Objective: To determine the global level of knowledge, attitudes, and practices towards dengue fever among the general population. Methods: To complete this systematic review and meta-analysis, a thorough search for pertinent English-language literature was undertaken during the study's extension until October 2023. The search used Google Scholar, Scopus, PubMed/MEDLINE, Science Direct, Web of Science, EMBASE, Springer, and ProQuest. A quality assessment checklist developed using a modified Newcastle- Ottawa Scale for the cross-sectional study was used to evaluate the risk of bias in the included papers. Inverse variance and Cochran Q statistics were employed in the STATA software version 14 to assess study heterogeneity. When there was heterogeneity, the Dersimonian and Liard random-effects models were used. Results: 59 Studies totaling 87 353 participants were included in this meta-analysis. These investigations included 86 278 participants in 55 studies on knowledge, 20 196 in 33 studies on attitudes, and 74 881 in 29 studies on practices. The pooled estimates for sufficient knowledge, positive attitudes, and dengue fever preventive behaviors among the general population were determined as 40.1% (95% CI 33.8%-46.5%), 46.8% (95% CI 35.8%-58.9%), and 38.3% (95% CI 28.4%-48.2%), respectively. Europe exhibits the highest knowledge level at 63.5%, and Africa shows the lowest at 20.3%. Positive attitudes are most prevalent in the Eastern Mediterranean (54.1%) and Southeast Asia (53.6%), contrasting sharply with the Americas, where attitudes are notably lower at 9.05%. Regarding preventive behaviors, the Americas demonstrate a prevalence of 12.1%, Southeast Asia at 28.1%, Western Pacific at 49.6%, Eastern Mediterranean at 44.8%, and Africa at 47.4%. Conclusions: Regional disparities about the knowledge, attitude and preventive bahaviors are evident with Europe exhibiting the highest knowledge level while Africa has the lowest. These findings emphasize the importance of targeted public health interventions tailored to regional contexts, highlighting the need for regionspecific strategies to enhance dengue-related knowledge and encourage positive attitudes and preventive behaviors.

Objective: To describe the situation of measles in Sri Lanka from May to November, 2023 and to define the role of virology laboratory towards case confirmation and epidemiological and genetic characterization of the outbreak. Methods: This retrospective study analyzed all samples tested for measles from 1st of May to 30th of November, 2023 at National Measles Rubella Laboratory, Sri Lanka. According to the World Health Organization (WHO) algorithm, serum and oropharyngeal/ nasopharyngeal swabs were tested with WHO recommended kits for anti-measles IgM and measles virus specific RNA, respectively. Selected RNA positive samples were sequenced at reference laboratory, India. Analysis of sequencing data and construction of phylogenetic tree were carried out at National Measles Rubella Laboratory. Data was analyzed using descriptive statistics. Results: Of the total 1 132 serum samples and 497 oropharyngeal/ nasopharyngeal swabs from 1 326 patients, 657 (49.5%) patients were confirmed as measles by anti-measles IgM, measles virus specific RNA or both. Males (55.6%, n=365) and the age group from >20 to ≤30 years (33.0%, n=217) predominated positive patients. All provinces reported measles positive cases. All samples sequenced (100%, n=42) were genotype D8 with 95.2% (n=40) bearing Victoria.Australia origin. Conclusions: We described resurgence of measles in an eliminated country, confirming the genotype to be D8, one of the two genotypes currently circulating globally. Further, the study strongly convinced the importance of a strengthened virological surveillance system in an eliminated country, despite its eliminated status.

Objective: To address the phylogenetic and phylogeographic relationship between different lineages of Anopheles (An.) subpictus species complex in most parts of the Asian continent by maximum utilization of Internal Transcriber Spacer 2 (ITS2) and cytochrome C oxidase I (COI) sequences deposited at the GenBank. Methods: Seventy-five ITS2, 210 COI and 26 concatenated sequences available in the NCBI database were used. Phylogenetic analysis was performed using Bayesian likelihood trees, whereas median-joining haplotype networks and time-scale divergence trees were generated for phylogeographic analysis. Genetic diversity indices and genetic differentiation were also calculated. Results: Two genetically divergent molecular forms of An. subpictus species complex corresponding to sibling species A and B are established. Species A evolved around 37-82 million years ago in Sri Lanka, India, and the Netherlands, and species B evolved around 22-79 million years ago in Sri Lanka, India, and Myanmar. Vietnam, Thailand, and Cambodia have two molecular forms: one is phylogenetically similar to species B. Other forms differ from species A and B and evolved recently in the above mentioned countries, Indonesia and the Philippines. Genetic subdivision among Sri Lanka, India, and the Netherlands is almost absent. A substantial genetic differentiation was obtained for some populations due to isolation by large geographical distances. Genetic diversity indices reveal the presence of a long-established stable mosquito population, at mutation-drift equilibrium, regardless of population fluctuations. Conclusions: An. subpictus species complex consists of more than two genetically divergent molecular forms. Species A is highly divergent from the rest. Sri Lanka and India contain only species A and B.

Objective: To report a new species of sandfly, Sergentomyia (Neophlebotomus) ashwanii sp. nov. (Diptera: Psychodidae) from Western Ghats, India. Methods: A systematic sandfly survey was conducted in the Thrissur and Kollam districts of Kerala, India using mechanical aspirators, light and sticky traps, both indoor and outdoor habitats, for a period of one year. Deoxyribonucleic acid barcoding of samples was performed targeting mitochondrial cytochrome oxidase I (COI) gene and sequence generated was subjected to phylogenetic analysis. Results: Sergentomyia (Neophlebotomus) ashwanii, a new sandfly species is recorded and described in this communication. A single row of 10-12 pointed teeth in the cibarium with 4-6 small denticles or fore-teeth are the key characteristics that is distinctive from other members of the subgenus Neophlebotomus. Mitochondrial COI barcode followed by phylogenetic analysis of the nucleotide sequence confirms that specimens of the species belong to the same taxonomic group while the genetic distance (14.2%) with the congeners established it to be a different species. Conclusions: The Western Ghats' being an important biodiversity hotspot and has dearth of systematic entomological surveys on sandflies. The current study tried to fill the void and also report a new sandfly species.

Objective: To evaluate the prevalence of Candida species in cancer patients with candidemia around the world, and to identify related risk factors and their antifungal resistance, with an emphasis on non-albicans Candida species (NACs). Methods: The published papers related to the subject were systematically searched in databases of MEDLINE (including PubMed), Web of Science, Scopus, Science Direct, and Google Scholar between the 1 st January 2000 and 21 st April 2021. Results: Among the 4 546 records, 69 studies met the inclusion criteria. The pooled prevalence of NACs in cancer patients with candidemia was 62% (95% CI 58%-67%; I 2 =94.85%, P=0.00). Based on type of cancer, the pooled prevalence of NACs in hematologic and solid cancer patients were 68% (95% CI 65%-70%) and 52% (95% CI 49%-54%), respectively. Among NACs, Candida (C.) parapsilosis was the most frequently isolated organism followed by C. tropicalis and C. glabrata. In addition, the therapeutic usage of antibiotics was found as the most common risk factor, accounting for 85% (95% CI 81%-89%) and central venous catheter accounting for 69% (95% CI 62%-77%). Conclusions: The incidence of Candida bloodstream infections among cancer patients is a growing concern, especially when the etiologic agents of candidemia tend to shift towards NACs.

Objective: To evaluate long-term effects of COVID-19, and to determine the risk factors in long-COVID in a cohort of the Turkish Thoracic Society (TTS)-TURCOVID multicenter registry. Methods: Thirteen centers participated with 831 patients; 504 patients were enrolled after exclusions. The study was designed in three-steps: (1) Phone questionnaire; (2) retrospective evaluation of the medical records; (3) face-to-face visit. Results: In the first step, 93.5% of the patients were hospitalized; 61.7% had a history of pneumonia at the time of diagnosis. A total of 27.1% reported clinical symptoms at the end of the first year. Dyspnea (17.00%), fatigue (6.30%), and weakness (5.00%) were the most prevalent long-term symptoms. The incidence of long-term symptoms was increased by 2.91 fold (95% CI 1.04-8.13, P=0.041) in the presence of chronic obstructive pulmonary disease and by 1.84 fold (95% CI 1.10-3.10, P=0.021) in the presence of pneumonia at initial diagnosis, 3.92 fold (95% Cl 2.29-6.72, P=0.001) of dyspnea and 1.69 fold (95% Cl 1.02-2.80, P=0.040) fatigue persists in the early-post-treatment period and 2.88 fold (95% Cl 1.52-5.46, P=0.001) in the presence of emergency service admission in the post COVID period. In step 2, retrospective analysis of 231 patients revealed that 1.4% of the chest X-rays had not significantly improved at the end of the first year, while computed tomography (CT) scan detected fibrosis in 3.4%. In step 3, 138 (27.4%) patients admitted to face-to-face visit at the end of first year; at least one symptom persisted in 49.27% patients. The most common symptoms were dyspnea (27.60%), psychiatric symptoms (18.10%), and fatigue (17.40%). Thorax CT revealed fibrosis in 2.4% patients. Conclusions: COVID-19 symptoms can last for extended lengths of time, and severity of the disease as well as the presence of comorbidities might contribute to increased risk. Long-term clinical issues should be regularly evaluated after COVID-19.

Objective: To investigate long-term symptoms after acute COVID-19, the link between symptoms and respiratory function, radiological changes in the post-COVID period, and risk factors for post-COVID syndrome. Methods: In this cross-sectional study, 123 participants who were admitted within the first 3 months were categorized as group 1, and those who applied after 3 months were categorized as group 2. According to thoracic imaging and pulmonary function tests, patients were split into 3 groups as mild, moderate and severe. Results: At least one symptom was present in 91.9% and 61.8% in acute and post-COVID period, respectively. Pulmonary function tests were normal in 60 (70.6%) in the first three months, and 30 (78.9%) in 91-days to 1-year period after acute COVID-19 infection. After 3 months, 22.4% of chest X-rays and 7.9% of computerized tomography revealed progression. Patients who developed acute complications (OR 9.91, 95% Cl 1.93-50.87), had 2 or more symptoms at admission (OR 7.73, 95% CI 2.56-23.33), had 1% to 14% CT involvement (OR 3.05, 95% CI 1.06-8.79), or had 50% or more CT involvement (OR 14.68, 95% CI 1.24-172.55) had a higher risk of developing post-COVID syndrome. Conclusions: COVID-19 symptoms can last for long time. Severity of symptoms, acute complications, and the extent of radiological involvement may all contribute to elevated risk of post-COVID syndrome. As a result, patients with COVID-19 should be checked for long-term clinical difficulties on regular basis.

Objective: To compare the DNA sequences of Leishmania (L.)donovani isolated from individuals in two districts of the Northern Province with other parts of Sri Lanka and neighboring countries. Methods: Samples were collected from military personnel at the Army Hospital, Narahenpita, Sri Lanka from November 2018 to March 2020. A portion of the samples was fixed, stained with Giemsa and observed under the light microscope. The genomic The DNA was extracted from the remaining portion of the samples using DNEasy blood tissue kit (Qiagen, Germany) and amplified using Leishmania genus-specific primers for molecular diagnosis initially. DNA was amplified using L. donovani species-specific primers by PCR and the amplified product was sequenced for comparison of nucleotide sequences. Results: Out of 76 suspected patients, at least one biological sample of 45 (59.2%) was positive for L. amastigotes upon microscopy. Overall, 33 (43.4%) were positive in Leishmania genus-specific PCR, but only 23 (30.3%) were positive in L. donovani specific PCR. The dendrogram indicates that the current sequences clustered together with those from Nepal and Gampaha districts (Western Province), Sri Lanka, while the Indian and Eastern African sequences clustered separately. Conclusions: The genetic diversity was low among the isolates, indicating a single and possibly a local point of origin. However, the similarity of Sri Lankan and Nepal strains indicate a possibility of a shared point of origin, which needs more extensive evidence to confirm.

Rationale: Guillain Barre syndrome (GBS) is an acute neurological illness leading to quadriparesis with respiratory involvement. It can be triggered by infections, vaccinations, surgery, trauma, transplantation and drugs. Anti-rabies cell culture vaccines introduced to overcome the high rate of neurological complications associated with tissue based rabies vaccine, can be very rarely associated with GBS. Patient concerns: A 50-year-old female presented with acute severe upper back pain evolving into pure motor quadriparesis following administration of human diploid cell vaccine for rabies. Diagnosis: Acute motor axonal neuropathy variant of GBS following anti-rabies human diploid cell vaccine. Interventions: Intravenous high dose steroids. Outcomes: Patient recovered completely within 1 month. Lessons: Although anti-rabies cell culture vaccines are highly immunogenic and safe, they are rarely associated with GBS. Clinicians should be aware of this link because prompt diagnosis and treatment can result in complete recovery and avoid complications.

Objective: To compare the efficacy and safety outcomes of different antileishmanial agents used in visceral leishmaniasis clinical trials. Methods: A systematic literature search in PubMed/MEDLINE, EMBASE, Cochrane, and Google Scholar was done using keywords 'randomized controlled trials', 'antileishmanial' and 'visceral leishmaniasis'. The outcomes included were cure rate, overall withdrawals, relapse rate, and treatment-emergent adverse events. Effect estimates through the frequentist network meta-analysis approach were presented as OR with 95% CI. Rankogram plots were used for identifying the 'best intervention' based on p-scores obtained using the surface under the cumulative ranking. The risk of bias was evaluated by using Pedro Scale. Results: Seventeen randomized controlled trials with 5 143 visceral leishmaniasis patients who received different antileishmanial agents (amphotericin B, miltefosine, paromomycin, meglumine antimoniate, sodium stibogluconate, sitamaquine, and pentavalent antimonials) and met the inclusion criteria were included. For efficacy outcomes of the treatments, the rankogram of the network meta-analysis revealed that paromomycin (p-score=0.814 8) has the highest probability of being best in the pool, followed by sodium stibogluconate (OR 0.82, 95% CI 0.24-2.79, p-score=0.758 0), amphotericin B+miltefosine (OR 0.66, 95% CI 0.02-19.04, p-score=0.732 9) as compared to the remaining treatments; however, the most of the treatment-emergent adverse events were reported with sitamaquine. Conclusions: Paromomycin reported the highest cure rates, while the maximum treatment-emergent adverse events were seen with sitamaquine.