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Objective: To evaluate the awareness, knowledge, and attitude on monkeypox viral infection among preclinical and clinical dental students in Malaysia. Methods: A cross-sectional study was conducted among 229 preclinical and clinical dental students via an online self-reported questionnaire. The questionnaire included 3 items on awareness, 15 items on knowledge, 9 items on attitude and 2 open-ended questions. Data were presented as frequencies and percentages. Chi-square test was used to compare knowledge and awareness scores between preclinical and clinical dental students and content analysis was performed for open-ended responses. Results: Preclinical and clinical dental students were aware of the existence of monkeypox (89.5% and 94.4%, respectively), that the disease emerged in non-endemic countries (81.0% and 87.1%, respectively) and that it was declared a public health emergency of international concern by the World Health Organization (73.3% and 79.0%, respectively). Clinical dental students’ overall knowledge level was significantly higher than preclinical dental students (P=0.014). Both preclinical (95.2%) and clinical (96.8%) dental students demonstrated positive attitudes toward monkeypox with no significant difference (P=0.736) noted between them. Three themes emerged from the open-ended questions: (1) reimplementation of nationwide lockdown, (2) impact on the economy and health, and (3) disruption to the educational system. Students also anticipated their face-to-face learning to be reduced should there be a new outbreak. Conclusions: Both preclinical and clinical dental students showed comparable awareness and attitudes, while the latter demonstrated greater satisfactory knowledge toward the re-emergence of monkeypox during the COVID-19 pandemic. Nonetheless, efforts to improve dental students’ understanding of this alarming outbreak are required, to safeguard their health and minimise transmission.

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Objective: Pneumocystis pneumonia (PcP) is a life-threatening infection caused by the opportunistic fungi Pneumocystis jirovecii. The emergence of the COVID-19 pandemic forced the focus of attention of health policymakers on these two infections due to their clinical and paraclinical similarities, which cause diagnostic dilemmas. This study was undertaken to evaluate and estimate the global prevalence and main leading risk factors of coronavirus-associated pneumocystosis (CAP). Methods: We searched related databases between December 2019 and May 2022 for studies reporting CAP. Meta-analysis was performed using StatsDirect software (version 2.7.9) according to the DerSimonian and Laird method applying the random-effects model. We evaluated heterogeneity using the χ²-based Q statistic (significant for P<0.05) and the I² statistic (>75% indicative of “notable” heterogeneity). Moreover, an odds ratio (OR) analysis was performed for eligible data. Results: Our meta-analysis included eight studies with 923 patients hospitalized with COVID-19; among them, 92 were PcP cases. The overall pooled prevalence of CAP was estimated at 11.5%. The mortality among CAP patients was lower than that of non-PcP patients (OR 1.93; 95% CI 0.86-4.31). Long-term corticosteroid therapy (OR 28.22; 95% CI 0.54-1 480.84) was the most predisposing factor for PcP among COVID-19 patients, followed by pulmonary diseases (OR 1.46; 95% CI 0.43-4.98), kidney diseases (OR 1.26; 95% CI 0.21-7.49), and acute respiratory destruction syndrome (OR1.22; 95% CI 0.05-29.28). Conclusions: The prevalence of PcP among the COVID-19 population is almost similar to the pre-COVID era. However, PcP-related mortality was decreased by the emergence of the COVID-19 pandemic. Women with COVID-19 are more susceptible to PcP than men. Acute respiratory distress syndrome, kidney diseases, pulmonary diseases, and long-term corticosteroid therapy increased the risk of PcP; however, transplantation and malignancy decreased the risk for PcP among COVID-19 patients. Further retrospective, case-control, prospective, and more precisely systematic review and meta-analysis studies are needed in this field.

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Objective: To investigate the genetic diversity of coronaviruses in wild and domestic birds in the bird park and live poultry markets of Ca Mau province in Vietnam in 2020. Methods: A total of 228 samples (121 from wild birds and 107 from poultry) were collected in the territory of Ca Mau province of Vietnam in 2020. The avian samples were tested for the presence of the four genera of coronaviruses using reverse transcription and nested PCR. Molecular genetic analysis using targeted NGS sequencing of RdRp gene was performed for 29 representative samples (12 samples from wild birds and 17 from poultry). Phylogenetic analysis was performed using the neighbour joininig method with 1000 bootstrap replications using MEGA X software. Results: Among wild birds, 21.5% samples were positive for the genetic material of coronaviruses and 38.3% samples were positive for coronaviruses among poultry. Genetic analysis of the partial sequence of RdRp gene from representative samples revealed that wild birds were carriers of gammacoronaviruses and deltacoronaviruses. Among poultry, three genotypes of infectious bronchitis virus (QX, Mass and Q1) were detected in chickens, with QX genotypes being predominant, and viruses of DCoV group were detected in domestic ducks. There was no detection of alphacoronaviruses or betacoronaviruses in the studied birds. Conclusions: Coronaviruses of genera Gammacoronavirus and Deltacoronavirus were detected in wild birds. A high percentage of infectious bronchitis virus was detected in poultry. Thus, there is a need for broader surveillance of coronaviruses in birds, which can be used for evaluation of diversity, evolution and distribution of coronaviruses in Vietnam. Continuous surveillance of coronaviruses circulation in wild and domestic animals is necessary for implementing strategic measures for poultry and domestic animal protection and for evaluation of possible risk of circulating coronaviruses to human health.

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Objective: To identify the moderating effects of cognitive reappraisal (CR) and expressive suppression (ES) on the relationship between posttraumatic stress (PTS) symptoms and posttraumatic growth (PTG) in university students. Methods: The survey included 1 987 Chinese university students who completed questionnaires on PTS symptoms in February 2020, with three follow-up surveys at two-month intervals until August 2020. We assessed CR and ES at February 2020 and PTG at August 2020. Growth mixture modeling was used to classify the PTS symptom trajectories. Multinomial logistic regression was used to recognize the predictors of class membership. The relationships among PTS symptoms, CR, ES, and PTG were examined using multi-group path analysis. Results: Sex, SARS-CoV-2 infection of a family member or friend, number of siblings, CR, and ES were significantly associated with PTS symptoms. Three latent classes were identified: ‘Increasing PTS’ (n=205, 10.0%) who had rapid deterioration of PTS symptoms, ‘Moderate PTS’ (n=149, 8.0%) who had a high level of PTS symptoms at the beginning and slightly increasing, and ‘Persistent Minimal PTS’ (n=1 633, 82.0%), who had slow resolution of PTS symptoms over time. Male, SARS-CoV-2 infection of a family member or friend, and having a lower CR and a higher ES, were more likely to have ‘Increasing PTS’. PTS at February 2020 predicted PTG only in ‘Increasing PTS’ class, and both CR and ES had moderating effects on the conversion between them. Conclusions: Most students recovered from posttraumatic stress of COVID-19 pandemic, but a small proportion expeienced increasing PTS symptoms, and those with this condition may benefit from emotional regulation intervention.

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Objective: To assess the role of debulking surgery in extensive hepatic alveolar echinococcosis (HAE). Methods: Five cases of extensive HAE undergoing debulking surgery with their long-term follow-ups were reported. Additionally, a systematic review was carried out. Results: The average age of patients in the study was (50.8±17.1) years (range 36 to 77 years). Three cases were female. The median follow-up period was 61 months (range 12 to 84 months). Left liver resections were performed in 2 cases and right hemihepatectomies were undertaken in 2 cases. Two patients (cases 2 and 4) developed early surgical complications, while one of them (case 4) who suffered from the recurrent sub-hepatic abscess died at 12 months postoperatively. Conclusions: This study highlights the importance of debulking surgery for the management of complex symptomatic HAE lesions in patients with no curative option available.

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Rationale: To report neurological paradox in a non-HIV patient with pulmonary tuberculosis. Patient concerns: A 26-year-old non-human immunodeficiency virus immunosuppressed female patient presented with diffused headache, diplopia, ascending paraparesis with loss of bowel and bladder control. Diagnosis: Disseminated neurological paradoxical reaction developed during tuberculosis treatment in a non-human immunodeficiency virus patient. Intervention: High-dose intravenous corticosteroid was added to the anti-tuberculous drugs, followed by tapered dose of oral prednisolone in 3 months. Outcome: A favorable neurological outcome was obtained 6 months later. Lessons: Neurological paradoxical reaction cannot be overlooked among the tuberculosis-treated cases who present with newly emerged neurological disorders.

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