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Sharaf RN, Diamond LC.
In this narrative medicine essay, two physicians write to their gravely ill 4-year-old daughter promising to try and remain hopeful despite their inability to protect her.
Actinomyces spp. cause several well-described syndromes including cervicofacial and pelvic infections. Actinomyces spp. infection as an opportunistic infection among people who inject drugs has rarely been described with few case reports published.
Methods and results
Here we describe four people who inject drugs admitted with Actinomyces spp. infections, all with an overlapping syndrome and who presented a challenge to both diagnose and to manage.
This case series highlights the potential to overlook Actinomyces spp. infection in people who inject drugs and aims to increase clinician awareness of diagnosis, empirical and directed treatment, and potential complications of this infection.
Genetic mutations that reduce intracellular superoxide production by granulocytes causes chronic granulomatous disease (CGD). These patients suffer from frequent and severe bacterial and fungal infections throughout their early life. Diagnosis is usually made in the first 2Â years of life but is sometimes only diagnosed when the patient is an adult although they may have suffered from symptoms since childhood.
A 26-year-old man was referred with weight loss, fever, hepatosplenomegaly and coughing. He had previously been diagnosed with lymphadenopathy in the neck at age 8 and prescribed anti-tuberculosis treatment. A chest radiograph revealed extensive right-sided consolidation along with smaller foci of consolidation in the left lung. On admission to hospital he had respiratory problems with fever. Laboratory investigations including dihydrorhodamine-123 (DHR) tests and mutational analysis indicated CGD. Stimulation of his isolated peripheral blood neutrophils (PMN) with phorbol 12-myristate 13-acetate (PMA) produced low, subnormal levels of reactive oxygen species (ROS). Aspergillus terreus was isolated from bronchoalveolar lavage (BAL) fluid and sequenced.
We describe, for the first time, the presence of pulmonary A. terreus infection in an adult autosomal CGD patient on long-term corticosteroid treatment. The combination of the molecular characterization of the inherited CGD and the sequencing of fungal DNA has allowed the identification of the disease-causing agent and the optimal treatment to be given as a consequence.
Plasmodium vivax is the predominant malaria species in northern Mauritania. Molecular data on P. vivax isolates circulating in West Africa are scarce. The present study analysed molecular markers associated with resistance to antifolates (Pvdhfr and Pvdhps), chloroquine (Pvmdr1), and artemisinin (Pvk12) in P. vivax isolates collected in two cities located in the Saharan zone of Mauritania.
Blood samples were obtained from P. vivax-infected patients recruited for chloroquine therapeutic efficacy study in 2013 and febrile patients spontaneously consulting health facilities in Nouakchott and Atar in 2015â€“2016. Fragments of Pvdhfr (codons 13, 33, 57, 58, 61, 117, and 174), Pvdhps (codons 382, 383, 512, 553, and 585), Pvmdr1 (codons 976 and 1076) and Pvk12 (codon 552) genes were amplified by PCR and sequenced.
Most of the isolates in Nouakchott (126/154, 81.8%) and Atar (44/45, 97.8%) carried the wild-type Pvdhfr allelic variant (IPFSTSI). In Nouakchott, all mutants (28/154; 18.2%) had double Pvdhfr mutations in positions 58 and 61 (allelic variant IPFRMSI), whereas in Atar only 1 isolate was mutant (S117N, allelic variant IPFSTNI). The wild-type Pvdhps allelic variant (SAKAV) was found in all tested isolates (Nouakchott, nâ€‰=â€‰93; Atar, nâ€‰=â€‰37). Few isolates in Nouakchott (5/115, 4.3%) and Atar (3/79, 3.8%) had the mutant Pvmdr1 allele 976F or 1076L, but not both, including in pre-treatment isolates obtained from patients treated successfully with chloroquine. All isolates (59 in Nouakchott and 48 in Atar) carried the wild-type V552 allele in Pvk12.
Polymorphisms in Pvdhfr, Pvdhps, Pvmdr1, and Pvk12 were limited in P. vivax isolates collected recently in Nouakchott and Atar. Compared to the isolates collected in Nouakchott in 2007â€“2009, there was no evidence for selection of mutants. The presence of one, but not both, of the two potential markers of chloroquine resistance in Pvmdr1 in pre-treatment isolates did not influence the clinical outcome, putting into question the role of Pvmdr1 mutant alleles 976F and 1076L in treatment failure. Molecular surveillance is an important component of P. vivax malaria control programme in the Saharan zone of Mauritania to predict possible emergence of drug-resistant parasites.
High blood pressure poses a major public health problem worldwide, including in the United States. Today, an estimated 1.13 billion people worldwide have hypertension (at the cut points of either â‰¥140 mm Hg for systolic or â‰¥90 mm Hg for diastolic blood pressure). The prevalence of hypertension has been forecast to escalate to about 1.56 billion people by 2025. These statistics provoke major concern because numerous observational studies have demonstrated a continuous and graded relationship of systolic and diastolic blood pressure with the risk of cardiovascular disease (CVD) and chronic kidney disease. The vascular risk starts at measures as low as 115 mm Hg for systolic and 75 mm Hg for diastolic blood pressure, which are considered optimal levels, and is consistent across sexes, age groups, race/ethnic categories, and countries. It is estimated that about half the risk of CVD that is associated with suboptimal systolic blood pressure is attributable to values in the 130 to 150 mm Hg range.
Deltamethrin-impregnated, long-lasting insecticidal nets (LLINs) were distributed in the study area from November 2014 to January 2015 to evaluate their impact on malaria transmission in the presence of insecticide-resistant vectors. Studies were carried out in 16 selected clusters in Keshkal sub-district, Chhattisgarh State, India to monitor and characterize deltamethrin resistance in Anopheles culicifacies sensu lato.
Deltamethrin susceptibility of An. culicifacies decreased in a post-LLIN survey compared to a pre-LLIN survey and was not significant (pâ€‰>â€‰0.05) while, the knockdown values showed significant increase (pâ€‰
Whelton PK, Williams B.
This Viewpoint compares and contrasts recommendations in the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) and 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guidelines, focusing on definitions of high BP, treatment targets, and BP management for CKD and at older ages.
Anita W. M. Suijkerbuijk, Albert Jan van Hoek, Jelle Koopsen, Robert A. de Man, Marie-Josee J. Mangen, Hester E. de Melker, Johan J. Polder, G. Ardine de Wit, Irene K. Veldhuijzen
by Anita W. M. Suijkerbuijk, Albert Jan van Hoek, Jelle Koopsen, Robert A. de Man, Marie-Josee J. Mangen, Hester E. de Melker, Johan J. Polder, G. Ardine de Wit, Irene K. Veldhuijzen
Background Chronic infection with hepatitis B or C virus (HBV/HCV) can progress to cirrhosis, liver cancer, and even death. In a low endemic country as the Netherlands, migrants are a key risk group and could benefit from early diagnosis and antiviral treatment. We assessed the cost-effectiveness of screening foreign-born migrants for chronic HBV and/or HCV using a societal perspective. Methods The cost-effectiveness was evaluated using a Markov model. Estimates on prevalence, screening programme costs, participation and treatment uptake, transition probabilities, healthcare costs, productivity losses and utilities were derived from the literature. The cost per Quality Adjusted Life Year (QALY) gained was estimated and sensitivity analyses were performed. Results For most migrant groups with an expected high number of chronically infected cases in the Netherlands combined screening is cost-effective, with incremental cost-effectiveness ratios (ICERs) ranging from â‚¬4,962/QALY gained for migrants originating from the Former Soviet Union and Vietnam to â‚¬9,375/QALY gained for Polish migrants. HBV and HCV screening proved to be cost-effective for migrants from countries with chronic HBV or HCV prevalence of â‰¥0.41% and â‰¥0.22%, with ICERs below the Dutch cost-effectiveness reference value of â‚¬20,000/QALY gained. Sensitivity analysis showed that treatment costs influenced the ICER for both infections. Conclusions For most migrant populations in a low-endemic country offering combined HBV and HCV screening is cost-effective. Implementation of targeted HBV and HCV screening programmes to increase early diagnosis and treatment is important to reduce the burden of chronic hepatitis B and C among migrants.
Guo, A., Wang, Y., Chen, B., Wang, Y., Yuan, J., Zhang, L., Hall, D., Wu, J., Shi, Y., Zhu, Q., Chen, C., Thiel, W. H., Zhan, X., Weiss, R. M., Zhan, F., Musselman, C. A., Pufall, M., Zhu, W., Au, K. F., Hong, J., Anderson, M. E., Grueter, C. E., Song, L.-S.
Junctophilin-2 (JP2) is a structural protein required for normal excitation-contraction (E-C) coupling. Following cardiac stress, JP2 is cleaved by Ca2+-dependent protease calpain, which disrupts the E-C coupling ultrastructural machinery and drives heart failure progression. Here we demonstrate that stress-induced proteolysis of JP2 liberates an N-terminal fragment (JP2NT) that translocates to the nucleus, binds to genomic DNA and controls expression of a spectrum of genes in cardiomyocytes. Transgenic overexpression of JP2NT in mice modifies the transcriptional profile resulting in attenuated pathological remodeling in response to cardiac stress. Conversely, loss of JP2NT function accelerates stress-induced development of hypertrophy and heart failure in mutant mice. These data reveal a self-protective mechanism in failing cardiomyocytes that transduce mechanical information (E-C uncoupling) into salutary transcriptional reprogramming in the stressed heart.
Moreno-Mayar, J. V., Vinner, L., de Barros Damgaard, P., de la Fuente, C., Chan, J., Spence, J. P., Allentoft, M. E., Vimala, T., Racimo, F., Pinotti, T., Rasmussen, S., Margaryan, A., Iraeta Orbegozo, M., Mylopotamitaki, D., Wooller, M., Bataille, C., Becerra-Valdivia, L., Chivall, D., Comeskey, D., Deviese, T., Grayson, D. K., George, L., Harry, H., Alexandersen, V., Primeau, C., Erlandson, J., Rodrigues-Carvalho, C., Reis, S., Bastos, M. Q. R., Cybulski, J., Vullo, C., Morello, F., Vilar, M., Wells, S.,
Studies of the peopling of the Americas have focused on the timing and number of initial migrations. Less attention has been paid to the subsequent spread of people within the Americas. We sequenced 15 ancient human genomes spanning Alaska to Patagonia; six are â‰¥10,000 years old (up to ~18x coverage). All are most closely related to Native Americans, including an Ancient Beringian individual, and two morphologically distinct "Paleoamericans." We find evidence of rapid dispersal and early diversification, including previously unknown groups, as people moved south. This resulted in multiple independent, geographically uneven migrations, including one that provides clues of a Late Pleistocene Australasian genetic signal, and a later Mesoamerican-related expansion. These led to complex and dynamic population histories from North to South America.
Kim, J.-M., Seok, O.-H., Ju, S., Heo, J.-E., Yeom, J., Kim, D.-S., Yoo, J.-Y., Varshavsky, A., Lee, C., Hwang, C.-S.
In bacteria, nascent proteins bear the pretranslationally generated N-terminal (Nt) formyl-methionine (fMet) residue. Nt-fMet of bacterial proteins is a degradation signal, termed fMet/N-degron. In contrast, proteins synthesized by cytosolic ribosomes of eukaryotes were presumed to bear unformylated Nt-Met. Here we found that the yeast formyltransferase Fmt1, although imported into mitochondria, could also produce Nt-formylated proteins in the cytosol. Nt-formylated proteins were strongly up-regulated in stationary phase or upon starvation for specific amino acids. This up-regulation strictly required the Gcn2 kinase, which phosphorylates Fmt1 and mediates its retention in the cytosol. We also found that the Nt-fMet residues of Nt-formylated proteins act as fMet/N-degrons, and identified the Psh1 ubiquitin ligase as the recognition component of this eukaryotic fMet/N-end rule pathway, which destroys Nt-formylated proteins.
The incidence of malaria in the Americas has decreased markedly in recent years. Honduras and the other countries of Mesoamerica and the island of Hispaniola have set the goal of eliminating native malaria by the year 2020. To achieve this goal, Honduras has recently approved national regulations to expand the possibilities of a shortened double dose primaquine (PQ) treatment for vivax malaria. Considering this new shortened anti-malarial treatment, the high frequency of G6PDd genotypes in Honduras, and the lack of routinely assessment of the G6PD deficiency status, this study aimed at investigating the potential association between the intake of PQ and haemolysis in malaria-infected G6PDd subjects.
This was a prospective cohort and open-label study. Participants with malaria were recruited. Plasmodium vivax infection was treated with 0.25Â mg/kg of PQ daily for 14Â days. Safety and signs of haemolysis were evaluated by clinical criteria and laboratory values before and during the 3rd and 7th day of PQ treatment. G6PD status was assessed by a rapid test (CareStartâ„¢) and two molecular approaches.
Overall 55 participants were enrolled. The frequency of G6PD deficient genotypes was 7/55 (12.7%), where 5/7 (71.4%) were hemizygous Aâˆ’â€‰males and 2/7 (28.6%) heterozygous Aâˆ’â€‰females. Haemoglobin concentrations were compared between G6PD wild type (B) and G6PDd Aâˆ’â€‰subjects, showing a significant difference between the means of both groups in the 3rd and 7th days. Furthermore, a statistically significant difference was evident in the change in haemoglobin concentration between the 3rd day and the 1st day for both genotypes, but there was no statistical difference for the change in haemoglobin concentration between the 7th day and the 1st day. Besides these changes in the haemoglobin concentrations, none of the patients showed signs or symptoms associated with severe haemolysis, and none needed to be admitted to a hospital for further medical attention.
The findings support that the intake of PQ during 14Â days of treatment against vivax malaria is safe in patients with a class III variant of G6PDd. In view of the new national regulations in the shortened treatment of vivax malaria for 7Â days, it is advisable to be alert of potential cases of severe haemolysis that could occur among G6PD deficient hemizygous males with a class II mutation such as the Santamaria variant, previously reported in the country.
Hwang KO, Thomas EJ, Petersen LA.
This Viewpoint argues for incorporating home blood pressure monitoring measures in primary care pay-for-performance (P4P) quality reporting.
Qamar A, Braunwald E.
In this Viewpoint, Eugene Braunwald and coauthor characterize the global prevalence of hypertension as an epidemic and call for collaborative efforts on the part of physicians, other health professionals, and governmental and nongovernmental agencies to develop innovative strategies to manage it, including screening and intervention in nontraditional settings such as barbershops and grocery stores.
Fisher NL, Curfman G.
This issue of JAMA, from illustrated cover to in-depth content, is dedicated to hypertension, a worldwide problem of enormous consequence. High blood pressure affects more than 1 billion people worldwide, and that number is increasing. Untreated or uncontrolled, hypertension is the single largest contributor to cardiovascular disease, causing stroke, heart failure, coronary artery disease, and kidney disease, and also is a major contributor to kidney disease. Progress over the last several decades has led to increased understanding of the relationship between blood pressure and health outcomes and to the development of multiple antihypertensive therapies that reduce the risk. New knowledge carries with it a mandate to address the growing global epidemic of hypertension.
Elise Arrive, Jean-Paul Viard, BenoÃ®t Salanave, Catherine Dollfus, Sophie Matheron, VÃ©ronique Reliquet, Elisa Arezes, Laura Nailler, Corinne Vigouroux, Josiane Warszawski, on behalf of the ANRS CO19 COVERTE and ENNS study groups
by Elise Arrive, Jean-Paul Viard, BenoÃ®t Salanave, Catherine Dollfus, Sophie Matheron, VÃ©ronique Reliquet, Elisa Arezes, Laura Nailler, Corinne Vigouroux, Josiane Warszawski, on behalf of the ANRS CO19 COVERTE and ENNS study groups
Aim Metabolic risk factors are poorly documented for the first generation of young adults who have lived with HIV since childhood. We compared their metabolic profile with that of adults of same age from the general population. Methods We conducted a cross-sectional analysis of data from two populations: (1) COVERTE (ANRS-CO19), a French national cohort of 18 to 30-year-old patients HIV-infected since childhood, and (2) ENNS, a national cross-sectional population-based household survey on nutrition. Body mass index (BMI), blood pressure, waist circumference, fasting glucose, triglycerides, and HDL-, LDL- and total cholesterol were measured in both studies. Direct standardization on overweight and education level and logistic regression were used to compare the prevalence of metabolic abnormalities between the two populations. Results Data from 268 patients from COVERTE and 245 subjects from ENNS were analyzed. Tobacco use was similar in both groups. HIV-infected patients had increased mean waist-to-hip ratio and triglycerides to HDL-cholesterol ratio and decreased mean HDL-cholesterol as compared to their counterparts from the general population in both genders. In HIV-infected patients, metabolic syndrome was identified in 13.2% of men (95% confidence interval [CI]: 7.1â€“19.2) and 10.4% (95% CI: 5.4â€“15.3) of women versus 10.6% (95%CI: 1.5â€“19.7) and 1.7% (95%CI: 0â€“4.1) in subjects from the general population, respectively. Conclusion Young adults infected with HIV since childhood had a higher prevalence of dyslipidemia and metabolically detrimental fat distribution than adults of same age of the general population, supporting close monitoring for cardiometabolic diseases.
Adriana Gielbert, Jemma K. Thorne, Jane M. Plater, Leigh Thorne, Peter C. Griffiths, Marion M. Simmons, Claire A. Cassar
by Adriana Gielbert, Jemma K. Thorne, Jane M. Plater, Leigh Thorne, Peter C. Griffiths, Marion M. Simmons, Claire A. Cassar
The prion hypothesis proposes a causal relationship between the misfolded prion protein (PrPSc) molecular entity and the disease transmissible spongiform encephalopathy (TSE). Variations in the conformation of PrPSc are associated with different forms of TSE and different risks to animal and human health. Since the discovery of atypical forms of bovine spongiform encephalopathy (BSE) in 2003, scientists have progressed the molecular characterisation of the associated PrPSc in order to better understand these risks, both in cattle as the natural host and following experimental transmission to other species. Here we report the development of a mass spectrometry based assay for molecular characterisation of bovine proteinase K (PK) treated PrPSc (PrPres) by quantitative identification of its N-terminal amino acid profiles (N-TAAPs) and tryptic peptides. We have applied the assay to classical, H-type and L-type BSE prions purified from cattle, transgenic (Tg) mice expressing the bovine (Tg110 and Tg1896) or ovine (TgEM16) prion protein gene, and sheep brain. We determined that, for classical BSE in cattle, the G96 N-terminal cleavage site dominated, while the range of cleavage sites was wider following transmission to Tg mice and sheep. For L-BSE in cattle and Tg bovinised mice, a C-terminal shift was identified in the N-TAAP distribution compared to classical BSE, consistent with observations by Western blot (WB). For L-BSE transmitted to sheep, both N-TAAP and tryptic peptide profiles were found to be changed compared to cattle, but less so following transmission to Tg ovinised mice. Relative abundances of aglycosyl peptides were found to be significantly different between the atypical BSE forms in cattle as well as in other hosts. The enhanced resolution provided by molecular analysis of PrPres using mass spectrometry has improved insight into the molecular changes following transmission of atypical BSE to other species.
Nicholas T. K. D. Dayie, Georgina Tetteh-Ocloo, Appiah-Korang Labi, Edeghonghon Olayemi, Hans-Christian Slotved, Margaret Lartey, Eric S. Donkor
by Nicholas T. K. D. Dayie, Georgina Tetteh-Ocloo, Appiah-Korang Labi, Edeghonghon Olayemi, Hans-Christian Slotved, Margaret Lartey, Eric S. Donkor
Background Pneumococcal carriage is the precursor for development of pneumococcal disease, and is also responsible for transmission of the organism from person-to-person. Individuals with Sickle Cell Disease (SCD) are more likely to develop invasive disease with S. pneumoniae compared to their healthy counterparts and the presentation of disease in the former is usually abrupt and severe. In Africa, little is known about the pneumococcus in relation to people with SCD Sickle Cell Disease (SCD). The aim of the study was to investigate the epidemiology of pneumococcal carriage among SCD patients including the carriage prevalence, risk factors, serotypes and antibiotic resistance. Method This was a cross sectional study involving 402 SCD patients recruited from Korle Bu Teaching Hospital and Princess Marie Louis Hospital in Accra from October 2016 to March 2017. The study subjects included 202 children of the age groups: â‰¤5 years (94), >5â€“9 years (75), â‰¥10â€“13 years (33) and 200 adults of the age groups: 14â€“20 years (46), 21â€“40 years (112), 41â€“60 years (25), â‰¤ 61 years (17). Nasopharyngeal (NP) swabs were collected from the study participants as well as epidemiological data on demographic, household and clinical features. The NP specimens were cultured for S. pneumoniae and the isolates were serotyped by latex agglutination. Antimicrobial susceptibility tests of the isolates were done by the disc diffusion test and E-test. Results Prevalence of S. pneumoniae carriage among children and adult SCD patients enrolled in the study were 79/202 (39.1%; 95% CI: 32.3 to 46.2) and 20/200 (10.0%; 95% CI: 6.2 to 15.0) respectively. Risk factors associated with pneumococcal carriage were age (OR = 1.137; 95% CI: 1.036â€“1.248; p = 0.007) and runny nose (OR = 5.371; 95% CI: 1.760â€“16.390; p = 0.003). Overall, twenty-six pneumococcal serotypes were isolated from the study participants and the predominant serotype was 6B (10.6%), followed by 23B (8.2%). Among the children, serotype coverage of the 13-valent Pneumococcal Conjugate Vaccine, which is currently used in Ghana was 32.4%. Prevalence of penicillin resistance among the pneumococcal isolates was 37.4% (37/99) and all the penicillin-resistant isolates exhibited intermediate penicillin resistance with the exception of one isolate that showed full resistance and was susceptible to ceftriaxone. Prevalence of resistance to the other antibiotics ranged from 2.5% (levofloxacin) to 85% (cotrimoxazole). Multidrug resistance occurred among 34.3% (34/99) of the pneumococcal isolates. Conclusion Pneumococcal carriage was four-fold higher in SCD children than adults and was characterized by predominance of non-vaccine serotypes and considerable level of multidrug resistance, though penicillin, cefotaxime and levofloxacin resistance appeared to be very low.
Fraiberger, S. P., Sinatra, R., Resch, M., Riedl, C., Barabasi, A.-L.
In areas of human activity where performance is difficult to quantify in an objective fashion, reputation and networks of influence play a key role in determining access to resources and rewards. To understand the role of these factors, we reconstructed the exhibition history of half a million artists, mapping out the coexhibition network that captures the movement of art between institutions. Centrality within this network captured institutional prestige, allowing us to explore the career trajectory of individual artists in terms of access to coveted institutions. Early access to prestigious central institutions offered life-long access to high-prestige venues and reduced dropout rate. By contrast, starting at the network periphery resulted in a high dropout rate, limiting access to central institutions. A Markov model predicts the career trajectory of individual artists and documents the strong path and history dependence of valuation in art.
Martin, H. C., Jones, W. D., McIntyre, R., Sanchez-Andrade, G., Sanderson, M., Stephenson, J. D., Jones, C. P., Handsaker, J., Gallone, G., Bruntraeger, M., McRae, J. F., Prigmore, E., Short, P., Niemi, M., Kaplanis, J., Radford, E. J., Akawi, N., Balasubramanian, M., Dean, J., Horton, R., Hulbert, A., Johnson, D. S., Johnson, K., Kumar, D., Lynch, S. A., Mehta, S. G., Morton, J., Parker, M. J., Splitt, M., Turnpenny, P. D., Vasudevan, P. C., Wright, M., Bassett, A., Gerety, S. S., Wright, C. F., FitzPatric
We estimated the genome-wide contribution of recessive coding variation from 6,040 families from the Deciphering Developmental Disorders study. The proportion of cases attributable to recessive coding variants was 3.6% in patients of European ancestry, compared to 50% explained by de novo coding mutations. It was higher (31%) in patients with Pakistani ancestry, due to elevated autozygosity. Half of this recessive burden is attributable to known genes. We identified two genes not previously associated with recessive developmental disorders, KDM5B and EIF3F, and functionally validated them with mouse and cellular models. Our results suggest that recessive coding variants account for a small fraction of currently undiagnosed non-consanguineous individuals, and that the role of noncoding variants, incomplete penetrance, and polygenic mechanisms need further exploration.
Î‘ngeliki Stefopoulou, George Balatsos, Angeliki Petraki, Shannon L. LaDeau, Dimitrios Papachristos, Î‘ntonios Michaelakis
by Î‘ngeliki Stefopoulou, George Balatsos, Angeliki Petraki, Shannon L. LaDeau, Dimitrios Papachristos, Î‘ntonios Michaelakis
Aedes albopictus tends to proliferate in small, often man-made bodies of water, largely present in urban private areas. For this reason, education and community participation are considered crucial for source reduction and mosquito control. In the current study, we identify mosquito breeding habitat and evaluate the effectiveness of resident education. Since 2010 several outbreaks of West Nile virus infection occurred in Greece however urban population has no previous experience with mosquitoâ€“borne disease related to Aedes species, such as Dengue, Zika and Chikungunya. After the introduction of Ae. albopictus in Greece, urban areas have been considered to be at risk of epidemic arboviral outbreaks and identifying effective control strategies is imperative. Our study examines the relationship between mosquito breeding sources and socioeconomic or demographic characteristics of different households in a Greek municipality and evaluates efficacy of resident education. The results revealed that only a minority of residents knew where mosquitoes breed (18.6%) and only 46% felt that residents had any responsibility for managing breeding habitat. Our findings strongly suggest that only the presence of scientific staff inspecting possible habitats in their properties, could be enough to stimulate practices towards source reduction. However, educational interventions alone with printed education material cannot enhance significant community participation and source reduction.
Fatima Mukhtar, Zahid A. Butt
by Fatima Mukhtar, Zahid A. Butt
Purpose The escalating burden of diabetes in countries tackling high burden of tuberculosis (TB) has adverse implications for co-infected individuals and National TB control efforts. We aimed to study whether there was a difference in treatment outcome among diabetic and non-diabetic pulmonary TB patients and identify the determinants of treatment outcome among the two groups. Materials and methods This prospective cohort study recruited new patients of pulmonary tuberculosis (PTB) aged 15 years and above who were diagnosed at and registered with Gulab Devi Chest Hospital, Lahore, Pakistan for anti-tuberculosis treatment (ATT). PTB patients were screened for diabetes using random and fasting blood glucose tests. Diabetic and non-diabetic PTB patients were followed up at second, fifth and sixth month of ATT and 6 months after ATT completion to determine treatment outcome. Multivariate logistic regression analysis was conducted to assess association between various factors and treatment outcome. Results Of 614 PTB patients, (n = 113 [18%]) were diabetic and (n = 501 [82%]) non-diabetic. Final model showed that diabetics were more likely to experience an unfavorable outcome as compared to non-diabetics (adjusted odds ratio [aOR] = 2.70, 95% Confidence Interval [CI] = 1.30 to 5.59). Other predictors of unfavorable outcome included rural residence (aOR = 1.98, 95% CI = 1.14 to 3.47), body mass index less than 18.50 (aOR = 1.89, 95% CI = 1.03 to 3.47) and being a smoker (aOR = 2.03, 95%CI = 1.04 to 3.94). Conclusion Our study shows unfavorable treatment outcome among diabetic PTB patients. Integrated models of care with screening/testing and management for diabetes and TB could improve TB treatment outcomes.
Venkatraman N, Ndiaye B, Bowyer G, et al.
AbstractBackgroundThe 2014 West African outbreak of Ebola virus disease highlighted the urgent need to develop an effective Ebola vaccine.MethodsWe undertook two Phase I studies assessing safety and immunogenicity of the viral vector MVA-EBO-Z, manufactured rapidly on a new duck cell line either alone or in a heterologous prime-boost regimen with ChAd3-EBO-Z followed by MVA-EBO-Z. Adult volunteers in the UK (n = 38) and Senegal (n=40) were vaccinated and an accelerated one week prime-boost regimen was assessed in Senegal. Safety was assessed by active and passive collection of local and systemic adverse events.ResultsThe standard and accelerated heterologous prime-boost regimes were well-tolerated and elicited potent cellular and humoral immunogenicity in the UK and Senegal, but vaccine-induced antibody responses were significantly lower in Senegal. Cellular immune responses measured by flow cytometry were significantly greater in African vaccinees receiving ChAd3 and MVA vaccines in the same rather than the contralateral limb.ConclusionsMVA biomanufactured on an immortalised duck cell line shows potential for very large-scale manufacturing with lower cost of goods. This first trial of MVA-EBO-Z in humans encourages further testing in Phase II studies with the one week prime-boost interval regimen appearing particularly suitable for outbreak control.
Julie A. Womack, Gina Novick, Terri Fried
by Julie A. Womack, Gina Novick, Terri Fried
Falls are an important concern for individuals living with HIV (HIV+). The purpose of this study was to understand perceptions of HIV+ individuals who had fallen regarding what caused their falls, prevention strategies that they used, and the impact of falls on their lives. Qualitative Description was the approach best suited to our study. We conducted in-depth interviews with 21 HIV+ individuals aged 47 to 71 years who had fallen within the past two years and who received care in a primary care/HIV clinic. Participants identified causes of falls as intrinsic (HIV, opportunistic infections, antiretroviral therapy, substance use, polypharmacy) or extrinsic (icy sidewalks, wet floors). Among those who felt that their falls could be prevented, prevention strategies included physical therapy and avoiding extrinsic fall risk factors. Some participants, however, felt that their falls could not be prevented. While some participants responded adaptively to falls, for many, the experience of falling was connected with deep feelings of loss and suffering. For these individuals, falls were understood to be â€œthe beginning of the endâ€ and a source of social isolation, changing family roles, diminished sense of self, and stigma.
Brunella Maria Pavan Taffner, Felipe Berno Mattos, Mariana Cartaxo da Cunha, FÃ¡bio Petersen Saraiva
by Brunella Maria Pavan Taffner, Felipe Berno Mattos, Mariana Cartaxo da Cunha, FÃ¡bio Petersen Saraiva
Objectives To evaluate, through (OCT), alterations in retinal thickness, secondary to use of ethambutol in the treatment of patients with tuberculosis. In addition to studying the use of simpler semiological tools, such as Amsler and Ishihara, in the screening of these cases. Methods Thirty patients with ethambutol were recruited from the reference service of tuberculosis treatment at the Federal University of EspÃrito Santo from May 2015 to July 2016. After clinical history, the following parameters were analyzed; best corrected visual acuity, biomicroscopy, tonometry, photomotor reflex testing, Ishihara test, Amslerâ€™s grid test, color digital retinography and optical coherence tomography with CIRRUS HD-OCT (Humphrey-Zeiss) every 2 months during treatment with ethambutol. They were divided into two groups according to the treatment: (1) standard group, two months of ethambutol; (2) extended group, nine to twelve months of ethambutol. Results There was a significant reduction in OCT thickness between the pre and post treatment times in ten eyes of the extended group, mean reduction of 7,8 microns and in seven eyes of the standard group, with an average of 5.57 microns. During the study, a significant reduction of retinal thickness was observed in both groups at two months of treatment, and the delta percentage was higher in those patients who presented reduction of visual acuity and / or change in the Ishihara test. Conclusion There was a significant reduction in the thickness of the nerve fiber layer by OCT in the patients studied, being more pronounced in those submitted to the extended treatment regimen. This reduction was observed two months after the start of therapy, and was more significant in the cases that presented changes in the Ishihara test.
Chong, L., Wen, J., Kubal, J., Sen, F. G., Zou, J., Greeley, J., Chan, M., Barkholtz, H., Ding, W., Liu, D.-J.
Achieving high catalytic performance with the lowest amount of platinum is critical in fuel cell cost reduction. We describe a method of preparing highly active yet stable electrocatalysts containing ultralow Pt content using Co or Co/Zn zeolitic imidazolate frameworks as precursors. Synergistic catalysis between strained Pt-Co core-shell nanoparticles over a platinum-group-metal-free (PGM-free) catalytic substrate led to excellent fuel cell performance under 1 atmosphere of O2 or air at both high voltage and high current domains. Two catalysts achieved the oxygen reduction reaction (ORR) mass activities of 1.08 A mgPtâ€“1/1.77 A mgPtâ€“1 and retained 64%/15% of initial values after 30,000 voltage cycles in fuel cell. Computational modeling reveals that the interaction between Pt-Co and PGM-free sites improves ORR activity and durability.
Chemaly, Roy F.; Clark, Tristan W.
No abstract available
Tao Li, Xin Du, Hemant Deepak Shewade, Kyaw Thu Soe, Hui Zhang
by Tao Li, Xin Du, Hemant Deepak Shewade, Kyaw Thu Soe, Hui Zhang
Background In China, internal migrants constitute one-fifth of tuberculosis (TB) patients registered for treatment in web-based TB information management system (TBIMS). Though China added a specific module in the web-based TBIMS in 2009, web-based transfer-out is not specifically recommended in the national guidelines. Objective In this country wide study among all registered migrant TB patients (2014â€“2015) that were transferred out using web-based TBIMS in China, to determine the i) timing of transfer-out in relation to period of treatment; ii) delay and attrition during transfer interval (between transfer-out and transfer-in); and iii) extent and risk factors for â€˜not evaluatedâ€™ as the treatment outcome. Methods This was a cohort study involving review of web-based TBIMS data. Modified Poisson regression was used to build a predictive model for risk factors of â€˜not evaluatedâ€™ as the treatment outcome. Results Among 7 284 patients, 5 900 (81.0%) were transferred out during the first two months after initiation of treatment or before treatment initiation and 7 088 (97.3%) patients had arrived at transfer-in unit. The median transfer interval was three (interquartile range: 0â€“14) days. Sixteen percent (1 176/7 284) patients had â€˜not evaluatedâ€™ as their treatment outcome. â€˜Not evaluatedâ€™ contributed to 66% of the unfavourable outcomes. Patients transferred from referral hospitals, migrated from out of prefecture, transferred out of prefecture, with sputum smear negative pulmonary TB, with TB pleurisy and with long delay between symptom onset and treatment initiation had significantly higher risk of â€˜not evaluatedâ€™ as the outcome. Conclusion Web-based transfer helped as the delay and attrition during the transfer interval was quite short and treatment outcomes of more than four-fifths of transferred out migrant TB patients were available with transfer-out BMU. Once strategies to address the independent predictors of â€˜not evaluatedâ€™ treatment outcome are devised, China may consider mandatory use of web-based TBIMS for transferring out migrant TB patients.
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False-negative Results of Human Immunodeficiency Virus (HIV) Rapid Testing in HIV Controllers
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Oseltamivir resistance in severe influenza A(H1N1)pdm09 pneumonia and acute respiratory distress syndrome: a French multicenter observational cohort study
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Baloxavir marboxil in Japanese pediatric patients with influenza: safety and clinical and virologic outcomes
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