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26 emner vises.
Jian Wu, Mariza Bortolanza, Guanghua Zhai, Anquan Shang, Zongxin Ling, Bin Jiang, Xiaochen Shen, Yiwen Yao, Jiong Yu, Lanjuan Li, Hongcui Cao
Journal of Medical Virology, 22.09.2021
Tilføjet 23.09.2021
Leonard B. Weinstock, Jill B. Brook, Arthur S. Walters, Ashleigh Goris, Lawrence B. Afrin, Gerhard J. Molderings
International Journal of Infectious Diseases, 23.09.2021
Tilføjet 23.09.2021
Haijun Tong
Frontiers in Immunology, 26.10.2022
Tilføjet 23.09.2021
Dendritic cells (DCs) are composed of multiple lineages of hematopoietic cells and orchestrate immune responses upon detecting the danger and inflammatory signals associated with pathogen and damaged tissues. Under steady-state, DCs are maintained at limited numbers and the functionally quiescent status. While it is known that a fine balance in the DC homeostasis and activation status is also important to prevent autoimmune diseases and hyperinflammation, mechanisms that control DC development and activation under stead-state remain not fully understood. Here we show that DC-specific ablation of CBL and CBL-B (CBL-/-CBL-B-/-) leads to spontaneous liver inflammation and fibrosis and early death of the mice. The mutant mice have a marked expansion of classic CD8α+/CD103+ DCs (cDC1s) in peripheral lymphoid organs and the liver. These DCs exhibit atypical activation phenotypes characterized by an increased production of inflammatory cytokines and chemokines but not the cell surface MHC-II and costimulatory ligands. While the mutant mice also have massive T cell activation, lymphocytes are not required for the disease development. The CBL-/-CBL-B-/- mutation enhances FLT3-mTOR signaling, due to defective FLT3 ubiquitination and degradation. Blockade of FLT3-mTOR signaling normalizes the homeostasis of cDC1s and attenuates liver inflammation. Our result thus reveals a critical role of CBLs in the maintenance of DC homeostasis and immune quiescence. This regulation could be relevant to liver inflammatory diseases and fibrosis in humans.
Læs mere Tjek på PubMedSondra Turjeman, Omry Koren
Trends in Microbiology, 22.09.2021
Tilføjet 23.09.2021
Antibiotic resistance is one of the leading medical challenges with which we are currently faced. Antibiotics, while powerful medical tools, also wreak havoc on the endogenous microbiota. Many believe that probiotics can restore the microbiota following antibiotic treatment and might even suppress the spread of antibiotic-resistance genes, but a recent study (Montassier et al.) suggests otherwise.
Læs mere Tjek på PubMedOr Shalev, Christoph Ratzke
Trends in Microbiology, 22.09.2021
Tilføjet 23.09.2021
Microbes often live associated with other organisms. Whereas the impact of microbes on their hosts is well studied, what such a lifestyle means for the microbes is poorly understood. To address this gap, Bansept et al. explore how microbes could evolve to cope with altering between host-associated and host-free lifestyles.
Læs mere Tjek på PubMedFrank G Sandmann, Mark Jit
Lancet Infectious Diseases, 23.09.2021
Tilføjet 23.09.2021
In The Lancet Infectious Diseases, Eric Haas and colleagues1 estimated the benefits of the rapid mass roll-out of the Pfizer–BioNTech vaccine in Israel between Dec 20, 2020, and April 10, 2021. They found substantial benefits of the vaccine in terms of preventing thousands of deaths, hospitalisations, and new SARS-CoV-2 infections in individuals aged 16 years and older.1 Thanks to the successful vaccination programme, non-pharmaceutical restrictions were gradually lifted in Israel in February–March, 2021,1,2 and the national economy is reported to have recovered in April–June 2021, with an estimated economic growth of more than 5·5% forecasted for 2021.
Læs mere Tjek på PubMedEric J Haas, John M McLaughlin, Farid Khan, Frederick J Angulo, Emilia Anis, Marc Lipsitch, Shepherd R Singer, Gabriel Mircus, Nati Brooks, Meir Smaja, Kaijie Pan, Jo Southern, David L Swerdlow, Luis Jodar, Yeheskel Levy, Sharon Alroy-Preis
Lancet Infectious Diseases, 23.09.2021
Tilføjet 23.09.2021
Without the national vaccination campaign, Israel probably would have had triple the number of hospitalisations and deaths compared with what actually occurred during its largest wave of the pandemic to date, and the health-care system might have become overwhelmed. Indirect effects and long-term benefits of the programme, which could be substantial, were not included in these estimates and warrant future research.
Læs mere Tjek på PubMedFabio Morecchiato, Marco Coppi, Ilaria Baccani, Niccolò Maggini, Nunziata Ciccone, Alberto Antonelli, Gian Maria Rossolini
International Journal of Infectious Diseases, 22.09.2021
Tilføjet 23.09.2021
Real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) analysis of nasopharyngeal swabs (NPS) or other respiratory specimens represents the reference method for SARS-CoV-2 infection diagnosis (WHO, 2020).
Læs mere Tjek på PubMedLugata John, Nesister Odero, Jackson Nziku, Bernard Njau
PLoS One Infectious Diseases, 22.09.2021
Tilføjet 22.09.2021
by Lugata John, Nesister Odero, Jackson Nziku, Bernard Njau
Objective Pregnant women satisfaction with the Prevention of Mother-To-Child HIV Transmission services is an essential parameter in the determination of the quality of care and performance. This study aimed to measure the gap between pregnant women expectations of PMTCT services and perceptions of the actual PMTCT services and the relationship between their service gap scores and socio-demographic characteristics.
Methods A cross-sectional descriptive study design was conducted from August to September 2020 on a sample of 105 participants. A pre-tested SERVIQUAL questionnaire was used to collect data and paired sample t-test, independent one-sample t-test, and one–way ANOVA was used to compare mean service gap scores. A p-value of < 0.05 was considered statistically significant.
Results The overall mean gap score was (+ 0.31) indicating pregnant women perceived value of the quality of care of PMTCT services. The gap score in the 5 service dimensions was as follows: empathy (+0.49), tangibles (+0.43), assurance (+0.22), responsiveness (+0.20), and reliability (+0.19). Marital status (p-value 0.031) was the only social demographic characteristic associated with pregnant women service gap scores.
Conclusion Overall, pregnant women perceptions of PMTCT services provided in the RCH clinic at KCMC were meet. Marital status was associated with the overall pregnant women service gap scores and perceived quality of care with PMTCT services. Pregnant women who were married had small service gap scores compared to either divorced or widowed or cohabiting women.
Læs mere Tjek på PubMedMayako Saito-Abe, Kiwako Yamamoto-Hanada, Kensuke Shoji, Miori Sato, Makoto Irahara, Yu Taniguchi, Makiko Sekiyama, Nathan Mise, Akihiko Ikegami, Masayuki Shimono, Reiko Suga, Masafumi Sanefuji, Shouichi Ohga, Masako Oda, Hiroshi Mitsubuchi, Isao Miyairi, Yukihiro Ohya
PLoS One Infectious Diseases, 22.09.2021
Tilføjet 22.09.2021
by Mayako Saito-Abe, Kiwako Yamamoto-Hanada, Kensuke Shoji, Miori Sato, Makoto Irahara, Yu Taniguchi, Makiko Sekiyama, Nathan Mise, Akihiko Ikegami, Masayuki Shimono, Reiko Suga, Masafumi Sanefuji, Shouichi Ohga, Masako Oda, Hiroshi Mitsubuchi, Isao Miyairi, Yukihiro Ohya
Background The relationship between allergic individuals and their responsiveness to routine vaccines has rarely been investigated. This study examined whether the seroprevalence of measles antibody differed between children with and without allergic diseases in the general pediatric population.
Methods The cross-sectional study was performed within a prospective general birth cohort (a pilot study of the Japan Environment & Children’s Pilot Study [JECS]) of children aged 8 years. The clinical history of allergic diseases, measles, and the concentration of measles immunoglobulin G titers in serum enzyme immunoassay were examined. Fisher’s exact tests were used to assess the relationships between the allergic characteristics of the children and their measles antibody positivity rates.
Results This study included 162 children. Any allergic disease was reported in 75 (46.3%). The measles antibody positivity rate was 94.7% among children with any allergic diseases and 92.0% among children without allergic diseases. Our results revealed no differences in measles antibody seropositivity between children with allergies and controls.
Conclusions Children with allergies mount and maintain a comparable immune response to the measles vaccine.
Læs mere Tjek på PubMedJuan Gómez-Salgado, Ingrid Adanaque-Bravo, Mónica Ortega-Moreno, Regina Allande-Cussó, Cristian Arturo Arias-Ulloa, Carlos Ruiz-Frutos
PLoS One Infectious Diseases, 22.09.2021
Tilføjet 22.09.2021
by Juan Gómez-Salgado, Ingrid Adanaque-Bravo, Mónica Ortega-Moreno, Regina Allande-Cussó, Cristian Arturo Arias-Ulloa, Carlos Ruiz-Frutos
Background The effects of the COVID 19 pandemic on the mental health of citizens from Asia, Europe, or North America begin to be known, but there are fewer publications on its effects in Latin American countries. In this study, its impact in Ecuador is described, with data collected during the first phase of the pandemic. The objective of this study was to analyse the level of psychological distress in the population of Ecuador during the first phase of the COVID-19 pandemic.
Methods and findings Cross-sectional observational study. The questionnaires were collected through an online self-developed questionnaire, between April 2 and May 17, 2020, using the non-probabilistic sampling methodology: snowball method. The variables considered were sociodemographic variables, physical symptoms, health status, COVID-19 contact history, preventive measures, and the General Health Questionnaire (GHQ-12). The percentage with high psychological distress (PD) (GHQ-12 ≥ 3) has been somewhat lower than that found in Europe, being women, young people, people with higher level of education, living without a partner, not living with children or children under 16 years of age, and with worse perception of health the groups with the highest PD. Differences have been observed with European studies regarding common symptoms, preventive measures to avoid contagion, percentage of infected relatives, or diagnostic tests performed.
Conclusions The use of the same research instrument, validated in Europe and adapted to Ecuador, has facilitated the comparison of the found results and differences, which can be explained by socio-economic or cultural variables, the health system, level of information, or by preventive measures put in place to prevent the pandemic.
Læs mere Tjek på PubMedBeatrice Njeri Irungu, Lilian C. Koech, Joyce M. Ondicho, Lucia K. Keter
PLoS One Infectious Diseases, 22.09.2021
Tilføjet 22.09.2021
by Beatrice Njeri Irungu, Lilian C. Koech, Joyce M. Ondicho, Lucia K. Keter
Introduction Quality of medicines in both developed and developing countries is sometimes compromised due to infiltration of counterfeit, substandard or degraded medicines into the markets. It is a public health concern as poor quality medicines endanger public health where patients are exposed to chemical toxins and/or sub-therapeutic doses. This could lead to reduced treatment efficacy and promote development of drug resistance. Co-trimoxazole, a fixed dose combination of sulfamethoxazole and trimethoprim, is a broad spectrum for bacterial diseases and is also used as a prophylaxis for opportunistic infections in HIV infected individuals. This study evaluated quality of selected co-trimoxazole suspension brands marketed in Nairobi County, Kenya.
Methods A total of 106 samples were collected, categorized into 15 brands and evaluated for active pharmaceutical ingredient content (API) and pH following United States Pharmacopeia. Assay for API was conducted using High Performance Liquid Chromatography. Results were compared with pharmacopeia references. Visual examination of labels and confirmation of retention status of the brands with Pharmacy and Poisons Board retention register was carried out.
Results The samples were primarily of local origin (86.7%). On October 23, 2019, retention status of six of the fifteen brands documented were no longer listed in the Pharmacy and Poisons Board retention register. Of the 106 samples tested 70.6% and 86.8% were compliant with United States Pharmacopeia (USP) specifications for pH and API respectively while 84.0% adhered to packaging and labelling requirements.
Conclusion This study has demonstrated that majority of co-trimoxazole suspensions tested were compliant with USP requirements. Additionally, it has provided evidence of poor quality co-trimoxazole medicines that could compromise treatment of infectious diseases in children. This emphasizes the need for regular quality assurance tests to ensure only quality medicines are in the market.
Læs mere Tjek på PubMedSara Ares-Blanco, Marta Pérez Álvarez, Ileana Gefaell Larrondo, Cristina Muñoz, Vanesa Aguilar Ruiz, Marta Castelo Jurado, Marina Guisado-Clavero
PLoS One Infectious Diseases, 22.09.2021
Tilføjet 22.09.2021
by Sara Ares-Blanco, Marta Pérez Álvarez, Ileana Gefaell Larrondo, Cristina Muñoz, Vanesa Aguilar Ruiz, Marta Castelo Jurado, Marina Guisado-Clavero
Background Patients with COVID-19 are follow-up in primary care and long COVID is scarcely defined. The study aim was to describe SARS-CoV-2 pneumonia and cut-offs for defining long COVID in primary care follow-up patients.
Methods A retrospective observational study in primary care in Madrid, Spain, was conducted. Data was collected during 6 months (April to September) in 2020, during COVID-19 first wave, from patients ≥ 18 years with SARS-CoV-2 pneumonia diagnosed. Variables: sociodemographic, comorbidities, COVID-19 symptoms and complications, laboratory test and chest X-ray. Descriptive statistics were used, mean (standard deviation (SD)) and medians (interquartile range (IQR)) respectively. Differences were detected applying X2 test, Student’s T-test, ANOVA, Wilcoxon-Mann-Whitney or Kruskal-Wallis depending on variable characteristics.
Results 155 patients presented pneumonia in day 7.8 from the onset (79.4% were hospitalized, median length of 7.0 days (IQR: 3.0, 13.0)). After discharge, the follow-up lasted 54.0 median days (IQR 42.0, 88.0) and 12.2 mean (SD 6.4) phone calls were registered per patient. The main symptoms and their duration were: cough (41.9%, 12 days), dyspnoea (31.0%, 15 days), asthenia (26.5%, 21 days). Different cut-off points were applied for long COVID and week 4 was considered the best milestone (28.3% of the sample still had symptoms after week 4) versus week 12 (8.3%). Patients who still had symptoms >4 weeks follow-up took place over 81.0 days (IQR: 50.5, 103.0), their symptoms were more prevalent and lasted longer than those ≤ 4 weeks: cough (63.6% 30 days), dyspnoea (54.6%, 46 days), and asthenia (56.8%, 29 days). Embolism was more frequent in patients who still had symptoms >4 weeks than those with symptoms ≤4 weeks (9.1% vs 1.8%, p value 0.034).
Conclusion Most patients with SARS-CoV-2 pneumonia recovered during the first 4 weeks from the beginning of the infection. The cut-off point to define long COVID, as persisting symptoms, should be between 4 to 12 weeks from the onset of the symptoms.
Læs mere Tjek på PubMedSimon N. Wood, Ernst C. Wit
PLoS One Infectious Diseases, 22.09.2021
Tilføjet 22.09.2021
by Simon N. Wood, Ernst C. Wit
Detail is a double edged sword in epidemiological modelling. The inclusion of mechanistic detail in models of highly complex systems has the potential to increase realism, but it also increases the number of modelling assumptions, which become harder to check as their possible interactions multiply. In a major study of the Covid-19 epidemic in England, Knock et al. (2020) fit an age structured SEIR model with added health service compartments to data on deaths, hospitalization and test results from Covid-19 in seven English regions for the period March to December 2020. The simplest version of the model has 684 states per region. One main conclusion is that only full lockdowns brought the pathogen reproduction number, R, below one, with R ≫ 1 in all regions on the eve of March 2020 lockdown. We critically evaluate the Knock et al. epidemiological model, and the semi-causal conclusions made using it, based on an independent reimplementation of the model designed to allow relaxation of some of its strong assumptions. In particular, Knock et al. model the effect on transmission of both non-pharmaceutical interventions and other effects, such as weather, using a piecewise linear function, b(t), with 12 breakpoints at selected government announcement or intervention dates. We replace this representation by a smoothing spline with time varying smoothness, thereby allowing the form of b(t) to be substantially more data driven, and we check that the corresponding smoothness assumption is not driving our results. We also reset the mean incubation time and time from first symptoms to hospitalisation, used in the model, to values implied by the papers cited by Knock et al. as the source of these quantities. We conclude that there is no sound basis for using the Knock et al. model and their analysis to make counterfactual statements about the number of deaths that would have occurred with different lockdown timings. However, if fits of this epidemiological model structure are viewed as a reasonable basis for inference about the time course of incidence and R, then without very strong modelling assumptions, the pathogen reproduction number was probably below one, and incidence in substantial decline, some days before either of the first two English national lockdowns. This result coincides with that obtained by more direct attempts to reconstruct incidence. Of course it does not imply that lockdowns had no effect, but it does suggest that other non-pharmaceutical interventions (NPIs) may have been much more effective than Knock et al. imply, and that full lockdowns were probably not the cause of R dropping below one.
Læs mere Tjek på PubMedUlrich Glogowsky, Emanuel Hansen, Simeon Schächtele
PLoS One Infectious Diseases, 22.09.2021
Tilføjet 22.09.2021
by Ulrich Glogowsky, Emanuel Hansen, Simeon Schächtele
To fight the spread of COVID-19, many countries implemented social distancing policies. This is the first paper that examines the effects of the German social distancing policies on behavior and the epidemic’s spread. Exploiting the staggered timing of COVID-19 outbreaks in extended event-study models, we find that the policies heavily reduced mobility and contagion. In comparison to a no-social-distancing benchmark, within three weeks, the policies avoided 84% of the potential COVID-19 cases (point estimate: 499.3K) and 66% of the potential fatalities (5.4K). The policies’ relative effects were smaller for individuals above 60 and in rural areas.
Læs mere Tjek på PubMedMagaly Villena-Tejada, Ingrid Vera-Ferchau, Anahí Cardona-Rivero, Rina Zamalloa-Cornejo, Maritza Quispe-Florez, Zany Frisancho-Triveño, Rosario C. Abarca-Meléndez, Susan G. Alvarez-Sucari, Christian R. Mejia, Jaime A. Yañez
PLoS One Infectious Diseases, 22.09.2021
Tilføjet 22.09.2021
by Magaly Villena-Tejada, Ingrid Vera-Ferchau, Anahí Cardona-Rivero, Rina Zamalloa-Cornejo, Maritza Quispe-Florez, Zany Frisancho-Triveño, Rosario C. Abarca-Meléndez, Susan G. Alvarez-Sucari, Christian R. Mejia, Jaime A. Yañez
Background The burden of the COVID-19 pandemic in Peru has led to people seeking alternative treatments as preventives and treatment options such as medicinal plants. This study aimed to assess factors associated with the use of medicinal plants as preventive or treatment of respiratory symptom related to COVID-19 during the pandemic in Cusco, Peru.
Method A web-based cross-sectional study was conducted on general public (20- to 70-year-old) from August 31 to September 20, 2020. Data were collected using a structured questionnaire via Google Forms, it consisted of an 11-item questionnaire that was developed and validated by expert judgment using Aiken’s V (Aiken’s V > 0.9). Both descriptive statistics and bivariate followed by multivariable logistic regression analyses were conducted to assess factors associated with the use of medicinal plants for COVID-19 prevention and respiratory symptom treatment during the pandemic. Prevalence ratios (PR) with 95% Confidence Interval (CI), and a P-value of 0.05 was used to determine statistical significance.
Results A total of 1,747 respondents participated in the study, 80.2% reported that they used medicinal plants as preventives, while 71% reported that they used them to treat respiratory symptoms. At least, 24% of respondents used medicinal plants when presenting with two or more respiratory symptoms, while at least 11% used plants for malaise. For treatment or prevention, the multivariate analysis showed that most respondents used eucalyptus (p < 0.001 for both), ginger (p < 0.022 for both), spiked pepper (p < 0.003 for both), garlic (p = 0.023 for prevention), and chamomile (p = 0.011 for treatment). The respondents with COVID-19 (p < 0.001), at older ages (p = 0.046), and with a family member or friend who had COVID-19 (p < 0.001) used more plants for prevention. However, the respondents with technical or higher education used less plants for treatment (p < 0.001).
Conclusion There was a significant use of medicinal plants for both prevention and treatment, which was associated with several population characteristics and whether respondents had COVID-19.
Læs mere Tjek på PubMedMark D. Penney, Yigit Yargic, Lee Smolin, Edward W. Thommes, Madhur Anand, Chris T. Bauch
PLoS One Infectious Diseases, 22.09.2021
Tilføjet 22.09.2021
by Mark D. Penney, Yigit Yargic, Lee Smolin, Edward W. Thommes, Madhur Anand, Chris T. Bauch
Vaccinating individuals with more exposure to others can be disproportionately effective, in theory, but identifying these individuals is difficult and has long prevented implementation of such strategies. Here, we propose how the technology underlying digital contact tracing could be harnessed to boost vaccine coverage among these individuals. In order to assess the impact of this “hot-spotting” proposal we model the spread of disease using percolation theory, a collection of analytical techniques from statistical physics. Furthermore, we introduce a novel measure which we call the efficiency, defined as the percentage decrease in the reproduction number per percentage of the population vaccinated. We find that optimal implementations of the proposal can achieve herd immunity with as little as half as many vaccine doses as a non-targeted strategy, and is attractive even for relatively low rates of app usage.
Læs mere Tjek på PubMedMalaria Journal, 22.09.2021
Tilføjet 22.09.2021
Abstract
Background
The FcγRs genotypes have been reported to play a key role in the defence against malaria parasites through both cellular and humoral immunity. This study aimed to investigate the possible correlation between FcγR (IIa, IIIa, and IIIb) genes polymorphism and the clinical outcome for anti‐malarial antibody response of Plasmodium falciparum infection among Saudi children.
Methods
A total of 600 volunteers were enrolled in this study, including 200 malaria-free control (MFC) subjects, 218 patients with uncomplicated malaria (UM) and 182 patients with severe malaria (SM). The FcγR genotypes were analysed using PCR amplification methods, and measurements of immunoglobulin were determined using enzyme-linked immunosorbent assay (ELISA) technique.
Results
The data revealed that the FcγRIIa-R/R131 showed a statistically significant association with SM patients when compared to UM patients. Furthermore, higher levels of IgG1, IgG2, and IgG4 were associated with the FcγRIIa-H/H131 genotype among UM patients. Although the FcγRIIa-F/V176 genotype was not associated with UM, it showed a significant association with severe malaria. Interestingly, the FcγRIIIa-V/V176 genotype offered protection against SM. Moreover, SM patients carrying the FcγRIIIa-F/F genotype showed higher levels of AMA-1-specific IgG2 and IgG4 antibodies. The FcγRIIIb-NA1/NA1 and FcγRIIIb-NA2/NA2 genotypes did not show significant differences between the UM and the MFC groups. However, the genotype FcγRIIIb-NA2/NA2 was statistically significantly associated with SM patients.
Conclusions
The data presented in this study suggest that the influence of the FcγRIIa-R/R131, FcγRIIIa-F/F176 and FcγRIIIb-NA2/NA2 genotypes are statistically significantly associated with SM patients. However, the FcγRIIa-H/H13 and FcγRIIIa-V/V176 genotypes have demonstrated a protective effect against SM when compared to UM patients. The impact of the FcyR (IIa, IIIa and IIIb) gene variants and anti-malaria IgG subclasses play an important role in susceptibility to malaria infection and disease outcome in Saudi children.
Læs mere Tjek på PubMedLiu, D., Shi, S., Liu, X., Ye, T., Wang, L., Qu, C., Yang, B., Zhao, Q.
BMJ Open, 22.09.2021
Tilføjet 22.09.2021
Objectives
To investigate the characteristics of new-onset atrial fibrillation (AF) and its impact on prognosis in acute pulmonary embolism (aPE).
Design
A retrospective cohort study
Setting
The study cohort included patients diagnosed with aPE who were admitted to the Renmin Hospital of Wuhan University from January 2017 to January 2019.
Participants
Patients were ≥18 years of age and hospitalised for aPE.
Outcome measures
AF was diagnosed based on an ECG recording or a Holter monitor during hospitalisation. aPE was diagnosed by CT pulmonary angiography. The prescription was determined from the discharge medication list. All-cause mortality was observed after 6-month follow-up. The logistic regression model and Cox proportional hazards model were used to study the risk factor of the new-onset AF and the predictor of all-cause mortality, respectively.
Results
A total of 590 patients with aPE were enrolled, 23 (3.9%) in the new-onset paroxysmal AF group, 31 (5.3%) in the new-onset persistent AF group and 536 (90.8%) in the sinus rhythm (SR) group. The incidence of the new-onset AF was 9.2% (54/590). A significant difference in age, heart rate, cardiac troponin I ultra, amino-terminal pro-brain natriuretic peptide, D-dimer, left atrial diameter, left ventricular ejection fraction, pulmonary infection, venous thromboembolism, congestive heart failure, chronic cor pulmonale and ischaemic heart disease was found among the three groups (p<0.05). Risk factors for the new-onset AF were massive PE, ischaemic heart disease and congestive heart failure. The survival rate of the paroxysmal and persistent AF group was significantly lower than that of the SR group within 6 months (60.9% and 51.6% vs 88.8%, p<0.001). New-onset persistent AF (OR 2.73; 95% CI 1.28 to 5.81; p=0.009) was an independent predictor affecting the 6-month survival in aPE patients.
Conclusions
Massive PE, ischaemic heart disease and congestive heart failure are high-risk factors which were related to new-onset AF in aPE. New-onset persistent AF was an independent predictor for 6-month all-cause mortality in PE patients.
Læs mere Tjek på PubMedZhang, D., Liao, H., Jia, Y., Yang, W., He, P., Wang, D., Chen, Y., Yang, W., Zhang, Y.-P.
BMJ Open, 22.09.2021
Tilføjet 22.09.2021
Objective
To develop a virtual reality simulation training programme, and further verify the effect of the programme on improving the response capacity of emergency reserve nurses confronting public health emergencies.
Design
A prospective quasiexperimental design with a control group.
Participants
A total of 120 nurses were recruited and randomly divided into the control group and the intervention group.
Intervention
Participants underwent a 3-month training. The control group received the conventional training of emergency response (eg, theoretical lectures, technical skills and psychological training), while the intervention group underwent the virtual reality simulation training in combination with skills training. The COVID-19 cases were incorporated into the intervention group training, and the psychological training was identical to both groups. At the end of the training, each group conducted emergency drills twice. Before and after the intervention, the two groups were assessed for the knowledge and technical skills regarding responses to fulminate respiratory infectious diseases, as well as the capacity of emergency care. Furthermore, their pandemic preparedness was assessed with a disaster preparedness questionnaire.
Results
After the intervention, the scores of the relevant knowledge, the capacity of emergency care and disaster preparedness in the intervention group significantly increased (p<0.01). The score of technical skills in the control group increased more significantly than that of the intervention group (p<0.01). No significant difference was identified in the scores of postdisaster management in two groups (p>0.05).
Conclusion
The virtual reality simulation training in combination with technical skills training can improve the response capacity of emergency reserve nurses as compared with the conventional training. The findings of the study provide some evidence for the emergency training of reserve nurses in better response to public health emergencies and suggest this methodology is worthy of further research and popularisation.
Læs mere Tjek på PubMedAntequera, A., Lopez-Alcalde, J., Stallings, E., Muriel, A., Fernandez Felix, B., del Campo, R., Ponce-Alonso, M., Fidalgo, P., Halperin, A. V., Madrid-Pascual, O., Alvarez-Diaz, N., Sola, I., Gordo, F., Urrutia, G., Zamora, J.
BMJ Open, 22.09.2021
Tilføjet 22.09.2021
Objective
To assess the role of sex as an independent prognostic factor for mortality in patients with sepsis admitted to intensive care units (ICUs).
Design
Systematic review and meta-analysis.
Data sources
MEDLINE, Embase, Web of Science, ClinicalTrials.gov and the WHO Clinical Trials Registry from inception to 17 July 2020.
Study selection
Studies evaluating independent associations between sex and mortality in critically ill adults with sepsis controlling for at least one of five core covariate domains prespecified following a literature search and consensus among experts.
Data extraction and synthesis
Two authors independently extracted and assessed the risk of bias using Quality In Prognosis Studies tool. Meta-analysis was performed by pooling adjusted estimates. The Grades of Recommendations, Assessment, Development and Evaluation approach was used to rate the certainty of evidence.
Results
From 14 304 records, 13 studies (80 520 participants) were included. Meta-analysis did not find sex-based differences in all-cause hospital mortality (OR 1.02, 95% CI 0.79 to 1.32; very low-certainty evidence) and all-cause ICU mortality (OR 1.19, 95% CI 0.79 to 1.78; very low-certainty evidence). However, females presented higher 28-day all-cause mortality (OR 1.18, 95% CI 1.05 to 1.32; very low-certainty evidence) and lower 1-year all-cause mortality (OR 0.83, 95% CI 0.68 to 0.98; low-certainty evidence). There was a moderate risk of bias in the domain adjustment for other prognostic factors in six studies, and the certainty of evidence was further affected by inconsistency and imprecision.
Conclusion
The prognostic independent effect of sex on all-cause hospital mortality, 28-day all-cause mortality and all-cause ICU mortality for critically ill adults with sepsis was uncertain. Female sex may be associated with decreased 1-year all-cause mortality.
PROSPERO registration number
CRD42019145054.
Læs mere Tjek på PubMedMunyayi, F. K., van Wyk, B.
BMJ Open, 22.09.2021
Tilføjet 22.09.2021
Introduction
Adolescents represent one of the most underserved population groups among people living with HIV. With successes in the elimination of mother to child transmission initiatives and advances in paediatric HIV treatment programmes, a large population of HIV-infected children are surviving into adolescence. Adolescence presents unique challenges that increase the risk of non-suppressed viral loads in adolescents living with HIV (ALHIV). There is a need to develop, implement and test interventions to improve viral suppression among ALHIV. Systematic reviews of recent studies present scarce and inconclusive evidence of effectiveness of current interventions, especially for adolescents. This protocol provides a description of a planned review of interventions to improve treatment outcomes among unsuppressed ALHIV.
Methods and analysis
A comprehensive search string will be used to search six bibliographic databases: PubMed/MEDLINE, Sabinet, EBSCOhost, CINAHL, Scopus and ScienceDirect, for relevant studies published between 2010 and 2020 globally, and grey literature. Identified articles will be exported into Mendeley Reference Management software and two independent reviewers will screen the titles, abstracts and full texts for eligibility. A third reviewer will resolve any discrepancies between the two initial reviewers. Studies reporting on interventions to improve viral suppression, retention and adherence for adolescents will be considered for inclusion. The systematic review will be performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Where feasible, a meta-analysis will be conducted using Stata Statistical Software: Release V.16. The quality of the studies and risk of bias will be assessed using the Critical Appraisal Skills Programme checklists and Risk of Bias in Non-randomised Studies of Interventions tool, respectively.
Ethics and dissemination
The systematic review entails abstracting and reviewing already publicly available data rather than any involvement of participants, therefore, no ethical clearance will be required. Results will be shared with relevant policy-makers, programme managers and service providers, and published and share through conferences and webinars.
PROSPERO registration number
CRD42021232440.
Læs mere Tjek på PubMedIsmail, M., Joudeh, A., Neshnash, M., Metwally, N., Seif, M. H., Al Nuaimi, A., Alsaadi, M. M., Al Abdulla, S., Selim, N. A. A.
BMJ Open, 22.09.2021
Tilføjet 22.09.2021
Objectives
To assess primary care physicians’ satisfaction towards COVID-19 pandemic management in Qatar and to identify the associated factors with their satisfaction.
Design
A cross-sectional web-based survey conducted from 1 June to 30 July 2020.
Setting
All the 27 public primary healthcare centres in Qatar.
Participants
294 primary care physicians working in the publicly run primary healthcare corporation in Qatar.
Primary outcome measures
Overall satisfaction towards COVID-19 management in Qatar and satisfaction towards each aspect of this management including COVID-19 clinical practice guidelines, psychological support, team dynamics, work safety as well as institutional and governmental regulations.
Results
294 primary care physicians participated in the survey with a response rate of 65%. Overall satisfaction of physicians towards COVID-19 19 management at Primary Health Care Corporation was 77%. The highest satisfaction was towards institutional and governmental support while it was the lowest towards the corporation case definition and management of COVID-19 guidelines. Female physicians were less satisfied with psychological support in comparison to males (64.1% and 51% respectively, p=0.049). Overall satisfaction towards case definition and management of COVID-19 guidelines were strongly correlated with their clarity, updating these guidelines in due time and applicability of the guidelines (r=0.759 P<0.001; r=0.701 P<0.001; r=0.698 P<0.001) respectively, while satisfaction towards work safety was strongly correlated with availability and quality of Personal Protective Equipment provided (r=0.83 P<0.001 and r=0.811 P<0.001 respectively).
Conclusion
Most primary care physicians in Qatar who responded to the survey were satisfied with the COVID-19 guidelines developed rapidly in response to this pandemic. Availability and quality of PPE were a particular concern. The clinicians who were less satisfied were younger and female.
Læs mere Tjek på PubMedMaldaner, V., Coutinho, J., Santana, A. N. d. C., Cipriano, G. F. B., Oliveira, M. C., Carrijo, M. d. M., Lino, M. E. M., Cahalin, L. P., Lima, A. G., Borges, R., Santos, D. B., Silva, I. O., Oliveira, L. V. F., Cipriano Jr., G.
BMJ Open, 22.09.2021
Tilføjet 22.09.2021
Introduction
A significant number of patients with COVID-19 may experience dyspnoea, anxiety, depression, pain, fatigue and physical impairment symptoms, raising the need for a multidisciplinary rehabilitation approach, especially for those with advanced age, obesity, comorbidities and organ failure. Traditional pulmonary rehabilitation (PR), including exercise training, psychosocial counselling and education, has been employed to improve pulmonary function, exercise capacity and quality of life in patients with COVID-19. However, the effects of inspiratory muscle training (IMT) in PR programmes remain unclear. This study aimed to determine whether the addition of a supervised IMT in a PR is more effective than PR itself in improving dyspnoea, health-related quality of life and exercise capacity in symptomatic patients with post-COVID-19.
Methods and analysis
This parallel-group, assessor-blinded randomised controlled trial, powered for superiority, aimed to assess exercise capacity as the primary outcome. A total of 138 are being recruited at two PR centres in Brazil. Following baseline testing, participants will be randomised using concealed allocation, to receive either (1) standard PR with sham IMT or (2) standard PR added to IMT. Treatment effects or differences between the outcomes (at baseline, after 8 and 16 weeks, and after 6 months) of the study groups will be analysed using an ordinary two-way analysis of variance.
Ethics and dissemination
This trial was approved by the Brazilian National Ethics Committee and obtained approval on 7 October 2020 (document number 4324069). The findings will be disseminated through publications in peer-reviewed journals and conference presentations.
Trial registration number
NCT04595097.
Læs mere Tjek på PubMedMwangala, P. N., Mabrouk, A., Wagner, R., Newton, C. R. J. C., Abubakar, A. A.
BMJ Open, 22.09.2021
Tilføjet 22.09.2021
Objective
In this systematic review, we aimed to summarise the empirical evidence on common mental disorders (CMDs), cognitive impairment, frailty and health-related quality of life (HRQoL) among people living with HIV aged ≥50 years (PLWH50 +) residing in sub-Saharan Africa (SSA). Specifically, we document the prevalence and correlates of these outcomes.
Design, data sources and eligibility criteria
The following online databases were systematically searched: PubMed, CINAHL, PsycINFO, Embase and Scopus up to January 2021. English-language publications on depression, anxiety, cognitive function, frailty and quality of life among PLWH50+ residing in SSA were included.
Data extraction and synthesis
We extracted information, including study characteristics and main findings. These were tabulated, and a narrative synthesis approach was adopted, given the substantial heterogeneity among included studies.
Results
A total of 50 studies from fifteen SSA countries met the inclusion criteria. About two-thirds of these studies emanated from Ethiopia, Uganda and South Africa. Studies regarding depression predominated (n=26), followed by cognitive impairment (n=13). Overall, PLWH50+ exhibited varying prevalence of depression (6%–59%), cognitive impairments (4%–61%) and frailty (3%–15%). The correlates of CMDs, cognitive impairment, frailty and HRQoL were rarely investigated, but those reported were sociodemographic variables, many of which were inconsistent.
Conclusions
This review documented an increasing number of published studies on HIV and ageing from SSA. However, the current evidence on the mental and well-being outcomes in PLWH50+ is inadequate to characterise the public health dimension of these impairments in SSA, because of heterogeneous findings, few well-designed studies and substantial methodological limitations in many of the available studies. Future work should have sufficiently large samples of PLWH50+, engage appropriate comparison groups, harmonise the measurement of these outcomes using a standardised methodology to generate more robust prevalence estimates and confirm predictors.
PROSPERO registration number
CRD42020145791.
Læs mere Tjek på PubMedMontagna, E., Donohoe, J., Zaia, V., Duggan, E., O'Leary, P., Waddington, J., O'Tuathaigh, C.
BMJ Open, 22.09.2021
Tilføjet 22.09.2021
Objectives
To explore and compare the perspectives of junior doctors in Brazil and Ireland regarding transition and professional socialisation during the COVID-19 pandemic, with the purpose of identifying better ways to support doctors as they assume their new professional role.
Design
27 semistructured interviews. Transcripts were analysed using qualitative thematic analysis. Cruess’ framework of professional socialisation in medicine supported the interpretation of these data.
Setting
Public health hospitals across four Brazilian states (Santa Catarina, São Paulo, Ceará, Paraíba) and County Cork in the South of Ireland.
Participants
Twenty-seven male and female medical junior doctors who had graduated between November 2019 and April 2020.
Results
Fourteen Brazilian and 13 Irish junior doctors were interviewed for this study. Entry to clinical practice during the pandemic had a significant impact on factors influencing the professional socialisation of junior doctors. This impact was reflected across the following six thematic areas: lack of preparedness; disrupted trajectory of role adaptation; fewer opportunities for experiential learning; solidarity and isolation; altered interactions with patients; challenges to health and well-being.
Conclusions
Transition to clinical practice is an important stage in junior doctors’ professional socialisation and identity formation. The COVID-19 pandemic created the opportunity for medical graduates to enter the workforce earlier than usual. Entering the workforce during this period created a lack of confidence among junior doctors concerning the boundaries of their new role and responsibilities, while simultaneously disrupting their social integration. Priorities to mitigate the impact of COVID-19 and future pandemics on this transition are presented.
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