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Living with a respiratory disease can be a distressing experience for patients and their families. Treatment often focuses on reducing symptoms, but there is increasing evidence that the provision of psychosocial support to patients (ie, any support, such as counselling, that addresses psychological or social issues) can improve management of their condition.
Natalie I Mazur, Louis J Bont, Johannes J M van Delden, Saad B Omer
Respiratory syncytial virus (RSV) is the second most frequent cause of death after malaria in the post-neonatal period,1 yet there is no vaccine or treatment besides supportive care.2 Prevention of RSV will be an important step in achieving Sustainable Development Goal target 3.2: to end preventable deaths of newborns and children younger than 5 years of age. Maternal vaccination is a powerful tool to prevent infection in the first months of life; neonatal tetanus mortality has been successfully reduced by 92% through maternal tetanus toxoid vaccination.
Marc Humbert, Nazzareno Galiè, Vallerie V McLaughlin, Lewis J Rubin, Gérald Simonneau
The recent publication in the European Respiratory Journal of the proceedings of the 6th World Symposium on Pulmonary Hypertension (WSPH) is an important milestone in pulmonary vascular medicine. Since the first WHO meeting on primary pulmonary hypertension in Geneva in October, 1973, these World Symposia have taken place in Evian (France, 1998), Venice (Italy, 2003), Dana Point (USA, 2008), and twice in Nice (France, 2013, and 2018). These events have paved the way for better understanding and management of pulmonary hypertension worldwide.
Barcenas-Morales, Gabriela; Cortes-Acevedo, Paulina; Doffinger, Rainer
Purpose of review
The current review gives a concise and updated overview of the relative new field of anticytokine autoantibodies (ACAA) and associated infections with a focus on recent findings regarding clinical manifestions, diagnostic and treatments.
Several recent case reports of unusual presentations of patients with neutralizing autoantibodies to IFN-γ and granulocyt macrophage colony-stimulating factor and expand the spectrum of clinical manifestations and suggest that anticytokine-mediated acquired immunodeficiency causing susceptibility to infection may be underdiagnosed. There is an expanding geographical distribution of antigranulocyt macrophage colony-stimulating factor associated Cryptococcus gattii infection. The spectrum of identified infections in patients with neutralizing antibodies to IFN-γ has a strong endemic component. Rituximab or cyclophophamide in addition to antimycobacterials could be a treatment options in refractory cases. NF-κB2 deficiency may be associated with a complex pattern of high titre neutralizing ACAA similar to autoimmune polyglandular syndrome type I and Thymoma. New technique for the detection of anticytokine antibodies are presented. Quantiferon testing, which is widely available for TB-diagnostic, may be repurposed to detect anti-IFN-γ autoantibodies. We propose that this test could be as well used to show if they are neutralizing.
ACAA are an emerging cause of acquired immunodeficiency which is likely underdiagnosed. Recent case reports document expanding spectra of clinical manifestations. NF-κB2 deficiency may be associated with a complex anti cytokine autoantibody pattern.
Correspondence to Rainer Doffinger, PhD, FRCPath, Department of Clinical Biochemistry and Immunology, Level E4, Addenbrooke's Hospital – Cambridge University Hospital, NHS Trust, Hills Road, Cambridge CB2 0QQ, UK. E-mail: email@example.com
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Florescu, Diana F.; Stohs, Erica J.
Purpose of review
Adenoviruses are an important cause of morbidity and mortality of solid organ transplant patients and remain a clinical challenge with regard to diagnosis and treatment. In this review, we provide an approach to identification and classification of adenovirus infection and disease, highlight risk factors, and outline management options for adenovirus disease in solid organ transplant patients.
Additional clinical data and pathologic findings of adenovirus disease in different organs and transplant recipients are known. Unlike hematopoietic cell transplant recipients, adenovirus blood PCR surveillance and preemptive therapy is not supported in solid organ transplantation. Strategies for management of adenovirus disease continue to evolve with newer antivirals, such as brincidofovir and adjunctive immunotherapies, but more studies are needed to support their use.
Distinguishing between adenovirus infection and disease is an important aspect in adenovirus management as treatment is warranted only in symptomatic solid organ transplant patients. Supportive care and decreasing immunosuppression remain the mainstays of management. Cidofovir remains the antiviral of choice for severe or disseminated disease. Given its significant nephrotoxic effect, administration of probenecid and isotonic saline precidofovir and postcidofovir infusion is recommended.
Correspondence to Diana F. Florescu, MD, 985400 Nebraska Medical Center, Omaha, NE 68198-5400, USA. Tel: +1 402 559 8609; e-mail: firstname.lastname@example.org
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Garcia E, Berhane KT, Islam T, et al.
This study uses Southern California Children’s Health Study data to examine associations between changes in regional air pollution (ozone, nitrogen dioxide, and particulate matter
Valérie Siroux, Emmanuelle Bouzigon
Asthma, the most prevalent chronic respiratory disease worldwide, results from a complex interplay between genetic, environmental, and behavioural risk factors. The genetic component of asthma is substantial, but the asthma loci identified so far explain only part of the genetic risk. Although it is well known that asthma is a heterogeneous disorder, constituted by overlapping separate syndromes,1,2 the extent to which this phenotypic heterogeneity reflects differences in risk factors and molecular mechanisms is still poorly characterised.
V.N. Krylov, M.V. Bourkaltseva, E.A. Pleteneva
Careful selection of bacteriophages for phage therapy is needed to avoid undesirable consequences. Different approaches to phage therapy are compared: from the use of multispecies industrially produced phage mixtures with wide range of antibacterial activity to the ‘magistral phage’ approach in which bacteriophages are selected for treating individual patients.
Michael Kreuter, Toby M Maher
Idiopathic pulmonary fibrosis is a chronic, progressive, fibrosing interstitial lung disease with an unfavourable prognosis.1 Although substantial progress has been made in the treatment of this devastating condition, the course of the disease and prognosis for patients is challenging to predict. Thus, there is an urgent need to identify prognostic biomarkers in idiopathic pulmonary fibrosis. Several study groups have reported protein and RNA biomarkers with the potential to determine risk of progression and worsening of fibrosis in patients with idiopathic pulmonary fibrosis.
Charlotte E Bolton, Binaya KC, Rajendra Koju, Ian P Hall
As life expectancy in Nepal improves and the population ages, non-communicable diseases are becoming increasingly important health issues. Respiratory conditions, particularly chronic obstructive pulmonary disease, contribute substantially to morbidity and mortality. In 2016, the prevalence of chronic obstructive pulmonary disease was estimated to be 4810 per 100 000 people, and it was accountable for 5·72% of all deaths in Nepal.1–3 Less is known about the prevalence of other respiratory diseases, such as interstitial lung disease, bronchiectasis, and lung cancer, but anecdotally these are also increasingly common.
Revolinski, Sara L.; Munoz-Price, L. Silva
Purpose of review
Clostridioides difficile infection is common in solid organ transplant and hematopoietic stem-cell transplant recipients and is associated with significant morbidity and mortality. These populations are also underrepresented in clinical trials, making optimal management difficult. Because of this, management of these populations follows national guideline recommendations. This review aims to summarize the recent relevant literature pertaining to the clinical management of C. difficile infection in transplant patients, with a particular focus on diagnosis, treatment, and prevention.
Early diagnosis of C. difficile colonization may mitigate both horizontal and vertical transmission (progression from colonization to colitis) of infection. Once diagnosed, recent literature suggests antibiotic treatment should align with that recommended by national guidelines. Fecal microbiota transplant is an emerging therapy for recurrent C. difficile infection, and recent data have demonstrated safety and efficacy. Prevention strategies including antimicrobial stewardship, probiotic administration, antibiotic administration, and bezlotoxumab may be beneficial in transplant populations, but more data are needed to confirm recent findings.
Studies evaluating C. difficile infection in transplant patients are only recently starting to emerge. Further research is needed to identify optimal treatment and prevention strategies, and to examine novel strategies such as microbiome manipulation.
Correspondence to Sara L. Revolinski, PharmD, School of Pharmacy, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA. Tel: +1 414 955 2873; e-mail: email@example.com
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Stuart A Taylor, Sue Mallett, Simon Ball, Sandy Beare, Gauraang Bhatnagar, Angshu Bhowmik, Peter Boavida, John Bridgewater, Caroline S Clarke, Marian Duggan, Steve Ellis, Robert Glynne-Jones, Vicky Goh, Ashley M Groves, Ayshea Hameeduddin, Sam M Janes, Edward W Johnston, Dow-Mu Koh, Sara Lock, Anne Miles, Stephen Morris, Alison Morton, Neal Navani, Alfred Oliver, Terry O'Shaughnessy, Anwar R Padhani, David Prezzi, Shonit Punwani, Laura Quinn, Hameed Rafiee, Krystyna Reczko, Andrea G Rockall, Peter Russell,
WB-MRI staging pathways have similar accuracy to standard pathways, and reduce the staging time and costs.
Baiu I, Melendez E.
This JAMA Patient Page describes the symptoms, diagnosis, and treatment of epiglottitis in children.
High hemagglutination inhibition (HAI) and neuraminidase inhibition (NAI) titers are generally associated with reduced influenza risk. While repeated influenza vaccination reduces seroresponse, vaccine effectiveness is not always reduced.
During the 2007-2008 influenza season, a randomized, placebo-controlled trial (FLUVACS) evaluated the efficacies of live-attenuated (LAIV) and inactivated influenza vaccines (IIV) among healthy adults aged 18-49 in Michigan; IIV vaccine efficacy (VE) and LAIV VE against influenza disease were estimated at 68% and 36%. Using the principal stratification/VE moderation framework, we analyzed data from this trial to assess how each VE varied by HAI or NAI responses to vaccination observed for vaccinated individuals and predicted counterfactually for placebo recipients. We also assessed how each VE varied with pre-vaccination/baseline variables including HAI titer, NAI titer, and vaccination history.
IIV VE appeared to increase with Day 30 post-vaccination HAI titer, albeit not significantly (p=0.20 and estimated VE 14.4%, 70.5%, and 85.5% at titer below the assay lower quantification limit, 512, and 4096 (maximum)). Moreover, IIV VE increased significantly with Day 30 post-vaccination NAI titer (p=0.040), with estimated VE zero at titer 10 and 92.2% at highest titer 640. There was no evidence that fold-change in post-vaccination HAI or NAI titer associated with IIV VE (p=0.76, 0.38). For LAIV, there was no evidence that VE associated with post-vaccination or fold-rise HAI or NAI titers (p-values >0.40). For IIV, VE increased with increasing baseline NAI titer in those previously vaccinated, but VE decreased with increasing baseline NAI titer in those previously unvaccinated. In contrast, for LAIV, VE did not depend on previous vaccination or baseline HAI or NAI titer.
Conclusions: Future efficacy trials should measure baseline and post-vaccination antibody titers in both vaccine and control/placebo recipients, enabling analyses to better elucidate correlates of vaccine- and natural-protection.
Trial registration: ClinicalTrials.gov NCT00538512. October 1, 2007.
A recent United Nations report lays out a grim scenario in North Korea, formally the Democratic People’s Republic of Korea: An estimated 11 million people—almost 44% of the population—are undernourished and millions lack clean drinking water, access to basic health services, and sanitation.
Madeleine K D Scott, Katie Quinn, Qin Li, Robert Carroll, Hayley Warsinske, Francesco Vallania, Shirley Chen, Mary A Carns, Kathleen Aren, Jiehuan Sun, Kimberly Koloms, Jungwha Lee, Jessika Baral, Jonathan Kropski, Hongyu Zhao, Erica Herzog, Fernando J Martinez, Bethany B Moore, Monique Hinchcliff, Joshua Denny, Naftali Kaminski, Jose D Herazo-Maya, Nigam H Shah, Purvesh Khatri
Monocyte count could be incorporated into the clinical assessment of patients with idiopathic pulmonary fibrosis and other fibrotic disorders. Further investigation into the mechanistic role of monocytes in fibrosis might lead to insights that assist the development of new therapies.
Leprosy typically manifests with skin and peripheral nerve involvement. Musculoskeletal complaints are the third most common, and can be the sole presenting manifestation. They range from arthralgia/arthritis in reactional states to full mimics of systemic rheumatic diseases. Remitting Seronegative Symmetrical Synovitis with Pitting Oedema syndrome has only been described once in a patient with already diagnosed Leprosy.
A 68-year-old male, from an endemic region of familial amyloid polyneuropathy, presented with an inaugural Remitting Seronegative Symmetrical Synovitis with Pitting Oedema like syndrome, more that 20 years after travelling to Leprosy endemic areas. Arthritis would resurface whenever oral prednisone was tapered, so methotrexate was started, controlling the complaints. Only one year later, after the appearance of peripheral neuropathy and skin lesions, it was possible to diagnose Leprosy, through the identification of Mycobacterium leprae bacilli in a peripheral nerve biopsy.
This report is an example of the heterogeneity of manifestations of Leprosy, namely rheumatic, and the challenge of diagnosing it when typical complaints are absent. It is also a reminder that this disease should be considered whenever a patient with a combination of skin/neurologic/rheumatic complaints has travelled to endemic countries in the past.
Vicki L Clifton
Maternal asthma is highly prevalent and is associated with clinically significant perinatal morbidity and mortality. There is an increased risk of small-for-gestational age, preterm birth, neonatal death, and neonatal hospitalisations in pregnancies complicated by asthma. This chronic disease thus represents a substantial health burden for women of reproductive age, affecting the wellbeing and quality of life for both the mother and her offspring.
Busse JW, Wang L, Guyatt GH.
In Reply Average effects have limitations, which is why we modeled the proportion of patients that achieved the minimally important difference for all continuous outcomes. Pooling the proportion of patients achieving 30% and 50% improvement from baseline scores for pain relief requires that trialists report this information, which the large majority did not.
Talha Khan Burki
On April 12, 2019, the Global Initiative for Asthma (GINA) released its updated recommendations. The guidelines included a major change in the management of patients with mild asthma. GINA now advises against starting any patient with asthma solely on short-acting β2 agonist (SABA) reliever inhalers. Instead, GINA recommends that all patients aged 12 years and older with mild asthma should be treated with low-dose inhaled corticosteroids, either regularly or taken as needed together with a medication for symptom relief, to reduce the risk of serious exacerbations and deaths.
Sergio Brasil Tufik, Monica Levy Andersen, Gabriel Natan Pires, Sergio Tufik
Sleep medicine was in its early days when Roffwarg, Muzio, and Dement published their authoritative review of the development of sleep throughout life.1 Rapid eye movement (REM) sleep had been discovered only about a decade earlier2 and most research efforts had been devoted to understanding what sleep really was from a physiological perspective. The review, therefore, focused on how sleep patterns modify and evolve across the lifespan, addressing REM sleep maturation from early childhood until old age.
Mark I Boulos, Trevor Jairam, Tetyana Kendzerska, James Im, Anastasia Mekhael, Brian J Murray
These normative values serve as a useful control reference for clinicians and for future research where it might be difficult to obtain polysomnographic controls. The resulting normative trends by age and sex might also be hypothesis-generating for a broad range of investigations.
Purpose of review
In the 100 years since the influenza pandemic of 1918–1919, the most deadly event in human history, we have made substantial progress yet we remain vulnerable to influenza pandemics This article provides a brief overview of important advances in preparing for an influenza pandemic, viewed largely from the perspective of the healthcare system.
We have gained insights into influenza pathogenicity, the animal reservoir and have improved global surveillance for new strains and tools for assessing the pandemic risk posed by novel strains. Public health has refined plans for severity assessment, distribution of countermeasures and nonpharmaceutical approaches. Modest improvements in vaccine technology include cell culture-based vaccines, adjuvanted vaccine and recombinant technology. Conventional infection control tools will be critical in healthcare settings. New evidence suggests that influenza virus may be present in aerosols; the contribution of airborne transmission and role of N95 respirators remains unknown. Baloxavir and pimodivir are new antivirals that may improve treatment, especially for severely ill patients. Optimal use and the risk of resistance require further study.
Despite the progress in pandemic preparedness, gaps remain including important scientific questions, adequate resources and most importantly, the ability to rapidly deliver highly effective vaccines.
Correspondence to Andrew Pavia, George and Esther Gross Presidential Professor and Chief, Division of Pediatric Infectious Diseases, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA. Tel: 1 801 581-6791; e-mail: firstname.lastname@example.org
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Write light. Watch how the air quickens.A gentle humming begins.
To investigate the carbapenem resistance mechanisms and clonal relationship of carbapenem-resistant Acinetobacter baumannii (CRAB) strains isolated in the intensive care unit (ICU) of the First Affiliated Hospital of Jiamusi University, management approaches to ICU clonal CRAB outbreaks were described.
The sensitivity of the antibiotic was determined using the VITEK-2 automated system. Carbapenemase genes (blaTEM, blaSHV, blaKPC, blaNDM, blaIMP-4, blaVIM, blaOXA-23, blaOXA-24, blaOXA-51, and blaOXA-58), AmpC enzyme genes (blaACC, blaDHA, blaADC), and ISAba1 were assessed for all collected isolates using polymerase chain reaction (PCR). The transfer of resistance genes was investigated via conjugation experiments. The clonal relationship of isolates was determined via enterobacterial repetitive intergenic consensus (ERIC)-PCR and multilocus sequence typing (MLST). When the detection rate of CRAB increased from 25% in 2010 to 92% in 2014, a number of actions were initiated, including enhanced infection control, staff education, and the cleaning of the hospital environment.
Clinical isolates were positive for the following genes: blaOXA23, blaOXA51, blaOXA24, blaADC, blaTEM, ISAba1, ISA-23, and ISA-ADC; however, blaOXA58, ISA-51, blaNDM, blaIMP, blaKPC, blaTEM, blaSHV, blaVIM, and blaACC were not detected. Four carbapenem-resistant isolates successfully transferred plasmids from A. baumannii isolates to E. coli J53. MLST showed that all strains belonged to ST2 except for one isolate, which belonged to the new genotype ST1199. The ERIC-PCR method found the following three genotypes: type A in 8, type B in 12, type C in 1, and two profiles (A, B) belonged to ST2. After taking control measures, the prevalence of CRAB isolates decreased, and the discovery rate of CRAB dropped to 11.4% in 2017.
The obtained result suggests that blaOXA-23-producing CC2 isolates were prevalent in the ICU of the First Affiliated Hospital of Jiamusi University. Targeted surveillance was implemented to identify the current situation of the ICU and the further implementation of infection control effectively prevented the spread of nosocomial infection.
Leonardo Martinez, Nathan C Lo, Olivia Cords, Philip C Hill, Palwasha Khan, Mark Hatherill, Anna Mandalakas, Alexander Kay, Julio Croda, C Robert Horsburgh, Heather J Zar, Jason R Andrews
Tuberculosis is a major cause of death and disability among children globally, yet children have been neglected in global tuberculosis control efforts. Historically, tuberculosis in children has been thought of as a family disease, and because of this, household contact tracing of children after identification of an adult tuberculosis case has been emphasised as the principal public health intervention. However, the population-level effect of household contact tracing is predicated on the assumption that most paediatric tuberculosis infections are acquired within the household.
Mycolicibacterium phlei (M. phlei) is known to be a non-pathogenic nontuberculous mycobacterium (NTM) which rarely causes diseases in humans. A disseminated NTM infection is mostly caused by the Mycobacterium avium complex (MAC) and is known to develop in immunocompromised hosts, like those with acquired immune deficiency syndrome (AIDS). Here, we report a case of disseminated M. phlei infection in an immunocompetent host carrying anti-interferon gamma (IFN-γ) autoantibodies.
We detected M. phlei in multiple organs of an elderly woman with no significant medical history except positivity for anti-IFN-γ autoantibodies. She tested negative for human immunodeficiency virus (HIV)-1, 2/ Human T-cell leukemia virus type 1 (HTLV-1) antibody. High-resolution computed tomography (HRCT) of the chest demonstrated a nodule in the left S1 + 2 segment, interlobular septal thickening, multi lymphadenopathy, and osteolysis. A maximum intensity projection image following fluorodeoxyglucose-positron emission tomography (FDG-PET) revealed multifocal hypermetabolic lesions in the nodule and all the swollen lymph nodes seen in HRCT. FDG also accumulated in multiple bones. Advanced primary lung cancer was suspected, and biopsies of each lesion were performed. The pathology revealed caseating granuloma, positive for acid-fast bacteria, and DNA sequencing of the acid-fast bacteria confirmed the organism to be M. phlei. The patient also tested positive for anti-IFN-γ autoantibodies. Based on these findings, she was diagnosed with disseminated M. phlei infection, with anti-IFN-γ autoantibodies.
Though known to be non-pathogenic, we show that M. phlei can be pathogenic like the MAC in immunocompetent individuals carrying anti-IFN-γ autoantibodies.
Vijay Shankar Balakrishnan
Young Pedro Suarez was a physician practising at a local health centre in northern Lima, Peru, in the 1980s, when the centre's director asked him to see patients with lung diseases. Suarez usually saw 50 patients a day, most of them with tuberculosis. “This was my first encounter with the tuberculosis problem, but it was also an opportunity to observe and understand the day-to-day difficulty in managing tuberculosis”, said Suarez, who is now a public health expert at Management Sciences for Health (Washington, DC, USA).
Human pathogens transmitted through environmental pathways are subject to stress and pressures outside of the host. These pressures may cause pathogen pathovars to diverge in their environmental persistence and their infectivity on an evolutionary time-scale. On a shorter time-scale, a single-genotype pathogen population may display wide variation in persistence times and exhibit biphasic decay.
We use a transmission modeling framework to develop an infectious disease model with biphasic pathogen decay. We take a differential algebra approach to assessing model identifiability, calculate basic reproduction numbers by the next generation method, and use simulation to explore model dynamics.
For both long and short time-scales, we demonstrate that epidemic-potential-preserving trade-offs have implications for epidemic dynamics: less infectious, more persistent pathogens cause epidemics to progress more slowly than more infectious, less persistent (labile) pathogens, even when the overall risk is the same. Using identifiability analysis, we show that the usual disease surveillance data does not sufficiently inform these underlying pathogen population dynamics, even when combined with basic environmental monitoring data. However, risk could be indirectly ascertained by developing methods to separately monitor labile and persistent subpopulations. Alternatively, determining the relative infectivity of persistent pathogen subpopulations and the rates of phenotypic conversion will help ascertain how much disease risk is associated with the long tails of biphasic decay.
A better understanding of persistence–infectivity trade-offs and associated dynamics can improve our ecological understanding of environmentally transmitted pathogens, as well as our risk assessment and disease control strategies.
Tejas Suri, Pawan Tiwari, Vijay Hadda, Antonio M Esquinas, Anant Mohan
We read with interest the randomised controlled trial by Jean-Pierre Frat and colleagues1 in The Lancet Respiratory Medicine, which compared preoxygenation with non-invasive ventilation versus high-flow nasal cannula oxygen therapy with apnoeic oxygenation during intubation of patients with acute hypoxaemic respiratory failure. The authors showed that neither non-invasive ventilation nor high-flow nasal cannula preoxygenation significantly altered the risk of severe hypoxaemia during intubation.
Jean-Pierre Frat, Jean-Damien Ricard, Stéphanie Ragot, Arnaud W Thille
We read with interest Vijay Hadda and colleagues' letter challenging the design of our study. In this randomised controlled trial, which included 313 patients undergoing intubation for acute hypoxaemic respiratory failure, we found that preoxygenation with non-invasive ventilation or high-flow oxygen therapy did not change the risk of severe hypoxaemia in the overall population.1 However, non-invasive ventilation reduced the risk of severe hypoxaemia in the predefined stratum of 242 patients with moderate-to-severe hypoxaemia.
Marina Papaiakovou, Robin B. Gasser, D. Tim J. Littlewood
Treatment and control programmes tackling soil-transmitted helminth (STH) infections require sensitive, reliable, and accurate diagnostic tools. There is a growing need for measures of infection intensity as programmes approach STH control. Quantitative real-time PCR (qPCR) is well suited to the detection of DNA targets present in stool, even in low-prevalence settings. Detecting low levels of infection becomes increasingly important when the breakpoint of transmission is approached, and is vital when monitoring for recrudescence once control, or possibly 'elimination', is achieved.
Rolfes M, Flannery B, Patel M, et al.
The emergence of leptospirosis-associated severe pulmonary hemorrhagic syndrome (SPHS) with high case fatality has been reported from many countries. Understanding of clinical disease and sequel of SPHS needs larger studies with adequate numbers. The purpose of this study was to describe the characteristics and sequel by different therapeutic approaches for SPHS in Leptospirosis in Sri Lanka.
This study was conducted at Teaching Hospital-Karapitiya (THK), Galle, Sri Lanka from June 2015 to December 2017. THK is the main tertiary care center for the Southern Province. All confirmed-cases of leptospirosis who presented during this period and were admitted to five medical units of THK were included in this study. SPHS was defined as a patient presenting; haemoptysis, arterial hypoxemia (Acute Lung Injury Score
Brucellosis is an infectious zoonotic disease and is common especially among pastoral communities in most low and middle-income countries. The aim of this study was to determine sero-prevalence, and risk factors of Brucella infection among Slaughterhouse workers, in Bahr el Ghazal region, South Sudan.
A cross sectional study was conducted among Slaughterhouse workers in Bahr el Ghazal region, South Sudan from December 2015 to May 2016. A pre-tested questionnaire was used in data collection. Each randomly selected participant was interviewed and a venous blood sample collected. The blood samples were screened for Brucellosis infection using Rose Bengal Plate Test (RBPT) and confirmed using Competitive Enzyme link Immuno Sorbet Assay (c-ELISA). Data was analyzed using Stata version 13 at 95% level of confidence.
A total of 234 Slaughterhouse workers were screen for Brucella infection. Overall, a third, 32.1% (75/234) of the participants were sero-positive for brucellosis. The prevalence of brucellosis was higher, 17.1% (40/234) in Wau state compared to other states. There was high prevalence among males, 28.6% (67/234) compared to females 3.4% (8/234). The mean age of study participants was 34.4 ± 9.6 years. A high proportion, 12.8% (30/234) of participants with confirmed brucellosis infection were 31–40 years of age. Brucellosis prevalence was high among butchers, 14.5% (34/234), and meat handlers, 9.0% (21/234).
Brucellosis is common among animal slaughterhouse workers in Bahr el Ghazal region, South Sudan. There is need for public awareness campaigns and educational programs to help sensitize communities on Brucella infection.
Milton Pividori, Nathan Schoettler, Dan L Nicolae, Carole Ober, Hae Kyung Im
Genetic risk factors for adult-onset asthma are largely a subset of the genetic risk for childhood-onset asthma but with overall smaller effects, suggesting a greater role for non-genetic risk factors in adult-onset asthma. Combined with gene expression and tissue enrichment patterns, we suggest that the establishment of disease in children is driven more by dysregulated allergy and epithelial barrier function genes, whereas the cause of adult-onset asthma is more lung-centred and environmentally determined, but with immune-mediated mechanisms driving disease progression in both children and adults.
Women in Africa are 50 times more likely to die as a result of a cesarean delivery as women in high-income countries, a team of investigators from several African countries has reported. Neonates fare poorly, too. Their mortality rate after cesarean delivery is high—44 per 1000 live births.
Pasteurella multocida (P. multocida) forms part of the normal flora of many animals. Although it is a common causative agent of skin and soft tissue infection after an animal bite or scratch, in rare cases it can cause spinal infections in humans.
A 68-year-old immunocompetent woman presented with fever and sudden onset of severe back pain mimicking aortic dissection. No findings related to the pain were revealed on enhanced computed tomography or initial magnetic resonance imaging (MRI) of the spine. The patient was found to be bacteremic with P. multocida, although she had no apparent injury related to animal contact. Repeated evaluation by MRI with gadolinium-contrast established the diagnosis of spinal epidural abscess. The patient was cured by the rapid initiation of antimicrobial therapy without surgery.
We describe the successful treatment of an individual with a spinal epidural abscess due to P. multocida without surgery. P. multocida infections may occur as sudden presentations. Obtaining the patient history of recent animal contact is essential. Repeated MRI evaluation may be required when spinal infections are suspected. To the best of our knowledge, this is the first report which describes a case of spinal epidural abscess due to this organism.
In this narrative medicine essay, a physician finds in the motion of diastole, the process of letting go and filling up, an apt metaphor for how to handle the burnout, anxiety, and depression of medical training.
Perak AM, Ning H, Kit BK, et al.
This national survey study uses National Health and Nutrition Examination Survey data from 1999-2016 to characterize trends in levels of lipids and apolipoprotein B in US youths aged 6 to 19 years.
In October, 2018, the International Union Against Tuberculosis and Lung Disease (The Union) and The World Diabetes Foundation released the first edition of new guidelines pertaining to the treatment of patients with concurrent tuberculosis and diabetes. “These are the first global guidelines on how to screen for and manage people with diabetes-tuberculosis…They are holistic and also include advice about infection control in diabetes clinics, recording and reporting, and about how to set up joint collaboration in the ministries of health”, says Anthony Harries (The Union, London, UK).
Ganesh Raghu, Kevin R Flaherty, David J Lederer, David A Lynch, Thomas V Colby, Jeffrey L Myers, Steve D Groshong, Brandon T Larsen, Jonathan H Chung, Mark P Steele, Sadia Benzaquen, Karel Calero, Amy H Case, Gerard J Criner, Steven D Nathan, Navdeep S Rai, Murali Ramaswamy, Lars Hagmeyer, J Russell Davis, Umair A Gauhar, Daniel G Pankratz, Yoonha Choi, Jing Huang, P Sean Walsh, Hannah Neville, Lori R Lofaro, Neil M Barth, Giulia C Kennedy, Kevin K Brown, Fernando J Martinez
The molecular test provided an objective method to aid clinicians and multidisciplinary teams in ascertaining a diagnosis of IPF, particularly for patients without a clear radiological diagnosis, in samples that can be obtained by a less invasive method. Further prospective clinical validation and utility studies are planned.
Diarrheal diseases resulting from scarce clean water and sanitation in countries with protracted armed conflicts take more children’s lives than the violence itself, according to a recent United Nations Children’s Fund (UNICEF) report.
Mathias Meyer, Johannes Budjan
The use of imaging for precise staging to determine the most appropriate treatment strategy is of utmost importance in non-small-cell lung cancer (NSCLC), given that it is the leading cause of death in developed countries.1 The National Comprehensive Cancer Network and European Society of Medical Oncology recommend intravenous contrast agent-enhanced chest CT, 18-fluorodeoxyglucose ([18F]-FDG)-PET-CT, and—depending on the guidelines—brain MRI studies for staging of NSCLC.2,3 Additionally, in cases of equivocal findings of metastasis at [18F]-FDG-PET-CT (eg, in the brain, spine, or liver), MRI is indicated.
Retningslinjer til sundhedsprofessionelle vedr. håndtering af infektion med zikavirus (2019)
Antiviral behandling af hiv smittede personer (2019)
Lumbalpunktur af patienter i blodfortyndende behandling (2019)
Reply to Barner and Bruno-Murtha
23.09.2019Clinical Infectious Diseases Advance Access
False-negative Results of Human Immunodeficiency Virus (HIV) Rapid Testing in HIV Controllers
21.09.2019Clinical Infectious Diseases Advance Access
Resistance of Influenza Virus to Antiviral Medications
20.09.2019Clinical Infectious Diseases Advance Access
Oseltamivir resistance in severe influenza A(H1N1)pdm09 pneumonia and acute respiratory distress syndrome: a French multicenter observational cohort study
20.09.2019Clinical Infectious Diseases Advance Access
Baloxavir marboxil in Japanese pediatric patients with influenza: safety and clinical and virologic outcomes
20.09.2019Clinical Infectious Diseases Advance Access
Hvorfor synes Professor Thomas Benfield, at du bør læse"Oral versus Intravenous Antibiotics for Bone and Joint Infection."?
Hvorfor anbefaler Professor Niels Obel artiklen"Early, Goal-Directed Therapy for Septic Shock - A Patient-Level Meta-Analysis."?
Hvad tænker Professor Thomas Benfield om"Duration of Antibiotic Treatment in Community-Acquired Pneumonia: A Multicenter Randomized Clinical Trial."?
Hvorfor anbefaler Professor Morten Sodemann artiklen"Evidence-based clinical guidelines for immigrants and refugees."?
Hvad mener Professor Niels Obel om artiklen"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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