Abstract Background: The 2020 pandemic of COVID-19 infection, which has already lasted more than 22 months, is not subsiding. Despite the available vaccina tions, the infection is still claiming many lives throughout the world, espe cially among the unvaccinated people. The newly discovered and fast spread ing Omicron variant also raises the concern if vaccination alone will be suffi cient to win this battle. Purpose: In this concept paper, we examine the poss ible use dapsone, a century-old and safe medication, to treat patients with se vere cases of pulmonary COVID-19 infection. Methods: We aim to delineate the similarities between IgA-mediated neutrophil-directed blistering skin diseases and the severe pulmonary COVID-19 infection by reviewing the re levant medical literatures, in order to compare the pathological mechanisms of these two different clinical situations. Results: Analysis of published re ports reveals strong evidence pointing to the involvement of IgA and neu trophils in both clinical situations. In addition, results of a small clinical trial showed efficacy of dapsone in patients suffered with severe COVID-19 infec tion. Conclusions: Since dapsone is effective in treating IgA-mediated skin diseases by blocking the binding of neutrophils to the tissue site, it could also be an effective treatment for severe cases of COVID-19 lung injury, which has a similar pathological mechanism.

Abstract Introduction: Black water fever (BWF) is a complication of severe Plasmo dium falciparum infection in hemolysis of erythrocytes into the bloodstream releasing the hemoglobin directly into the blood vessels and causes severe anemia and passage of dark/cola color urine, leading to acute renal failure. Hemoglobinuria or BWF is a rare and severe manifestation of falciparum malaria characterized by sudden intravascular hemolysis followed by fever and presence of abnormal hemoglobin in the urine. Aim: The aim of this study was to diagnose and treat severe malaria infection in a Nigerian patient admitted to the Casualty of the IDH Hospital. Case Presentation: A 20-year-old Nigerian boy came to Kuwait and started complaining abdominal pain, nausea, vomiting and fever two days after his arrival. The investigation revealed high fever (40.8˚C), heart rate 125, blood pressure of 100/60 mmHg. The physical examination was unremarkable, including a normal neurologic examination, no hepatosplenomegaly, rash and neck rigidity. The Giemsa stained thick and thin blood examination confirmed the severe infection of Plasmodium falciparum with 41.0% parasitemia. The patient was admitted to the hospital and started intravenous Quinine (1200 mg loading dose in 5% glucose over 4 hours). The patient was feeling much better on next morning but became unconscious by evening and shifted to ICU. His all CBC parame ters were higher and started passing dark/cola color urine. The 12 units of whole blood were exchanged on next morning and became fully conscious on 4th day and his anemia and thrombocytopenia were improved and the color of the urine also became normal. Conclusion: Quinine is used in both compli cated and uncomplicated malaria and may cause black water fever in severe infection of P. falciparum. It is caused by the hemolysis of erythrocytes due to malaria and also with the metabolism of quinine, making these cells more vulnerable to hemolysis in falciparum malaria and also in G6PD deficiency.

Abstract Knowledge of the clinical and biological profile of patients infected with HIV and hepatitis B and/or C is essential in order to identify and implement effec tive management strategies. Methods: This was a retrospective descriptive study from January 01, 2016 to June 01, 2021. Adult patients aged at least 18 years infected with HIV type 1 and/or 2, naïve to ARV treatment. Univariate analyses were assessed using Pearson’s Chi2 test. The Student Newman test was used for comparison between groups using R software version 4.0.2. Ob jective: To draw up the epidemiological, clinical, paraclinical and evolutio nary profiles of HIV-treated-patients in relation to HIV/HBV and HIV/HCV co-infections in order to allow the identification and the implementation of effective management strategies. Results: Of the 379 patients included 280 (73.88%) were women. At treatment initiation, the mean age was 40.14 ± 11.84 years. The majority of patients consulted at WHO stage III (51.45%).Clinical suspicion was the most frequent screening circumstance (51.71%). The pathologies frequently reported at the first consultation were diarrhea (28%) and shingles (16%). Body mass index was normal in 50.5% of patients.HIV1 infection was the majority (91.03%). A total of 270 had a CD4 count at treatment initiation. The mean CD4 cell count was 304.17 ± 242.06 cells/µL,and 116 (42.59%) of them had a CD4 ≤ 200 cells/µL. Viral load at treatment initiation was documented in 62 patients (16.35%) and 70.97% of them had a detectable viral load (greater than 1000 copies/mL). The clinical and biologi cal evolution was relatively good in patients after therapeutic initiation.HIV-HBV co-infection was 24.11% and HIV-HCV co-infection was 2.26%. The mortality rate was 3.69%. Conclusion: These results reflect a significant delay in HIV infection diagnosis. Furthermore, hepatitis B and/or C is co-infections that increasingly affect people living with HIV. It also appears that COVID 19 disease has had a strong impact on patient management. Thus, new screening strategies must be implemented to encourage early di agnosis of HIV, hepatitis B and C. Effective strategies are also necessary to fight HIV in the context of epidemics and/or pandemics.

Abstract Background: In March 2020, the World Health Organization declared the coronavirus disease 2019 a pandemic, this was caused by the Severe Acute Respiratory Syndrome Coronavirus 2. The overall mortality from this re mains high, yet there are limited studies assessing the associated factors in Africa. Objective: To identify the factors associated with mortality in hospi talized COVID-19 patients in Douala, Cameroon. Method: We conducted a single-centre retrospective cross-sectional study by reviewing records of pa tients managed for COVID-19 between March and June 2020. Diagnosis was confirmed by real-time RT-PCR. Outcome of interest was mortality during hospitalization. We inputted and analyzed data using SPSS version 25.0,compared mortality between groups using the Chi’s squared test and the Fisher’s exact test where appropriately investigated for associations using the Logistic regression in a stepwise approach and alpha-value set at P = 0.05. Results: We analyzed 282 case files, 68% were males (M:F = 2:1) and a mean age of 52 (±15) years. We had an overall mortality of 31.5% (89/282 patients) and 54% (50/92 patients) admitted in the ICU died. Patients aged 0 - 39 years had a significantly lesser odds of mortality compared to those > 70 years (OR:0.2 (0.1 - 0.5) P < 0.001). Hemodynamic instability at presentation showed association with mortality (P < 0.001) ranging as follows; moderate disease OR: 7.3 (2.4 - 21.8) versus Sepsis OR: 317 (58.3 - 1729.3). Mortality was as high as 63% in those with alveolar consolidation on CT scan (OR: 0.3 (0.1 -0.6)), those with a 75% - 100% involvement of the lung parenchyma had a significantly higher mortality compared with those of <10% involvement (OR: 0.02 (0.01 - 0.06) P < 0.001). About 55% of patients placed on supple mental oxygen died (OR: 0.2 (0.1 - 0.3)) and up to 80% (OR: 0.1 (0.01 - 1.0)) of intubated patients died. In the ICU population, placement on non-invasive mechanical ventilation (AOR: 0.5 (0.2 - 1.2)) and intubation (AOR: 0.3 (0.03 -2.6)) showed no significant differences in terms of mortality. Conclusion:The in-hospital mortality in COVID-19 patients is very high and hospitalisa tion into the ICU is associated with even higher mortality. Advanced age,diffused lung involvement (particularly with alveolar consolidation), hemo dynamic instability at presentation and altered level of consciousness fa voured hospitalisation in the ICU. Once in the ICU, placement on mechani cal ventilation did not reduce death discernibly .

Abstract Introduction: Black water fever (BWF) is a complication of severe Plasmodium falciparum infection in hemolysis of erythrocytes into the bloodstream releasing the hemoglobin directly into the blood vessels and causes severe anemia and passage of dark/cola color urine, leading to acute renal failure. Hemoglobinuria or BWF is a rare and severe manifestation of falciparum malaria characterized by sudden intravascular hemolysis followed by fever and presence of abnormal hemoglobin in the urine. Aim: The aim of this study was to diagnose and treat severe malaria infection in a Nigerian patient admitted to the Casualty of the IDH Hospital. Case Presentation: A 20-year-old Nigerian boy came to Kuwait and started complaining abdominal pain, nausea, vomiting and fever two days after his arrival. The nvestigation revealed high fever (40.8˚C), heart rate 125, blood pressure of 100/60 mmHg. The physical examination was unremarkable, including a normal neurologic examination, no hepatosplenomegaly, rash and neck rigidity. The Giemsa stained thick and thin blood examination confirmed the severe infection of Plasmodium falciparum with 41.0% parasitemia. The patient was admitted to the hospital and started intravenous Quinine (1200 mg loading dose in 5% glucose over 4 hours). The patient was feeling much better on next morning but became unconscious by evening and shifted to ICU. His all CBC parameters were higher and started passing dark/cola color urine. The 12 units of whole blood were exchanged on next morning and became fully conscious on 4th day and his anemia and thrombocytopenia were improved and the color of the urine also became normal. Conclusion: Quinine is used in both complicated and uncomplicated malaria and may cause black water fever in severe infection of P. falciparum. It is caused by the hemolysis of erythrocytes due to malaria and also with the metabolism of quinine, making these cells more vulnerable to hemolysis in falciparum malaria and also in G6PD deficiency.

Abstract Background: The 2020 pandemic of COVID-19 infection, which has already lasted more than 22 months, is not subsiding. Despite the available vaccinations, the infection is still claiming many lives throughout the world, especially among the unvaccinated people. The newly discovered and fast spreading Omicron variant also raises the concern if vaccination alone will be sufficient to win this battle. Purpose: In this concept paper, we examine the possible use dapsone, a century-old and safe medication, to treat patients with severe cases of pulmonary COVID-19 infection. Methods: We aim to delineate the similarities between IgA-mediated neutrophil-directed blistering skin diseases and the severe pulmonary COVID-19 infection by reviewing the relevant medical literatures, in order to compare the pathological mechanisms of these two different clinical situations. Results: Analysis of published reports reveals strong evidence pointing to the involvement of IgA and neutrophils in both clinical situations. In addition, results of a small clinical trial showed efficacy of dapsone in patients suffered with severe COVID-19 infection. Conclusions: Since dapsone is effective in treating IgA-mediated skin diseases by blocking the binding of neutrophils to the tissue site, it could also be an effective treatment for severe cases of COVID-19 lung injury, which has a similar pathological mechanism.

Abstract Context: The resistance to pyrethroids in malaria vectors continues to grow in Africa and could therefore compromise or reduce substantially the effectiveness of LLINs in preventing malaria. It is therefore of paramount importance to evaluate the protective efficacy of LLINs in children sleeping in areas of vector resistance to insecticides in order to draw lessons for future interventions. This study assesses the effect of the use of LLINs on malaria morbidity in clusters of low and high resistance of vectors to pyrethroids. Methods: This is a cross-sectional case-control study with one control for one case that was conducted in the communes of Kétou, Ifangni, Kétou, and Pobè in the Plateau department of southern Benin. The use of LLINs and malaria morbidity was measured and compared in children from clusters of low and high vector resistance to insecticides. In each commune, 30 cases and 30 controls were recruited for a total of 240 children under 5 years of age from villages with low and high insecticide resistance. Results: According to the localities of origin of the children, of all parents of children surveyed, 169 (70.4%) asserted the children slept under an LLIN the day before they arrived at the health center. This rate represents 70.8% (85 children) among the cases and 70.0% (84 children) among the controls without significant difference (p = 0.8). The use of LLINs the day before the survey, the frequency of their use during the two weeks preceding the day of the survey, their availability at the household level, the use of other tools for protection against mosquito bites are the same in the two groups of children (cases and controls) (p > 0.05) as well in low and high resistance villages. On the other hand, the parasite prevalence, the splenomegaly and the geometric means of the parasite densities, are significantly higher in the cases than in the controls (p < 0.05). Conclusion: The evaluation of epidemiological indicators in children under five years old at the level of health centers did not enable demonstrating the impact of resistance on the operational effectiveness of the LLINs. The information collected within the four health facilities only reflects the situation that should normally be seen in the population under the real conditions of use of LLINs in high and low resistance areas.

Abstract Paenibacillus is a spore forming gram positive rod that is usually found in the environment. We describe a case of a patient who contracted this organism having never left the hospital after birth. This neonate contracted Paenibacillus septic shock requiring support with venous-arterial extracorporeal membrane oxygenation (ECMO) while still admitted to the hospital after birth. This patient initially presented in severe septic shock due to a Streptococcus agalactiae infection requiring hemodynamic support with ECMO. Following treatment for the Streptococcus agalactiae infection, and while still on ECMO support, the blood culture became positive for Paenibacillus. Given that our patient had never left the hospital after birth, the finding of this organism in the blood is unique. The primary defense against this bacterium is usually the skin. The only invasive procedure this patient had was ECMO cannulation which is done in a sterile fashion. Most species are susceptible to vancomycin,clindamycin, fluoroquinolones, aminoglycosides, carbapenems, penicillin,and cephalosporins. This patient was treated with penicillin G for 14 days for the S. agalactiae infection prior to the blood culture being positive for Paenibacillus. More than a hundred species had been identified in the genus Paenibacillus, however, few found to cause human infection. This case is unique as it is the first pediatric case with a Paenibacillus infection and the first pediatric case where this organism which rarely causes human infection was found in the blood culture of a patient on ECMO.

Abstract Anaemia is common in critically ill patients and has been shown to be a predictor of mortality in general Intensive Therapy Unit (ITU). Patients with Corona Virus Infectious Disease 2019 (CV-19) have also been reported to be anaemic, more profound in those admitted to ITU. We report our experience in the management of anaemic CV-19 patients admitted to ITU between 1st March and 1st June 2020. Demographic and clinical variables collected included age, sex, BMI, Charlson comorbidity index (CCI), Acute Physiology and Chronic Health Evaluation (APACHE) II score, haemoglobin concentration, blood transfusion, and mortality. 105 patients were admitted to the ITU with Severe Acute Respiratory Syndrome Coronavirus 2 disease requiring invasive mechanical ventilation and 73 patients with complete dataset were included in the study. Results: 36 patients (49%) were anaemic on admission, with 56 (77%) patients developing anaemia at some stage in the first 7 days of ITU stay. Anaemia at admission to ITU, a higher CCI and a higher APACHE II score were all independently associated with a blood transfusion (OR 12.5, 95% CI: 1.48 - 106, p = 0.02), (OR 1.95, 95% CI: 1.08 - 3.52, p = 0.03) and (OR 4.8, 95% CI: 1.48 - 15.6, p = 0.009) respectively. Univariable analysis showed that an increasing age (OR 2.15, 95% CI:1.18 - 3.91, p = 0.01) and a higher APACHE II score (OR 1.60, 95% CI 1.01- 2.54, p = 0.04) were significantly associated with mortality. There was also some evidence of an association with mortality for CCI, although the results for this variable were only of borderline statistical significance. Neither haemoglobin concentration (OR 1.09, 95% CI: 0.83 - 1.43, p = 0.55) or anaemia (OR 1.08, 95% CI: 0.41 - 2.85, p = 0.87) at admission to ITU was significantly associated with mortality. 13 patients received blood transfusions, with a mean (SD) pretransfusion Hb of 75.2 (12.02). These numbers were too small to identify any association between receiving blood transfusion and mortality.

Abstract Background: Nigeria is currently a malaria endemic country with an estimated 76% of her population at risk of contracting malaria [1]. According to a study in Nigeria, the first line of action mothers took when their children under 5 years have malaria showed that over 50% of them used non-prescription drugs they have at home or bought from pharmacy stores. And 60% of the most commonly used drugs for malaria treatment were chloroquine [2]. Many recent studies have demonstrated re-emergence of chloroquine-sensitive P. falciparum, suggesting a possible role in future malaria control [3]. Objective: The aim of this study was to investigate the effect of home-based oral chloroquine treatment among children under 5 years with Plasmodium falciparum malaria attending Jos University Teaching Hospital and OLA Hospital in Jos Metropolis. Method: This is a cross-sectional study of 93 malaria and non-malaria children. Malaria diagnosis was carried out using microscopical examination of Leishman’s stained thick and thin blood films, P. falciparum parasitemia was assessed by standard microscopy techniques and complete blood count was done using Beckman Coulter Analyzer. Results: The body temperature on admission was significantly lower (p < 0.05) in the control group (36.80˚C ± 0.07˚C) than in the three malaria groups. The mean body temperature of chloroquine treated children with malaria was significantly lower (p < 0.05) than that of children presenting with severe malaria. Parasitaemia was significantly lower (p < 0.05) in the pre admission chloroquine treated group (18.13% ± 0.49%) than in the non-treated simple malaria group (34.35% ± 2.75%) and severe malaria group (43.57% ± 5.49%), respectively. The average number of days before the cases were reported in the hospital was 4.80 days. The haemoglobin concentration of 7.23 ± 1.01 g/dl obtained for non-treated malaria patients indicates a mild anaemia, whereas the haemoglobin concentration values of 9.60 ± 0.51 g/dl and 10.52 ± 0.16 g/dl obtained for chloroquine treated children and control children respectively show that the two groups of children were not anaemic and the values obtained were within the normal range. Conclusion: The results obtained in this study demonstrate that there was significant positive impact of chloroquine treatment on Plasmodium falciparum parasitemia and degree of anemia in children under 5 years with Plasmodium falciparum in Jos Metropolis.

Abstract The severe acute respiratory syndrome coronavirus 2 infection typically presents with respiratory symptoms. Additionally, there are a number of less frequent neurological manifestations of infection with the coronavirus disease 2019 (COVID-19) with case reports suggesting an association with the Guillain-Barre syndrome. Most patients present with the typical upper respiratory symptoms in association with these neurological symptoms. We present a case of an unvaccinated gentleman with none of the typical respiratory symptoms of COVID-19 who presented with the Guillain Barre syndrome and myalgia. His symptoms settled following treatment with intravenous immunoglobulins. This case highlights the importance of testing for COVID-19 in patients without typical symptoms but who present with neurological illness and supports the use of intravenous immunoglobulin therapy.

Abstract Bloodstream infection (BSI) is an important cause of morbidity and mortality worldwide. If we can make early diagnosis and start effective antibiotic treatment in time, the hospitalization time of patients with bloodstream infection can be significantly shortened. However, the current diagnosis of bloodstream infection cannot achieve the ideal therapeutic effect to a large extent because of the matrix effect of blood and the long turnaround time of blood culture. Therefore, a new detection method with a short turnaround time and high sensitivity is needed for the early diagnosis and timely treatment to improve the prognosis of patients. Metagenomic next-generation sequencing (mNGS) is a recently developed method for the comprehensive analysis of all microorganisms and genetic materials in clinical samples and is expected to be the main method for the early diagnosis of bloodstream infections. This review discusses the clinical application of mNGS in bloodstream infections. We also discuss technical challenges that need to be addressed to improve the diagnostic applicability of mNGS.

Abstract Background: Despite the efforts at establishing Prevention of Mother to Child Transmission (PMTCT) programs in Rwanda, there are still children who are becoming infected through mother-to-child transmission of HIV. The purpose of our research study was to explore the experiences of HIV positive women using PMTCT program to prevent HIV transmission in Rwanda. Methodology: In this study, a qualitative approach using a critical ethnographic design was used to answer to our research question and with the aim to discover the meaning, process, and context of the studied phenomenon. In this paper, we discussed ethnography, critical ethnography, and its related philosophical assumptions as well as illustrating the rational for the use of critical ethnography to study the PMTCT program. Critical ethnography ultimately will contribute to raising awareness on how we can prevent new infections among children born from HIV positive mothers who are using the PMTCT program. The findings suggested a wide range of challenging factors that are shaped by social, political, cultural, economic, ethnic, and gender values, and that directly and indirectly affect the uptake of the PMTCT program. While using the critical realist ontology, we discovered multiple truths about the challenging factors for HIV+ mothers experience to uptake the PMTCT program. We triangulated their experiences with the findings gathered from healthcare providers, PMTCT leaders and policymakers, field observation, and document analysis. No previous studies on this phenomenon used a critical lens to explore the reality behind a wide range of experiences of mothers using the PMTCT program to prevent HIV transmission in Rwanda. Conclusion: The critical nature of this inquiry contributed to the depth and breadth of knowledge related to the delivery of the PMTCT program to prevent MTCT of HIV.

Abstract Turmeric is an herbal plant that is widely used as a traditional herbal medicine in many countries. Curcumin displays its anti-viral activities through several mechanisms of action. In this case report we present a 10-year-old child with herpetic vesiculo-ulcerative lesions who was treated with turmericalong with systemic acyclovir which resulted in complete healing by the third day of application.