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Benjamas Chuaychoo, Kanokwan Rattanasaengloet, Run Banlengchit, Navin Horthongkham, Niracha Athipanyasilp, Kanyarat Totanarungroj, Nisa Muangman
International Journal of Infectious Diseases, 21.07.2021
Tilføjet 22.07.2021
Influenza virus is an important cause of adult hospitalization while respiratory syncytial virus (RSV) infection is increasingly recognized, especially in older adults with co-morbidities (Falsey et al. 2014; Lee et al. 2013; Olsen et al. 2010; Walker and Ison 2014). In studies from America, Europe, and Asia, RSV infection represented 2.3% to 13.0% of adult hospitalizations (Falsey et al. 2005; Falsey et al. 2014; Lee et al. 2013; Loubet et al. 2017; Malosh et al. 2017; Naorat et al. 2013; Olsen et al.
Læs mere Tjek på PubMedLijun Xu, Yufan Xu, Yanghao Zheng, Xiuming Peng, Zongxing Yang, Qing Cao, Dairong Xiang, Handan Zhao
Clinical & Experimental Immunology, 21.07.2021
Tilføjet 22.07.2021
Eric P. Caragata, Heverton L.C. Dutra, Pedro H.F. Sucupira, Alvaro G.A. Ferreira, Luciano A. Moreira
Trends in Parasitology, 21.07.2021
Tilføjet 22.07.2021
In this review we examine how exploiting the Wolbachia–mosquito relationship has become an increasingly popular strategy for controlling arbovirus transmission. Field deployments of Wolbachia-infected mosquitoes have led to significant decreases in dengue virus incidence via high levels of mosquito population suppression and replacement, emphasizing the success of Wolbachia approaches. Here, we examine how improved knowledge of Wolbachia–host interactions has provided key insight into the mechanisms of the essential phenotypes of pathogen blocking and cytoplasmic incompatibility.
Læs mere Tjek på PubMedNathella Pavan Kumar, Chandrasekaran Padmapriyadarsini, Anuradha Rajamanickam, Perumal Kannabiran Bhavani, Arul Nancy, Bharathi Jayadeepa, Nandhini Selvaraj, Dinesh Ashokan, Rachel Mariam Renji, Vijayalakshmi Venkataramani, Srikanth Tripathy, Subash Babu
International Journal of Infectious Diseases, 21.07.2021
Tilføjet 22.07.2021
Bacillus Calmette–Guérin (BCG) is a live-attenuated vaccine largely established to protect against childhood meningitis and disseminated tuberculosis (TB) (Foster et al., 2021) Several epidemiological findings suggest that BCG may increase the capacity of the immune system to fight against pathogens other than TB (Leentjens et al., 2015) and such non-specific responses augment both T cell–mediated adaptive and innate immune memory in a process called trained immunity and this could have important implications for improving vaccination strategies.
Læs mere Tjek på PubMedEmerging Infectious Diseases, 21.07.2021
Tilføjet 22.07.2021
Philipp Fervers, Jonathan Kottlors, Nils Große Hokamp, Johannes Bremm, David Maintz, Stephanie Tritt, Orkhan Safarov, Thorsten Persigehl, Nils Vollmar, Paul Martin Bansmann, Nuran Abdullayev
PLoS One Infectious Diseases, 21.07.2021
Tilføjet 22.07.2021
by Philipp Fervers, Jonathan Kottlors, Nils Große Hokamp, Johannes Bremm, David Maintz, Stephanie Tritt, Orkhan Safarov, Thorsten Persigehl, Nils Vollmar, Paul Martin Bansmann, Nuran Abdullayev
Purpose Cardiovascular comorbidity anticipates severe progression of COVID-19 and becomes evident by coronary artery calcification (CAC) on low-dose chest computed tomography (LDCT). The purpose of this study was to predict a patient’s obligation of intensive care treatment by evaluating the coronary calcium burden on the initial diagnostic LDCT.
Methods Eighty-nine consecutive patients with parallel LDCT and positive RT-PCR for SARS-CoV-2 were included from three centers. The primary endpoint was admission to ICU, tracheal intubation, or death in the 22-day follow-up period. CAC burden was represented by the Agatston score. Multivariate logistic regression was modeled for prediction of the primary endpoint by the independent variables “Agatston score > 0”, as well as the CT lung involvement score, patient sex, age, clinical predictors of severe COVID-19 progression (history of hypertension, diabetes, prior cardiovascular event, active smoking, or hyperlipidemia), and laboratory parameters (creatinine, C-reactive protein, leucocyte, as well as thrombocyte counts, relative lymphocyte count, d-dimer, and lactate dehydrogenase levels).
Results After excluding multicollinearity, “Agatston score >0” was an independent regressor within multivariate analysis for prediction of the primary endpoint (p<0.01). Further independent regressors were creatinine (p = 0.02) and leucocyte count (p = 0.04). The Agatston score was significantly higher for COVID-19 cases which completed the primary endpoint (64.2 [interquartile range 1.7–409.4] vs. 0 [interquartile range 0–0]).
Conclusion CAC scoring on LDCT might help to predict future obligation of intensive care treatment at the day of patient admission to the hospital.
Læs mere Tjek på PubMedEleanor E. Friedman, Samantha A. Devlin, Moira C. McNulty, Jessica P. Ridgway
PLoS One Infectious Diseases, 21.07.2021
Tilføjet 22.07.2021
by Eleanor E. Friedman, Samantha A. Devlin, Moira C. McNulty, Jessica P. Ridgway
Since the onset of the COVID-19 pandemic, it has been unclear how vulnerable people with HIV (PwH) are to SARS-CoV-2 infection. We sought to determine if PwH are more likely to test positive for SARS-CoV-2 than people without HIV, and to identify risk factors associated with SARS-CoV-2 positivity among PwH. We conducted a cross-sectional study in which we collected electronic medical record data for all patients who underwent SARS-CoV-2 PCR testing at an academic medical center. Presence of HIV and other chronic diseases were based on the presence of ICD-10 diagnosis codes. We calculated the percent positivity for SARS-CoV-2 among PwH and among people without HIV. Among PwH, we compared demographic factors, comorbidities, HIV viral load, CD4 T-cell count, and antiretroviral therapy (ART) regimens between those who tested positive for SARS-CoV-2 and those who tested negative. Comparisons were made using chi squared tests or Wilcoxon rank sum tests. Multivariate models were created using logistic regression. Among 69,763 people tested for SARS-CoV-2, 0.6% (431) were PwH. PwH were not significantly more likely to test positive for SARS-CoV-2 than people without HIV (7.2% (31/431) vs 8.4% (5820/69763), p = 0.35), but were more likely to be younger, Black, and male (p-values < .0001). There were no significant differences in HIV clinical factors, chronic diseases, or ART regimens among PwH testing positive for SARS-CoV-2 versus those testing negative. In our sample, PwH were not more likely to contract SARS-CoV-2, despite being more likely to be members of demographic groups known to be at higher risk for infection. Differences between PwH who tested positive for SARS-CoV-2 and those who tested negative were only seen in Hispanic/Latino ethnicity (non-Hispanic or Latino vs unknown Hispanic or Latino ethnicity (OR 0.2 95% CI (0.6, 0.9)) and site of testing(inpatient vs outpatient OR 3.1 95% CI (1.3, 7.4)).
Læs mere Tjek på PubMedFrank Trübner, Lisa Steigert, Fabian Echterdiek, Norma Jung, Kirsten Schmidt-Hellerau, Wolfram G. Zoller, Julia-Stefanie Frick, You-Shan Feng, Gregor Paul
PLoS One Infectious Diseases, 21.07.2021
Tilføjet 22.07.2021
by Frank Trübner, Lisa Steigert, Fabian Echterdiek, Norma Jung, Kirsten Schmidt-Hellerau, Wolfram G. Zoller, Julia-Stefanie Frick, You-Shan Feng, Gregor Paul
Background The objective of this study was to identify clinical risk factors for COVID-19 in a German outpatient fever clinic that allow distinction of SARS-CoV-2 infected patients from other patients with flu-like symptoms.
Methods This is a retrospective, single-centre cohort study. Patients were included visiting the fever clinic from 4th of April 2020 to 15th of May 2020. Symptoms, comorbidities, and socio-demographic factors were recorded in a standardized fashion. Multivariate logistic regression was used to identify risk factors of COVID-19, on the bases of those a model discrimination was assessed using area under the receiver operation curves (AUROC).
Results The final analysis included 930 patients, of which 74 (8%) had COVID-19. Anosmia (OR 10.71; CI 6.07–18.9) and ageusia (OR 9.3; CI 5.36–16.12) were strongly associated with COVID-19. High-risk exposure (OR 12.20; CI 6.80–21.90), especially in the same household (OR 4.14; CI 1.28–13.33), was also correlated; the more household members, especially with flu-like symptoms, the higher the risk of COVID-19. Working in an essential workplace was also associated with COVID-19 (OR 2.35; CI 1.40–3.96), whereas smoking was inversely correlated (OR 0.19; CI 0.08–0.44). A model that considered risk factors like anosmia, ageusia, concomitant of symptomatic household members and smoking well discriminated COVID-19 patients from other patients with flu-like symptoms (AUROC 0.84).
Conclusions We report a set of four readily available clinical parameters that allow the identification of high-risk individuals of COVID-19. Our study will not replace molecular testing but will help guide containment efforts while waiting for test results.
Læs mere Tjek på PubMedDevendra Raj Singh, Dev Ram Sunuwar, Sunil Kumar Shah, Lalita Kumari Sah, Kshitij Karki, Rajeeb Kumar Sah
PLoS One Infectious Diseases, 21.07.2021
Tilføjet 22.07.2021
by Devendra Raj Singh, Dev Ram Sunuwar, Sunil Kumar Shah, Lalita Kumari Sah, Kshitij Karki, Rajeeb Kumar Sah
Background Food insecurity is a serious social and public health problem which is exacerbated by the COVID-19 pandemic especially in resource-poor countries such as Nepal. However, there is a paucity of evidence at local levels. This study aims to explore food insecurity among people from the disadvantaged community and low-income families during the COVID-19 pandemic in Province-2 of Nepal.
Methods The semi-structured qualitative interviews were conducted virtually among purposively selected participants (n = 41) from both urban and rural areas in eight districts of Province 2 in Nepal. All the interviews were conducted in the local language between July and August 2020. The data analysis was performed using thematic network analysis in Nvivo 12 Pro software.
Results The results of this study are grouped into four global themes: i) Impact of COVID-19 on food security; ii) Food insecurity and coping strategies during the COVID-19 pandemic, iii) Food relief and emergency support during the COVID-19 pandemic, and iv) Impact of COVID-19 and food insecurity on health and wellbeing. Most participants in the study expressed that families from low socioeconomic backgrounds and disadvantaged communities such as those working on daily wages and who rely on remittance had experienced increased food insecurity during the COVID-19 pandemic. Participants used different forms of coping strategies to meet their food requirements during the pandemic. Community members experienced favouritism, nepotism, and partiality from local politicians and authorities during the distribution of food relief. The food insecurity among low-income and disadvantaged families has affected their health and wellbeing making them increasingly vulnerable to the COVID-19 infection.
Conclusion Food insecurity among low-income and disadvantaged families was found to be a serious problem during the COVID-19 pandemic. The study suggests that the relief support plan and policies should be focused on the implementation of immediate sustainable food security strategies to prevent hunger, malnutrition, and mental health problems among the most vulnerable groups in the community.
Læs mere Tjek på PubMedJonathan Salcedo, Monica Rosales, Jeniffer S. Kim, Daisy Nuno, Sze-chuan Suen, Alicia H. Chang
PLoS One Infectious Diseases, 21.07.2021
Tilføjet 22.07.2021
by Jonathan Salcedo, Monica Rosales, Jeniffer S. Kim, Daisy Nuno, Sze-chuan Suen, Alicia H. Chang
Background Tuberculosis (TB) incidence in Los Angeles County, California, USA (5.7 per 100,000) is significantly higher than the U.S. national average (2.9 per 100,000). Directly observed therapy (DOT) is the preferred strategy for active TB treatment but requires substantial resources. We partnered with the Los Angeles County Department of Public Health (LACDPH) to evaluate the cost-effectiveness of AiCure, an artificial intelligence (AI) platform that allows for automated treatment monitoring.
Methods We used a Markov model to compare DOT versus AiCure for active TB treatment in LA County. Each cohort transitioned between health states at rates estimated using data from a pilot study for AiCure (N = 43) and comparable historical controls for DOT (N = 71). We estimated total costs (2017, USD) and quality-adjusted life years (QALYs) over a 16-month horizon to calculate the incremental cost-effectiveness ratio (ICER) and net monetary benefits (NMB) of AiCure. To assess robustness, we conducted deterministic (DSA) and probabilistic sensitivity analyses (PSA).
Results For the average patient, AiCure was dominant over DOT. DOT treatment cost $4,894 and generated 1.03 QALYs over 16-months. AiCure treatment cost $2,668 for 1.05 QALYs. At willingness-to-pay threshold of $150K/QALY, incremental NMB per-patient under AiCure was $4,973. In univariate DSA, NMB were most sensitive to monthly doses and vocational nurse wage; however, AiCure remained dominant. In PSA, AiCure was dominant in 93.5% of 10,000 simulations (cost-effective in 96.4%).
Conclusions AiCure for treatment of active TB is cost-effective for patients in LA County, California. Increased use of AI platforms in other jurisdictions could facilitate the CDC’s vision of TB elimination.
Læs mere Tjek på PubMedRicardo Ramírez-Aldana, Juan Carlos Gomez-Verjan, Omar Yaxmehen Bello-Chavolla, Carmen García-Peña
PLoS One Infectious Diseases, 21.07.2021
Tilføjet 22.07.2021
by Ricardo Ramírez-Aldana, Juan Carlos Gomez-Verjan, Omar Yaxmehen Bello-Chavolla, Carmen García-Peña
COVID-19 is a respiratory disease caused by SARS-CoV-2, which has significantly impacted economic and public healthcare systems worldwide. SARS-CoV-2 is highly lethal in older adults (>65 years old) and in cases with underlying medical conditions, including chronic respiratory diseases, immunosuppression, and cardio-metabolic diseases, including severe obesity, diabetes, and hypertension. The course of the COVID-19 pandemic in Mexico has led to many fatal cases in younger patients attributable to cardio-metabolic conditions. Thus, in the present study, we aimed to perform an early spatial epidemiological analysis for the COVID-19 outbreak in Mexico. Firstly, to evaluate how mortality risk from COVID-19 among tested individuals (MRt) is geographically distributed and secondly, to analyze the association of spatial predictors of MRt across different states in Mexico, controlling for the severity of the disease. Among health-related variables, diabetes and obesity were positively associated with COVID-19 fatality. When analyzing Mexico as a whole, we identified that both the percentages of external and internal migration had positive associations with early COVID-19 mortality risk with external migration having the second-highest positive association. As an indirect measure of urbanicity, population density, and overcrowding in households, the physicians-to-population ratio has the highest positive association with MRt. In contrast, the percentage of individuals in the age group between 10 to 39 years had a negative association with MRt. Geographically, Quintana Roo, Baja California, Chihuahua, and Tabasco (until April 2020) had higher MRt and standardized mortality ratios, suggesting that risks in these states were above what was nationally expected. Additionally, the strength of the association between some spatial predictors and the COVID-19 fatality risk varied by zone.
Læs mere Tjek på PubMedAmna Tariq, Juan M. Banda, Pavel Skums, Sushma Dahal, Carlos Castillo-Garsow, Baltazar Espinoza, Noel G. Brizuela, Roberto A. Saenz, Alexander Kirpich, Ruiyan Luo, Anuj Srivastava, Humberto Gutierrez, Nestor Garcia Chan, Ana I. Bento, Maria-Eugenia Jimenez-Corona, Gerardo Chowell
PLoS One Infectious Diseases, 21.07.2021
Tilføjet 22.07.2021
by Amna Tariq, Juan M. Banda, Pavel Skums, Sushma Dahal, Carlos Castillo-Garsow, Baltazar Espinoza, Noel G. Brizuela, Roberto A. Saenz, Alexander Kirpich, Ruiyan Luo, Anuj Srivastava, Humberto Gutierrez, Nestor Garcia Chan, Ana I. Bento, Maria-Eugenia Jimenez-Corona, Gerardo Chowell
Mexico has experienced one of the highest COVID-19 mortality rates in the world. A delayed implementation of social distancing interventions in late March 2020 and a phased reopening of the country in June 2020 has facilitated sustained disease transmission in the region. In this study we systematically generate and compare 30-day ahead forecasts using previously validated growth models based on mortality trends from the Institute for Health Metrics and Evaluation for Mexico and Mexico City in near real-time. Moreover, we estimate reproduction numbers for SARS-CoV-2 based on the methods that rely on genomic data as well as case incidence data. Subsequently, functional data analysis techniques are utilized to analyze the shapes of COVID-19 growth rate curves at the state level to characterize the spatiotemporal transmission patterns of SARS-CoV-2. The early estimates of the reproduction number for Mexico were estimated between Rt ~1.1–1.3 from the genomic and case incidence data. Moreover, the mean estimate of Rt has fluctuated around ~1.0 from late July till end of September 2020. The spatial analysis characterizes the state-level dynamics of COVID-19 into four groups with distinct epidemic trajectories based on epidemic growth rates. Our results show that the sequential mortality forecasts from the GLM and Richards model predict a downward trend in the number of deaths for all thirteen forecast periods for Mexico and Mexico City. However, the sub-epidemic and IHME models perform better predicting a more realistic stable trajectory of COVID-19 mortality trends for the last three forecast periods (09/21-10/21, 09/28-10/27, 09/28-10/27) for Mexico and Mexico City. Our findings indicate that phenomenological models are useful tools for short-term epidemic forecasting albeit forecasts need to be interpreted with caution given the dynamic implementation and lifting of social distancing measures.
Læs mere Tjek på PubMedAnn M. Navar, Stacey N. Purinton, Qingjiang Hou, Robert J. Taylor, Eric D. Peterson
PLoS One Infectious Diseases, 21.07.2021
Tilføjet 22.07.2021
by Ann M. Navar, Stacey N. Purinton, Qingjiang Hou, Robert J. Taylor, Eric D. Peterson
Introduction At the population level, Black and Hispanic adults in the United States have increased risk of dying from COVID-19, yet whether race and ethnicity impact on risk of mortality among those hospitalized for COVID-19 is unclear.
Methods Retrospective cohort study using data on adults hospitalized with COVID-19 from the electronic health record from 52 health systems across the United States contributing data to Cerner Real World DataTM. In-hospital mortality was evaluated by race first in unadjusted analysis then sequentially adjusting for demographics and clinical characteristics using logistic regression.
Results Through August 2020, 19,584 patients with median age 52 years were hospitalized with COVID-19, including n = 4,215 (21.5%) Black and n = 5,761 (29.4%) Hispanic patients. Relative to white patients, crude mortality was slightly higher in Black adults [22.7% vs 20.8%, unadjusted OR 1.12 (95% CI 1.02–1.22)]. Mortality remained higher among Black adults after adjusting for demographic factors including age, sex, date, region, and insurance status (OR 1.13, 95% CI 1.01–1.27), but not after including comorbidities and body mass index (OR 1.07, 95% CI 0.93–1.23). Compared with non-Hispanic patients, Hispanic patients had lower mortality both in unadjusted and adjusted models [mortality 12.7 vs 25.0%, unadjusted OR 0.44(95% CI 0.40–0.48), fully adjusted OR 0.71 (95% CI 0.59–0.86)].
Discussion In this large, multicenter, EHR-based analysis, Black adults hospitalized with COVID-19 had higher observed mortality than white patients due to a higher burden of comorbidities in Black adults. In contrast, Hispanic ethnicity was associated with lower mortality, even in fully adjusted models.
Læs mere Tjek på PubMedSandip Das Sanyam, Sanjay Kumar Sah, Pankaj Chaudhary, Matthew J. Burton, Jeremy J. Hoffman
PLoS One Infectious Diseases, 21.07.2021
Tilføjet 22.07.2021
by Sandip Das Sanyam, Sanjay Kumar Sah, Pankaj Chaudhary, Matthew J. Burton, Jeremy J. Hoffman
Background Nepal was under a severe lockdown for several months in 2020 due to the COVID-19 pandemic. There were concerns regarding misinformation circulating on social media. This study aimed to analyse the knowledge and awareness of COVID-19 amongst eye care professionals in Nepal during the first wave of the pandemic.
Methodology We invited 600 participants from 12 ophthalmic centres across Nepal to complete a qualitative, anonymous online survey. Altogether, 25 questions (both open and closed-ended) were used. An overall performance score was calculated from the average of the 12 “Knowledge” questions for all the participants.
Results Of the 600 eye care professionals invited, 310 (51%) participated in the survey. The symptoms of COVID-19 were known to 94%, whilst only 49% of the participants were aware how the disease was transmitted, with 54% aware that anyone can be infected with SARS-CoV-2. Almost 98% of participants recognized the World Health Organization’s (WHO) awareness message, but surprisingly, 41% of participants felt that consumption of hot drinks helps to destroy the virus, in contradiction to WHO information. Importantly, 95% of the participants were aware of personal protective equipment (PPE) and what the acronym stands for. Social distancing was felt to be key to limiting the disease spread; whilst 41% disagreed that PPE should be mandatory for eye care practitioners. The mean overall “Knowledge” performance score was 69.65% (SD ± 22.81).
Conclusion There is still considerable scope to improve the knowledge of COVID-19 amongst ophthalmic professionals in Nepal. Opinion is also split on measures to prevent transmission, with misinformation potentially fuelling confusion. It is recommended to follow WHO and national guidelines, whilst seeking published scientific evidence behind any unofficial statements, to accurately inform one’s clinical practice.
Læs mere Tjek på PubMedFolake Temitope Fadare, Anthony Ifeanyi Okoh
PLoS One Infectious Diseases, 21.07.2021
Tilføjet 22.07.2021
by Folake Temitope Fadare, Anthony Ifeanyi Okoh
Globally, there is an increasing occurrence of multidrug-resistant (MDR) Enterobacteriaceae with extended-spectrum β-lactamases (ESBLs) and/or plasmid-encoded AmpC (pAmpC) β-lactamases in clinical and environmental settings of significant concern. Therefore, we aimed to evaluate the occurrence of ESBL/pAmpC genetic determinants, and some essential non-β-lactam genetic determinants in the MDR phenotypic antimicrobial resistance in Enterobacteriaceae isolates recovered from hospital wastewater. We collected samples from two hospitals in Amathole and Chris Hani District Municipalities in the Eastern Cape Province, South Africa, within October and November 2017. Using the matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF), we identified a total of 44 presumptive Enterobacteriaceae isolates. From this, 31 were identified as the targeted Enterobacteriaceae members. Thirty-six percent of these belonged to Klebsiella oxytoca, while 29% were Klebsiella pneumoniae. The other identified isolates included Citrobacter freundii and Escherichia coli (10%), Enterobacter asburiae (6%), Enterobacter amnigenus, Enterobacter hormaechei, and Enterobacter kobei (3%). We established the antibiotic susceptibility profiles of these identified bacterial isolates against a panel of 18 selected antibiotics belonging to 11 classes were established following established guidelines by the Clinical and Laboratory Standard Institute. All the bacterial species exhibited resistance phenotypically against at least four antibiotic classes and were classified as MDR. Notably, all the bacterial species displayed resistance against cefotaxime, ampicillin, nalidixic acid, and trimethoprim-sulfamethoxazole. The generated multiple antibiotic resistance indices ranged between 0.5 to 1.0, with the highest value seen in one K. oxytoca isolated. Molecular characterization via the Polymerase Chain Reaction uncovered various ESBLs, pAmpCs, and other non-β-lactam encoding genes. Of the phenotypically resistant isolates screened for each class of antibiotics, the ESBLs detected were blaCTX-M group (including groups 1, 2, and 9) [51.6% (16/31)], blaTEM [32.3% (10/31)], blaOXA-1-like [19.4% (6/31)], blaSHV [12.9% (4/31)], blaPER [6.5% (2/31)], blaVEB [3.2% (1/31)], blaOXA-48-like and blaVIM [15.4% (2/13)], and blaIMP [7.7% (1/13)]. The pAmpC resistance determinants detected were blaCIT [12.9% (4/31)], blaFOX [9.7% (3/31)], blaEBC [6.5% (2/31)], and blaDHA [3.2% (1/31)]. The frequencies of the non-β-lactam genes detected were catII [79.2% (19/24)], tetA [46.7% (14/30)], sulI and sulII [35.5% (11/31)], tetB [23.3% (7/30)], aadA [12.9% (4/31)], tetC [10% (3/30)], and tetD [3.3% (1/30)]. These results indicate that hospital wastewater is laden with potentially pathogenic MDR Enterobacteriaceae with various antibiotic resistance genes that can be spread to humans throughout the food chain, provided the wastewaters are not properly treated before eventual discharge into the environment.
Læs mere Tjek på PubMedMuhammad Adam Norrulashikin, Fadhilah Yusof, Nur Hanani Mohd Hanafiah, Siti Mariam Norrulashikin
PLoS One Infectious Diseases, 21.07.2021
Tilføjet 22.07.2021
by Muhammad Adam Norrulashikin, Fadhilah Yusof, Nur Hanani Mohd Hanafiah, Siti Mariam Norrulashikin
The increasing trend in the number new cases of influenza every year as reported by WHO is concerning, especially in Malaysia. To date, there is no local research under healthcare sector that implements the time series forecasting methods to predict future disease outbreak in Malaysia, specifically influenza. Addressing the problem could increase awareness of the disease and could help healthcare workers to be more prepared in preventing the widespread of the disease. This paper intends to perform a hybrid ARIMA-SVR approach in forecasting monthly influenza cases in Malaysia. Autoregressive Integrated Moving Average (ARIMA) model (using Box-Jenkins method) and Support Vector Regression (SVR) model were used to capture the linear and nonlinear components in the monthly influenza cases, respectively. It was forecasted that the performance of the hybrid model would improve. The data from World Health Organization (WHO) websites consisting of weekly Influenza Serology A cases in Malaysia from the year 2006 until 2019 have been used for this study. The data were recategorized into monthly data. The findings of the study showed that the monthly influenza cases could be efficiently forecasted using three comparator models as all models outperformed the benchmark model (Naïve model). However, SVR with linear kernel produced the lowest values of RMSE and MAE for the test dataset suggesting the best performance out of the other comparators. This suggested that SVR has the potential to produce more consistent results in forecasting future values when compared with ARIMA and the ARIMA-SVR hybrid model.
Læs mere Tjek på PubMedNick Scott, Allan Saul, Tim Spelman, Mark Stoove, Alisa Pedrana, Alexander Saeri, Emily Grundy, Liam Smith, Michael Toole, Chandini Raina McIntyre, Brendan S. Crabb, Margaret Hellard
PLoS One Infectious Diseases, 21.07.2021
Tilføjet 22.07.2021
by Nick Scott, Allan Saul, Tim Spelman, Mark Stoove, Alisa Pedrana, Alexander Saeri, Emily Grundy, Liam Smith, Michael Toole, Chandini Raina McIntyre, Brendan S. Crabb, Margaret Hellard
Background Whilst evidence of use of face masks in reducing COVID-19 cases is increasing, the impact of mandatory use across a large population has been difficult to assess. Introduction of mandatory mask use on July 22, 2020 during a resurgence of COVID-19 in Melbourne, Australia created a situation that facilitated an assessment of the impact of the policy on the epidemic growth rate as its introduction occurred in the absence of other changes to restrictions.
Methods and findings Exponential epidemic growth or decay rates in daily COVID-19 diagnoses were estimated using a non-weighted linear regression of the natural logarithm of the daily cases against time, using a linear spline model with one knot (lspline package in R v 3.6.3). The model’s two linear segments pivot around the hinge day, on which the mask policy began to take effect, 8 days following the introduction of the policy. We used two forms of data to assess change in mask usage: images of people wearing masks in public places obtained from a major media outlet and population-based survey data. Potential confounding factors (including daily COVID-19 tests, number of COVID-19 cases among population subsets affected differentially by the mask policy–e.g., healthcare workers) were examined for their impact on the results. Daily cases fitted an exponential growth in the first log-linear segment (k = +0.042, s.e. = 0.007), and fitted an exponential decay in the second (k = -0.023, s.e. = 0.017) log-linear segment. Over a range of reported serial intervals for SARS-CoV-2 infection, these growth rates correspond to a 22–33% reduction in an effective reproduction ratio before and after mandatory mask use. Analysis of images of people in public spaces showed mask usage rose from approximately 43% to 97%. Analysis of survey data found that on the third day before policy introduction, 44% of participants reported “often” or “always” wearing a mask; on the fourth day after, 100% reported “always” doing so. No potentially confounding factors were associated with the observed change in growth rates.
Conclusions The mandatory mask use policy substantially increased public use of masks and was associated with a significant decline in new COVID-19 cases after introduction of the policy. This study strongly supports the use of masks for controlling epidemics in the broader community.
Læs mere Tjek på PubMedOlga Zimmermannova
Frontiers in Immunology, 26.10.2022
Tilføjet 21.07.2021
Advances in understanding how cancer cells interact with the immune system allowed the development of immunotherapeutic strategies, harnessing patients’ immune system to fight cancer. Dendritic cell-based vaccines are being explored to reactivate anti-tumor adaptive immunity. Immune checkpoint inhibitors and chimeric antigen receptor T-cells (CAR T) were however the main approaches that catapulted the therapeutic success of immunotherapy. Despite their success across a broad range of human cancers, many challenges remain for basic understanding and clinical progress as only a minority of patients benefit from immunotherapy. In addition, cellular immunotherapies face important limitations imposed by the availability and quality of immune cells isolated from donors. Cell fate reprogramming is offering interesting alternatives to meet these challenges. Induced pluripotent stem cell (iPSC) technology not only enables studying immune cell specification but also serves as a platform for the differentiation of a myriad of clinically useful immune cells including T-cells, NK cells, or monocytes at scale. Moreover, the utilization of iPSCs allows introduction of genetic modifications and generation of T/NK cells with enhanced anti-tumor properties. Immune cells, such as macrophages and dendritic cells, can also be generated by direct cellular reprogramming employing lineage-specific master regulators bypassing the pluripotent stage. Thus, the cellular reprogramming toolbox is now providing the means to address the potential of patient-tailored immune cell types for cancer immunotherapy. In parallel, development of viral vectors for gene delivery has opened the door for in vivo reprogramming in regenerative medicine, an elegant strategy circumventing the current limitations of in vitro cell manipulation. An analogous paradigm has been recently developed in cancer immunotherapy by the generation of CAR T-cells in vivo. These new ideas on endogenous reprogramming, cross-fertilized from the fields of regenerative medicine and gene therapy, are opening exciting avenues for direct modulation of immune or tumor cells in situ, widening our strategies to remove cancer immunotherapy roadblocks. Here, we review current strategies for cancer immunotherapy, summarize technologies for generation of immune cells by cell fate reprogramming as well as highlight the future potential of inducing these unique cell identities in vivo, providing new and exciting tools for the fast-paced field of cancer immunotherapy.
Læs mere Tjek på PubMedInfection, 21.07.2021
Tilføjet 21.07.2021
BMC Infectious Diseases, 21.07.2021
Tilføjet 21.07.2021
Abstract
Background
Methadone therapy clinics have been recently introduced in Tanzania, aiming at reducing risk behaviors and infection rates of viral hepatitis and HIV among people who use drugs. The objective of this study was to estimate the prevalence, associated factors and knowledge level of these conditions among people who use drugs attending a methadone clinic in Tanzania.
Methods
We enrolled 253 People who using drugs receiving Methadone therapy. Clinical data was retrospectively collected from the medical records and face-to face interviews were conducted to determine the behavioral risk factors and respondents’ knowledge on viral hepatitis and HIV.
Results
An overall seroprevalence of viral hepatitis (either hepatitis B surface antigen or anti-hepatitis C virus) was 6.3%, while that of hepatitis B virus mono infection was 3.5% and anti-hepatitis C antibodies was 3.5%. Seroprevalence of HIV was 12.6%. Viral hepatitis was strongly predicted by advanced age (> 35 years) (p = 0.02) and staying at Kirumba area (p = 0.004), and HIV infection was predicted by increased age (> 37 years) (p = 0.04) and female sex (p < 0.001). Regarding the knowledge of viral hepatitis, majority of the respondents were unaware of the transmission methods and availability of hepatitis B virus vaccines and only 17% were classified as well informed (provided ≥4 correct answers out of 7 questions). Good knowledge was highly predicted by higher education level of the individual (p = 0.001).
Conclusions
Despite the efforts to curb viral hepatitis and HIV infections through Methadone clinics, infection rates among people who use drugs are still high and the general knowledge on preventive measures is inadequate.
Læs mere Tjek på PubMedBMC Infectious Diseases, 20.07.2021
Tilføjet 21.07.2021
Abstract
Background
The incidence and prevalence of non-tuberculous mycobacterial pulmonary disease (NTM-PD) are reportedly increasing in many parts of the world. However, there are few published data on NTM-PD-related death. Using data from a national inpatient database in Japan, we aimed in this study to identify the characteristics of patients with NTM-PD and clinical deterioration and to identify risk factors for in-hospital mortality.
Methods
We examined data from the Diagnosis Procedure Combination (DPC) database in Japan from July 2010 to March 2014. We extracted data for HIV-negative NTM-PD patients who required unscheduled hospitalization. We evaluated these patients’ characteristics and performed multivariable logistic regression analysis to identify risk factors for all-cause in-hospital mortality.
Results
A total of 16,192 patients (median age: 78 years; women: 61.2%) were identified. The median body mass index (BMI) was 17.5 kg/m2 (IQR 15.4–20.0). All cause In-hospital death occurred in 3166 patients (19.6%). The median BMI of the patients who had died was 16.0 kg/m2 (IQR 14.2–18.4). Multivariable analysis revealed that increased mortality was associated with male sex, lower BMI, lower activities of daily living scores on the Barthel index, hemoptysis, and comorbidities, including pulmonary infection other than NTM, interstitial lung disease, pneumothorax, and malignant disease.
Conclusions
We found associations between being underweight and having several comorbidities and increased in-hospital mortality in patients with NTM-PD. Preventing weight loss and management of comorbidities may have a crucial role in improving this disease’s prognosis.
Læs mere Tjek på PubMedKah Wai Looi, Yukari Matsui, Mari Kono, Chandramathi Samudi Raju, Nozomi Kojima, Jin Xu Ong, Chin Aun Tan, Chong Siang Ang, Peter Hao Yuan Tan, Hemalatha Shamnugam, Shamala Devi A/P K.C Sekaran, Sharifah Faridah Syed Omar, Lucy Chai See Lum
International Journal of Infectious Diseases, 21.07.2021
Tilføjet 21.07.2021
Dengue is the most rapidly spreading arboviral infection of major public health concern. Best estimates indicate a worldwide annual incidence of 390 million dengue infections of which around 96 million episodes manifest varying levels of clinical severity (Bhatt et al., 2013). Additionally, the Global Burden of Dengue study in 2013 reported 60 million symptomatic dengue infections per year resulting in about 10 000 deaths (Stanaway et al., 2016). As yet, neither safe, effective and affordable dengue vaccines nor specific therapies are widely available in the tropical regions which bear the highest burden of dengue disease.
Læs mere Tjek på PubMedGovinda Siripurapu, Sameer Abdul Samad, Saman Fatima, Naveet Wig, M.V. Padma Srivastava
International Journal of Infectious Diseases, 21.07.2021
Tilføjet 21.07.2021
Acanthamoebae are free living amoebae ubiquitously present in the environment. Human exposure to this organism is quite frequent, as reflected by its high seroprevalence of more than 80% in the general population ([4]Brindley et al., 2009). Both trophozoites and cysts can enter the body via contact lens use, skin wounds, or inhalation and can hematogenously disseminate to the central nervous system (Acanthamoeba - Granulomatous Amebic Encephalitis (GAE); Keratitis |Acanthamoeba |Parasites |CDC, n.d.
Læs mere Tjek på PubMedMaximilian Gertler, Eva Krause, Welmoed van Loon, Niklas Krug, Franka Kausch, Chiara Rohardt, Heike Rössig, Janine Michel, Andreas Nitsche, Marcus A. Mall, Olga Nikolai, Franziska Hommes, Susen Burock, Andreas K. Lindner, Frank P. Mockenhaupt, Ulrich Pison, Joachim Seybold
International Journal of Infectious Diseases, 21.07.2021
Tilføjet 21.07.2021
Containment of the current COVID-19 pandemic(Lu et al., 2020, Zhu et al., 2020) requires broad-scale testing capacities(Zhu and Wong, 2020) for patients, potentially contagious persons and groups at risk of infection. Laboratory capacities for real-time reverse transcriptase polymerase chain reaction (rtRT-PCR) have been significantly increased in many countries, and are complemented by novel rapid test devices based on antigen detection(Rai et al., 2021). Still, professional-collected (oro-)nasopharyngeal samples are considered the gold standard(Marty et al., 2020, Pan et al., 2020).
Læs mere Tjek på PubMedChristian Leli, Luigi Di Matteo, Franca Gotta, Elisa Cornaglia, Daria Vay, Iacopo Megna, Rosalia Emanuela Pensato, Riccardo Boverio, Andrea Rocchetti
International Journal of Infectious Diseases, 21.07.2021
Tilføjet 21.07.2021
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a single-stranded positive-sense RNA virus and has four main structural proteins: spike, envelope, membrane protein and nucleocapsid protein (Naqvi et al., 2020) and is a member of the human coronavirus family (HCoV) of which, six were already known to cause disease (Yin and Wunderink, 2018). Among these, four are known as human endemic coronaviruses: HCoV-229E, HCoV-NL63, HCoV-OC43 and HCoV-HKU1 causing acute self-limiting common cold symptoms (Yin and Wunderink, 2018), while the other two, SARS-CoV and MERS-CoV, were cause of outbreaks of severe lower respiratory tract infection (Drosten et al., 2003; Zaki et al., 2012).
Læs mere Tjek på PubMedAdori, C., Daraio, T., Kuiper, R., Barde, S., Horvathova, L., Yoshitake, T., Ihnatko, R., Valladolid-Acebes, I., Vercruysse, P., Wellendorf, A. M., Gramignoli, R., Bozoky, B., Kehr, J., Theodorsson, E., Cancelas, J. A., Mravec, B., Jorns, C., Ellis, E., Mulder, J., Uhlen, M., Bark, C., Hökfelt, T.
Science Advances, 21.07.2021
Tilføjet 21.07.2021
Hepatic nerves have a complex role in synchronizing liver metabolism. Here, we used three-dimensional (3D) immunoimaging to explore the integrity of the hepatic nervous system in experimental and human nonalcoholic fatty liver disease (NAFLD). We demonstrate parallel signs of mild degeneration and axonal sprouting of sympathetic innervations in early stages of experimental NAFLD and a collapse of sympathetic arborization in steatohepatitis. Human fatty livers display a similar pattern of sympathetic nerve degeneration, correlating with the severity of NAFLD pathology. We show that chronic sympathetic hyperexcitation is a key factor in the axonal degeneration, here genetically phenocopied in mice deficient of the Rac-1 activator Vav3. In experimental steatohepatitis, 3D imaging reveals a severe portal vein contraction, spatially correlated with the extension of the remaining nerves around the portal vein, enlightening a potential intrahepatic neuronal mechanism of portal hypertension. These fundamental alterations in liver innervation and vasculature uncover previously unidentified neuronal components in NAFLD pathomechanisms.
Læs mere Tjek på PubMedKukimoto-Niino, M., Katsura, K., Kaushik, R., Ehara, H., Yokoyama, T., Uchikubo-Kamo, T., Nakagawa, R., Mishima-Tsumagari, C., Yonemochi, M., Ikeda, M., Hanada, K., Zhang, K. Y. J., Shirouzu, M.
Science Advances, 21.07.2021
Tilføjet 21.07.2021
The dedicator of cytokinesis (DOCK) family of guanine nucleotide exchange factors (GEFs) promotes cell motility, phagocytosis, and cancer metastasis through activation of Rho guanosine triphosphatases. Engulfment and cell motility (ELMO) proteins are binding partners of DOCK and regulate Rac activation. Here, we report the cryo–electron microscopy structure of the active ELMO1-DOCK5 complex bound to Rac1 at 3.8-Å resolution. The C-terminal region of ELMO1, including the pleckstrin homology (PH) domain, aids in the binding of the catalytic DOCK homology region 2 (DHR-2) domain of DOCK5 to Rac1 in its nucleotide-free state. A complex α-helical scaffold between ELMO1 and DOCK5 stabilizes the binding of Rac1. Mutagenesis studies revealed that the PH domain of ELMO1 enhances the GEF activity of DOCK5 through specific interactions with Rac1. The structure provides insights into how ELMO modulates the biochemical activity of DOCK and how Rac selectivity is achieved by ELMO.
Læs mere Tjek på PubMedSun, Y., DeJaco, R. F., Li, Z., Tang, D., Glante, S., Sholl, D. S., Colina, C. M., Snurr, R. Q., Thommes, M., Hartmann, M., Siepmann, J. I.
Science Advances, 21.07.2021
Tilføjet 21.07.2021
Adsorptive hydrogen storage is a desirable technology for fuel cell vehicles, and efficiently identifying the optimal storage temperature requires modeling hydrogen loading as a continuous function of pressure and temperature. Using data obtained from high-throughput Monte Carlo simulations for zeolites, metal-organic frameworks, and hyper–cross-linked polymers, we develop a meta-learning model that jointly predicts the adsorption loading for multiple materials over wide ranges of pressure and temperature. Meta-learning gives higher accuracy and improved generalization compared to fitting a model separately to each material and allows us to identify the optimal hydrogen storage temperature with the highest working capacity for a given pressure difference. Materials with high optimal temperatures are found in close proximity in the fingerprint space and exhibit high isosteric heats of adsorption. Our method and results provide new guidelines toward the design of hydrogen storage materials and a new route to incorporate machine learning into high-throughput materials discovery.
Læs mere Tjek på PubMedMusumari, P. M., Mbikayi, S. M., Srithanaviboonchai, K., Techasrivichien, T., Tangmunkongvorakul, A., Tshilolo, L.
BMJ Open, 21.07.2021
Tilføjet 21.07.2021
Objectives
Blood transfusion is a life-saving procedure and is also associated with a range of risks including the occurrence of symptoms of acute transfusion reactions (ATRs). Very few studies in sub-Saharan Africa have reported on ATRs. The present study addresses this gap in the literature by documenting the prevalence of and factors associated with ATRs in the Democratic Republic of Congo (DRC).
Design
This is a cross-sectional descriptive and analytical study using blood bank data from a general referral hospital.
Setting
Centre Hospitalier Mère-Enfant (CHME) Monkole, a general referral hospital in Kinshasa, DRC.
Participants
General population who have received blood transfusion in CHME Monkole between 2014 and 2019.
Results
The data set included a total of 7166 patients; 3153 (44%) men and 4013 (56%) women. The overall prevalence of symptoms of ATRs was 2.6%; the lowest prevalence was in 2017 (2.34%) and highest in 2018 (2.95%) and 2019 (2.94%). The documented symptoms included 74 (39.6%) cases of dyspnoea/respiratory distress, 60 (32.1%) cases of fever, 36 (19.2%) cases of pruritus/urticaria and 17 (9.1%) cases of vomiting. None of the studied factors was associated with symptoms of ATRs.
Conclusion
Symptoms of ATRs were not uncommon in the studied population. Dyspnoea and respiratory distress, fever and pruritus/urticaria were the most common symptoms of ATRs. This study highlights the need for a clinical and biological surveillance to detect, prevent and manage ATRs in the context of the DRC.
Læs mere Tjek på PubMedEreso, B. M., Sagbakken, M., Gradmann, C., Yimer, S. A.
BMJ Open, 21.07.2021
Tilføjet 21.07.2021
Objective
To compare tuberculosis (TB) treatment outcomes and associated factors among patients attending community-based versus facility-based directly observed treatment, short course (DOTS).
Design
A prospective cohort study.
Setting
The study was conducted in Southwest Ethiopia. There were seven hospitals (five primary, one general and one specialised), 120 health centres and 494 health posts.
Participants
A total of 1161 individuals consented to participate in the study (387 patients under community-based DOTS (CB-DOTS) and 774 patients under facility-based DOTS (FB-DOTS)). Individuals who could not respond to the questions, mentally or critically ill patients, and those less than 15 years old, were excluded from the study.
Primary outcome measure
TB treatment outcomes were compared among patients under CB-DOTS versus FB-DOTS. Risk ratio (RR), risk difference (RD) and confidence interval (CI) were calculated among the study groups. In addition, 2 or Fisher’s exact tests were used to compare group differences, with a p value of <0.05 considered statistically significant.
Results
Patients who opted for CB-DOTS were more likely to be cured by 12% than those who opted for FB-DOTS (RR=1.12, 95% CI=0.96 to 1.30). Patients under CB-DOTS had a lesser risk of death (RR=0.93, 95% CI=0.49 to 1.77) and a lower risk of treatment failure (RR=0.86, 95% CI=0.22 to 3.30) than those under FB-DOTS. Furthermore, patients who opted for CB-DOTS were less likely to have a positive sputum smear result at the end of the treatment period (p=0.042) compared with their counterparts.
Conclusion
The study showed that CB-DOTS is more effective than FB-DOTS in terms of improving cure rate and sputum conversion rate, as well as lowering treatment failure rate. Our findings show the need for scaling up and a further decentralisation of CB-DOTS approach to improve access to TB treatment service for the rural community.
Læs mere Tjek på PubMedMotiwala, M. A., Habib, S., Ghafoor, R., Irfan, S.
BMJ Open, 21.07.2021
Tilføjet 21.07.2021
Introduction
Various intracanal medicaments have been used in cases of chronic apical periodontitis for appropriate disinfection of the root canal system to eliminate microbes especially from the inaccessible areas. Calcium hydroxide is the most common intracanal medicament available in various forms, but its effectiveness with or without iodoform using microbial culture is unknown. Therefore, our aim is to compare the antimicrobial efficacy of Calcipex and Metapex in endodontic treatment of teeth presenting with chronic apical periodontitis by assessing the bacterial load reduction.
Method and analysis
60 single rooted teeth of patients with diagnosis of chronic apical periodontitis will be selected and the canals debrided chemomechanically. The patients will be randomised into two groups: Calcipex and Metapex. The first sample (S1) for bacterial culture will be taken before placement of intracanal medicament and the second sample (S2) will be taken after 7 days, before final obturation from the canal and sent to lab for culture. Colony-forming unit will be evaluated. Paired t-test will be used to assess difference between antimicrobial efficacies within the group of medicaments. Independent sample t-test will be used to assess antimicrobial efficacies between groups. Level of significance will be kept at 0.05.
Ethics and dissemination
Approval from Aga Khan University Hospital Ethical review committee is taken. Findings will be reported according to the Standard Protocol Items for Randomised Trials guidelines. Research findings will be disseminated through annual reports, peer-reviewed journals and conferences.
Trial registration number
NCT04336709.
Læs mere Tjek på PubMedLeonard B. Bacharier
American Journal of Respiratory and Critical Care Medicine , 20.07.2021
Tilføjet 21.07.2021
American Journal of Respiratory and Critical Care Medicine, Volume 204, Issue 2, Page 115-116, July 15, 2021.
Læs mere Tjek på PubMedJohn R. Balmes
American Journal of Respiratory and Critical Care Medicine , 20.07.2021
Tilføjet 21.07.2021
American Journal of Respiratory and Critical Care Medicine, Volume 204, Issue 2, Page 118-120, July 15, 2021.
Læs mere Tjek på PubMedMarcel A. Behr, Eva Kaufmann, Jacalyn Duffin, Paul H. Edelstein, Lalita Ramakrishnan
American Journal of Respiratory and Critical Care Medicine , 20.07.2021
Tilføjet 21.07.2021
American Journal of Respiratory and Critical Care Medicine, Volume 204, Issue 2, Page 142-148, July 15, 2021.
Læs mere Tjek på PubMedJonathan Thorsen, Jakob Stokholm, Morten Arendt Rasmussen, Martin Steen Mortensen, Asker Daniel Brejnrod, Mathis Hjelmsø, Shiraz Shah, Bo Chawes, Klaus Bønnelykke, Søren Johannes Sørensen, Hans Bisgaard
American Journal of Respiratory and Critical Care Medicine , 20.07.2021
Tilføjet 21.07.2021
American Journal of Respiratory and Critical Care Medicine, Volume 204, Issue 2, Page 149-158, July 15, 2021.
Læs mere Tjek på PubMedDavid M. Stieb, Greg J. Evans, Teresa M. To, Pascale S. J. Lakey, Manabu Shiraiwa, Marianne Hatzopoulou, Laura Minet, Jeffrey R. Brook, Richard T. Burnett, Scott A. Weichenthal
American Journal of Respiratory and Critical Care Medicine , 20.07.2021
Tilføjet 21.07.2021
American Journal of Respiratory and Critical Care Medicine, Volume 204, Issue 2, Page 168-177, July 15, 2021.
Læs mere Tjek på PubMedFelix Ritzmann, Praneeth Chitirala, Nadine Krüger, Markus Hoffmann, Wei Zuo, Frank Lammert, Sigrun Smola, Naveh Tov, Noga Alagem, Philipp M. Lepper, Stefan Pöhlmann, Christoph Beisswenger, Christian Herr, Robert Bals
American Journal of Respiratory and Critical Care Medicine , 20.07.2021
Tilføjet 21.07.2021
American Journal of Respiratory and Critical Care Medicine, Volume 204, Issue 2, Page 224-227, July 15, 2021.
Læs mere Tjek på PubMed