Background: Malaria parasites have developed resistance to most of the known antimalarial drugs in clinical practice, with reports of artemisinin resistance emerging in South East Asia (SEA). We sort to find the status of artemisinin resistance and efficacy of different modalities of the current artemisinin-based combination therapies (ACTs). Methods: We carried out a systematic search in 11 electronic databases to identify in vivo studies published between 2001 and 2017 that reported artemisinin resistance. This was then followed by A network meta-analysis to compare the efficacy of different ACTs. Quality assessment was performed using the Cochrane Risk of Bias (ROB) tool for randomized controlled trials and National Institute of Health (NIH) tool for cross-sectional studies. The study protocol was registered in PROSPERO under number CRD42018087574. Results: With 8400 studies initially identified, 82 were eligible for qualitative and quantitative analysis. Artemisinin resistance was only reported in South East Asia. K13 mutation C580Y was the most abundant mutation associated with resistance having an abundance of 63.1% among all K13 mutations reported. Although the overall network meta-analysis had shown good performance of dihydroartemisinin piperaquine in the early years, a subgroup analysis of the recent years revealed a poor performance of the drug in relation to

Background The first case of the novel coronavirus disease 2019 (COVID-19) in Libya was diagnosed in March 2020. We aimed to determine the epidemiological, clinical, and laboratory characteristics of COVID-19 in Libya. Method In this retrospective descriptive study, we analyzed the demographics, initial clinical presentation, history, comorbidities, laboratory findings, complications, and outcomes of hospitalized patients with COVID-19 at several centers in the Western part of Libya between March 24, 2020, and December 3, 2020. Results The study included 811 (67.2%) men and 396 (32.8%) women. The median (interquartile range [IQR]) age was 56 (40–64). A total of 173 (14.3%) patients developed respiratory distress syndrome, while 70 (5.8%) developed circulatory shock and hypotension; 190 (15.7%) were admitted to the intensive care unit. Acute cardiac injury occurred in 27 (2.2%) patients, and 45 (3.7%) developed arrhythmia. Acute kidney injury occurred in 44 (3.6%) patients. Of the patients admitted during the study period, 149 (12.3%) died. The predominant comorbidities ordered in a descending manner were as follows; diabetes mellitus, presented 490 (40.6%), hypertension in 414 (34.3%), chronic kidney disease in 114 (9.4%), and lung diseases in 103 (8.5%). The total white blood cell, neutrophil; monocyte; D-dimer; creatinine kinase; creatine kinase–MB; creatinine; total bilirubin; alanine and aspartate aminotransferase; and hypersensitive troponin were increased among non-survivors, whereas lymphocyte and platelet counts were decreased among non-survivors. Conclusion This is the first report of the clinical presentations and laboratory findings in patients hospitalized with COVID-19 in Libya. Libyan authorities must implement several restrictions to control the pandemic. However, incoming international travelers pose a challenge to the local authorities, especially with the recent discovery of new variants.

e23095 Background: Infectious diseases are the second leading cause of death in the field of oncology. Around 60% of deaths are infection related to cancer patients, especially with underlying hematological malignancies. This study assesses the changing trends of mortality in cancer patients from infectious causes in the past 40 years. Methods: This is a retrospective analysis on 151440 cancer patients who died from infectious causes between 1973 and 2014, identified in the Surveillance, Epidemiology, and End Results (SEER) Program database. Results: Pneumonia and influenza were the most common infections (n = 72133) followed by parasitic diseases and other infections (n = 47310) and septicemia (n = 31119), respectively. The average survival was 65.31 months, while pneumonia and influenza had the highest survival of all. Prostate cancer was the most common cancer associated with infectious diseases (n = 20068) followed by breast cancer (n = 16676) and Kaposi sarcoma (n = 13046), respectively. During 1998-2001, an overshoot in infection-related mortality was significantly noted (APC = 26.74%; 95%CI = 3.7:54.9). However, since 1973, the greatest reduction in infection-related mortality was recorded during 2012-2014 (APC = -37.15; 95%CI = -48.6: -23.2). Compared to other infectious diseases, ‘parasitic and other infections including HIV’ accounted for the highest incidence (SIR = 1.77; 95% CI = 1.69:1.84), where blood vessel tumors occurred the most in this category (SIR = 88.83; 95%CI = 2.25:494.9). Afterward, septicemia was the second most common infectious disease (SIR = 0.84; 95%CI = 0.81:0.88). Except for leukemia, lymphoma, plasma cell tumors, and mast cell tumors, hematologic tumors revealed the highest incidence of septicemia (SIR = 51.9; 95%CI = 1.31:289.16). Gender, race, marital status, an infectious organism, and tumor characteristics (behavior and grade); all accounted for significant differences in survival (P < 0.0001). The nomogram has outstanding discrimination ability (c-index = 0.85) with very minimal differences from the actual observations of 1-, 3-, and 5-year survival probabilities. Conclusions: Infection-related mortality in cancer patients declined from 1973 to 2014. The most common infections in cancer patients were Pneumonia and influenza, followed by parasitic diseases, other infections, and septicemia. Prostate cancer was the most common cancer associated with infectious diseases, followed by breast cancer and Kaposi sarcoma.

Background Predictive markers represent a solution for the proactive management of severe dengue. Despite the low mortality rate resulting from severe cases, dengue requires constant examination and round-the-clock nursing care due to the unpredictable progression of complications, posing a burden on clinical triage and material resources. Accordingly, identifying markers that allow for predicting disease prognosis from the initial diagnosis is needed. Given the improved pathogenesis understanding, myriad candidates have been proposed to be associated with severe dengue progression. Thus, we aim to review the relationship between the available biomarkers and severe dengue. Methodology We performed a systematic review and meta-analysis to compare the differences in host data collected within 72 hours of fever onset amongst the different disease severity levels. We searched nine bibliographic databases without restrictive criteria of language and publication date. We assessed risk of bias and graded robustness of evidence using NHLBI quality assessments and GRADE, respectively. This study protocol is registered in PROSPERO (CRD42018104495). Principal findings Of 4000 records found, 40 studies for qualitative synthesis, 19 for meta-analysis. We identified 108 host and viral markers collected within 72 hours of fever onset from 6160 laboratory-confirmed dengue cases, including hematopoietic parameters, biochemical substances, clinical symptoms, immune mediators, viral particles, and host genes. Overall, inconsistent case classifications explained substantial heterogeneity, and meta-analyses lacked statistical power. Still, moderate-certainty evidence indicated significantly lower platelet counts (SMD -0.65, 95% CI -0.97 to -0.32) and higher AST levels (SMD 0.87, 95% CI 0.36 to 1.38) in severe cases when compared to non-severe dengue during this time window. Conclusion The findings suggest that alterations of platelet count and AST level—in the first 72 hours of fever onset—are independent markers predicting the development of severe dengue.

The aim of the study was to determine the association between pet ownership and cardiovascular risk factors and mortality. Electronic search was conducted through nine databases including PubMed for relevant publications reporting cardiovascular events and mortality among pet owners. Meta-analysis was used to pool the results. Of a total of 2818 reports screened, 26 studies were included in our systematic review and meta-analysis. Higher survival rate was observed in the pet owners group after pooling nonadjusted and adjusted hazard ratios for cardiovascular mortality at 0.73 [95% confidence interval (CI) 0.62–0.86] and 0.81 (0.68–0.97), respectively. A similar trend was observed for the pooled nonadjusted hazard ratio for overall mortality 0.73 (0.62–0.87) but not the adjusted hazard ratio 0.40 (0.04–3.78). Cat owners have a reduction in cardiovascular mortality but not overall mortality after pooling the adjusted hazard ratio 0.79 (0.63–0.99) and 1.04 (0.90–1.21), respectively. However, no significant association between dog owners and survival rate was observed for overall and cardiovascular-specific mortality. Pet owners had significantly lower heart rate (mean difference 95% CI: −2.32 (−3.07 to −1.57), mean arterial pressure −2.60 (−4.25 to −0.95) and SBP −1.69 (−3.06 to −0.31) but not DBP −0.23 (−1.05 to 0.60). No significant difference was observed between pet owners and nonpet owners in prevalence of hypertension. Our study draws attention to the beneficial effects of the human--pet bond; therefore, we recommend pet acquisition for better cardiovascular outcomes after controlling for zoonotics and pet-induced allergies.