Nyt fra tidsskrifterne

This JAMA Clinical Guidelines Synopsis summarizes the European Society of Cardiology’s 2019 guidelines for diagnosis and management of acute pulmonary embolism.

Myopia, or nearsightedness, causes blurry vision that usually is corrected with glasses, contact lenses, or refractive surgery. The lifetime prevalence of myopia has been reported to be 80% to 90% in population-based studies in Asia. Myopia is also very common in other parts of the world, with a prevalence of almost 50% in many parts of Europe and an estimated increase in prevalence from 25.0% in 1971-1972 to 41.6% in 1999-2004 in the US.

An investigational antisense oligonucleotide drug improved cerebrospinal fluid (CSF) levels of the protein responsible for up to a fifth of familial amyotrophic lateral sclerosis (ALS) cases among people of European origin, researchers reported in the New England Journal of Medicine.

A highly potent, long-acting drug candidate with a novel mode of action showed promising anti-HIV activity in recent phase 1 trials. The slow-release compound, lenacapavir (previously GS-6207), would be used in combination with other antiretroviral agents, researchers said at the 23rd International AIDS Conference.

Two men with coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) survived after treatment with off-the-shelf regulatory T cells, also known as Tregs, Johns Hopkins physicians recently reported. The investigational allogenic Tregs with lung-homing markers were derived from cord blood.

This nonrandomized controlled trial allowed children with appendicitis and their families to choose antibiotic therapy vs laparoscopic appendectomy as initial management, and compares 1-year disability days and treatment success—no need for later surgery—between the groups.

Are antibiotics as good as surgery for pediatric appendicitis? The answer depends on who is asking the question. In this issue of JAMA, Minneci et al report outcomes from a nonrandomized study of nonoperative treatment of 1068 pediatric patients with uncomplicated appendicitis. Because of how the minimal clinically important difference (MCID) was defined and who defined it, the study yielded a statistically negative result. Success was defined as not requiring appendectomy within 1 year of study enrollment. Surgeons defined the minimal acceptable success rate for antibiotic treatment of appendicitis as more than 70%. However, members of a multidisciplinary group (including patients, families, community pediatricians, emergency medicine physicians, nurses, patient educators, and payers) that served as part of the research team had a very different perspective, and indicated a 50% success rate would be acceptable. In the study by Minneci et al, 245 of the 370 patients (66%) treated with antibiotics successfully avoided appendectomy. The study failed from the surgeon’s perspective, but patients would have considered this outcome a success. Whose opinion matters?…

This Viewpoint discusses evidence supporting use of conversational agents in health care—artificial intelligence (AI) programs that interpret users’ questions or concerns and respond with answers—and proposes 12 domains (eg, safety, transparency, security) that clinicians and health care organizations should evaluate before using them for patient care.

In this Viewpoint the president of the Ford Foundation calls on philanthropic and other wealthy organizations to make creative and generous grants to less well-endowed counterpart institutions and communities to redress the racial and socioeconomic disparities exposed by the COVID-19 pandemic and continued killings of Black Americans.

This Viewpoint describes the unique challenges faced by Lebanon, a small densely populated country with a fragmented health care system, in its response to the emerging COVID-19 pandemic, and it summarizes organizational, testing, and communications policies the nation has implemented that might be useful to other resource-limited countries and settings.

This Viewpoint discusses the success of US legislation to help prevent medication overdoses in children and suggests strategies to continue to reduce these overdoses, including changes to child-resistant packaging.

This Viewpoint discusses the role of the Advisory Committee on Immunization Practices, a federal advisory committee that makes vaccine-related recommendations to the CDC and DHHS, in guiding the development and deployment of COVID-19 vaccines.

This Viewpoint proposes principles and processes to allow pooling of individual patient data from clinical trials given decelerating participant recruitment at sites where the COVID-19 surge has been controlled and new cases are diminishing.

This JAMA Insights Clinical Update reviews the central role of apolipoprotein B100 molecule (apoB)–containing lipoproteins in the development of atherosclerotic cardiovascular disease (ASCVD), with implications for patient risk assessment and choice of lipid-lowering therapy.

A 68-year-old woman with history of uterine carcinoma (unknown histology) treated 30 years prior had 2 months of generalized abdominal pain and distention but no fever, nausea, vomiting, diarrhea, constipation, blood in the stool, or weight loss. CBC and serum chemistries were unremarkable; CT and MRI showed pelvic ascites and an enhancing lesion at the base of the cecum; CEA level was 18 ng/mL (normal

This Arts and Medicine feature discusses Amabié, a 19th-century Japanese yōkai character said to protect against spread of infection, who has become the symbol of public health hygiene in Japan during the COVID-19 pandemic.

In this narrative medicine essay, a gastroenterologist recalls a microagression from a patient during fellowship training and realizes the fault lay with the medicine profession and calls for antiracist training as one measure in dismantling race-based health disparities.

This Medical News story discusses the challenge of minimizing the risk of COVID-19 in kindergarten through 12th grades while maintaining prepandemic educational standards.

This case series describes COVID-19 symptoms persisting a mean of 60 days after onset among Italian patients previously discharged from COVID-19 hospitalization.

This study describes coronavirus disease 2019 (COVID-19) case rates and deaths among federal and state prisoners and compares them with corresponding rates for the US population.

This JAMA Patient Page describes practices for keeping household medicine safely stored away from children and what to do if an unintentional medicine exposure happens.

This Viewpoint reviews the historical convergence and then divergence of psychiatry and neurology as clinical disciplines and calls for a transformation of graduate and postgraduate education to integrate the two and span intersections of the humanities, philosophy, and science.

Journal of Medical Virology, Accepted Article.

Journal of Medical Virology, Accepted Article.

Journal of Medical Virology, Accepted Article.

Journal of Medical Virology, Accepted Article.

Journal of Medical Virology, Accepted Article.

Journal of Medical Virology, Accepted Article.

Journal of Medical Virology, Accepted Article.

Journal of Medical Virology, Accepted Article.

Journal of Medical Virology, Accepted Article.

AbstractBackgroundSince the World Health Organization recommended single low-dose (0.25mg/kg) primaquine (PQ) in combination with artemisinin-based combination therapies (ACTs) in areas of low transmission or artemisinin-resistant P. falciparum, several single-site studies have been conducted to assess its efficacy.MethodsAn individual patient meta-analysis to assess the gametocytocidal and transmission-blocking efficacy of PQ used in combination with different ACTs was conducted. Random effects logistic regression was used to quantify PQ effect on (i) gametocyte carriage in the first two weeks post-treatment; (ii) the probability of infecting at least one mosquito or of a mosquito becoming infected.ResultsIn 2,574 participants from fourteen studies, PQ reduced PCR-determined gametocyte carriage on days 7 and 14, most apparently in patients presenting with gametocytaemia on day 0 (Odds Ratio (OR)=0.22; 95%CI 0.17-0.28 and OR=0.12; 95%CI 0.08–0.16, respectively). The rate of decline in gametocyte carriage was faster when PQ was combined with artemether-lumefantrine (AL) compared to dihydroartemisinin-piperaquine (DP) (p=0.010 for day 7). Addition of 0.25mg/kg PQ was associated with near complete prevention of transmission to mosquitoes.ConclusionPrimaquine’s transmission-blocking effects are achieved with 0.25 mg/kg PQ. Gametocyte persistence and infectivity are lower when PQ is combined with AL compared to DP.

AbstractBackgroundRespiratory syncytial virus (RSV) is an important cause of respiratory illness worldwide, however, burden data on mother-infant pairs remain sparse in sub-Saharan Africa where HIV is prevalent. We evaluated the impact of maternal HIV infection on the burden of RSV among mothers and their infants in western Kenya.MethodsWe enrolled pregnant women (≤20 weeks gestation) and followed them and their newborns weekly for up to 3-6 months post-partum, to document cases of acute respiratory illness (ARI). Nasal/ oropharyngeal swabs were collected and tested for RSV using polymerase chain reaction. Analyses were stratified by maternal HIV-status, and incidence computed per 1,000 person-months.ResultsCompared to RSV-negative ARI cases, RSV-positive cases were associated with cough, apnoea and hospitalization among infants. RSV incidence per 1,000 person-months among mothers was 4.0 (95% confidence interval (CI), 3.2-4.4), and was twice that among the HIV-infected (8.4; 95% CI, 5.7-12.0) compared to the HIV-uninfected mothers (3.1; 95% CI 2.3-4.0). Among infants, incidence per 1,000 person-months was 15.4 (95% CI, 12.5-18.8); incidence did not differ by HIV exposure or prematurity.ConclusionHIV-infection may increase the risk of RSV illness among pregnant women. Future maternal RSV vaccines may have added benefit in high HIV prevalence areas.

AbstractDirect acting antiviral therapies rapidly clear chronic hepatitis C virus (HCV) infection and restore natural killer (NK) cell function. We investigated NK cell memory formation following HCV clearance by examining NK cell phenotype and responses from control and chronic HCV patients before and after therapy following sustained virologic response at 12 weeks post-therapy (SVR12). NK cell phenotype at SVR12 differed significantly from paired pre-treatment samples, with an increase in maturation markers CD16, CD57 and KLRG1. HCV patients possessed stronger cytotoxic responses against HCV infected cells as compared to healthy controls; a response that further increased following SVR12. The antigen-specific response was mediated by KLRG1+ NK cells, as demonstrated by increased degranulation and proliferation in response to HCV antigen only. Our data suggest that KLRG1+ HCV-specific memory NK cells develop following viral infection, providing insight into their role in HCV clearance and relevance with regard to vaccine design.

Infective endocarditis (IE) is a severe infectious disease with a high long-term mortality, up to 33% at 4 years (Martínez-Sellés et al., 2008). Its annual incidence was estimated at 33.8 per million inhabitants in France (Selton-Suty et al., 2012). Acute kidney injury (AKI) is a common complication of IE, which was recently estimated to occur in 39.8% of cases (Ritchie et al., 2017).

According to data from the global burden of disease study, hearing loss is currently the second leading cause of years lived with a disability. Approximately 1.4 billion people, or 18.7% of the world’s population are currently living with hearing loss (James et al. 2018; Graydon et al. 2019). This burden is unequally distributed, with over 80% of affected individuals residing in low- and middle-income countries where access to specialty care is often limited (Fagan and Jacobs 2009; Graydon et al.

Coronavirus disease 2019 (COVID-19) was first reported in Wuhan (China) in December 2019 and has since caused numerous fatalities and economic losses worldwide, (Nicola et al., 2020). The mortality rate of COVID-19 varies significantly by country, race, and socioeconomic status (Aldridge et al., 2020). The differences are believed to be caused by a variety of factors, including ethnicity, medical systems, and age structure. Factors such as poor socioeconomic status or weak immunity appear to increase vulnerability to COVID-19 (Grant et al., 2020).

Infectious diseases, such as diphtheria, pertussis, tetanus, Haemophilus influenzae type B, and poliomyelitis (polio), are seriously harmful to children's health. Vaccination is the most effective way to control these diseases. In 2010, the State Food and Drug Administration approved the DTaP-IPV/Hib combination vaccine (from now on referred to as the pentavalent vaccine) for cell-free pertussis (DTaP), inactivated poliomyelitis and Haemophilus influenzae type B (combination), and children started to be vaccinated with this pentavalent vaccine on May 11, 2011, in China.

Abstract Purpose Cardiac involvement in dengue fever is underdiagnosed due to low index of clinical suspicion and its contribution to hemodynamic instability in severe dengue is not well known. Methods A prospective observational study was conducted among admitted patients ≥ 14 years of age having confirmed dengue fever. Patients on medications affecting heart rhythm/rate, pre-existing heart disease and electrolyte abnormalities were excluded. A baseline electrocardiography (ECG), Trop-I and NT-proBNP were done for all patients. The biomarkers were measured using enzyme-linked fluorescent assay and recommended cut-off were used. Patients with elevated biomarkers underwent 2-dimensional echocardiography. Diagnosis of myocarditis was as per European Society of Cardiology (ESC) 2013 criteria. Results A total of 182 patients were recruited with mean age of 30 ± 12.6 years and 31% were females. Dengue with warning signs was present in 85 (47%) and severe dengue in 60 (33%) patients. ECG abnormalities were observed in 44 (24%) patients, biomarkers were elevated in 27 (15%) patients and 11 (6%) patients had echocardiographic abnormalities. According to ESC 2013 criteria, dengue fever with myocarditis was diagnosed in 13 [7.1% (95% CI 3.4–10.9)] patients. The patients with myocarditis were more likely to have shortness of breath, bleeding manifestations and higher respiratory rate at baseline. Clinical features of fluid overload were more common (69% vs. 1.7%, p 

ABSTRACTBackgroundThe natural history of non-central nervous system (CNS) disseminated coccidioidomycosis (DCM) has not been previously characterized. The historical VA-Armed Forces coccidioidomycosis patient group provides a unique cohort of patients not treated with standard antifungal therapy allowing for characterization of the natural history of coccidioidomycosis.MethodsWe conducted a retrospective study of 531 VA-Armed Forces coccidioidomycosis patients diagnosed between 1955-1958 and followed to 1966. Groups were identified as non-disseminated coccidioidomycosis (non-DCM, 462 patients), DCM (44 patients), and CNS (25 patients). The duration of initial infection, fate of primary infection, all-cause mortality and mortality secondary to coccidioidomycosis were assessed and compared between groups.ResultsMortality due to coccidioidomycosis at last known follow up was significantly different across the groups: 0.65% in non-DCM, 25% in DCM, and 88% in CNS (P

AbstractHIV transmission is increased during acute and early HIV (AEH). Rapid antiretroviral therapy may shorten the duration of infectivity. We show rapid antiretroviral therapy in AEH is acceptable and effective, with 69.0% of participants starting ART within 7 days of HIV diagnosis disclosure and 88.1% achieving suppression by 48 weeks.

AbstractBackgroundOne underexplored driver of inappropriate antibiotic prescribing for acute respiratory illnesses (ARI) is patients’ prior care experiences. When patients receive antibiotics for an ARI, patients may attribute their clinical improvement to the antibiotics, regardless of their true benefit. These experiences, and experiences of family members, may drive whether patients seek care or request antibiotics when they have subsequent ARIs.MethodsUsing encounter data from a national United States insurer, we identified patients

AbstractBackgroundSalmonella Enteritidis and Salmonella Typhimurium are major causes of bloodstream infection and diarrheal disease in East Africa. Sources of human infection, including the role of the meat pathway, are poorly understood.MethodsWe collected cattle, goat, and poultry meat pathway samples from December 2015 through August 2017 in Tanzania and isolated Salmonella using standard methods. Meat pathway isolates were compared with nontyphoidal Salmonella (NTS) isolated from persons with bloodstream infection and diarrheal disease from 2007 through 2017 from Kenya by core genome multi-locus sequence typing (cgMLST). Isolates were characterized for antimicrobial resistance, virulence genes, and diversity.ResultsWe isolated NTS from 164 meat pathway samples. Of 172 human NTS isolates, 90 (52.3%) from stool and 82 (47.7%) from blood, 53 (30.8%) were Salmonella Enteritidis ST11 and 62 (36.0%) Salmonella Typhimurium ST313. We identified cgMLST clusters within Salmonella Enteritidis ST11, Salmonella Heidelberg ST15, Salmonella Typhimurium ST 19, and Salmonella II 42:r:- ST1208 that included both human and meat pathway isolates. Salmonella Typhimurium ST313 was isolated exclusively from human samples. Human and poultry isolates bore more antimicrobial resistance and virulence genes and were less diverse than isolates from other sources.ConclusionsOur findings suggest that the meat pathway may be an important source of human infection by some clades of Salmonella Enteritidis ST11 in East Africa, but not of human Salmonella Typhimurium ST313 infection. Research is needed to systematically examine the contribution of other types of meat, animal products, produce, water, and environmental exposures to nontyphoidal Salmonella disease in East Africa.

Humans are protected from most African trypanosomes via high-density lipoproteins, known as trypanosome lytic factor (TLF). In humans, IgM antibodies are found associated with TLF. The recent work by Verdi et al. studied the origin of these antibodies and their binding partners, suggesting a new model for TLF uptake.

Abstract Background Extracellular vesicles (EVs) have been broadly studied in malaria for nearly a decade. These vesicles carry various functional biomolecules including RNA families such as microRNAs (miRNA). These EVs-derived microRNAs have numerous roles in host-parasite interactions and are considered promising biomarkers for disease severity. However, this field lacks clinical studies of malaria-infected samples. In this study, EV specific miRNAs were isolated from the plasma of patients from Thailand infected with Plasmodium vivax and Plasmodium falciparum. In addition, it is postulated that these miRNAs were differentially expressed in these groups of patients and had a role in disease onset through the regulation of specific target genes. Methods EVs were purified from the plasma of Thai P. vivax-infected patients (n = 19), P. falciparum-infected patients (n = 18) and uninfected individuals (n = 20). EV-derived miRNAs were then prepared and abundance of hsa-miR-15b-5p, hsa-miR-16-5p, hsa-let-7a-5p and hsa-miR-150-5p was assessed in these samples. Quantitative polymerase chain reaction was performed, and relative expression of each miRNA was calculated using hsa-miR-451a as endogenous control. Then, the targets of up-regulated miRNAs and relevant pathways were predicted by using bioinformatics. Receiver Operating Characteristic with Area under the Curve (AUC) was then calculated to assess their diagnostic potential. Results The relative expression of hsa-miR-150-5p and hsa-miR-15b-5p was higher in P. vivax-infected patients compared to uninfected individuals, but hsa-let-7a-5p was up-regulated in both P. vivax-infected patients and P. falciparum-infected patients. Bioinformatic analysis revealed that these miRNAs might regulate genes involved in the malaria pathway including the adherens junction and the transforming growth factor-β pathways. All up-regulated miRNAs could potentially be used as disease biomarkers as determined by AUC; however, the sensitivity and specificity require further investigation. Conclusion An upregulation of hsa-miR-150-5p and hsa-miR-15b-5p was observed in P. vivax-infected patients while hsa-let-7a-5p was up-regulated in both P. vivax-infected and P. falciparum-infected patients. These findings will require further validation in larger cohort groups of malaria patients to fully understand the contribution of these EVs miRNAs to malaria detection and biology.…

The US Centers for Disease Control and Prevention (CDC) has listed dental care-related aerosols or droplets as high risk on the basis of presumed equivalence of these aerosols to those that might occur during medical procedures.1 In the dental setting, risk of transmission might be related primarily to treatment of asymptomatic and minimally symptomatic patients.2…

The disjointed public health response to the COVID-19 pandemic has demonstrated one clear truth: the value of timely, publicly available data. The John Hopkins University (JHU) Center for Systems Science and Engineering's COVID-19 dashboard1 exists to provide this information. What grew from a modest effort to track a novel cause of pneumonia in China quickly became a mainstay symbol of the pandemic, receiving over 1 billion hits per day within weeks of its creation, primarily driven by the general public seeking information on the emerging health crisis.

Clinical outcomeConvalescent plasma therapyCoronavirus disease 2019 (COVID-19)…