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A newer antimalaria medication with a simplified dosing regimen may be useful in US patients as prophylaxis or as an antirelapse treatment, according to a review in the Morbidity and Mortality Weekly Report.
An updated recommendation from CDC’s Advisory Committee on Immunization Practices (ACIP) suggests adults aged 65 years or older should receive only the 23-valent pneumococcal polysaccharide vaccine (PPSV23) with a few exceptions.
Darrow JJ, Avorn J, Kesselheim AS.
This study uses publicly available and FDA data to describe changes in drug testing laws and standards, the use of new FDA approval programs and standards, changes in the role and authority of the FDA, and changes in the number of drugs the FDA has approved from 1983 to 2018.
In this narrative medicine essay, a resident physician shares the story of a young Haitian woman with cancer whose survival was threatened with deportation for having missed her residency application deadline and of his role in advocating for her care with US citizenship and immigration services.
Cooney L, Balcezak T.
This JAMA Performance Improvement article reports the methods and outcomes of a cognitive screening program implemented at a US hospital to assess medical staff aged 70 years or older for clinical competency every 2 years as a requirement for reappointment.
Baiu I, Melendez E.
This JAMA Patient Page describes the causes, symptoms, diagnosis, and treatment of periorbital and orbital cellulitis.
Weitz JI, Bauersachs R, Becker B, et al.
This phase 2 clinical noninferiority trial compared 4 doses of postoperative osocimab, a monoclonal antibody against factor XI, vs enoxaparin and apixiban on venous thromboembolism incidence among patients undergoing knee replacement.
Hoffman KE, Penson DF, Zhao Z, et al.
This cohort study compares functional outcomes, including sexual and bowel function and urinary incontinence, associated with active surveillance, surgery, or radiation therapy 5 years after treatment.
Parsons J, Zahrieh D, Mohler JL, et al.
This randomized trial compares the effect of a counseling intervention to promote consumption of 7 or more daily vegetable servings vs an educational control on time to PSA- and biopsy-defined cancer progression in men with early-stage prostate cancer.
Krist AH, Owens DK, Mangione CM.
In Reply Dr Pinsky asks for more clarity on the USPSTF’s recent recommendation. The USPSTF found that women with a personal or family history of breast or ovarian cancer, or an ancestry associated with BRCA1/2 mutations, are at increased risk for having a BRCA1/2 mutation. For these women, the benefits of risk assessment and potentially counseling and testing outweigh the harms. Determining whether a woman may be a candidate for referral for counseling and possible genetic testing is a multistep process for primary care clinicians. The first step is to identify women with a personal or family history of breast or ovarian cancer or an ancestry associated with BRCA1/2 mutations (eg, Ashkenazi Jewish women). For these women, the next step is to perform a risk assessment using 1 of several brief risk assessment tools. Last, for women found to be at higher risk using these tools, clinicians should refer or provide genetic counseling. This includes more definitive risk assessment, counseling about genetic testing, shared decision-making about whether to be tested, and potentially genetic testing.
Swails JL, Aibana O, Stoll BJ.
In Reply Based on the letters from Mr Schneider, Drs Everett and Isea, and Dr Battisti, we find 2 key issues to discuss—transparency and competency. We absolutely agree that increased transparency and access to data, both from medical schools and through ERAS, would facilitate holistic review. Program directors have been lamenting the erosion of meaningful performance measures for years as medical schools increasingly moved to pass-fail grading. We wonder what role the narrow focus on academic metrics in residency selection may have played during this transition. Broadening the selection criteria beyond academic metrics in true holistic review may be a more successful approach for encouraging data release than further demands for score details. Realistic solutions include use of additional information already collected by ERAS, such as student experiences (volunteer work, research productivity) and attributes (language skills, regional ties, distance traveled), to filter applicants for review. Once a reasonable number of applications is identified, each can be individually assessed for mission-specific factors including medical knowledge.
Diaz-Soto, Maria P.; Morgan, Brooks W.; Davalos, Long; Herrera, Phabiola; Denney, Joshua; Roldan, Rollin; Paz, Enrique; Jaymez, Amador A.; Chirinos, Eduardo E.; Portugal, Jose; Quispe, Rocio; Brower, Roy G.; Checkley, William; INTENSIVOS Cohort Study
Weaning protocols establish readiness-to-wean criteria to determine the opportune moment to conduct a spontaneous breathing trial. Weaning protocols have not been widely adopted or evaluated in ICUs in low- and middle-income countries. We sought to compare clinical outcomes between participants whose weaning trials were retrospectively determined to have been premature, opportune, or delayed based on when they met readiness-to-wean criteria.
Prospective, multicenter observational study.
Five medical ICUs in four public hospitals in Lima, Perú.
Adults with acute respiratory failure and at least 24 hours of invasive mechanical ventilation (n = 1,657).
Measurements and Main Results:
We established six readiness-to-wean criteria and retrospectively categorized our sample into three weaning groups: 1) premature: if the weaning trial took place before fulfilling all criteria, 2) opportune: if the weaning trial took place within 24 hours after fulfilling the criteria, and 3) delayed: if the weaning trial took place over 24 hours after fulfilling criteria. We compared 90-day mortality, ventilator-free days, ICU-free days, and hospital-free days between premature, opportune, and delayed weaning groups. In our sample, 761 participants (60.8%) were classified as having a premature weaning trial, 196 underwent opportune weaning (15.7%), and 295 experienced delayed weaning (23.6%). There was no significant difference in 90-day mortality between the groups. Both the premature and delayed weaning groups had poorer clinical outcomes with fewer ventilator-free days (–2.18, p = 0.008) and (–3.49, p < 0.001), ICU-free days (–2.25, p = 0.001) and (–3.72, p < 0.001), and hospital-free days (–2.76, p = 0.044) and (–4.53, p = 0.004), respectively, compared with the opportune weaning group.
Better clinical outcomes occur with opportune weaning compared with premature and delayed weaning. If readiness-to-wean criteria can be applied in resource-limited settings, it may improve ICU outcomes associated with opportune weaning.
The INTENSIVOS Cohort Study are as follows: Roy G. Brower, Francesca Capanni, Maria A. Caravedo, Jorge Cerna, William Checkley, Eduardo E. Chirinos, Long Davalos, Aldo De Ferrari, Joshua A. Denney, Augusto Dulanto, Phabiola Herrera, Amador A. Jaymez, Nicole Mongilardi, Carmen Paredes, Enrique Paz, Maria Alejandra Pereda, Jose Portugal, Rocio Quispe, Rollin Roldan, and Navid Shams.
Dr. Diaz-Soto and Mr. Morgan analyzed and interpreted the data, and drafted the article. Dr. Davalos collected, analyzed, and interpreted the data, and drafted the article. Drs. Herrera, Roldan, Paz, Jaymez, Chirinos, Portugal, and Quispe collected the data and drafted the article. Dr. Denney helped with the study design, collected the data, and drafted the article. Dr. Brower helped with the study design, interpreted the data, and drafted the article. Dr. Checkley designed and supervised the study, obtained funding, analyzed and interpreted the data, and drafted the article.
This study was supported by a Pathway to Independence Award (R00HL096955) from the National Heart, Lung and Blood Institute, National Institutes of Health.
Dr. Diaz-Soto disclosed that this study was supported by a the National Heart, Lung and Blood Institute, National Institutes of Health. The remaining authors have disclosed that they do not have any potential conflicts of interest.
We received ethics approval and permission to conduct this study in each of the participating institutions: Hospital Nacional Edgardo Rebagliati Martins, Hospital Nacional Guillermo Almenara Irigoyen, Hospital Nacional Arzobispo Loayza, Hospital de Emergencias Casimiro Ulloa. Ethics approvals were obtained from the institutional review boards of A.B. PRISMA and ESSALUD Hospital Nacional Edgardo Rebagliati Martins in Lima, Peru, and the Johns Hopkins School of Medicine, in Baltimore, MD. We obtained a waiver of written informed consent to conduct this observational study.
Availability of data and materials: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
For information regarding this article, E-mail: email@example.com
Copyright © by 2020 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
It is believed that the current prevalence of malaria in endemic areas reflects selection for the carrier form of sickle cell trait through a survival advantage. Malaria has been incriminated as a great cause of mortality in people with sickle cell disease (SCD). However, people with SCD, a high-risk group, do not benefit from free or subsisized malaria prevention and treatment in Cameroon unlike other vulnerable groups which may be due to insufficient evidence to guide policy makers. This study aimed at describing clinical and socio-demographic characteristics of patients with malaria, determining the prevalence of malaria in hospitalized children and in those with SCD and without, compare frequency of presentation of malaria related complications (using clinical and laboratory elements that define severe malaria) between children admitted for malaria with SCD and those without and finally, determing the risk factors for death in children admitted for malaria.
This was a retrospective analysis of admission records of children age 1 to 18 years with a confirmed malaria diagnosis admitted at the Laquintinie Hospital during January 2015 through December 2018. Clinical features, laboratory characteristics and outcome of malarial infections, stratified by SCD status were studied. Patients with HIV infection, malnutrition, renal failure and discharged against medical advice were excluded from the study. Data were analysed using Epi-info 7 software and analysis done. Chi square test, Odds ratios, CI and student’s t test were used to determine association between variables. Statistical significance was set at p-value ≤0.05.
The prevalence of malaria was lower among children with SCD than it was among children without SCD (23.5% vs 44.9%). Similarly, among those with a positive microscopy, the mean parasite density was significantly lower among children with SCD than it was among children without SCD (22,875.6 vs 57,053.6 parasites/ μl with t-value − 3.2, p-value 0.002). The mean hemoglobin concentration was lower in SCD as compared to non SCD (5.7 g/l vs 7.4 g/l, t-value − 12.5, p-value
Compliance to anti-TB treatment is crucial in achieving cure and avoiding the emergence of drug resistance. Electronic health (eHealth) interventions are included in the strategy to end the global Tuberculosis (TB) epidemic by 2035. Evidences showed that mobile messaging systems could improve patient adherence to clinic appointment for diagnosis and treatment. This review aimed to assess the effect of mobile-phone messaging on anti-TB treatment success.
All randomized controlled trial (RCT) and quasi-experimental studies done prior to August 26, 2019 were included in the review. Studies were retrieved from PubMed, EMBASE, Cochrane and ScienceDirect databases including, grey and non-indexed literatures from Google and Google scholar. Quality of studies were independently assessed using Cochrane Risk of Bias Assessment Tool. A qualitative synthesis and quantitative pooled estimation were used to measure the effect of phone messaging on TB treatment success rate. PRISMA flow diagrams were used to summarize article selection process.
A total of 1237 articles were identified, with 14 meeting the eligibility criteria for qualitative synthesis. Eight studies with a total of 5680 TB patients (2733 in intervention and 2947 in control groups) were included in meta-analysis. The pooled effect of mobile-phone messaging revealed a small increase in treatment success compared to standard of care (RR 1.04, 95% CI 1.02 to 1.06), with low heterogeneity (I2 = 7%, p
In recent decades, there has been a marked increase in the number of reported cases of pertussis around the world, and pertussis continues to be a frequently occurring disease despite an effective childhood vaccination. This study aims to determine the role of household contacts of children diagnosed with pertussis in Casablanca Morocco.
From November 2015 to October 2017, children suspected of whooping cough that consulted Ibn Rochd University hospital at Casablanca with their household contacts were enrolled in the study. Nasopharyngeal (NP) samples of the suspected children were analyzed by culture and RT-PCR. For the household contacts, NP and blood samples were collected and analyzed by RT-PCR and specific detection of pertussis toxin antibodies by ELISA, respectively.
During the study period, the survey was carried out on 128 infants hospitalized for pertussis suspicion and their families (N = 140). B. pertussis DNA was specifically detected in 73 (57%) samples, coexistence of B. pertussis and B. parapertussis DNA in 3 (2.3%) samples, coexistence of B. pertussis and B. holmesii DNA in 10 (7.81%) and only one (0.78%) sample was IS 481 RT-PCR positive without the possibility of determining the Bordetella species with the diagnostic tools used. Confirmations of Pertussis infection in household contacts by culture, RT- PCR and serology were 10, 46 and 39%, respectively.
B. pertussis DNA was confirmed in the infants as well in their mothers in 38% of the cases. Co detection of B. pertussis and B. parapertussis DNA in 2% and co-detection of B. pertussis and B. holmesii DNA in 4%. B. holmesii DNA alone was detected in 5 NP samples of index cases and their mothers.
The results of this study confirm that B. pertussis is still circulating in children and adults, and were likely a source of pertussis contamination in infants still not vaccinated. The use of RT-PCR specific for B. pertussis in the diagnosis of adults is less sensitive and should be associated with serologic tests to improve diagnosis of pertussis and contributes to preventing transmission of the disease in infants.
Patients with asplenia have a significantly increased lifelong risk of severe invasive infections, particular post-splenectomy sepsis (PSS). Clear preventive measures have been described in the literature, but previous studies found poor implementation of prevention recommendations. Aim of the study is to improve the adherence to guideline-based preventive measures and thereby reduce the incidence of PSS by a novel telephone-delivered intervention that involves both patients and their physicians.
A prospective controlled, two-armed historical control group design is used to evaluate the new intervention compared to usual care. The intervention for patients includes both educational aspects and, building on the Health Action Process Approach (HAPA), intervention components that promote motivation and planning of preventive measures. For physicians the intervention is primarily information-based. The primary outcome, the adherence to preventative measures, is indicated by a study-specific ‘Preventing PSS-score’ (PrePSS-score), which is assessed at baseline and at 6-months follow-up. Secondary outcomes include, amongst others, patient self-efficacy and action-planning, asplenia-specific health literacy, general self-management and asplenia-specific self-management. In a process-evaluating part of the study interview-data on patients’ and physicians’ evaluation of the intervention will be gathered.
This trial will provide evidence about the effectiveness of the novel prevention intervention for asplenic patients. If demonstrated beneficial, the intervention manual will be made publicly available to enable implementation in practice. The experience gained within this trial may also be valuable for prevention strategies in patients with other diseases.
German Clinical Trials Register (DRKS): DRKS00015238; Trial registration date 07. December 2018.
In India, Accredited Social Health Activists (ASHAs) deliver services for diagnosis and treatment of malaria, although unlicensed medical practitioners (UMPs) (informal health providers) are most preferred in communities. A cross sectional survey was conducted to: (i) assess knowledge and treatment-seeking practices in the community, and (ii) explore the diagnosis and treatment practices related to malaria of UMPs working in rural and tribal-dominated high malaria endemic areas of central India, and whether they adhere to the national guidelines.
A multi-stage sampling method and survey technique was adopted. Heads of the households and UMPs were interviewed using a structured interview schedule to assess knowledge and malaria treatment practices.
Knowledge regarding malaria symptoms was generally accurate, but misconceptions emerged related to malaria transmission and mosquito breeding places. Modern preventive measures were poorly accessed by the households. UMPs were the most preferred health providers (49%) and the first choice in households for seeking treatment. UMPs typically lacked knowledge of the names of malaria parasite species and species-specific diagnosis and treatment. Further, irrational use of anti-malarial drugs was common.
UMPs were the most preferred type of health care providers in rural communities where health infrastructure is poor. The study suggests enhancing training of UMPs on national guidelines for malaria diagnosis and treatment to strengthen their ability to contribute to achievement of India’s malaria elimination goals.
The intraerythrocytic development cycle (IDC) of the rodent malaria Plasmodium chabaudi is coordinated with host circadian rhythms. When this coordination is disrupted, parasites suffer a 50% reduction in both asexual stages and sexual stage gametocytes over the acute phase of infection. Reduced gametocyte density may not simply follow from a loss of asexuals because investment into gametocytes (“conversion rate”) is a plastic trait; furthermore, the densities of both asexuals and gametocytes are highly dynamic during infection. Hence, the reasons for the reduction of gametocytes in infections that are out-of-synch with host circadian rhythms remain unclear. Here, two explanations are tested: first, whether out-of-synch parasites reduce their conversion rate to prioritize asexual replication via reproductive restraint; second, whether out-of-synch gametocytes experience elevated clearance by the host’s circadian immune responses.
First, conversion rate data were analysed from a previous experiment comparing infections of P. chabaudi that were in-synch or 12 h out-of-synch with host circadian rhythms. Second, three new experiments examined whether the inflammatory cytokine TNF varies in its gametocytocidal efficacy according to host time-of-day and gametocyte age.
There was no evidence that parasites reduce conversion or that their gametocytes become more vulnerable to TNF when out-of-synch with host circadian rhythms.
The factors causing the reduction of gametocytes in out-of-synch infections remain mysterious. Candidates for future investigation include alternative rhythmic factors involved in innate immune responses and the rhythmicity in essential resources required for gametocyte development. Explaining why it matters for gametocytes to be synchronized to host circadian rhythms might suggest novel approaches to blocking transmission.
Specialespecifikt kursus om immundefekt og feber af ukendt årsag
28.01.2020 - 29.01.2020
International Congress on Infectious Diseases (ICID) 2020
Kuala Lumpur, Malaysia
20.02.2020 - 23.02.2020
Dansk Selskab for Intern Medicin (DSIM) årsmøde og overrækkelse af Hagedorn prisen 2020
Novo Nordisk Fonden, Tuborg Havnevej 19, 2900 Hellerup
Conference on Retroviruses and Opportunistic Infections (CROI) 2020
Boston, Massachusetts, USA
8.03.2020 - 11.03.2020
Når CROI går i fisk - med transmissioner fra CROI 2020
10.03.2020 - 11.03.2020
Retningslinjer til sundhedsprofessionelle vedr. håndtering af infektion med zikavirus (2019)
Antiviral behandling af hiv smittede personer (2019)
Lumbalpunktur af patienter i blodfortyndende behandling (2019)
Cryptococcal meningitis and immune reconstitution inflammatory syndrome in a pediatric patient with HIV after switching to second line antiretroviral therapy: a case report
21.01.2020Latest Results for BMC Infectious Diseases
Impaired cytokine responses to live Staphylococcus epidermidis in preterm infants precede Gram-positive late-onset sepsis
21.01.2020Clinical Infectious Diseases Advance Access
“Rapid Start” treatment to End the (Other) Epidemic: Walking the Tight-rope without a Net
21.01.2020Clinical Infectious Diseases Advance Access
Outcomes Associated with Medications for Opioid Use Disorder Among Persons Hospitalized for Infective Endocarditis
21.01.2020Clinical Infectious Diseases Advance Access
Sensory nociceptive neurons contribute to host protection during enteric infection with Citrobacter rodentium
21.01.2020The Journal of Infectious Diseases Advance Access
Hvad tænker Professor Jens Lundgren om"Dolutegravir plus Two Different Prodrugs of Tenofovir to Treat HIV."?
Hvorfor synes Professor Troels Lillebæk, at du bør læse"The global prevalence of latent tuberculosis: a systematic review and meta-analysis."?
Hvorfor synes Professor Lars Østergaard, at du bør læse"Efficacy of antibiotic treatment in patients with chronic low back pain and Modic changes (the AIM study): double blind, randomised, placebo controlled, multicentre trial."?
Hvorfor synes Professor Thomas Benfield, at du bør læse"Oral versus Intravenous Antibiotics for Bone and Joint Infection."?
Hvorfor synes Professor Niels Obel, at du bør læse"Early, Goal-Directed Therapy for Septic Shock - A Patient-Level Meta-Analysis."?
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