Sepsis remains a major cause of mortality in critical care, and the failures of highly touted trials have caused experts to call for re-evaluation of the approach toward sepsis.

Introduction: Immune reconstitution inflammatory syndrome (IRIS) is referred to as the flare up of an underlying, previously undiagnosed infection or the worsening of a previously treated infection soon after antiretroviral therapy (ART) is started. Information about the prevalence and associated risk factors for IRIS in resource-constrained countries like Tanzania where access to ART is increasing is scarce. Therefore, this study was conducted to determine the prevalence and risk factors associated with IRIS among patients attending care and treatment clinic at Muhimbili National Hospital (CTC-MNH). Methods: A retrospective cohort study was conducted in patients receiving highly active antiretroviral therapy (HAART) who attended CTC-MNH between July 2016 and June 2018. Mann Whitney test was used to compare median CD4+ cells count and viral load at baseline and after 6 months of treatment. Associated factors were analysed using multi-logistic regression. Statistics were done using GraphPad Prism 7 software and a p-value < 0.05 was considered statistically significant. Results: Of 318 patients, 8.5% encountered IRIS. Compared to baseline readings, there were significant increases in CD4+ cells (P < 0.0001) and decrease in viral load count (P < 0.0001). Patients who did not adhere to HAART were more likely to develop IRIS [Adjusted Odds Ratio (AOR) = 4.2, 95% CI; 1.14-15.60, P = 0.03]. Conclusion: This study found relatively low prevalence of IRIS as compared to those reported elsewhere. Moreover, poor adherence to HAART was found to be a risk factor for IRIS.

Immunity is the state of protection against infectious disease conferred either through an immune response generated by immunization or previous infection. Generated immune responses may be long lasting even lifelong or gives immediate, but short-lived protection. In malaria-endemic areas, young children and pregnant women are particularly susceptible to malaria, but with exposures protective immunity against malaria develop although sterile immunity is never achieved. Assuring protection to vulnerable populations, prophylaxis against malaria is advocated to pregnancy women and sickle cell disease children. Unfortunately, prophylaxis has been suggested to cause a decrease in exposure that curtails the development of acquired protective immunity, leaving individuals more susceptible to malaria in future. To describe this event, a review on effects of intermittent preventive therapy in pregnant women primigravidae (first pregnancy) in particular and chemoprophylaxis against malaria in sickle cell disease children was conducted.