The global distribution of lymphatic filariasis, 2000–18: a geospatial analysis

Background Lymphatic filariasis is a neglected tropical disease that can cause permanent disability through disruption of the lymphatic system. This disease is caused by parasitic filarial worms that are transmitted by mosquitos. Mass drug administration (MDA) of antihelmintics is recommended by WHO to eliminate lymphatic filariasis as a public health problem. This study aims to produce the first geospatial estimates of the global prevalence of lymphatic filariasis infection over time, to quantify progress towards elimination, and to identify geographical variation in distribution of infection. Methods A global dataset of georeferenced surveyed locations was used to model annual 2000–18 lymphatic filariasis prevalence for 73 current or previously endemic countries. We applied Bayesian model-based geostatistics and time series methods to generate spatially continuous estimates of global all-age 2000–18 prevalence of lymphatic filariasis infection mapped at a resolution of 5 km2 and aggregated to estimate total number of individuals infected. Findings We used 14 927 datapoints to fit the geospatial models. An estimated 199 million total individuals (95% uncertainty interval 174–234 million) worldwide were infected with lymphatic filariasis in 2000, with totals for WHO regions ranging from 3·1 million (1·6–5·7 million) in the region of the Americas to 107 million (91–134 million) in the South-East Asia region. By 2018, an estimated 51 million individuals (43–63 million) were infected. Broad declines in prevalence are observed globally, but focal areas in Africa and southeast Asia remain less likely to have attained infection prevalence thresholds proposed to achieve local elimination. Interpretation Although the prevalence of lymphatic filariasis infection has declined since 2000, MDA is still necessary across large populations in Africa and Asia. Our mapped estimates can be used to identify areas where the probability of meeting infection thresholds is low, and when coupled with large uncertainty in the predictions, indicate additional data collection or intervention might be warranted before MDA programmes cease

Five insights from the Global Burden of Disease Study 2019

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3.5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.Peer reviewe

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC. Funding Bill & Melinda Gates Foundation

Determining minimum inhibitory concentration growth rate and sensitivity of Yersinia to beta-lactam antibiotics

Background: Diarrhea is one of the most important causes of children mortality in developing countries. Gastroenteritis causes mortality in children younger than five years old annually. The presence of antibiotics resistance species among these bacteria are major health problems. Objective: This study aimed to determine the antibiotic susceptibility and MIC50%, MIC90% of Yersinia to three beta-lactam antibiotics. Methods: This experimental study was determined sensitivity of different species of Yersinia to three beta-lactam antibiotics (Ampicillin-Cefazolin Cefotaxime ). In total 50 species (39 from different human sources, environments, foods and 11 from Pasteur institutions in Paris) were used. Minimum inhibitory concentration (MIC) was carried out by serial dilution method. Findings: Among three tested antibiotics, the lowest MIC 50%, MIC 90% were obtained for Cefotaxime (≤0.125μg/ml and 0.5μg/ml). All the tested species showed resistance to Ampicillin and very low sensitivity toward Cefazolin. Conclusion: The results showed that Cefotaxime was more effective against Yersinia species in compared to Ampicillin and Cefazolin. Keywords: Yersinia spp, Beta lactam, minimum inhibitory concentration (MIC), Ampicillin, Cefazolin, Cefotaxim

"The Effect of Bacterial Infection on the Quality of Human’s Spermatozoa"

Studies represent that bacterial infection of the semen can have a direct role in spermatozoid parameters change and may result in men's infertility. In the present study 160 semens were examines for bacterial infection. 55(34.4%) were infected by different species of bacteria, but those infected only by 4 species were undertaken for further study.These bacteria were Streptococci pyogen, Entrococci, E.coli and Staphylococci. The percentage mean results of morphology for the above bacteria were 25.75, 51.04, 47.86, and 41.50 respectively, while for the sterile samples were 52.84; higher for all but significant for Strep. Pyogen when tested with 95% confidence. The mean grades A, B, C and D from semen infected by the above bacteroi were 28.65, 23.59, 14.86 and 42 percent whereas for the sterile sampleswere 28.51, 30.56, 20.30 and 20.57, respectively. It may be concluded that the bacteria causing genitaltract infection can defect the morphology and the motility of men's spermatozoa

Prevalence and Multiple Drug Resistance of Shigella sonnei Isolated from Diarrheal Stool of Children

Background : Science the discovery of antibiotic, the incidence of antibiotic resistance has been inevitable. Although there has been many study in these area but problem still exists. The aim of this research was to study the serotyping and multiple antibiotic resistance patterns of Shigell sonnei isolated from diarrheal stool of children.Methods : The stool samples of children from zero to fourteen years of age admitted at Children Medical Center in Tehran were tested over period of twelvemonth. Identification of isolates was carried out according to standard methods and the antibiotic susceptibility test was performed using Kirby Bauer disk method.Results : Of the 200 samples analyzed 6 (3%) were tested positive for Shigella sonnei The antibiotic resistance patterns showed that all were résistance to tetracycline, streptomycin, clindamycin and cortimoxazol, and 66.7% of the samples had multiples resistance to above antibiotics.Conclusion:The results showed that multiple antibiotics resistance of Shigella sonnei is increasing, therefore awareness about the prevention by improved hygiene and proper medication are needed to reduce the burden of the preventable infectious diseases among young children.  </p

The Effect of Repeated Transfusions on Active Cytomegalovirus Infection, in the Presence of IgM, in Patients with Thalassemia Major in Iran

Background: With due attention to the prevalence of thalassemia in Iran and patients' importunate needs for blood intake, this study aimed to inspect contaminations due to repeated blood transfusion which does not sift in blood donation. One such contamination is cytomegalovirus infection, which is an important pathogen in immunosuppressive patients or receivers of transplanted organs.Methods: This cross sectional study was conducted on 311 thalassemia patients under age of 15 yr who was receiving blood from Hospitals in Tehran and Noorabad Mamasani repeatedly. To determine active infection (presence of IgM antibodies) of cytomegalovirus, ELISA method was used. In addi­tion, 225 healthy people under age of 15 yr were studied as testified group and finally all data were analyzed using SPSS ver. 11.5.Results: 12.9 % of patients were positive from the view point of active infection. Regional separation of patients showed that the patients resided in Tehran are more contaminated to this virus than patients of other cities.Conclusion: The range of cytomegalovirus active infection in thalassemia patients is high. One reason might be the infected blood intake or immunosuppressant (weakness of immune system) in patients, there­fore immunity care of these patients and negative serologic blood intake with respect to and also he­matic parents (parents with the same blood) are important

Efficacy of Ciprofloxacin, Ceftizoxims and Carbenicillin on Klebsiella species isolated from hospital specimens

Background and Objective: Klebsiella species are gram-negative bacteria with positive voges proskauer (VP) reaction. Klebsiella species are found as commensal in human digestive and respiratory system. This group of organisms can create a serious health hazards in hospitalized patients, and their ability to drug resistance is a major health problems. This study was done to evaluate the efficacy of Ciprofloxacin, Ceftizoxims and Carbenicillin on Klebsiella species isolated from hospital specimens. Materials and Methods: In this laboratory study, 1200 clinical samples were isolated from patients in Imam Khomeini hospital, Tehran, Iran. The identification Klebsiella species were carried out according to conventional biochemical tests. The minimum inhibitory concentration (MIC) of carbenicillin, ceftizoxime, and ciprofloxacin antibiotics were determined using Macrodilution broth test. Results: Out of 1200 isolated samples, 25% were identified as Klebsiella species. 73% of identified Klebsiella were obtained from urine samples. Klebsiella.peumoniae with rate of 94% was the most abundant among other species. The results of MIC and minimum bactericidal concentration by using standard microdilution method showed drug resistance range of 16-1024 μg/ml, 4-256 μg/ml and 0.25-16 μg/ml for carbenicillin, ceftizoxime, and ciprofloxacin, respectivley. In general, 94%, 6% and 1% of species were resistance to carbenicillin, ceftizoxime and ciprofloxacin, respectively. Conclusion: Ciprofloxacin and Ceftizoxime are suitable for the treatment of infections due to Klebsiella species