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E. Cambau, P. Saunderson, L. Gillini
We thank our colleagues Diana Lockwood, Stephen Walker, and Bushan Kumar for their positive comments [1,2] about our paper published in Clinical Microbiology and Infection showing the results of antimicrobial resistance (AMR) testing in leprosy .
Wing Ho Man, Marlies A van Houten, Marieke E Mérelle, Arine M Vlieger, Mei Ling J N Chu, Nicolaas J G Jansen, Elisabeth A M Sanders, Debby Bogaert
Our data suggest that the nasopharyngeal microbiota can serve as a valid proxy for lower respiratory tract microbiota in childhood LRTIs, that clinical LRTIs in children result from the interplay between microbiota and host characteristics, rather than a single microorganism, and that microbiota-based diagnostics could improve future diagnostic and treatment protocols.
Pierre-François Laterre, Gwenhael Colin, Pierre-François Dequin, Thierry Dugernier, Thierry Boulain, Samareh Azeredo da Silveira, Frédéric Lajaunias, Antonio Perez, Bruno François
The nature of adverse events was consistent with the profile of the study population and CAL02 showed a promising safety profile and tolerability. However, the difference between high-dose and low-dose CAL02 could not be assessed in this study. Efficacy was in line with the expected benefits of neutralising toxins. The results of this study support further clinical development of CAL02 and provide a solid basis for a larger clinical study.
Oyebola Fasugba, Allen C Cheng, Victoria Gregory, Nicholas Graves, Jane Koerner, Peter Collignon, Anne Gardner, Brett G Mitchell
The use of chlorhexidine solution for meatal cleaning before catheter insertion decreased the incidence of catheter-associated asymptomatic bacteriuria and UTI and has the potential to improve patient safety.
Andrew J Stewardson, Kalisvar Marimuthu, Sharmila Sengupta, Arthur Allignol, Maisra El-Bouseary, Maria J Carvalho, Brekhna Hassan, Monica A Delgado-Ramirez, Anita Arora, Ruchika Bagga, Alex K Owusu-Ofori, Joseph O Ovosi, Shamsudin Aliyu, Hala Saad, Souha S Kanj, Basudha Khanal, Balkrishna Bhattarai, Samir K Saha, Jamal Uddin, Purabi Barman, Latika Sharma, Tarek El-Banna, Rabaab Zahra, Mansab Ali Saleemi, Amarjeet Kaur, Kenneth Iregbu, Nkolika SC Uwaezuoke, Pierre Abi Hanna, Rita Feghali, Ana L Correa, Maria
Carbapenem resistance is associated with increased length of hospital stay and mortality in patients with bloodstream infections in LMICs. These data will inform global estimates of the burden of antimicrobial resistance and reinforce the need for better strategies to prevent, diagnose, and treat CRE infections in LMICs.
Erik Lenguerrand, Michael R Whitehouse, Andrew D Beswick, Setor K Kunutsor, Pedro Foguet, Martyn Porter, Ashley W Blom, National Joint Registry for England, Wales, Northern Ireland and the Isle of Man
We have identified several risk factors for revision for prosthetic joint infection following knee replacement. Some of these factors are modifiable, and the use of targeted interventions or strategies could lead to a reduced risk of revision for prosthetic joint infection. Non-modifiable factors and the time-specific nature of the effects we have observed will allow clinicians to appropriately counsel patients preoperatively and tailor follow-up regimens.
Marijn C Verwijs, Stephen K Agaba, Jean-Claude Sumanyi, Marie Michele Umulisa, Lambert Mwambarangwe, Viateur Musengamana, Mireille Uwineza, Vicky Cuylaerts, Tania Crucitti, Vicky Jespers, Janneke H H M van de Wijgert
Point-of-care testing for urogenital infections might improve case-finding and infection management and is feasible in resource-poor settings. Point-of-care tests should be further developed, including those targeting multiple conditions. Additional studies in other populations, including populations with low prevalence of sexually transmitted and urogenital infections, are warranted.
Annie Haakenstad, Anton Connor Harle, Golsum Tsakalos, Angela E Micah, Tianchan Tao, Mina Anjomshoa, Jessica Cohen, Nancy Fullman, Simon I Hay, Tomislav Mestrovic, Shafiu Mohammed, Seyyed Meysam Mousavi, Molly R Nixon, David Pigott, Khanh Tran, Christopher J L Murray, Joseph L Dieleman
Tracking global malaria spending provides insight into how far the world is from reaching the malaria funding target of $6·6 billion annually by 2020. Because most countries with a high burden of malaria are low income or lower-middle income, mobilising additional government resources for malaria might be challenging.
Anne-Flore Plane, Pierre-Emmanuel Marsan, Damien du Cheyron, Xavier Valette
A 58-year-old man was hospitalised in our intensive care unit for severe, acute respiratory distress syndrome caused by an influenza virus infection. After 31 days, he was gradually weaned off mechanical ventilation. However, on the day after extubation, he had to be reintubated because of further respiratory distress. Emergency intubation was performed after rapid sequence induction using the short-acting anaesthetic agent etomidate, intravenously, at a dose of 0·3 mg/kg, and the muscle relaxant succinylcholine, intravenously, at a dose of 1 mg/kg.
Pere Domingo, Virginia Pomar, Albert Mauri, Nicolau Barquet
Meningococcal disease was first clinically characterised by Gaspard Vieusseux in 1805, and its causative agent was identified by Anton Weichselbaum in 1887, who named it Diplococcus intracellularis menigitidis. From the beginning, the disease was dreaded because of its epidemic nature, predilection for previously healthy children and adolescents, and high mortality. In the last decade of the 19th century, the concept of serum therapy for toxin-related bacterial diseases was identified. This concept was applied to meningococcal disease therapy, in an independent way, by Wilhelm Kolle, August von Wasserman, and Georg Jochmann in Germany, and Simon Flexner in the USA, resulting in the first successful approach for the treatment of meningococcal disease.
Sandra B Andersen, B Jesse Shapiro, Christina Vandenbroucke-Grauls, Marjon G J de Vos
Medicine and clinical microbiology have traditionally attempted to identify and eliminate the agents that cause disease. However, this traditional approach is becoming inadequate for dealing with a changing disease landscape. Major challenges to human health are non-communicable chronic diseases, often driven by altered immunity and inflammation, and communicable infections from agents which harbour antibiotic resistance. This Review focuses on the so-called evolutionary medicine framework, to study how microbial communities influence human health.
Miaomiao Liu, Ebaa M El-Hossary, Tobias A Oelschlaeger, Mohamed S Donia, Ronald J Quinn, Usama Ramadan Abdelmohsen
Natural products have been a rich source of compounds with structural and chemical diversity for drug discovery. However, antibiotic resistance in bacteria has been reported for nearly every antibiotic once it is used in clinical practice. In the past decade, pharmaceutical companies have reduced their natural product discovery projects because of challenges, such as high costs, low return rates, and high rediscovery rates. The largely unexplored marine environment harbours substantial diversity and is a large resource to discover novel compounds with novel modes of action, which is essential for the treatment of drug-resistant bacterial infections.
Rocco Friebel, Rachel Silverman, Amanda Glassman, Kalipso Chalkidou
Since its inception in 2002, the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) has disbursed more than US$39 billion across 120 countries. Funding provided by donors, mainly the USA, France, the UK, Germany, and Japan, has undoubtedly affected the lives of millions of people. As the Global Fund approaches its Sixth Replenishment Conference—to be held in France in October, 2019—the recently published results report1 appears to make a compelling case for further investment.
Tatiana Schäffer Gregianini,
Claudete Farina Seadi,
Luiz Domingos Zavarize Neto,
Letícia Garay Martins,
Guilherme Cerutti Muller,
Selir Maria Straliotto,
Ana Beatriz Gorini da Veiga
Human parainfluenza virus (hPIV) is an important pathogen in respiratory infections, however the health burden of hPIV is underestimated. This study describes the infections by hPIV1‐3 in Rio Grande do Sul, Brazil, from 1990 to 2017, providing data of the frequency and seasonality of cases and associated clinical symptoms.
Method of study
Nasopharyngeal samples of patients with respiratory infection were collected, clinical data were analyzed, and immunofluorescence was used to detect hPIV.
Respiratory viruses were detected in 33.63% of respiratory infections. In a total of 11 606 cases of viral respiratory infection, 781 were positive for hPIV; hPIV prevalence ranged from 2.14% to 27% of viral respiratory infections. hPIV1 circulates mainly during fall; hPIV3 circulation, in turn, starts in fall and peaks during spring; and cases of hPIV2 are reported along the year, with peaks in fall and early spring. The most affected age group was children, with hPIV prevalence of 74.23% in patients for less than 1 year. A higher proportion of girls were infected than boys, however, no difference by sex was observed considering all age groups. The most frequent type was hPIV3, especially in hospitalized patients. Both hPIV1 and 3 were associated with dyspnea, while hPIV2 caused mild symptoms mainly in nonhospitalized patients. Nineteen fatalities occurred, 89.5% of them associated with risk factors (prematurity; chronic diseases; age, 60 years).
hPIV causes a high number of respiratory infections, leading to hospitalization especially in children; epidemiological and surveillance studies are important for the control and management of respiratory infections.
Siriorn P. Watcharananan
Human adenovirus (HAdV) infection can cause substantial morbidity in kidney transplant (KT) recipients. Cell‐mediated immunity plays an important role in controlling HAdV infection after KT.
We prospectively (January 2015 to June 2018) investigated the absolute lymphocyte count (ALC) and interferon‐γ‐producing CD4+ and CD8
+ T cells at diagnosis and at viral clearance by an intracellular cytokine assay after stimulating with HAdV whole lysate, hexon, and penton proteins. HAdV infection was defined as the presence of HAdV DNA load in plasma or clinical specimens measured by the polymerase chain reaction assay.
Eighteen adult KT recipients were diagnosed with HAdV infection at a median of 16 months (interquartile range [IQR], 2‐39) after KT. The majority (94%) had HAdV‐associated hemorrhagic cystitis. The median ALC at viral clearance was significantly higher compared with diagnosis (2257 cells/mm3 [IQR, 1544‐3078] vs 1001 cells/mm3 [IQR, 641‐1385]; P
Laura Navika Yamani,
Maria Inge Lusida
Outbreaks of hepatitis A have occurred in some cities in Indonesia. In Surabaya, the capital city of East Java province, Indonesia, hepatitis A outbreaks have been reported since2013, with a marked increase in the number of cases in 2015. The aim of the present study was to analyze the genetic and serology of acute symptomatic cases (early infection) during a hepatitis A outbreak and asymptomatic cases after the outbreak in two junior high schools in Surabaya in 2015 to 2016. Students with acute symptomatic hepatitis A during the outbreak and other students who were asymptomatic 3 to 4 months after the outbreak were enrolled. Asymptomatic students had no symptoms from the outbreak until they were enrolled. Sera were collected to identify anti‐hepatitis A virus (HAV) IgM (by enzyme‐linked immunosorbent assay) and HAV genetic variations/genotypes (using polymerase chain reaction [PCR]‐sequencing and phylogenetic analysis). A total of 33 (97.1%) out of 34 sera of students with acute symptoms were positive for anti‐HAV IgM and 18% of them were positive by PCR, identified as HAV subgenotype IA. No prominent amino acid variations were observed from reported HAV sequences from Indonesia. Among 38 sera of asymptomatic students, most (55.3%) were positive for anti‐HAV IgM, while none were positive by PCR. In conclusion, HAV‐IA was the only subgenotype identified in acute symptomatic cases during the outbreak. The percentage of HAV‐specific IgM‐positive cases was very high among acute symptomatic students, but that was also high among asymptomatic students, which might contribute as the important source of infection during the outbreak.
Seyit Ali Buyuktuna,
Crimean‐Congo hemorrhagic fever (CCHF) is a tick‐mediated viral infection. Patients with CCHF may show various clinical presentations. The cause of this difference in the clinical course is not completely understood. Apoptosis is programmed cell death and plays an important role in regulating the immune system. Our knowledge of the role of apoptosis in CCHF disease is limited. We investigated the role of apoptosis and their relationship with the severity of the disease in CCHF.
Thus, in 30 patients with CCHF and 30 healthy individuals, we analyzed the serum levels of cytochrome C, apoptotic protease activating factor‐1 (Apaf 1), caspase 3, caspase 8, caspase 9, sFas, sFasL, perforin, granzyme B, and CK18 by enzyme‐linked immunosorbent assay. This is the first study that research the serum levels of the mentioned apoptosis markers in adult patients with CCHF.
We found that the serum levels of sFasL, cytochrome C, Apaf 1, caspase 3, caspase 8, caspase 9, perforin, granzyme B, and M30 were statistically significantly different in the acute phase of the disease compared with healthy individuals and patients in convalescent period. There was no association between the clinical severity of the disease and apoptosis markers.
In conclusion, the results of our study suggested that the extrinsic and intrinsic apoptosis pathway play an important role in CCHF.
Gibbs, Andrew; Hatcher, Abigail; Jewkes, Rachel; Sikweyiya, Yandisa; Washington, Laura; Dunkle, Kristin; Magni, Sarah; Peacock, Dean; Khumalo, Mzwakhe; Christofides, Nicola
Qualitative research emphasizes men’s experiences of trauma increase HIV-risk. We seek to understand associations between experience of traumatic events and HIV-risk behaviours amongst heterosexual men in two trials in urban informal settlements in South Africa.
Cross-sectional surveys among men in Johannesburg and Durban, South Africa, enrolled in intervention trials. Adjusted logistic regression and structural equation modelling (SEM) assessed associations between men’s experiences of poverty and traumatic events, and HIV-risk behaviours (inconsistent condom use, transactional sex, number of sex partners). We explored mediated pathways from trauma to HIV risk via mental health and alcohol, gender attitudes, and intimate partner violence (IPV).
Amongst 2394 men, in adjusted logistic regression, transactional sex and four or more sex partners were associated with witnessing the murder of a family member, witnessing a murder of a stranger, experiencing excessive pain, been kidnapped, and witnessing a rape. More consistent condom use was associated with witnessing the murder of a family member, being kidnapped, and witnessing a rape. In three separate SEMS pathways were consistent, trauma directly increased transactional sex, and past year sexual partners, and increased consistent condom use. Risk was increased through mental health pathways, and gender inequitable attitudes and practices.
Men’s HIV-risk behaviours in this population emerges at the confluence of poverty, traumatic experiences, and gender inequalities. Effective HIV-prevention interventions needs to reduce men’s experiences of poverty and trauma, transform gender norms and reduce the mental health impact of trauma.
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Corresponding author: Andrew Gibbs, Andrew.firstname.lastname@example.org,
The authors report no conflicts of interest related to this work.
Funding: This research is funded through the What Works To Prevent Violence? A Global Programme on Violence Against Women and Girls (VAWG) funded by the UK Government's Department for International Development (DFID). And funds were managed by the South African Medical Research Council.
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Tim J. Harrison,
The long‐term persistence of immunity following universal infant immunization against hepatitis B virus (HBV) and the need for a subsequent booster dose in adolescence remain under debate. With data derived from Long'an County, Guangxi, China, we reported previously that the prevalence of hepatitis B surface antigen (HBsAg) among adults born from 1987 to 1993 increases with age, although these individuals had received a first dose of the vaccine within 24 hours of birth. Here, we sought the source of transmission by comparison of genotypes among their family members using phylogenetic analysis of complete HBV S gene sequences. For comparison, we screened 2199 vaccinated individuals aged 5 to 17 in Cang Wu County and 1592 vaccinated individuals aged 3 to 7 in Ling Shan County in Guangxi for HBsAg carriers and investigate their family members. In total, 50 asymptomatic HBsAg carriers who were vaccinated at birth and 152 family members were analyzed. The results showed that 25% (95% CI: 6.0‐44.0) of the HBsAg‐positive children had not acquired their HBV infection from their mothers. This phenomenon showed a trend that increases with age. Antibody escape mutations were detected in 22.9% (95% CI: 11.0‐34.8) of the isolates. In conclusion, a booster dose may be necessary for adolescence who were vaccinated at birth in highly endemic countries.
Kyle D. Webster,
Miko M. Bruyn,
Sarah K. Zalwango,
Jennifer L. Barkin,
Michael J. Boivin,
Amara E. Ezeamama
Caregiver socio‐emotional attributes are major determinants of child well‐being. This investigation in vulnerable school‐aged Ugandan children estimates relationships between children's well‐being and their caregiver's anxiety, depression and social support.
Perinatally HIV‐infected, HIV‐exposed uninfected and HIV‐unexposed Ugandan children and their caregivers were enrolled. Perinatal HIV status was determined by 18 months of age using DNA‐polymerase chain‐reaction test; status was confirmed via HIV rapid diagnostic test when children were 6–18 years old. Five indicators of child well‐being (distress, hopelessness, positive future orientation, esteem and quality of life (QOL)) and caregivers’ socioemotional status (depressive symptoms, anxiety and social support) were measured using validated, culturally adapted and translated instruments. Categories based on tertiles of each caregiver psychosocial indicator were defined. Linear regression analyses estimated percent differences (β) and corresponding 95% confidence intervals (CI) for child well‐being in relation to caregiver's psychosocial status.
As per tertile increment, caregiver anxiety was associated with 2.7% higher distress (95%CI:0.2%, 5.3%) and lower self‐esteem/QOL (β = −1.3%/−2.6%; 95%CI: −5.0%,‐0.2%) in their children. Child distress/hopelessness increased (β = 3.3%/7.6%; 95%CI:0.4%, 14.7%) and self‐esteem/QOL decreased 2.3% (β = −2.3%/−4.4%; 95%CI: −7.2%, −1.3%) as per tertile increment in caregiver depression. Higher caregiver social support was associated with lower distress and higher positive outlook (β = 3%; 95%CI:1.4%, 4.5%) in their children. HIV‐infected/exposed children had most caregiver depression‐related QOL deficit (β = −5.2%/−6.8%; 95%CI: −12.4%, −0.2%) and HIV‐unexposed children had most caregiver social support‐related enhancements in positive outlook (β=4.5%; 95%CI:1.9%, 7.1%).
Caregiver anxiety, depressive symptoms and low social support were associated with worse well‐being in school‐aged and adolescent children. Improvement of caregiver mental health and strengthening caregiver social support systems may be a viable strategy for improving well‐being of vulnerable children and adolescents in this setting.
Les attributs socio‐affectifs des responsables d'enfants sont des déterminants majeurs du bien‐être des enfants. Cette investigation menée auprès d'enfants ougandais vulnérables d’âge scolaire a estimé les relations entre le bien‐être des enfants et l'anxiété, la dépression et le soutien social de leur responsable.
Des enfants ougandais infectés par le VIH de manière périnatale, exposés au VIH mais non infectés, et non exposés au VIH ainsi que leurs responsables ont été inscrits. Le statut VIH périnatal a été déterminé à l’âge de 18 mois à l'aide du test de PCR de l’ADN; le statut a été confirmé par un test de diagnostic rapide du VIH chez les enfants âgés de 6 à 18 ans. Cinq indicateurs du bien‐être de l'enfant (détresse, désespoir, orientation future positive, estime et qualité de vie (QV)), et le statut psychosocial des responsables (symptômes dépressifs, anxiété et soutien social) ont été mesurés à l'aide de méthodes validées, adaptées à la culture et respectées et d'outils traduits. Des catégories basées sur les tertiles de chaque indicateur psychosocial du responsable ont été définies. Des analyses de régression linéaire ont estimé les différences en pourcentage (β) et les intervalles de confiance (IC) à 95% correspondants pour le bien‐être de l'enfant par rapport au statut psychosocial de leurs responsables.
Par incrément de tertile, l'anxiété des responsables était associé à 2,7% de détresse plus élevé (IC95%: 0,2%, 5,3%) et de faible estime de soi/QV (β = −1,3%/−2,6%; IC95%: −5,0%, −0,2%) chez leurs enfants. La détresse et le désespoir des enfants augmentaient (β = 3,3%/7,6%; IC95%: 0,4%, 14,7%) et l'estime de soi/QV diminuait de 2,3% (β = −2,3%/−4,4%; IC95%: −7,2%, −1,3%) par incrément de tertile de la dépression chez le responsable. Un soutien social plus élevé des responsables était associé à une détresse moindre et à une perspective positive plus élevée (β = 3%; IC95%: 1,4%, 4,5%) chez leurs enfants. Les enfants infectés/exposés au VIH présentaient pour la plupart un déficit de QV lié à la dépression de leurs responsables (β = −5,2%/−6,8%; IC95%: −12,4%, −0,2%), et ceux non exposés au VIH présentaient pour la plupart des améliorations en perspective positive liées au soutien social de leurs responsables (β = 4,5%; IC95%: 1,9%, 7,1%).
L'anxiété, les symptômes dépressifs et un faible soutien social du responsable étaient associés à un bien‐être précaire chez les enfants d’âge scolaire et les adolescents. L'amélioration de la santé mentale des responsables et le renforcement des systèmes de soutien social pour les responsables peuvent constituer une stratégie viable pour améliorer le bien‐être des enfants et des adolescents vulnérables dans cette région.
To analyse the impact of non‐communicable diseases (NCDs) on household out‐of‐pocket (OOP) expenses, catastrophic health payments and medical impoverishment in Mongolia, a middle‐income country with a high population health insurance coverage rate.
Secondary data analysis of the Mongolian Household Socioeconomic Survey with 12 840 households, including information on standard of living, OOP spending, and health conditions of household members. Measures of catastrophic spending and medical impoverishment were constructed for Mongolia. The association of medical impoverishment and catastrophic spending with a range of socioeconomic and demographic covariates and health conditions was assessed using multiple regression models.
OOP health spending contributed to an 8% increase in the incidence of poverty in Mongolia. The impoverishment associated with medical expenses is concentrated in the poorer quintiles, indicating some deepening of poverty among the already poor. Households with a member affected by NCDs and with multiple morbidities were more likely to experience catastrophic spending and medical impoverishment than those with infectious diseases. The main drivers of the financial distress were expenditures incurred for outpatient services, including for diagnostics and drugs.
Despite high rates of population health insurance coverage, health expenditures have substantial impoverishing effects in Mongolia, with the impacts being greater among households containing individuals with chronic conditions. Addressing the goal of universal health coverage (UHC) in Mongolia needs attention to the depth of coverage, especially for expenditures on outpatient care and medicines, and targeting the poor effectively.
Anthony J. Santella,
The number of men who have sex with men (MSM) living with human immunodeficiency virus (HIV) in China has increased rapidly and thus immediate highly active antiretroviral therapy (HAART) after diagnosis was implemented as a strategy to reduce the HIV transmission.
MSM who were diagnosed with HIV and received HAART between 2013 to 2015 in Xi’an were divided into three groups (>350, 200‐350, and 350 cell/μL group, whereas 400 (27.7%) cases and 352 (24.4%) cases were in the 200‐350 cell/μL group and
Evandro Leite Rodrigues Bitencurt,
Jones Anderson Monteiro Siqueira,
Tallyta Barros Medeiros,
Renato da Silva Bandeira,
Ricardo José Guimarães,
Joana D'Arc Pereira Macarenhas,
Dielle Monteiro Teixeira,
Rita S.U. Silva,
Edvaldo Carlos Brito Loureiro,
Mônica Cristina Silva,
Luciana Damascena Silva,
Yvone Benchimol Gabbay
Norovirus (NoV) is a major cause of nonbacterial acute gastroenteritis (AGE) outbreaks worldwide, with infections reported in semiclosed environments, particularly in hospitals and nursing homes. Astrovirus (HAstV) is prevalent worldwide, especially in developing countries. We aimed to determine the prevalence, spatial distribution, and genetic diversity of NoV and HAstV in children under 5 years of age in Rio Branco city, Acre State, Amazon Region, Brazil. Stool samples from children with (n = 240) and without (n = 248) AGE were collected from January to December 2012 from seven neighborhoods. The overall NoV prevalence was 12.3% (60 of 488); representing 15.8% (38 of 240) of the symptomatic samples and 8.9% (22 of 248) of the controls. HAstVs infection was observed in 4.7% (23 of 488) of the samples tested, 6.2% (15 of 240) of AGE cases, and 2.4% (6 of 248) of the controls (plus two without information about feces consistency). Infections were found in all age groups with higher frequency in children less than two years of age, for both viruses. NoV was detected in all neighborhoods, with a higher concentration in the fourth (30%; 18 of 60). NoV nucleotide sequencing performed in 86.7% (52 of 60) of the positive samples showed the circulation of the strains GII.4 (57.7%; 30 of 52), GIIPe/GII.4 (19.2%; 10 of 52), GII.7, GII.Pg/GII.1, and GII.Pc (3.8%; 2 of 52 for each), GII.6 and GII.Pg (1.9%; 1 of 52 for each), and GI.3 (7.7%; 4 of 52). Three GII.4 variants were detected: Den Haag_2006b (n = 1), New Orleans_2009 (n = 1), and Sydney_2012 (n = 14). HAstV types HAstV‐1a (81.8%; 9 of 11) and HAstV‐2c (18.2%; 2 of 11) were observed in the 47.8% (11 of 23) of characterized samples. This is the first data obtained in Acre State regarding the prevalence of these viruses and provides epidemiological and molecular information for a better understanding of their role among children with and without AGE.
Laura N. Wangai,
Christian G. Meyer,
Thirumalaisamy P. Velavan
Kenya has, in the last decade, made tremendous progress in the fight against malaria. Nevertheless, continued surveillance of the genetic diversity and population structure of Plasmodium falciparum is required to refine malaria control and to adapt and improve elimination strategies. Twelve neutral microsatellite loci were genotyped in 201 P. falciparum isolates obtained from the Kenyan–Ugandan border (Busia) and from two inland malaria‐endemic sites situated in western (Nyando) and coastal (Msambweni) Kenya. Analyses were done to assess the genetic diversity (allelic richness and expected heterozygosity, [He]), multilocus linkage disequilibrium () and population structure. A similarly high degree of genetic diversity was observed among the three parasite populations surveyed (mean He = 0.76; P > 0.05). Except in Msambweni, random association of microsatellite loci was observed, indicating high parasite out‐breeding. Low to moderate genetic structure (FST = 0.022–0.076; P
Hermann Landry Munshili Njifon,
Chavely Gwladys Monamele,
Mohamadou Ripa Njankouo,
In Cameroon, genome characterization of influenza virus has been performed only in the Southern regions meanwhile genetic diversity of this virus varies with respect to locality. The Northern region characterized by a Sudan tropical climate might have distinct genetic characterization. This study aimed to better understand the genetic diversity of influenza A(H3N2) viruses circulating in Northern Cameroon. Sequences of three gene segments (hemagglutinin (HA), neuraminidase (NA) and matrix (M) genes) were obtained from 16 A(H3N2) virus strains collected during the 2014 to 2016 influenza seasons in Garoua. The HA gene segments were analysed with respect to reference strains while the NA and M gene was analysed for reported genetic markers of resistance to antivirals. Analysis of the HA sequences revealed that majority of the virus strains grouped together with the 2016‐2017 vaccine strain (3C.2a‐A/Hong Kong/4801/2014) while 3/5 (60%) of the 2015 viral strains grouped together with the 2015‐2016 vaccine strain 3C.3a‐A/Switzerland/9715293/2013. Within clade 3C.2a, Northern Cameroon sequences mostly grouped in sub‐clade A3 (10/16). Analysis of the coding regions of the NA and M genes showed that none had genetic markers of resistance to neuraminidase inhibitors but all strains possessed the S31N substitution of resistance to amantadine. Due to some discrepancies observed in this region with respect to the Southern regions of Cameroon, there is necessity of including all regions within a country in the sentinel surveillance of influenza. These data will enable to track changes in influenza viruses in Cameroon.
Lee B, Bartsch S, Hayden M, et al.
AbstractBackgroundRegions are considering the use of electronic registries to track patients that carry antibiotic-resistant bacteria including carbapenem-resistant Enterobacteriaceae (CRE). Implementing such a registry can be challenging and requires time, effort, and resources; therefore, there is a need to better understand the potential impact.MethodsWe developed an agent-based model of all inpatient healthcare facilities (90 acute care hospitals, 9 long-term acute care hospitals, 351 skilled nursing facilities, and 12 ventilator-capable skilled nursing facilities) in the Chicago metropolitan area, surrounding communities, and patient flow using our Regional Healthcare Ecosystem Analyst software platform. Scenarios explored the impact of a registry that tracked patients carrying CRE to help guide infection prevention and control.ResultsWhen all Illinois facilities participated (n=402), the registry reduced the number of new carriers by 11.7% and CRE prevalence by 7.6% over a 3-year period. When 75% of the largest Illinois facilities participated (n=304), registry use resulted in a 11.6% relative reduction in new carriers (16.9% and 1.2% in participating and non-participating facilities, respectively) and 5.0% relative reduction in prevalence. When 50% participated (n=201), there were 10.7% and 5.6% relative reductions in incident carriers and prevalence, respectively. When 25% participated (n=101), there was a 9.1% relative reduction in incident carriers (20.4% and 1.6% in participating and non-participating facilities, respectively) and 2.8% relative reduction in prevalence.ConclusionImplementing an XDRO registry reduced CRE spread, even when only 25% of the largest Illinois facilities participated due to patient sharing. Non-participating facilities garnered benefits, with reductions in new carriers.
Since May 2016, WHO recommended a 9–12 month short-treatment regimen for multidrug-resistant tuberculosis (MDR-TB) treatment known as the ‘Bangladesh Regimen’. However, limited data exist on the appropriateness thereof, and its implementation in low- and middle-income countries (LMIC). We report here on the pilot phase of the evaluation of the Bangladesh regimen in Gabon, prior to its endorsement by the WHO.
This ongoing observational study started in September 2015. Intensive training of hospital health workers as well as community information and education were conducted. GeneXpert-confirmed MDR-TB patients received the second-line anti-tuberculosis drugs (4KmMfxPtoHCfzEZ/5MfxCfzEZ). Sputum smears and cultures were done monthly. Adverse events were monitored daily.
Eleven patients have been treated for MDR-TB piloting the short regimen. All were HIV-negative and presented in poor health with extensive pulmonary lesions. The overall sputum culture conversion rate was 64% after 4 months of treatment. Three patients developed marked hearing loss; one a transient cutaneous rash. Of 11 patients in our continuous care, 7 (63.6%) significantly improved clinically and bacteriologically. One (9.1%) patient experienced a treatment failure, two (18.2%) died, and one (9.1%) was lost to follow up.
Our pioneering data on systematic MDR-TB treatment in Gabon, with currently almost total absence of resistance against the second-line drugs, demonstrate that a 9-month regimen has the capacity to facilitate early culture negativity and sustained clinical improvement. Close adverse events monitoring and continuous care are vital to success.
We report the activity and circulation of influenza viruses in Algeria during four influenza seasons, from a national surveillance study carried out from 2009‐2010 to 2012‐2013. A total of 2766 samples from in‐ and outpatients, with no age restriction, were collected. The overall proportion of specimens that tested influenza positive was 46.0%. Overall, 96.6% of influenza A viruses were subtyped, and A/H1 subtypes accounted for 57.3% of influenza A viruses. Influenza A/H1 and A/H3 virus subtypes cocirculated in 2009‐2010. In 2010‐2011, a high proportion of type B viruses (66.2%) was observed. The subtype H3N2 was identified in 99% of cases typed in 2011‐2012. Influenza A/H3N2 and B virus cocirculated in 2012‐2013. A remarkably low influenza vaccination rate of 2.4% was observed among all age groups. Antibiotics were prescribed for 926 (41.3%) patients, and no difference was observed between patients with confirmed influenza and patients with influenza‐like illness not related to influenza. The burden of influenza is largely undocumented in Algeria and strategies to expand this surveillance across the country are needed. Strategies to increase vaccination coverage are warranted to control and prevent influenza in individuals at risk of complications as well as in the general population.
Several studies carried out in Benin have shown the involvement of Anopheles gambiae sensu lato (s.l.), the Anopheles funestus group in malaria transmission, but none of them reported the contribution of the Anopheles nili group to the transmission of this disease. The current study investigated the question through an entomological cross-sectional survey performed in Northern Benin.
Mosquito samplings were performed in September and October 2017 in 4 villages located in two districts: Bambaba and Wodara (Kérou district) and, Péhunco 2 and Béké (Péhunco district). The collections were carried out indoors and outdoors using human landing catches (HLC) to assess the human biting rate (HBR) and pyrethrum spray catches (PSC) to evaluate the blood feeding rate and the blood meal origin using the ELISA test. All collected mosquitoes were morphologically identified and, the polymerase chain reaction (PCR) technique was used for molecular identification of sibling species of An. gambiae s.l., An. funestus group and An. nili group sporozoite index (SI) was also assessed by the ELISA test.
Overall, An. gambiae s.l., An. funestus group and An. nili group were the three vectors found in the study area. A significantly higher human biting rate (HBR) was recorded in An. nili group (5 bites/human/night) compared to An. funestus group (0.656 bites/human/night) in the Kérou district (p
Malaria prevention in Cameroon mainly relies on the use of ITNs. Although several free distribution campaigns of treated nets have been conducted across the country, bed net usage remains very low. A household survey was conducted to assess knowledge of the population and practices affecting treated net usage in the city of Yaoundé.
A community-based descriptive cross-sectional survey was conducted in January 2017 in 32 districts of the city of Yaoundé. Parents (household head, spouse or an elder representative) who consented to the study, were interviewed using a structured pre-tested questionnaire. Interviews were conducted in French or English. A questionnaire consisting of 22 questions was administered to know (i) people’s knowledge and attitude on preventive measures; and, (ii) attitudes concerning the treatment of malaria and estimated amount spent for malaria prevention and treatment.
A total of 1643 household heads were interviewed. Over 94% of people interviewed associated malaria transmission to mosquito bites. The main methods used against mosquito bites were: treated bed nets (94%; n = 1526) and insecticide spray or coils (32.2%; n = 523). The majority of people interviewed reported using bed nets mainly to prevent from mosquito bites (84.4%, n = 1257), rather than for malaria prevention (47.3%). Knowledge and attitude analysis revealed that people with university or secondary level of education have better knowledge of malaria, prevention and treatment measures compared to those with the primary level (OR = 7.03; P
Margossian, Renee; Williams, Paige L.; Yu, Wendy; Jacobson, Denise L.; Geffner, Mitchell E.; DiMeglio, Linda A.; Van Dyke, Russell B.; Spector, Stephen A.; Schuster, Gertrud U.; Stephensen, Charles B.; Miller, Tracie L.; Lipshultz, Steven E.; for the Pediatric HIV/AIDS Cohort Study (PHACS)
Disordered bone mineral metabolism and low vitamin D concentrations are associated with cardiovascular abnormalities; few studies have evaluated this relationship in HIV-infected youth.
Adolescent Master Protocol (AMP) is a Pediatric HIV/AIDS Cohort Study (PHACS) network study conducted across 14 United States sites.
Among perinatally HIV-infected (PHIV) and HIV-exposed uninfected (PHEU) youth enrolled in AMP, we evaluated associations of vitamin D (measured as 25-hydroxyvitamin D [25OHD]), parathyroid hormone (PTH), calcium, phosphate, and fibroblast growth factor-23 (FGF-23) concentrations with echocardiographic measures of left ventricular (LV) structure, function and concentrations of NT-proBNP, a biomarker of cardiac damage.
Among 485 participants (305 PHIV, 180 PHEU) with echocardiograms and bone mineralization measures, low 25OHD (< 20 ng/mL) was common among all participants (48% PHIV and 44% PHEU), but elevated PTH (> 65 pg/mL) was identified more often among PHIV than PHEU participants (9% vs 3%, p=0.02). After adjusting for HIV status and demographic covariates, both low 25OHD and elevated PTH were associated with lower mean LV mass z-scores, while elevated PTH was associated with higher mean fractional shortening z-scores. Participants with low 25OHD also had slightly higher mean LV end-systolic wall stress z-scores, but differences were more pronounced in PHEU than in PHIV participants. FGF-23 was inversely related to end-diastolic septal thickness both overall and among PHIV participants.
In this cohort of PHIV and PHEU youth, we observed associations of 25OHD, PTH, and FGF-23 with both structural and functional cardiac parameters, supporting links between bone mineral metabolism and cardiac status.
Corresponding Author: Renee Margossian, MD, Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115. Tel: 617 355-6429, Fax: 617 739-6282. email@example.com
Conflicts of Interest and Source of Funding: The authors have no conflicts of interest to disclose. This work was supported by the National Institutes of Health
Funding source: The Pediatric HIV/AIDS Cohort Study (PHACS) was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development with co-funding from the National Institute on Drug Abuse, the National Institute of Allergy and Infectious Diseases, the Office of AIDS Research, the National Institute of Mental Health, the National Institute of Neurological Disorders and Stroke, the National Institute on Deafness and Other Communication Disorders, the National Heart Lung and Blood Institute, the National Institute of Dental and Craniofacial Research, and the National Institute on Alcohol Abuse and Alcoholism, through cooperative agreements with the Harvard T.H. Chan School of Public Health (HD052102) and the Tulane University School of Medicine (HD052104).
Note: The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the National Institutes of Health or U.S. Department of Health and Human Services.
Financial Disclosure Statement: The authors have no financial relationships relevant to this article to disclose.
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Neurotropic viruses, such as the rabies virus (RABV) and Japanese encephalitis virus (JEV), induce neuronal dysfunction and complication, causing neuronal damage. Currently, there are still no effective clinical treatments for neuronal injury caused by neurotropic viruses. Memantine, a drug capable of passing through the blood‐brain barrier, noncompetitively and reversibly binds to n‐methyl‐
d‐aspartic acid (NMDA) receptors. Memantine is used to treat Alzheimer's disease by blocking the activation of extra axonal ion channels, thus preventing neuronal degeneration by inhibiting the abnormal cytosolic Ca
2+ increase. To explore whether memantine can alleviate neurological disturbances caused by RABV and JEV, the following experiments were carried out: (1) for primary neurons cultured in vitro infected with RABV, the addition of memantine showed neuroprotection. (2) In the RABV challenge experiments, memantine had limited therapeutic effect, mildly extending the survival time of mice. In contrast, memantine significantly prolonged the survival time of mice infected with JEV, by reducing the intravascular cuff and inflammatory cell infiltration in mice. Furthermore, memantine decreases the amount of JEV virus in mice brain.
Özgür M. Koc,
Background and Aim
The hepatitis B virus (HBV) prevalence study performed in 2003 in Belgium is believed to be underestimating HBV prevalence due to underrepresentation of the non‐Belgian population. Therefore, we assessed the prevalence and risk factors of HBV infection in a multi‐ethnic region situated in Middle‐Limburg Belgium, in 2017.
Between May and November 2017, blood samples and questionnaires were taken from patients who presented at the emergency department of a large educational hospital. Blood samples were tested for hepatitis B surface antigen (HBsAg) and hepatitis B core antibodies (anti‐HBc). A sample size of 1000 persons was required to obtain a representative sample of the general Middle‐Limburg population.
Of the 1131 patients screened, the overall HBsAg prevalence was 0.97% with differences between Belgians (0.67%) and first‐generation‐migrants (2.55%), (P = 0.015). Five (45.5%) of 11 HBsAg‐positive individuals were not aware of their HBV status. All five (100%) newly diagnosed HBsAg‐positive patients had further clinical evaluation and all had a normal level of alanine aminotransferase (ALT). The prevalence of anti‐HBc was 8.4%, and was significantly associated with age‐gender‐ethnicity interaction, presence of HBV‐infected household member, hepatitis C virus infection, men who have sex with men, and hemodialysis.
In this area with large immigrant populations, we found a higher prevalence of HBV infection compared with the nationwide study of 2003. National HBV screening for first‐generation migrants is needed as this high‐risk group will go unnoticed due to the possible incorrect interpretation of normal ALT values.
Kew Seih Teck,
Rhanye Mac Guad,
Amin Hans Rostenberghe,
Gan Siew Hua
Respiratory syncytial virus (RSV) is a common pathogen affecting the respiratory tract in infants. To date, there is limited data on RSV occurrence in Malaysia especially in the north east of Peninsular Malaysia which is significantly affected by the rainy (monsoon) season. This study aimed to determine the prevalence, risk factors (the presence of a male sibling and older school age siblings, parental education level, monthly income, chronic lung disease, immunocompromised, being a passive smoker, multipara, breastfeeding, prematurity, congenital heart disease, nursery attendance and rainy season) as well as clinical manifestations of RSV in hospitalized infants and children with LRTI. Patients’ nasopharyngeal aspirates were tested for RSV antigen, questionnaires and seasonal variations were used to assess RSV infection. Approximately 22.6% of children were infected with RSV; mean age 7.68 ± 5.45 months. The peak incidence of RSV as a causative agent for LRTI in infants was less than or equal to one year old (83%) with approximately 50.5% of the affected children in the younger age group (six months amd below). RSV infection was significantly but independently associated with the rainy season (OR 3.307, 95% CI 1.443‐3.688, p
To assess long‐term antiretroviral therapy (ART) outcomes during rapid HIV programme expansion in the public sector of Eswatini (formerly Swaziland).
This is a retrospectively established cohort of HIV‐positive adults (≥16 years) who started first‐line ART in 25 health facilities in Shiselweni (Eswatini) between 01/2006 and 12/2014. Temporal trends in ART attrition, treatment expansion and ART coverage were described over 9 years. We used flexible parametric survival models to assess the relationship between time to ART attrition and covariates.
Of 24 772 ART initiations, 6% (n = 1488) occurred in 2006, vs. 13% (n = 3192) in 2014. Between these years, median CD4 cell count at ART initiation increased (113–265 cells/mm3). The active treatment cohort expanded 8.4‐fold, ART coverage increased 8.0‐fold (7.1% in 2006 vs. 56.8% in 2014) and 12‐month crude ART retention improved from 71% to 86%. Compared with the pre‐decentralisation period (2006–2007), attrition decreased by 5% (adjusted hazard ratio [aHR] 0.95, 95% confidence interval 0.88–1.02) during HIV‐TB service decentralisation (2008–2010), by 17% (aHR 0.83, 0.75–0.92) during service consolidation (2011–2012), and by 20% (aHR 0.80, 0.71–0.90) during further treatment expansion (2013–2014). The risk of attrition was higher for young age, male sex, pathological baseline haemoglobin and biochemistry results, more toxic drug regimens, WHO III/IV staging and low CD4 cell count; access to a telephone was protective.
Programmatic outcomes improved during large expansion of the treatment cohort and increased ART coverage. Changes in ART programming may have contributed to better outcomes.
S.E. van Roeden, P.C. Wever, J.J. Oosterheert
Melenotte et al. point out that in patients with possible chronic Q fever, a PET-CT scan was not routinely performed and that an infectious focus had not been ruled out in all patients . Diagnostic work-up in patients with possible chronic Q fever was not standardized: a PET-CT scan was performed in 52% (n = 60) and echocardiography in 72% (n = 83) of patients. Of patients with possible chronic Q fever that died during follow-up (n = 8), four died of non-haematological cancer, one died of liver cirrhosis, one died during a surgical procedure for peripheral arterial disease, one died of pneumonia, and one died of unknown causes with low serological titres around that time.
on behalf of the DIABIMMUNE Study Group
Previous data about the role of viruses in the development of allergic immunoglobulin E (IgE) sensitization are contradictory. The aim of this study was to determine the possible associations between exposure to different viruses (rhinovirus, enterovirus, norovirus, and parechovirus) during the first year of life and IgE sensitization. Viruses were analyzed from stool samples collected monthly from infants participating in a prospective birth cohort study. From that study, 244 IgE sensitized case children and 244 nonsensitized control children were identified based on their allergen‐specific IgE antibody levels at the age of 6, 18, and 36 months. Stool samples (n = 4576) from the case and control children were screened for the presence of rhinovirus, enterovirus, norovirus, and parechovirus RNA by reverse transcription quantitative polymerase chain reaction. The study showed that rhinovirus was the most prevalent virus detected, present in 921 (20%) samples. None of the viruses were associated with IgE sensitization in the full cohort but after stratifying by sex, the number of rhinovirus positive samples was inversely associated with IgE sensitization in boys (odds ratio [OR]: 0.81; 95% confidence interval [CI]: 0.69‐0.94; P = 0.006). There was also a temporal relation between rhinoviruses and IgE sensitization, as rhinovirus exposure during the first 6 months of life was associated with a reduced risk of subsequent IgE sensitization in boys (OR: 0.76; 95% CI: 0.6‐0.94; P = 0.016). In conclusion, early exposure to rhinoviruses was inversely associated with IgE sensitization but this protective association was restricted to boys.
E. Sando et al.
Successful replication of the AIDS retrovirus, HIV, requires that its genomic RNA be packaged in assembling virus particles with high fidelity. However, cellular mRNAs can also be packaged under some conditions. Viral RNA (vRNA) contains a ‘packaging signal’ (ψ) and is packaged as a dimer, with two vRNA monomers joined by a limited number of base pairs. It has two conformers, only one of which is capable of dimerization and packaging. Recent years have seen important progress on the 3D structure of dimeric ψ.
Human immunodeficiency virus, hepatitis B virus and hepatitis C virus are among the greatest threats to blood safety for the recipient. They are also the leading cause of death, chronic and life-threatening abnormalities. Therefore, this study was aimed to assess the Sero-prevalence of HIV, Hepatitis B and C virus among blood donors at the University of Gondar Comprehensive Specialized Hospital.
A retrospective cross-sectional study was used to estimate the seroprevalence of HIV, Hepatitis B and C virus among blood donors at the University of Gondar Comprehensive Specialized Hospital from May–July 2018. Screening of HIV, HBV, and HCV was done by using the Enzyme-Linked ImmunoSorbent Assay. Records of 5983 first time blood donors were collected and reviewed by using a checklist from registration book. Data was entered in statistical package EP Info version 3.5.1, and data cleaned and analyzed using the statistical package SPSS version 16.0.
Of 5983 blood donors, 85.5% (5118/5983) donors were males and 14.5% (865/5983) were females. The median age was 27 years and the highest blood donations age category was between 20 to 51.2% (29/5983) followed by 30 to 39 years of age, 21.6% (1295/5983). The prevalence of HIV, HBV and HCV infections were 2.5% (95% CI: 1.07–2.398), 4.1% (95% CI: 0.461–1.053) and 1.6% (95% CI: 0.845–3.354), respectively. HIV infection was significantly associated with gender (p = 0.021, x2 = 5.358) and HCV infection with age group (p = 0.003, x2 = 17.673). Of all donated blood, 8.2% (489/5983) had serological evidence for at least one of the screened pathogens and 58 (0.96%) of them had multiple infections.
This study showed a significant prevalence of HIV, HBV, and HCV among blood donors, 2.5% (147/5983), 4.1% (244/5983) and 1.6% (98/5983), respectively. Therefore, strict selection of blood donors with an emphasis on getting voluntary blood donors, and highly sensitive and specific tests for screening of blood donors for HIV, HBV, and HCV using standard methods are highly recommended to ensure the safety of blood for the recipient.
Malango T. Msukwa,
Joep J. van Oosterhout,
To assess the association between timing of maternal combination ART (cART) initiation and stillbirth among HIV‐infected pregnant women in Malawi's Option B+ programme.
Cohort study of HIV‐infected pregnant women delivering singleton live or stillborn babies at ≥28 weeks of gestation using routine data from maternity registers between 1 January 2012 and 30 June 2015. We defined stillbirth as death of a foetus at ≥28 weeks of gestation. We report proportions of stillbirth according to timing of maternal cART initiation (before pregnancy, 1st or 2nd trimester, or 3rd trimester or labour). We used logistic regression, with robust standard errors to account for clustering of women within health facilities, to investigate the association between timing of cART initiation and stillbirth.
Of 10 558 mother–infant pairs abstracted from registers, 8380 (79.4%) met inclusion criteria. The overall rate of stillbirth was 25 per 1000 deliveries (95% confidence interval 22–29). We found no significant association between timing of maternal cART initiation and stillbirth. In multivariable models, older maternal age, male sex of the infant, breech vaginal delivery, delivery at
Ann R. Falsey,
To investigate the viral etiology of acute respiratory infection (ARI) in hospitalized adults and elderly patients in Croatia, compare the prevalence of detected viruses, and to determine clinical characteristics and seasonal occurrence of investigated infections.
From January 2016 to June 2018, a total of 182 adult patients presented with symptoms of ARI and admitted to the hospital were tested for 15 respiratory viruses by multiplex reverse‐transcription polymerase chain reaction. Clinical data were collected by retrospective analysis of the patient's chart.
A virus was identified in 106 (58.5%) of the patients. The most commonly detected virus was influenza virus (41.5%), followed by respiratory syncytial virus (13.8%), human metapneumovirus (13.0%), parainfluenza viruses (12.2%), rhinoviruses (11.4%), adenovirus and coronaviruses with equal frequencies (3.3%), and enterovirus (1.6%). The serum level of C‐reactive protein and white blood cell count were significantly lower in patients with respiratory viruses identified when compared with those in whom no virus was detected (P
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Reply to Barner and Bruno-Murtha
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Hvad tænker Professor Morten Sodemann om"Evidence-based clinical guidelines for immigrants and refugees."?
Hvad synes Professor Niels Obel om"Use of statins and risk of AIDS-defining and non-AIDS-defining malignancies among HIV-1 infected patients on antiretroviral therapy."?
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