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Alice Alberti, Stefano Corbella, Silvio Taschieri, Luca Francetti, Kausar Sadia Fakhruddin, Lakshman Perera Samaranayake
PLoS One Infectious Diseases, 22.07.2021
Tilføjet 23.07.2021
by Alice Alberti, Stefano Corbella, Silvio Taschieri, Luca Francetti, Kausar Sadia Fakhruddin, Lakshman Perera Samaranayake
Fungal infections are common on oral mucosae, but their role in other oral sites is ill defined. Over the last few decades, numerous studies have reported the presence of fungi, particularly Candida species in endodontic infections, albeit in relatively small numbers in comparison to its predominant anaerobic bacteriome. Here, we review the fungal biome of primary and secondary endodontic infections, with particular reference to the prevalence and behavior of Candida species. Meta-analysis of the available data from a total of 39 studies fitting the inclusion criteria, indicate the overall weighted mean prevalence (WMP) of fungal species in endodontic infections to be 9.11% (from a cumulative total of 2003 samples), with 9.0% in primary (n = 1341), and 9.3% in secondary infections (n = 662). Nevertheless, WMP for fungi in primary and secondary infections which were 6.3% and 7.5% for culture-based studies, increased to 12.5% and 16.0% in molecular studies, respectively. The most prevalent fungal species was Candida spp. The high heterogeneity in the reported fungal prevalence suggests the need for standardized sampling, and speciation methods. The advent of the new molecular biological analytical platforms, such as the next generation sequencing (NGS), and matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF), that enables identification and quantitation of a broad spectrum of hitherto unknown organisms in endodontic infections should radically alter our understanding of the endodontic mycobiome in the future. Candida spp. appear to be co-pathogens with bacteria in approximately one in ten patients with endodontic infections. Hence, clinicians should comprehend the importance and the role of fungi in endodontic infections and be cognizant of the need to eradicate both bacteria and fungi for successful therapy.
Læs mere Tjek på PubMedHyo-In Rhyou, Young-Hee Nam, Su-Chin Kim, Go-Eun Doo, Chae-Yeon Ha, Hee-Joo Nam, Sung-Dae Woo, Youngsoo Lee, Jae-Hyuk Jang, Hyun-Young Lee, Young-Min Ye
PLoS One Infectious Diseases, 22.07.2021
Tilføjet 23.07.2021
by Hyo-In Rhyou, Young-Hee Nam, Su-Chin Kim, Go-Eun Doo, Chae-Yeon Ha, Hee-Joo Nam, Sung-Dae Woo, Youngsoo Lee, Jae-Hyuk Jang, Hyun-Young Lee, Young-Min Ye
Cefaclor, a second-generation oral cephalosporin, is the most frequently prescribed cephalosporin in Korea. Studies, however, have yet to analyze the incidence of cefaclor-associated adverse drug reactions (ADRs), including hypersensitivity (HS), according to total national usage rates. This study aimed to investigate the incidence rates and clinical features of cefaclor ADRs reported to the Korean Adverse Event Reporting System (KAERS) and Health Insurance Review and Assessment Service (HIRA) database for the most recent 5 years. Reviewing the HIRA database, which contains information on all insurance claims, including prescribed medications and patient demographics, we identified the total number of individuals who had been prescribed cefaclor and other cephalosporins including 2nd generation without cefaclor and 3rd generation antibiotics from January 2014 to December 2018. Additionally, we retrospectively analyzed all ADRs reported to the KAERS for these drugs over the same study period. Incidence rates for ADRs, HS, and anaphylaxis to cefaclor were 1.92/10,000 persons, 1.17/10,000 persons, and 0.38/10,000 persons, respectively, lower than those to other 2nd and 3rd cephalosporins. Among all ADRs, HS (60.9% vs. 43.6% vs. 44.8%, P
Læs mere Tjek på PubMedZaw Myo Tun, Dale A. Fisher, Sharon Salmon, Clarence C. Tam
PLoS One Infectious Diseases, 22.07.2021
Tilføjet 23.07.2021
by Zaw Myo Tun, Dale A. Fisher, Sharon Salmon, Clarence C. Tam
Background Methicillin-Resistant Staphylococcus aureus (MRSA) is endemic in hospitals worldwide. Intrahospital transfers may impact MRSA acquisition risk experienced by patients. In this study, we investigated ward characteristics and connectivity that are associated with MRSA acquisition.
Methods We analysed electronic medical records on patient transfers and MRSA screening of in-patients at an acute-care tertiary hospital in Singapore to investigate whether ward characteristics and connectivity within a network of in-patient wards were associated with MRSA acquisition rates over a period of four years.
Results Most patient transfers concentrated in a stable core network of wards. Factors associated with increased rate of MRSA acquisition were MRSA prevalence among patients transferred from other wards (rate ratio (RR): 7.74 [95% confidence interval (CI): 3.88, 15.44], additional 5 percentage point), critical care ward (RR: 1.72 [95% CI: 1.09, 2.70]) and presence of MRSA cohorting beds (RR: 1.39 [95% CI: 1.03, 1.90]. Oncology ward (RR: 0.66 [95% CI: 0.46, 0.94]) (compared to medical ward), and median length of stay (RR: 0.70 [95% CI: 0.55, 0.90], additional 1.5 days) were associated with lower acquisition rates. In addition, we found evidence of interaction between MRSA prevalence among patients transferred from other wards and weighted in-degree although the latter was not associated with MRSA acquisition after controlling for confounders.
Conclusion Wards with higher MRSA prevalence among patients transferred from other wards were more likely to have higher MRSA acquisition rate. Its effect further increased in wards receiving greater number of patients. In addition, critical care ward, presence of MRSA cohorting beds, ward specialty, and median length of stay were associated with MRSA acquisition.
Læs mere Tjek på PubMedMichal Shauly-Aharonov, Asher Shafrir, Ora Paltiel, Ronit Calderon-Margalit, Rifaat Safadi, Roee Bicher, Orit Barenholz-Goultschin, Joshua Stokar
PLoS One Infectious Diseases, 22.07.2021
Tilføjet 23.07.2021
by Michal Shauly-Aharonov, Asher Shafrir, Ora Paltiel, Ronit Calderon-Margalit, Rifaat Safadi, Roee Bicher, Orit Barenholz-Goultschin, Joshua Stokar
Importance Patients with diabetes are known to be at increased risk for infections including severe coronavirus disease 2019 (COVID-19) but the relationship between COVID-19 severity and specific pre-infection glucose levels is not known.
Objective To assess the differential effects of pre-infection glucose levels on the risk for severe COVID-19 amongst patients with and without diabetes.
Design Population based historical cohort study.
Setting National state-mandated HMO.
Patients All adult patients with a positive SARS-COV2 test between March-October 2020.
Exposure Recent fasting blood glucose (FBG) and glycated hemoglobin (HBA1C), age, gender, body mass index (BMI) and diagnoses of diabetes, hypertension, ischemic heart disease.
Outcome Risk for severe COVID-19, defined as resulting in ≥10 hospitalization days, ICU admission or death.
Results 37,121 patients with a positive SARS-COV2 test were identified; 707 defined as severe (1.9%). Unadjusted risk factors for severe disease were age (OR = 1.1 for every year increase; 95% CI 1.09–1.11, p < 0.001), male gender (OR = 1.34, 95% CI 1.06–1.68, p = 0.012); BMI (OR = 1.02 for 1 kg/m2 increase, 95% CI 1.00–1.04, p = 0.025). Controlling for these factors, we found an association between pre-infection FBG and the risk of severe COVID-19, with a differential effect in patients with and without a diagnosis of diabetes. For patients without diabetes, elevated FBG in the pre-diabetes range (106–125 mg/dl) was associated with severe COVID-19 (OR 1.55 95% CI 1.04–2.26 p = 0.027). For patients with a diagnosis of diabetes, we found a J-shaped association between pre-infection glucose control and the risk for severe COVID-19 where the lowest risk for was for patients with FBG 106–125 mg/dl; the risk increased with higher pre-infection glucose levels but strikingly also for patients with a low pre-infection FBG (
Læs mere Tjek på PubMedMohammad Hashemzadeh, Aram Asareh Zadegan Dezfuli, Azar Dokht Khosravi, Mohammad Savari, Fatemeh Jahangirimehr
PLoS One Infectious Diseases, 22.07.2021
Tilføjet 23.07.2021
by Mohammad Hashemzadeh, Aram Asareh Zadegan Dezfuli, Azar Dokht Khosravi, Mohammad Savari, Fatemeh Jahangirimehr
Background Nocardia species belong to the aerobic actinomycetes group of bacteria which are gram-positive and partially acid-fast Bacilli. These bacteria may sometimes be associated with nosocomial infections. Nocardia diseases are not required to be reported to public health authorities in Iran. Hence, the present study was designed to determine the prevalence of human Nocardia spp. in Iran by using a systematic review and meta-analysis according to the preferred reporting items for systematic reviews and meta-Analyses statement.
Methods The data of the prevalence of Nocardia species were collected from databases such as Embase, PubMed/MEDLINE via Ovid, Web of Science, Scopus and Google Scholar as well as national Iranian databases, including SID, Magiran. Analyses were conducted by STATA 14.0.
Results The meta-analyses showed that the proportion of Nocardia spp. in Iranian studies varied from 1.71(1.17, 2.24) to 0.46(0.09, 0.83). N. asteroides (21% [95% CI 1.17, 2.24]), N. cyriacigeorgica (17% [95% CI 0.99, 1.77]), N. facanica (10% [95% CI 0.75, 1.00]) were considered to be common causative agents.
Conclusions Our study presents that despite the fact that Nocardia spp. are normally are saprophytic organisms, are currently accounts as emerging pathogens due to an increase in immunocompromised patients among Iranian populations. Considering our results, the establishment of advanced diagnostic facilities for the rapid detection of Nocardia infections are required for optimal therapeutic strategies of Nocardia spp. in Iran. Our findings could help the programmatic management of the disease within the context of Nocardia control programs.
Læs mere Tjek på PubMedXiangqun Ju, Karen Canfell, Kirsten Howard, Gail Garvey, Joanne Hedges, Megan Smith, Lisa Jamieson
PLoS One Infectious Diseases, 22.07.2021
Tilføjet 23.07.2021
by Xiangqun Ju, Karen Canfell, Kirsten Howard, Gail Garvey, Joanne Hedges, Megan Smith, Lisa Jamieson
Objective Working in partnership with Indigenous communities in South Australia, we aimed to develop, pilot test and estimate utility scores for health states relating to cervical cancer screening, precancer, and invasive cervical cancer and precancer/cancer treatment among Indigenous women.
Methods Development and pilot testing of hypothetical cervical cancer health states, specifically through the lens of being an Indigenous Australian woman, was done with an Indigenous Reference Group in conjunction with five female Indigenous community members. Six health states were developed. These included: (1) Screened: cytology normal; (2) human papillomaviruses (HPV) positive with cytology normal; (3) low grade cytology (LSIL);(4) high grade cytology (HSIL); (5) early stage cervical cancer and; (6) later stage cervical cancer. Utility scores were calculated using a two-stage standard gamble approach among a large cohort of Indigenous Australian women taking part in a broader study involving oral HPV infection. The mean and standard deviation (SD) of the rank, percentage of respondents with a utility = 1 (perfect health) and utility score of each health state was summarised. Mean (SD) and medians and inter-quartile range (IQR) over 12 months and lifetime duration were calculated. Potential differences by age and residential location were assessed using the Wilcox Sum Rank test.
Results Data was obtained from 513 Indigenous women aged 19+ years. Mean utility scores were higher for the four non-cancer health states than for invasive cervical cancer states (p-values
Læs mere Tjek på PubMedFederica Scarpina, Marco Godi, Stefano Corna, Ionathan Seitanidis, Paolo Capodaglio, Alessandro Mauro
PLoS One Infectious Diseases, 22.07.2021
Tilføjet 23.07.2021
by Federica Scarpina, Marco Godi, Stefano Corna, Ionathan Seitanidis, Paolo Capodaglio, Alessandro Mauro
Evidence about the psychological functioning in individuals who survived the COVID-19 infectious is still rare in the literature. In this paper, we investigated fearful facial expressions recognition, as a behavioural means to assess psychological functioning. From May 15th, 2020 to January 30th, 2021, we enrolled sixty Italian individuals admitted in multiple Italian COVID-19 post-intensive care units. The detection and recognition of fearful facial expressions were assessed through an experimental task grounded on an attentional mechanism (i.e., the redundant target effect). According to the results, our participants showed an altered behaviour in detecting and recognizing fearful expressions. Specifically, their performance was in disagreement with the expected behavioural effect. Our study suggested altered processing of fearful expressions in individuals who survived the COVID-19 infectious. Such a difficulty might represent a crucial sign of psychological distress and it should be addressed in tailored psychological interventions in rehabilitative settings and after discharge.
Læs mere Tjek på PubMedEmiko Desvaux, Antoine Hamon, Sandra Hubert, Cheïma Boudjeniba, Bastien Chassagnol, Jack Swindle, Audrey Aussy, Laurence Laigle, Jessica Laplume, Perrine Soret, Pierre Jean-François, Isabelle Dupin-Roger, Mickaël Guedj, Philippe Moingeon
PLoS One Infectious Diseases, 22.07.2021
Tilføjet 23.07.2021
by Emiko Desvaux, Antoine Hamon, Sandra Hubert, Cheïma Boudjeniba, Bastien Chassagnol, Jack Swindle, Audrey Aussy, Laurence Laigle, Jessica Laplume, Perrine Soret, Pierre Jean-François, Isabelle Dupin-Roger, Mickaël Guedj, Philippe Moingeon
While establishing worldwide collective immunity with anti SARS-CoV-2 vaccines, COVID-19 remains a major health issue with dramatic ensuing economic consequences. In the transition, repurposing existing drugs remains the fastest cost-effective approach to alleviate the burden on health services, most particularly by reducing the incidence of the acute respiratory distress syndrome associated with severe COVID-19. We undertook a computational repurposing approach to identify candidate therapeutic drugs to control progression towards severe airways inflammation during COVID-19. Molecular profiling data were obtained from public sources regarding SARS-CoV-2 infected epithelial or endothelial cells, immune dysregulations associated with severe COVID-19 and lung inflammation induced by other respiratory viruses. From these data, we generated a protein-protein interactome modeling the evolution of lung inflammation during COVID-19 from inception to an established cytokine release syndrome. This predictive model assembling severe COVID-19-related proteins supports a role for known contributors to the cytokine storm such as IL1β, IL6, TNFα, JAK2, but also less prominent actors such as IL17, IL23 and C5a. Importantly our analysis points out to alarmins such as TSLP, IL33, members of the S100 family and their receptors (ST2, RAGE) as targets of major therapeutic interest. By evaluating the network-based distances between severe COVID-19-related proteins and known drug targets, network computing identified drugs which could be repurposed to prevent or slow down progression towards severe airways inflammation. This analysis confirmed the interest of dexamethasone, JAK2 inhibitors, estrogens and further identified various drugs either available or in development interacting with the aforementioned targets. We most particularly recommend considering various inhibitors of alarmins or their receptors, currently receiving little attention in this indication, as candidate treatments for severe COVID-19.
Læs mere Tjek på PubMedTarek Abdel Latif Ghonimi, Mohamad Mahmood Alkad, Essa Abdulla Abuhelaiqa, Muftah M. Othman, Musab Ahmed Elgaali, Rania Abdelaziz M. Ibrahim, Shajahan M. Joseph, Hassan Ali Al-Malki, Abdullah Ibrahim Hamad
PLoS One Infectious Diseases, 22.07.2021
Tilføjet 23.07.2021
by Tarek Abdel Latif Ghonimi, Mohamad Mahmood Alkad, Essa Abdulla Abuhelaiqa, Muftah M. Othman, Musab Ahmed Elgaali, Rania Abdelaziz M. Ibrahim, Shajahan M. Joseph, Hassan Ali Al-Malki, Abdullah Ibrahim Hamad
Context Patients on maintenance dialysis are more susceptible to COVID-19 and its severe form. We studied the mortality and associated risks of COVID-19 infection in dialysis patients in the state of Qatar.
Methods This was an observational, analytical, retrospective, nationwide study. We included all adult patients on maintenance dialysis therapy who tested positive for COVID-19 (PCR assay of the nasopharyngeal swab) during the period from February 1, 2020, to July 19, 2020. Our primary outcome was to study the mortality of COVID-19 in dialysis patients in Qatar and risk factors associated with it. Our secondary objectives were to study incidence and severity of COVID-19 in dialysis patients and comparing outcomes between hemodialysis and peritoneal dialysis patients. Patient demographics and clinical features were collected from a national electronic medical record. Univariate Cox regression analysis was performed to evaluate potential risk factors for mortality in our cohort.
Results 76 out of 1064 dialysis patients were diagnosed with COVID-19 (age 56±13.6, 56 hemodialysis and 20 peritoneal dialysis, 56 males). During the study period, 7.1% of all dialysis patients contracted COVID-19. Male dialysis patients had double the incidence of COVID-19 than females (9% versus 4.5% respectively; p<0.01). The most common symptoms on presentation were fever (57.9%), cough (56.6%), and shortness of breath (25%). Pneumonia was diagnosed in 72% of dialysis patients with COVID-19. High severity manifested as 25% of patients requiring admission to the intensive care unit, 18.4% had ARDS, 17.1% required mechanical ventilation, and 14.5% required inotropes. The mean length of hospital stay was 19.2 ± -12 days. Mortality due to COVID-19 among our dialysis cohort was 15%. Univariate Cox regression analysis for risk factors associated with COVID-19-related death in dialysis patients showed significant increases in risks with age (OR 1.077, CI 95%(1.018–1.139), p = 0.01), CHF and COPD (both same OR 8.974, CI 95% (1.039–77.5), p = 0.046), history of DVT (OR 5.762, CI 95% (1.227–27.057), p = 0.026), Atrial fibrillation (OR 7.285, CI 95%(2.029–26.150), p = 0.002), hypoxia (OR: 16.6; CI 95%(3.574–77.715), p =
Læs mere Tjek på PubMedTadesse Teferi Mersha, Biruk Mekonnen Wolde, Nigus Abebe Shumuye, Abrha Bsrat Hailu, Abrahim Hassen Mohammed, Yisehak Tsegaye Redda, Birhanu Hadush Abera, Habtamu Taddele Menghistu
PLoS One Infectious Diseases, 22.07.2021
Tilføjet 23.07.2021
by Tadesse Teferi Mersha, Biruk Mekonnen Wolde, Nigus Abebe Shumuye, Abrha Bsrat Hailu, Abrahim Hassen Mohammed, Yisehak Tsegaye Redda, Birhanu Hadush Abera, Habtamu Taddele Menghistu
Neglected tropical zoonotic diseases (NTZDs) continue to have a major effect on the health of humans and animals. In this study, a one health approach was used to prioritize and rank neglected tropical zoonotic diseases at the regional and zonal levels in Tigray National Regional State, Ethiopia. For prioritization of NTZDs a cross-sectional study through a structured questionnaire was administered to 313 health experts from human and animal health sectors. In addition, focus group discussions (FGD) were held with purposively selected key informants. Descriptive, and Multivariable analysis was applied to report the results and a ranked list of diseases was developed at the zonal and regional level. In the region, 8 of the 12 World Health Organization listed NTZDs were considered major diseases including anthrax, brucellosis, bovine tuberculosis, taeniasis, leishmaniasis, rabies, schistosomiasis, and soil-transmitted helminths. Considering the zoonotic and socioeconomic importance of the diseases at the regional level, rabies ranked 1stwhereas anthrax, bovine tuberculosis, leishmaniasis, and brucellosis were ranked from 2nd to 5th, respectively. The FGD result also supported the prioritization result. The Multivariable analysis showed a statistically significant difference in the zonal distribution of anthrax (р = 0.009, OR = 1.16), taeniasis (p<0.001, OR = 0.82), leishmaniasis (p<0.001, OR = 1.91), rabies (p = 0.020, OR = 0.79) and soil-transmitted helminths (p = 0.007, OR = 0.87) but not for brucellosis (p = 0.585), bovine tuberculosis (p = 0.505), and schistosomiasis (p = 0.421). Anthrax (p<0.001, OR = 26.68), brucellosis (p<0.001, OR = 13.18), and taeniasis (p<0.001, OR = 6.17) were considered as the major zoonotic diseases by veterinary practitioners than human health practitioners whereas, leishmaniasis was recognized as a major health challenge by human health professionals. Understanding the priority diseases in the region is supportive for informed decision-making and prioritizes the limited resources to use. Furthermore, strengthening the collaboration between human and animal health professions is important to control the diseases.
Læs mere Tjek på PubMedMagdalena Chorazka, Domenica Flury, Kathrin Herzog, Werner C. Albrich, Danielle Vuichard-Gysin
PLoS One Infectious Diseases, 22.07.2021
Tilføjet 23.07.2021
by Magdalena Chorazka, Domenica Flury, Kathrin Herzog, Werner C. Albrich, Danielle Vuichard-Gysin
Objectives Respiratory syncytial virus (RSV) can cause severe disease in adults, but far less is known than for influenza. The aim of our study was to compare the disease course of RSV infections with influenza infections among hospitalized adults.
Methods We retrieved clinical data from an ongoing surveillance of adults hospitalized with RSV or influenza virus infection in two acute care hospitals in North-Eastern Switzerland during the winter seasons 2017/2018 and 2018/2019. Our main analysis compared the odds between RSV and influenza patients for admission to an intensive care unit (ICU) or in-hospital death within 7 days after admission.
Results There were 548 patients, of whom 79 (14.4%) had an RSV and 469 (85.6%) an influenza virus infection. Both groups were similar with respect to age, sex, smoking status, nutritional state, and comorbidities. More RSV patients had an infiltrate on chest radiograph on admission (46.4% vs 29.9%, p = .007). The proportion of patients with RSV who died or were admitted to ICU within seven days after admission was 19.0% compared to 10.2% in influenza patients (p = .024). In multivariable analysis, a higher leukocyte count (adjusted OR 1.07, 95% CI 1.02–1.13, p = .013) and the presence of a pneumonic infiltrate (aOR 3.41, 95% CI 1.93–6.02) significantly increased the risk for experiencing the adverse primary outcome while the effect of the underlying viral pathogen became attenuated (aOR 1.18, 95% CI 0.58–2.41, p = .0.655).
Conclusions Our results suggest that RSV is responsible for clinical courses at least as severe as influenza in adults. This supports the need for better guidance on diagnostic strategies as well as on preventive and therapeutic measures for hospitalized adults with RSV infection.
Læs mere Tjek på PubMedPh.D. Mollie M. Van Gordon, Ph.D. Kevin A. McCarthy, Ph.D. Joshua L. Proctor, MBA Brittany L. Hagedorn
International Journal of Infectious Diseases, 22.07.2021
Tilføjet 22.07.2021
Whitfield, T., Fernandez, C., Davies, K., Defres, S., Griffiths, M., Hooper, C., Tangney, R., Burnside, G., Rosala- Hallas, A., Moore, P., Das, K., Zuckerman, M., Parkes, L., Keller, S., Roberts, N., Easton, A., Touati, S., Kneen, R., Stahl, J. P., Solomon, T.
BMJ Open, 22.07.2021
Tilføjet 22.07.2021
Introduction
Herpes simplex virus (HSV) encephalitis is a rare severe form of brain inflammation that commonly leaves survivors and their families with devastating long-term consequences. The virus particularly targets the temporal lobe of the brain causing debilitating problems in memory, especially verbal memory. It is postulated that immunomodulation with the corticosteroid, dexamethasone, could improve outcomes by reducing brain swelling. However, there are concerns (so far not observed) that such immunosuppression might facilitate increased viral replication with resultant worsening of disease. A previous trail closed early because of slow recruitment.
Method
DexEnceph is a pragmatic multicentre, randomised, controlled, open-label, observer-blind trial to determine whether adults with HSV encephalitis who receive dexamethasone alongside standard antiviral treatment with aciclovir for have improved clinical outcomes compared with those who receive standard treatment alone. Overall, 90 patients with HSV encephalitis are being recruited from a target of 45 recruiting sites; patients are randomised 1:1 to the dexamethasone or control arms of the study. The primary outcome measured is verbal memory as assessed by the Weschler Memory Scale fourth edition Auditory Memory Index at 26 weeks after randomisation. Secondary outcomes are measured up to 72 weeks include additional neuropsychological, clinical and functional outcomes as well as comparison of neuroimaging findings. Patient safety monitoring occurs throughout and includes the detection of HSV DNA in cerebrospinal fluid 2 weeks after randomisation, which is indicative of ongoing viral replication. Innovative methods are being used to ensure recrutiment targets are met for this rare disease.
Discussion
DexEnceph aims to be the first completed randomised controlled trial of corticosteroid therapy in HSV encephalitis. The results will provide evidence for future practice in managing adults with the condition and has the potential to improve outcomes .
Ethics and dissemination
The trial has ethical approval from the UK National Research Ethics Committee (Liverpool Central, REF: 15/NW/0545, 10 August 2015). Protocol V.2.1, July 2019. The results will be published and presented as soon as possible on completion.
Trial registration numbers
ISRCTN11774734, EUDRACT 2015-001609-16.
Læs mere Tjek på PubMedMangal, T., Whittaker, C., Nkhoma, D., Ng'ambi, W., Watson, O., Walker, P., Ghani, A., Revill, P., Colbourn, T., Phillips, A., Hallett, T., Mfutso-Bengo, J.
BMJ Open, 22.07.2021
Tilføjet 22.07.2021
Background
COVID-19 mitigation strategies have been challenging to implement in resource-limited settings due to the potential for widespread disruption to social and economic well-being. Here we predict the clinical severity of COVID-19 in Malawi, quantifying the potential impact of intervention strategies and increases in health system capacity.
Methods
The infection fatality ratios (IFR) were predicted by adjusting reported IFR for China, accounting for demography, the current prevalence of comorbidities and health system capacity. These estimates were input into an age-structured deterministic model, which simulated the epidemic trajectory with non-pharmaceutical interventions and increases in health system capacity.
Findings
The predicted population-level IFR in Malawi, adjusted for age and comorbidity prevalence, is lower than that estimated for China (0.26%, 95% uncertainty interval (UI) 0.12%–0.69%, compared with 0.60%, 95% CI 0.4% to 1.3% in China); however, the health system constraints increase the predicted IFR to 0.83%, 95% UI 0.49%–1.39%. The interventions implemented in January 2021 could potentially avert 54 400 deaths (95% UI 26 900–97 300) over the course of the epidemic compared with an unmitigated outbreak. Enhanced shielding of people aged ≥60 years could avert 40 200 further deaths (95% UI 25 300–69 700) and halve intensive care unit admissions at the peak of the outbreak. A novel therapeutic agent which reduces mortality by 0.65 and 0.8 for severe and critical cases, respectively, in combination with increasing hospital capacity, could reduce projected mortality to 2.5 deaths per 1000 population (95% UI 1.9–3.6).
Conclusion
We find the interventions currently used in Malawi are unlikely to effectively prevent SARS-CoV-2 transmission but will have a significant impact on mortality. Increases in health system capacity and the introduction of novel therapeutics are likely to further reduce the projected numbers of deaths.
Læs mere Tjek på PubMedWei, Q., Zhou, M., Liu, J., Zhang, S., Gao, F., Lin, H., Chen, Z.
BMJ Open, 22.07.2021
Tilføjet 22.07.2021
Introduction
Osteonecrosis (ON) is characterised by the destruction of the normal blood supply to the bone tissue. ON is the main cause of disability in patients with systemic lupus erythematosus (SLE). Studies have reported the existence of many risk factors for SLE complicated by ON, including the use of high-dose glucocorticoids and high disease activity. The correlation between antiphospholipid antibodies (aPLs) and ON in SLE has been controversial. We aim to conduct a systematic review of the literature related to SLE, aseptic ON and aPLs, to provide a reference for the clinical screening of high-risk patients and for early prevention.
Methods and analysis
The following six databases will be searched: MEDLINE/PubMed, Embase, Web of Science, Chinese Biomedical Literature Database, Wan-Fang Database and China National Knowledge Infrastructure. The database searches will not be restricted by date. Case–control studies, cohort studies or observational studies that compare aPLs between SLE patients with and without ON will be considered eligible. Articles published in English and Chinese will be included. Two researchers will independently perform the processes of study selection, data extraction and study quality assessment. The Newcastle–Ottawa Quality Assessment Scale will be used to assess the quality of the retrieved studies. A meta-analysis will be performed after screening the studies. Data will be analysed using ORs for dichotomous data.
Ethics and dissemination
Ethical approval is not required because this systematic review will use published data. The systematic review will be electronically disseminated through a peer-reviewed publication or conference presentations.
PROSPERO registration number
CRD42020209637.
Læs mere Tjek på PubMedIslam, S. J., Nayak, A., Hu, Y., Mehta, A., Dieppa, K., Almuwaqqat, Z., Ko, Y.-A., Patel, S. A., Goyal, A., Sullivan, S., Lewis, T. T., Vaccarino, V., Morris, A. A., Quyyumi, A. A.
BMJ Open, 22.07.2021
Tilføjet 22.07.2021
Background
The COVID-19 pandemic adversely affected the socially vulnerable and minority communities in the USA initially, but the temporal trends during the year-long pandemic remain unknown.
Objective
We examined the temporal association of county-level Social Vulnerability Index (SVI), a percentile-based measure of social vulnerability to disasters, its subcomponents and race/ethnic composition with COVID-19 incidence and mortality in the USA in the year starting in March 2020.
Methods
Counties (n=3091) with ≥50 COVID-19 cases by 6 March 2021 were included in the study. Associations between SVI (and its subcomponents) and county-level racial composition with incidence and death per capita were assessed by fitting a negative-binomial mixed-effects model. This model was also used to examine potential time-varying associations between weekly number of cases/deaths and SVI or racial composition. Data were adjusted for percentage of population aged ≥65 years, state-level testing rate, comorbidities using the average Hierarchical Condition Category score, and environmental factors including average fine particulate matter of diameter ≥2.5 μm, temperature and precipitation.
Results
Higher SVI, indicative of greater social vulnerability, was independently associated with higher COVID-19 incidence (adjusted incidence rate ratio per 10 percentile increase: 1.02, 95% CI 1.02 to 1.03, p<0.001) and death per capita (1.04, 95% CI 1.04 to 1.05, p<0.001). SVI became an independent predictor of incidence starting from March 2020, but this association became weak or insignificant by the winter, a period that coincided with a sharp increase in infection rates and mortality, and when counties with higher proportion of white residents were disproportionately represented (‘third wave’). By spring of 2021, SVI was again a predictor of COVID-19 outcomes. Counties with greater proportion of black residents also observed similar temporal trends in COVID-19-related adverse outcomes. Counties with greater proportion of Hispanic residents had worse outcomes throughout the duration of the analysis.
Conclusion
Except for the winter ‘third wave’, when majority of the white communities had the highest incidence of cases, counties with greater social vulnerability and proportionately higher minority populations experienced worse COVID-19 outcomes.
Læs mere Tjek på PubMedMathews, M., Spencer, S., Hedden, L., Marshall, E. G., Lukewich, J., Meredith, L., Ryan, D., Buote, R., Liu, T., Volpe, E., Gill, P. S., Ryan, B., Schacter, G., Wickett, J., Freeman, T. R., Sibbald, S. L., Wong, E., McKay, M., McCracken, R., Brown, J. B.
BMJ Open, 22.07.2021
Tilføjet 22.07.2021
Introduction
Given the recurrent risk of respiratory illness-based pandemics, and the important roles family physicians play during public health emergencies, the development of pandemic plans for primary care is imperative. Existing pandemic plans in Canada, however, do not adequately incorporate family physicians’ roles and perspectives. This policy and planning oversight has become increasingly evident with the emergence of the novel coronavirus disease, COVID-19, pandemic. This study is designed to inform the development of pandemic plans for primary care through evidence from four provinces in Canada: British Columbia, Newfoundland and Labrador, Nova Scotia, and Ontario.
Methods and analysis
We will employ a multiple-case study of regions in four provinces. Each case consists of a mixed methods design which comprises: (1) a chronology of family physician roles in the COVID-19 pandemic response; (2) a provincial policy analysis; and (3) qualitative interviews with family physicians. Relevant policy and guidance documents will be identified through targeted, snowball and general search strategies. Additionally, these policy documents will be analysed to identify gaps and/or emphases in existing policies and policy responses. Interviews will explore family physicians’ proposed, actual and potential roles during the pandemic, the facilitators and barriers they have encountered throughout and the influence of gender on their professional roles. Data will be thematically analysed using a content analysis framework, first at the regional level and then through cross-case analyses.
Ethics and dissemination
Approval for this study has been granted by the Research Ethics of British Columbia, the Health Research Ethics Board of Newfoundland and Labrador, the Nova Scotia Health Authority Research Ethics Board and the Western University Research Ethics Board. Findings will be disseminated via conferences and peer-reviewed publications. Evidence and lessons learnt will be used to develop tools for government ministries, public health units and family physicians for improved pandemic response plans for primary care.
Læs mere Tjek på PubMedOrtega, E., Corcoy, R., Gratacos, M., Cos Claramunt, F. X., Mata-Cases, M., Puig-Treserra, R., Real, J., Vlacho, B., Castelblanco, E., Domingo, P., Khunti, K., Franch-Nadal, J., Mauricio, D.
BMJ Open, 22.07.2021
Tilføjet 22.07.2021
Aim
This study’s objective was to assess the risk of severe in-hospital complications of patients admitted for COVID-19 and diabetes mellitus (DM).
Design
This was a cross-sectional study.
Settings
We used pseudonymised medical record data provided by six general hospitals from the HM Hospitales group in Spain.
Outcome measures
Multiple logistic regression analyses were used to identify variables associated with mortality and the composite of mortality or invasive mechanical ventilation (IMV) in the overall population, and stratified for the presence or absence of DM. Spline analysis was conducted on the entire population to investigate the relationship between glucose levels at admission and outcomes.
Results
Overall, 1621 individuals without DM and 448 with DM were identified in the database. Patients with DM were on average 5.1 years older than those without. The overall in-hospital mortality was 18.6% (N=301), and was higher among patients with DM than those without (26.3% vs 11.3%; p<0.001). DM was independently associated with death, and death or IMV (OR=2.33, 95% CI: 1.7 to 3.1 and OR=2.11, 95% CI: 1.6 to 2.8, respectively; p<0.001). In subjects with DM, the only variables independently associated with both outcomes were age >65 years, male sex and pre-existing chronic kidney disease. We observed a non-linear relationship between blood glucose levels at admission and risk of in-hospital mortality and death or IMV. The highest probability for each outcome (around 50%) was at random glucose of around 550 mg/dL (30.6 mmol/L), and the risks flattened above this value.
Conclusion
The results confirm the high burden associated with DM in patients hospitalised with COVID-19 infection, particularly among men, the elderly and those with impaired kidney function. Moreover, hyperglycaemia on admission was strongly associated with poor outcomes, suggesting that personalised optimisation could help to improve outcome during the hospital stay.
Læs mere Tjek på PubMedDun, Y., Ripley-Gonzalez, J. W., Zhou, N., You, B., Li, Q., Li, H., Zhang, W., Thomas, R. J., Olson, T. P., Liu, J., Dong, Y., Liu, S.
BMJ Open, 22.07.2021
Tilføjet 22.07.2021
Objectives
To observe the weight change in Chinese youth during a 4-month COVID-19 lockdown, and the association between weight change and mental health, physical activity and sedentary time changes, and dietary habits.
Design
A retrospective observational study.
Settings
Two universities located in Zhejiang and Hunan provinces, China.
Participants
This study enrolled 12 889 college students whose body weight was measured before the lockdown (1 December 2019–20 January 2020) at the two universities, and reported their weight measured at home or community after the end of the lockdown (1–23 May 2020) via an online follow-up questionnaire.
Primary and secondary outcome measures
The primary outcome was the weight change in Chinese youth during a 4-month lockdown resulting from the COVID-19 pandemic. The secondary outcomes were the relationships of weight change to COVID-19-related stress, depression, anxiety, physical activity and sedentary time changes, and dietary habits.
Results
Participants’ ages ranged from 17 to 27 years (M=19, SD=1) with 80.2% identified as female. The average absolute and relative changes in body weight were 2.6 (95% CI 2.0 to 3.2)) kg and 4.2% (95% CI 4.0% to 4.3%) for men, and 2.1 (1.9 to 2.4) kg and 4.2% (95% CI 3.9% to 4.4%) for women. An increase in overweight and obese individuals according to Asian cut-off points as a demographic percentage by 4.5% and 2.7% and 4.8% and 3.4% in men and women, respectively (P<0.001), was observed. Weight gain was significantly associated with increased sedentary time and an increase in COVID-19-related stress and depression score.
Conclusion
The present study’s results suggest that the risk of weight gain in Chinese youth during the lockdown increased and that strategies to decrease sedentary time and improve mental health may be warranted to mitigate weight gain during and after the COVID-19 pandemic.
Læs mere Tjek på PubMedBMC Infectious Diseases, 22.07.2021
Tilføjet 22.07.2021
Abstract
Background
Predicting hospital length of stay (LoS) for patients with COVID-19 infection is essential to ensure that adequate bed capacity can be provided without unnecessarily restricting care for patients with other conditions. Here, we demonstrate the utility of three complementary methods for predicting LoS using UK national- and hospital-level data.
Method
On a national scale, relevant patients were identified from the COVID-19 Hospitalisation in England Surveillance System (CHESS) reports. An Accelerated Failure Time (AFT) survival model and a truncation corrected method (TC), both with underlying Weibull distributions, were fitted to the data to estimate LoS from hospital admission date to an outcome (death or discharge) and from hospital admission date to Intensive Care Unit (ICU) admission date. In a second approach we fit a multi-state (MS) survival model to data directly from the Manchester University NHS Foundation Trust (MFT). We develop a planning tool that uses LoS estimates from these models to predict bed occupancy.
Results
All methods produced similar overall estimates of LoS for overall hospital stay, given a patient is not admitted to ICU (8.4, 9.1 and 8.0 days for AFT, TC and MS, respectively). Estimates differ more significantly between the local and national level when considering ICU. National estimates for ICU LoS from AFT and TC were 12.4 and 13.4 days, whereas in local data the MS method produced estimates of 18.9 days.
Conclusions
Given the complexity and partiality of different data sources and the rapidly evolving nature of the COVID-19 pandemic, it is most appropriate to use multiple analysis methods on multiple datasets. The AFT method accounts for censored cases, but does not allow for simultaneous consideration of different outcomes. The TC method does not include censored cases, instead correcting for truncation in the data, but does consider these different outcomes. The MS method can model complex pathways to different outcomes whilst accounting for censoring, but cannot handle non-random case missingness. Overall, we conclude that data-driven modelling approaches of LoS using these methods is useful in epidemic planning and management, and should be considered for widespread adoption throughout healthcare systems internationally where similar data resources exist.
Læs mere Tjek på PubMedDidem Görgün Hattatoğlu, Birsen Pınar Yıldız
Journal of Medical Virology, 21.07.2021
Tilføjet 22.07.2021
Tarun Kumar Suvvari, LV Simhachalam Kutikuppala, Christos Tsagkaris, Anna Chiara Corriero, Venkataramana Kandi
Journal of Medical Virology, 21.07.2021
Tilføjet 22.07.2021
Silvia Carbonell‐Sahuquillo, María Isabel Lázaro‐Carreño, Jorge Camacho, Ana Barrés‐Fernández, Eliseo Albert, Ignacio Torres, José Rafael Bretón‐Martínez, Cecilia Martínez‐Costa, David Navarro
Journal of Medical Virology, 21.07.2021
Tilføjet 22.07.2021
Olivier UWISHEMA, Baha Aldeen Abdalaziz Alshareif, Mohamed Yousif Elamin Yousif, Mohammed Eltahier Abdalla Omer, Alfredo Lorenzo Recio Sablay, Rabeet Tariq, Amirsaman Zahabioun, Rehema Mkamburi Mwazighe, Helen Onyeaka
Journal of Medical Virology, 21.07.2021
Tilføjet 22.07.2021
Olivier Uwishema, Ekene Mary Nnagha, Elie Chalhoub, Goodluck Nchasi, Rehema Mkamburi Mwazighe, Burak Talha Akin, Irem Adanur, Helen Onyeaka
Journal of Medical Virology, 21.07.2021
Tilføjet 22.07.2021
Philipp Sprengholz, Cornelia Betsch
Journal of Medical Virology, 21.07.2021
Tilføjet 22.07.2021
Ahmad M. Saad, Ahmed ES. Abdel‐Megied, Rizk A. Elbaz, Sobhy E. Hassab El‐Nabi, Rami M. Elshazli
Journal of Medical Virology, 21.07.2021
Tilføjet 22.07.2021
Jordan Z. Neises, Md Saddam Hossain, Rifat Sultana, Kevin N. Wanniarachchi, Jared W. Wollman, Eric Nelson, Bonny L. Specker, Adam D. Hoppe, Steven R. Lawson, Natalie W. Thiex
Journal of Medical Virology, 21.07.2021
Tilføjet 22.07.2021
Nicholas I. Paton, Joseph Musaazi, Cissy Kityo, Stephen Walimbwa, Anne Hoppe, Apolo Balyegisawa, Arvind Kaimal, Grace Mirembe, Phionah Tukamushabe, Gilbert Ategeka, James Hakim, Henry Mugerwa, Abraham Siika, Jesca Asienzo, Barbara Castelnuovo, Agnes Kiragga, Andrew Kambugu
New England Journal of Medicine, 21.07.2021
Tilføjet 22.07.2021
New England Journal of Medicine, Volume 385, Issue 4, Page 330-341, July 2021.
Læs mere Tjek på PubMedEric J. Rubin, Lindsey R. Baden, Katrina A. Armstrong, Stephen Morrissey
New England Journal of Medicine, 21.07.2021
Tilføjet 22.07.2021
Victoria T. Chu, Anna R. Yousaf, Karen Chang, Noah G. Schwartz, Clinton J. McDaniel, Scott H. Lee, Christine M. Szablewski, Marie Brown, Cherie L. Drenzek, Emilio Dirlikov, Dale A. Rose, Julie Villanueva, Alicia M. Fry, Aron J. Hall, Hannah L. Kirking, Jacqueline E. Tate, Tatiana M. Lanzieri, Rebekah J. Stewart
New England Journal of Medicine, 21.07.2021
Tilføjet 22.07.2021
New England Journal of Medicine, 21.07.2021
Tilføjet 22.07.2021
Stephen J.W. Evans, Nicholas P. Jewell
New England Journal of Medicine, 21.07.2021
Tilføjet 22.07.2021
Jamie Lopez Bernal, Nick Andrews, Charlotte Gower, Eileen Gallagher, Ruth Simmons, Simon Thelwall, Julia Stowe, Elise Tessier, Natalie Groves, Gavin Dabrera, Richard Myers, Colin N.J. Campbell, Gayatri Amirthalingam, Matt Edmunds, Maria Zambon, Kevin E. Brown, Susan Hopkins, Meera Chand, Mary Ramsay
New England Journal of Medicine, 21.07.2021
Tilføjet 22.07.2021
Garth Rapeport, Emma Smith, Anthony Gilbert, Andrew Catchpole, Helen McShane, Christopher Chiu
New England Journal of Medicine, 21.07.2021
Tilføjet 22.07.2021
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 PubMed