Dr. Khan has completed his graduate degree in medicine (MD) from Kng Edward Medical College. He obtained Masters in Public Health (MPH) from New York Mecial College, with specialized training in tropical medicine and obtained Diploma in Tropical Medicine (DTMH). Dr. Khan started his career as research clinical epidemiologist at Kingsbrook Jewish Medical Center, Brooklyn, New York. He worked as Direcor of Hospital Epidemiology and Infection Control at Long Island College of State University of New York and Director of Epidemiology and Occupational Health at Lourdes Health System in New Jersey. Dr. Khan worked as Director of Public Health and Communicable Disease at WHO Collaborative Infection ControlCenter in Saudi Arabia. Currently he is system Director of Epidemiology and Infection Control at major healthcare system in south west florida. He consulted for Joint Commission International and presented at international conferences.

South West Florida red tides are a natural phenomenon caused by dense aggregations of single cell or several species of unicellular organisms. Patches of discolored water, dead or dying fish, and respiratory irritants in the air often characterize these algal blooms. In humans, two distinct clinical entities, depending on the route of exposure, are associated with exposure to the Florida red tide toxins (particularly the brevetoxins). The two known forms of red tide toxins-associated clinical entities in humans first characterized in Florida are an acute gastroenteritis with neurologic symptoms after ingestion of contaminated shellfish (i.e. NSP) and an apparently reversible upper respiratory syndrome after the inhalation of the aerosols of the dinoflagellate and their toxins. Red Tide Symptoms: IRRITATED EYES AND THROAT, COUGH, RUNNY NOSE TIGHTNESS OF CHEST OR WHEEZING,, SHORTNESS OF BREATH. Blue Green Algae Symptoms: Direct contact with the organism or breathing of toxin, Rash, Stomach cramps, Nausea, Diarrhea , Vomiting, Liver toxicity, Nervous system effects, Irritation of eyes, notes, throat.. Blue Green Algae is Cyanobacteria can live in freshwater, saltwater or brackish water, most blue-green algae do not produce chemicals harmful to humans or animals, some types make natural substances called cyantotoxins. Safety concerns refrain form recreational, Fish caught near the bloom may have high accumulation of cyanotoxins in the organs

Dr. Satsuki Nakamura graduated from Sapporo Medical University School of Medicine in 2002, and have been engaged in respiratory practice as a clinician in Japan. She holds a specialist from the Japanese Respiratory Society, and now works in Ootakanomori hospital in Chiba Prefecture

Introduction: The incidence of tuberculosis in Japan is 13.3/100000, which is on a downward trend, but is higher than in Western countries, and those patients are more common in the elderly. Also, in Japan, lung cancer death is the third most common disease, and the number of deaths is first among all neoplasm. Case report: An 86-year-old woman who was referred to our hospital during an outpatient clinic because of chest abnormal shadow. While CT findings were two tumor, one was a diameter of 2.5 cm in the upper right lobe and the other was diameter of 5 cm in the middle lobe was observed. We thought they must be lung cancer, and surgery was performed. The tissue of upper lung tumor showed epithelioid cell granuloma, and the middle lobe tumor showed invasive adenocarcinoma with HE staining. With those results, and in addition, whole-blood interferon gamma release assay was positive, we diagnosis that she had lung cancer with tuberculosis. Because of her age and performance state, we didn’t do chemical treatment for her cancer, and we just did standard treatment for her tuberculosis. 6 weeks later, M. avium（MA） was detected in mycobacterial cultures of tissue lavage fluid submitted at the time of surgery, and the epithelioid granuloma of the upper lobe tissue was diagnosed to be due to pulmonary MAC disease. Conclusions: When finding an abnormal shadow on the chest, careful differential diagnosis is needed especially in the elderly people in countries where TB is endemic.

Trachomatous trichiasis is targeted for elimination by 2020. It is globally accepted that there is an excess risk of trachomatous trichiasis in women compared to men with many factors contributing to this finding. We sought to update previous work on the subject and to undertake some sub-analyses to help interpret the findings. This secondary data analysis used data collected through the Global Trachoma Mapping Project (GTMP), a large set of standardized population-based trachoma prevalence surveys from 2013-16. Our analysis included 693 evaluation units (EUs) in 16 countries with a total sample of 1,143,742 residents’ age 15 years and above. RevMan 5 was used to generate an age-adjusted Mantel-Haenszel odds ratio and 95% confidence intervals (CI). Among the 498,317 men examined 3,566 had trichiasis. Among the 645,425 women examined 9,156 women had trichiasis. The overall excess burden of trichiasis in women compared to men was 1.87 (95% CI: 1.45, 2.42) while in the 503 EU with a prevalence of trachomatous trichiasis ≥ 0.2% (the WHO threshold for elimination) the excess burden of trichiasis in women compared to men was 2.01 (95% CI: 1.58 , 2.55). There was considerable heterogeneity in the findings at the country level. Surveys in Ethiopia (24.9% of total participants) had an OR of 3.16 (95% CI 2.95, 3.39) while surveys in Nigeria (33.6% of total participants) had an OR of 1.59 (95% CI; 1.50, 1.69). At the EU level we did not find an association between the odds of trichiasis in women compared to men according to the prevalence of trichiasis. Our findings suggest that gender-specific excess varies considerably across Africa; in all settings however efforts are needed to reach women with trachoma management services.

Rina Priastini Susilowati has completed his PhD at the age of 50 years from Airlangga University Surabaya Indonesia. She is the Head Departement of Biology. She has published more than 25 papers in reputed journals and has been serving as an editorial board member of repute. Since 2009 she has done a lot of research in the field of medicinal plants and their effects on insect death, vectors of diseases that can interfere with human health.

Population control of the dengue vector mosquito, Aedes aegypti, is difficult due to many reasons, one being the development of resistance to neurotoxic insecticides employed. The development of Aedes aegypti larvae was treated with Passiflora foetida leaf extract with a multilevel dose of 0.2 g / mL; 0.4 g / mL; 0.8 g / mL; 1.6 g / mL and 3.2 g / mL. Larvae mortality was observed after 24 hours of the extract treatment. A set of physiological parameters were recorded in control developing larvae and novaluron was administered continuously to Aedes aegypti larvae, since early third instar. Larval instar period duration was recorded from third instar until pupation. Passiflora foetida leaf extract treatment inhibited adult emergence, induced immature mortality, altered adult sex ratio and caused delay in larval development. Moreover, Passiflora foetida leaf extract: i) significantly affected chitin content during larval development; ii) induced a discontinuous and altered cuticle in some regions while epidermis was often thinner or missing; iii) rendered chitin cuticle presence discontinuous and less evident. In both control and Passiflora foetida leaf extract treatment, chitin was present in the peritrophic matrix. This study showed quantitatively and qualitatively evidence of Passiflora foetida leaves extract effects on Aedes aegypti larval development. The effective doses to used this extract is 3.2 g/mL, cause can kill 100% of Aedes aegypti larvae.

Monica Puspa Sari has completed his magister of biomedical at the age of 31 years from Indonesian University. She is the lecturer in parasitology at the Christian University of Krida Krida Wacana, Jakarta Indonesia

The use of synthetic insecticides continuously can cause adverse affects in the form of environmental pollution, such as death of living things, insects become more resistant with pesticide, even gene mutations can occur in insects. Therefore we need insecticide from plants that more safer to use. One of them is a plant from the Rutaceae family known as Maja or Bael (Aegle marmelos) which is used for controlling vector-borne diseases. Maja leaves have the potential as an insecticide because they contain several chemical compounds such as alkaloids, terpenoids, saponin, and tannin. The purpose of the study was to look at the morphological changes of Aedes aegypti larvae due to administration of maja leaves extract with acetone solvent. This experimental study used a completely randomized design with negative control in the form of aquadest, positive control in the form of temephos 1% and maja leaves extract treatment with acetone solvent concentration of 0.1 g/mL, 0.2 g/mL, 0.4 g/mL, 0.6 g/mL, 0.8 g/mL and 1.6 g/mL. Ae. aegypti larvae mortality was assessed for 24 hours and the morphological changes were immediately seen using a light microscope. Within one hour, mortality of Ae. aegypti larvae appeared at concentrations of 1.6 g/mL. The negative control group did not show morphological changes. While the positive control group using temephos showed a change in the color of the head to blackish brown, damage to the abdomen and pecten and the rear abdomen changed to a more blackish brown color. Maja leaves extract with acetone concentration of 1.6 g/ mL causes color changes in the head of Ae. aegypti larvae and damage to the abdomen. Abdomen larvae of the Ae. aegypti appear to shrank. The effective dose of maja leaves extract needed to kill Ae. aegypti larvae is 1.6 g/mL with damage especially to the abdomen.

Bijayata Shrestha completed her Masters Degree in Microbiology (Medical) at the age of 28 years from Tribhuwan University, Nepal. She started working in HAMS hospital, Kathmandu, Nepal in 2009 A.D. right after completing her Undergraduate degree in Medical Laboratory Technology (BMLT) from Rajiv Gandhi University of Health Sciences, India. She is currently designated as in-charge of Pathology department in the Hospital and her duties and responsibilities include QC analysis, laboratory report authorization and staff duty roster maintenance. Besides, She is also working as a lecturer to PCL Nursing students in HAMS Nursing College since 2010 A.D.

Background: Enteric fever is one of the most common diseases encountered worldwide and is endemic in Nepal. This study was conducted to access antibiotic susceptibility pattern of Salmonella isolates from culture positive cases of enteric fever. Methods: Altogether 505 blood samples were collected from patients clinically suspected of enteric fever attending HAMS Hospital. All blood samples were cultured by BACTEC method and sub cultured in blood agar and MacConkey agar plates. All isolates were identified by colony characteristics, biochemical tests and serotyping methods. Antibiotic susceptibility test was performed by modified Kirby Bauer disc diffusion method interpreted with CLSI guideline. Result: Isolation rate of Salmonella species was 3.6%. Among 18 Salmonella isolates, 10 were S. typhi, 8 were S. paratyphi A. The prevalence rate of infection was high among the age group 11-20 years (50%) and among the male patients. However, there was no significant association of enteric fever with gender of patients (p=2.47). All 18 isolates were sensitive to Amoxycillin, Azithromycin, Ceftriaxone and Chloramphenicol, Ciprofloxacin and Ofloxacin. Majority of isolates were sensitive to Cefixime (94.4%), Cotrimoxazole (94.4%) and Cephotaxime (90%). There were no any MDR isolates. Higher percentage of isolates was resistant to Nalidixic acid (87.5%). Conclusion: The decreased susceptibility to Fluroquinolones of S. typhi and S. Paratyphi A can be correlated with resistance to Nalidixic acid. Commonly used third generation Cephalosporins and rolled back first line drugs be the choice in case of NARS isolates

Rami Saadeh is an Assistant Professor in Jordan University of Science and Technology in Jordan. Rami earned his PhD in Environmental health and Epidemiology from Indiana University in the US. Rami worked as a dentist in small villages and Palestinians’ refugee camps in Jordan, taught public health courses for years in Jordan, Saudi Arabia, and the US, and worked as the State Oral Health Epidemiologist in West Virginia, US. His research focuses on environmental and social disparities among communities, with special emphasis on susceptible groups such children and low socio – economic status populations

Objectives: The aim of this study was to examine the incidence of Needle Stick and Sharp Injuries (NSSIs) among Health Care Workers (HCWs) at King Hussein Medical Center (KHMC) in Jordan between 2013 and 2018. Methods: We retrospectively reviewed all NSSIs reports referred from various departments at KHMC to the Preventive Medicine Department between the years 2013 to 2018. Incidence rates of NSSIs were then calculated and the rates stratified according to age, gender, job, department, site of injury and the procedure that caused the injury. Results: There was a significant association between the incidence of NSSIs and other independent variables (p < .001). The reported incidence of NSSIs among nurses, cleaners, physicians, other workers and lab technicians were 39.7%, 36.3%, 10.4%, 7.4%, and 5.9%, respectively, during the 5-year period. Hospital wards were the most common locations where injuries took place (46.1%). Further, injuries occurred more frequently during medical waste collection (38.2%). Conclusion: The incidence of NSSIs was the highest among nurses and cleaners. Safety policies and training among the above high-risk groups should be reviewed to reduce the risk of NSSIs. Multi center studies at a national level should be conducted to examine if the findings of this study are national trends.

Ikhsan is Resident of Pulmonology and Respiratory Medicine in Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia. The high number of TB cases in Indonesia made him interested in conducting research on TB, especially drug resistant TB.

Background and Purpose: Multi Drug Resistant Tuberculosis is a major health problem in the world, the occurrence genes mutation of Mycobacterium tuberculosis causes resistance to anti tuberculosis drugs. KatG and inhA genes are the most common mutated genes that play a role in resistant to Isoniazid. In 2016 WHO recommended Shorter Term Regimens of MDR TB, that using high-dose Isoniazid. High-doses Isoniazid cannot be effective to be given if mutation occur in the katG gene. Mutation of inhA gene cause low level resistant, which means high-doses Isoniazid may be effective. The aims of this study are to identify katG and inhA gene mutations in MDR TB patients at H. Adam Malik General Hospital Medan, Indonesia. Methods: This study was an observational study conducted from July-November 2019 on 30 MDR-TB patients. Samples was taken from the sputum of MDR TB patients that diagnosed by rapid molecular test (Xpert). Identification of katG and inhA gene mutation on M.tuberculosis was done by using Multiplex Polymerase Chain Reaction technique. Results: From 30 MDR-TB patients, 23 (76.67%) mutation occur in only katG gene, single mutation in inhA gene was not found, combination of mutation katG and inhA genes found in 4 (13.33%) isolates.

Felly Iswa is Resident of Pulmonology and Respiratory Medicine in Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia. The high number of TB cases in Indonesia made him interested in conducting research on TB, especially drug resistant TB.

Background and Purpose: DR-TB is one of 10 causes of death worldwide where cases are increasing every year. Complicated treatment & side effects caused by treatment often lead to treatment failure and complications that can lead to death in patients. This study aims to assess the side effects of individual regimens for drug resistant TB treatment on renal function, and electrolytes in DR-TB patient at Adam Malik General Hospital in 2016. Methods: This study was a retrospective conducted on 176 DR-TB patients in 2016. Medical Records were analyzed to assess the side effects experienced by each patient, as well as the regimen and outcome during the treatment. Results: 176 DR-TB patients found, 116 (65.7%) men & 60 women with an average age of 43.1 ± 12.5 years. Side effects of renal function (N 15; 8.5%), electrolyte: hypokalaemia (N 27; 15.3%), hyponatremia (N 15 8.5%). The most common use of regimen is Km/Cs-Eto-Lfx-Z (N 150; 85.2%). Cured were found (N 71; 40.3%), failure (N 9; 5.1%), dropout (N 56; 31.8%) & death (21.1%) in 37 patient.