppm) and salicylic acid (17.4195 µg/mL) respectively. A dose of 160 µg/mL of the methanol extract significantly (P<0.05) resulted in (60.00 ± 5.78) % mortality rate within 90 minutes, and (100.00 ± 0.00) % mortality as the dose was double (320 µg/mL) after 120 minutes. Conclusion: These thus indicate the presence of phytochemicals in E. praetermissa leaf with cytotoxic potential

EFFECT OF DIURNAL INTERMITTENT FASTING (DIF) ON ANTIOXIDANT AND PRO INFLAMMATORY MEDIATORS ACTIVITY IN MALE RAT MODEL OF TYPE 2 DIABETES MELLITUS

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by persistent hyperglycemia, oxidative stress, and systemic inflammation. Diurnal intermittent fasting (DIF), a fasting pattern synchronized with circadian rhythms, has been proposed as a potential strategy to alleviate metabolic disturbances, but evidence from controlled animal studies remains limited. Materials and Methods: This experimental study employed a post-test-only control group design using thirty-six male Wistar rats. T2DM was induced by streptozotocin (65 mg/kg) and nicotinamide (230 mg/kg). Animals were divided into four groups: diabetic control (G1), and three DIF-treated groups fasting two (G2), three (G3), and six (G4) days per week. Blood glucose was measured weekly. On day 28, serum levels of superoxide dismutase (SOD) and interleukin-6 (IL-6) were analyzed using enzyme-linked immunosorbent assay (ELISA). Results:DIF significantly reduced blood glucose levels in all intervention groups compared to the control (p < 0.05). The G4 group showed the highest SOD activity and the greatest IL-6 reduction (p < 0.05). However, there was no significant glucose difference between G3 and G4, suggesting a plateau in glycemic improvement. Conclusion: DIF improves glycemic control, enhances antioxidant defense through increased SOD activity, and reduces systemic inflammation via IL-6 suppression in a T2DM rat model. These findings support the potential of DIF as a complementary therapeutic approach for T2DM, although further research is needed to determine the optimal fasting regimen and its applicability in humans