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Malaria Journal, 25.11.2021
Tilføjet 26.11.2021
Abstract
Background
In the Greater Mekong Subregion, adults are at highest risk for malaria, particularly those who visit forests. The absence of effective vector control strategies and limited periods of exposure during forest visits suggest that chemoprophylaxis could be an appropriate strategy to protect forest goers against malaria.
Methods
Alongside a clinical trial of anti-malarial chemoprophylaxis in northern Cambodia, qualitative research was conducted, including in-depth interviews and observation, to explore the acceptability of malaria prophylaxis for forest goers, the implementation opportunities, and challenges of this strategy.
Results
Prophylaxis with artemether–lumefantrine for forest goers was found to be acceptable under trial conditions. Three factors played a major role: the community’s awareness and perception of the effectiveness of prophylaxis, their trust in the provider, and malaria as a local health concern. The findings highlight how uptake and adherence to prophylaxis are influenced by the perceived balance between benefits and burden of anti-malarials which are modulated by the seasonality of forest visits and its influence on malaria risk.
Conclusions
The implementation of anti-malarial prophylaxis needs to consider how the preventive medication can be incorporated into existing vector-control measures, malaria testing and treatment services. The next step in the roll out of anti-malarial prophylaxis for forest visitors will require support from local health workers.
Læs mere Tjek på PubMedMalaria Journal, 25.11.2021
Tilføjet 26.11.2021
Abstract
Background
In recent years, the incidence rate of vivax malaria recurrence still had 3.1% in Yunnan Province population after eradication therapy using primaquine (PQ). In order to understand the specific failure reasons for preventing vivax malaria relapses, a preliminary exploration on the CYP2D6 enzyme activity was carried out in the vivax malaria patients in Yunnan Province population by analysing mutational polymorphism in the coding region of CYP2D6 gene.
Methods
Blood samples were collected from vivax malaria patients with suspected relapse (SR) and non-relapsed (NR) malaria in Yunnan Province. The DNA fragments containing 9 exons regions of human CYP2D6 gene were amplified by performing PCR and sequenced. The sequencing results were aligned by using DNAStar 11.0 to obtain the coding DNA sequence (CDS) of CYP2D6 gene. DnaSP 6.11.01 software was used to identify mutant polymorphisms and haplotypes of the CDS chain. The waterfall function of GenVisR package in R was utilized to visualize the mutational landscape. The alleles of CYP2D6 gene were identified according to the criteria prescribed by Human Cytochrome P450 (CYP) Allele Nomenclature Committee Database and the CYP2D6 enzyme activity was predicted based on diploid genotype.
Results
A total of 320 maternal CDS chains, including 63 from SR group and 257 from NR group, were obtained. Twelve mutant loci, including c.31 (rs769259), c.100 (rs1065852), c.271 (rs28371703), c.281 (rs28371704), c.294 (rs28371705), c.297 (rs200269944), c.336 (rs1081003), c.408 (rs1058164), c.505 (rs5030865), c.801 (rs28371718), c.886 (rs16947), and c.1,457 (rs1135840) were observed on the 640 CDS chains (including 320 maternal and 320 paternal chains). The high-frequency mutation at rs1135840 (0.703) and low-frequency mutation, such as rs28371703, were detected only in the SR group. The frequency of mutant rs1058164 and rs1135840 were significantly increased in the SR group (
({x}^{2})
= 4.468, 5.889, P < 0.05), as opposed to the NR group. Of the 23 haplotypes (from Hap_1 to Hap_23), the nomenclatures of 11 allelic forms could be found: Hap_3 was non-mutant, Hap_2 accounted for the highest frequency (36.9%, 236/640), and Hap_9 had the most complex sequence structure, containing 7 loci mutations. Allele *10 was the most frequent among these genotypes (0.423). Among the allele *10 standard named genotypes, *1/*10, *1/*1 and *2/*10 were significantly more frequent in the NR group (
({x}^{2})
= 3.911, P < 0.05) and all showed uncompromised enzyme activity; the impaired genotype *10/*39 was more frequent in the SR group (
({x}^{2})
= 10.050, P < 0.05), and genotype *4/*4was detected only in the SR group.
Conclusion
In the patients receiving PQ dosage in Yunnan Province population, both rs1135840 single nucleotide polymorphism and *10 allele form was common in the CYP2D6 gene. Low-frequency mutation sites, such as rs28371703, were only presented in patients with vivax malaria relapse.
Læs mere Tjek på PubMedMalaria Journal, 25.11.2021
Tilføjet 26.11.2021
Abstract
Background
Plasmodium interspersed repeat (pir) is the largest multigene family in the genomes of most Plasmodium species. A variety of functions for the PIR proteins which they encode have been proposed, including antigenic variation, immune evasion, sequestration and rosetting. However, direct evidence for these is lacking. The repetitive nature of the family has made it difficult to determine function experimentally. However, there has been some success in using gene expression studies to suggest roles for some members in virulence and chronic infection.
Methods
Here pir gene expression was examined across the life cycle of Plasmodium berghei using publicly available RNAseq data-sets, and at high resolution in the intraerythrocytic development cycle using new data from Plasmodium chabaudi.
Results
Expression of pir genes is greatest in stages of the parasite which invade and reside in red blood cells. The marked exception is that liver merozoites and male gametocytes produce a very large number of pir gene transcripts, notably compared to female gametocytes, which produce relatively few. Within the asexual blood stages different subfamilies peak at different times, suggesting further functional distinctions. Representing a subfamily of its own, the highly conserved ancestral pir gene warrants further investigation due to its potential tractability for functional investigation. It is highly transcribed in multiple life cycle stages and across most studied Plasmodium species and thus is likely to play an important role in parasite biology.
Conclusions
The identification of distinct expression patterns for different pir genes and subfamilies is likely to provide a basis for the design of future experiments to uncover their function.
Læs mere Tjek på PubMedMalaria Journal, 25.11.2021
Tilføjet 26.11.2021
Abstract
Background
Malaria elimination in Brazil poses several challenges, including the control of Plasmodium falciparum foci and the hidden burden of Plasmodium vivax in pregnancy. Maternal malaria and fetal health outcomes were investigated with a perinatal surveillance study in the municipality of Cruzeiro do Sul, Acre state, Brazilian Amazon. The research questions are: what are the causal effects of low birth weight on low Apgar at 5-min and of perinatal anaemia on stillbirth?
Methods
From November 2018 to October 2019, pregnant women of ≥ 22 weeks or puerperal mothers, who delivered at the referral maternity hospital (Juruá Women and Children’s Hospital), were recruited to participate in a malaria surveillance study. Clinical information was obtained from a questionnaire and abstracted from medical reports. Haemoglobin level and presence of malarial parasites were tested by haematology counter and light microscopy, respectively. Low Apgar at 5-min and stillbirth were the outcomes analysed in function of clinical data and epidemiologic risk factors for maternal malaria infection using both a model of additive and independent effects and a causal model with control of confounders and use of mediation.
Results
In total, 202 (7.2%; N = 2807) women had malaria during pregnancy. Nearly half of malaria infections during pregnancy (n = 94) were P. falciparum. A total of 27 women (1.03%; N = 2632) had perinatal malaria (19 P. vivax and 8 P. falciparum). Perinatal anaemia was demonstrated in 1144 women (41.2%; N = 2779) and low birth weight occurred in 212 newborns (3.1%; N = 2807). A total of 75 newborns (2.7%; N = 2807) had low (< 7) Apgar scores at 5-min., and stillbirth occurred in 23 instances (30.7%; n = 75). Low birth weight resulted in 7.1 higher odds of low Apgar at 5-min (OR = 7.05, 95% CI 3.86–12.88, p < 0.001) modulated by living in rural conditions, malaria during pregnancy, perinatal malaria, and perinatal anaemia. Stillbirth was associated with perinatal anaemia (OR = 2.56, 95% CI 1.02–6.42, p = 0.0444) modulated by living in rural conditions, falciparum malaria during pregnancy, perinatal malaria, and perinatal fever.
Conclusions
While Brazil continues its path towards malaria elimination, the population still faces major structural problems, including substandard living conditions. Here malaria infections on pregnant women were observed having indirect effects on fetal outcomes, contributing to low Apgar at 5-min and stillbirth. Finally, the utility of employing multiple statistical analysis methods to validate consistent trends is vital to ensure optimal public health intervention designs.
Læs mere Tjek på PubMedMalaria Journal, 25.11.2021
Tilføjet 26.11.2021
Abstract
Background
The return of chloroquine-sensitive Plasmodium falciparum in sub-Saharan Africa countries offers the opportunity for the reintroduction of chloroquine (CQ) either in combination with other drugs or as a single therapy for the management of malaria. This study assesses the influence of individual study sites on the selection of CQ sensitive P. falciparum markers in the Central region of Ghana.
Methods
Genomic DNA was extracted from an archived filter paper blood blot from Cape Coast, Elmina, Assin Fosu, and Twifo Praso using the Chelex DNA extraction method. The age metadata of the patients from whom the blood spots were taken was collected. The prevalence of CQ-sensitive markers of pfcrt K76 and pfmdr1 N86 was performed using nested PCR and RFLP. The data were analysed using Chi-square and Odd ratio.
Results
The overall prevalence of CQ-sensitive P. falciparum markers, pfcrt K76 and pfmdr1 N86 in the Central Region of Ghana were 142 out of 184 (77.17%) and 180 out of 184 (97.83%), respectively. The distribution of pfcrt K76 was assessed among the age groups per the individual study sites. 12 out of 33 (36.36%), 8 out of 33 (24.24%) and 6 out of 33 (18.18%) of pfcrt K76 CQ-sensitive marker were isolated from age 0 to 5 years, 16 to 30 years and 31 to 45 years old respectively at Cape Coast. Assin Fosu and Twifo Praso had the highest pfcrt K76 prevalence in 0–5 years, followed by 16–30 years and 6–15 years of age. The results showed that there was a significant prevalence of pfcrt K76 in all study sites; Cape Coast (χ2 = 26.48, p < 0.0001), Assin Fosu (χ2 = 37.67, p < 0.0001), Twifo Praso (χ2 = 32.25, p < 0.0001) and Elmina (χ2 = 17.88, p < 0.0001). Again, the likelihood to detect pfcrt K76 (OR (95% CI) was 7.105 (3.118–17.14), p < 0.0001 and pfmdr1 (2.028 (1.065–3.790), p < 0.001) among P. falciparum isolates from Cape Coast to be seven times and two times, respectively.
Conclusion
The study showed a significant selection and expansion of chloroquine-sensitive P. falciparum markers in all the selected study areas in the Central region. This finding has a significant implication for the future treatment, management, and control of P. falciparum malaria.
Læs mere Tjek på PubMedElizabeth A. Stuart, David W. Dowdy
Nature, 25.11.2021
Tilføjet 25.11.2021
Nature Medicine, Published online: 25 November 2021; doi:10.1038/s41591-021-01585-2
New research can help policymakers make evidence-based decisions about the risks and benefits of in-person schooling; strategic use of the available data will be key to getting this right.
Læs mere Tjek på PubMedAws Waleed M. Al-Hayani, Iris Martínez Alemany, Carlos Santonja, Alfonso Cabello Úbeda, Laura Prieto Pérez, María Carmen Ceballos-Rodríguez, Irene Carrillo Acosta, Miguel de Górgolas Hernández-Mora, Beatriz Álvarez Álvarez
International Journal of Infectious Diseases, 25.11.2021
Tilføjet 25.11.2021
Sweet Syndrome (SS) belongs to a group of diseases known as neutrophilic dermatoses. An uncommon variant named Histiocytoid Sweet Syndrome (HSS) can be associated with a variety of conditions, including cancer, infections, drug toxicity and others.Here we present an instance of HSS in an HIV-positive patient in the setting of an infectious disease.
Læs mere Tjek på PubMedMiklós Fagyas, Zsolt Fejes, Renáta Sütő, Zsuzsanna Nagy, Borbála Székely, Marianna Pócsi, Gergely Ivády, Edina Bíró, Gabriella Bekő, Attila Nagy, György Kerekes, Zoltán Szentkereszty, Zoltán Papp, Attila Tóth, János Kappelmayer, Béla Nagy
International Journal of Infectious Diseases, 25.11.2021
Tilføjet 25.11.2021
Wen, L. M., Xu, H., Jawad, D., Buchanan, L., Rissel, C., Phongsavan, P., Baur, L. A., Taki, S.
BMJ Open, 25.11.2021
Tilføjet 25.11.2021
Objectives
This study aimed to investigate perceived impacts, ways of communication with professionals and information sources related to COVID-19, and explore whether these impacts or information sources were associated with ethnicity that is, language spoken at home.
Design
A cross-sectional study.
Setting
Sydney, Australia during the period from March to October 2020.
Participants
Mothers of young children participating in an existing trial.
Outcome measures
Mothers were asked to respond to a set of survey questions related to COVID-19 via telephone. The questions included a mental health scale, and how they communicated with health professionals and their information sources related to COVID-19 during the COVID-19 pandemic.
Results
Of 537 mothers who completed the survey (81% response rate), 45% reported they spoke a language other than English at home. Overall, 136 (26%) reported experiencing mental distress. 234 (44%) reported that COVID-19 affected the way they receive and communicate health-related information with health professionals, especially for those from non-English speaking backgrounds with an adjusted odds ratio (AOR) 1.58 (95% CI 1.10 to 2.27). They were less likely to use a face-to-face service (AOR 0.55, 95% CI 0.37 to 0.80) and more likely to use social media (AOR 2.11, 95% CI 1.40 to 3.17) for health-related information. Regarding sources of COVID-19-related information, mothers from non-English-speaking backgrounds were more likely to rely on family members (AOR 1.49, 95% CI 1.01 to 2.19) and social media (AOR 3.34, 95% CI 2.05 to 5.43).
Conclusions
COVID-19 has significantly impacted mothers with young children in regard to their mental health, means of communication with health professionals and sources of health information. Mothers from non-English-speaking communities were less likely to use a face-to-face service, and more likely to seek information from family members and social media. Appropriate health support for non-English-speaking community needs to take these factors into account.
Trial registration number
ANZCTR:12618001571268.
they
Læs mere Tjek på PubMedNcama, B. P., Kuupiel, D., Duma, S. E., Mchunu, G., Guga, P., Slotow, R.
BMJ Open, 25.11.2021
Tilføjet 25.11.2021
Objective
The WHO has declared food safety as a public health concern. Transport hubs such as taxi ranks, bus stations and other transport exchange sites are major food trading/purchasing sites, particularly in Africa. Research evidence is needed to improve food safety policies and ensure consumption of safe food, owing to the increasing burden of foodborne diseases, particularly in the WHO Africa Region. We systematically mapped and described research evidence on food safety at transport stations in Africa.
Design
A scoping review guided by the Arksey and O’Malley framework.
Data sources
We searched for original research articles in PubMed, Web of Science, and EBSCOhost (Academic search complete, CINAHL with Full-text and Health Source), SCOPUS, and Google Scholar from their inception to 25 October 2020.
Eligibility criteria for selecting studies
We included studies that focused on food safety, involved transport stations, involved African countries and were published in English.
Data extraction and synthesis
Data extraction was performed by two reviewers using a piloted-tested form. Thematic analysis was used to organise the data into themes and subthemes, and a narrative summary of the findings is presented.
Results
Of the total 23 852 articles obtained from the database searches, 16 studies published in 6 countries met the inclusion criteria. These 16 studies were published between 1997 and 2019, with the most (5) in 2014. Of the 16 studies, 43.8% (7) were conducted in South Africa, 3 studies in Ghana, 2 in Ethiopia and 1 study each in Nigeria, Kenya, Lesotho and Zambia. Most (44.4%) of the included studies focused on microbial safety of food; few studies (22.2%) focused on hygienic practices, and one study investigated the perspective of consumers or buyers. Microbes detected in the foods samples were Salmonella spp, Escherichia coli, Shigella spp, Bacillus sp, Staphylococcus aureus, which resulted mainly from poor hygiene practices.
Conclusions
There is limited research that focused on food safety at transport stations in Africa, especially on aspects such as hygiene practices, food storage and occupational health and food safety. Therefore, we recommend more research in these areas, using various primary study designs, to inform and improve food safety policies and practices for transport stations in African countries alongside improving access to clean water/handwashing facilities, and undertaking structural changes to facilitate behaviours and monitoring for unintended consequences such as livelihoods of vulnerable populations.
Læs mere Tjek på PubMedGarcia-Sangenis, A., Morros, R., Aguilar-Sanchez, M., Medina-Perucha, L., Leiva, A., Ripoll, J., Martinez-Pecharroman, M., Bartolome-Moreno, C. B., Magallon Botaya, R., Marin-Canada, J., Molero, J. M., Moragas, A., Troncoso, A., Monfa, R., Llor, C., SCOUT Study Group, Bolibar, Ouchi-Vernet, Berenguera, Cots, Cobo, Gomez, Cabello, Vicens-Caldentey, Ramirez-Manent, Soler-Mieras, Quintana-Torres, Llobera-Canaves, Roca-Casas, Yanez-Juan, Alcoceba-Cruixent, Ballester-Camps, Bulilete, Consuelo Camionero-Soto, Bordoy, Antonia Sanchez-Calavera, Royan-Molero, Shafi-Tabatebaei, Garcia-Roy, Jabal-Calvillo, Lasilla-Fernandez, Hurtado-Gutierrez, Vich-Perez, Triano-Sanchez, Avila-Sanchez, Gomez-Garcia, Prieto-Checa, Nogueol-Alvarez, Sanchez-Inigo, Garcia Espinosa, Leandro, Gonzalez, Ortiz
BMJ Open, 25.11.2021
Tilføjet 25.11.2021
Introduction
Uncomplicated lower urinary tract infections (uLUTI) are a common problem in primary care. Current local guidelines recommend the use of a single 3 g dose of fosfomycin. However, most general practitioners (GP) prefer short-course therapies to single-dose therapy. No study has compared head-to-head short-course antimicrobial agents for uLUTIs. Therefore, the aim of this randomised clinical trial is to compare three different short-course antibiotic therapies with a single-dose of fosfomycin for these infections.
Methods and analysis
This will be a pragmatic, multicentre, parallel group, open trial. Women aged 18 or older and with symptoms of uLUTI and a positive urine dipstick analysis will be randomised to one of the following four groups: a single dose of 3 g of fosfomycin, 2 days of 3 g of fosfomycin o.d., 3 days of pivmecillinam 400 mg three times per day (t.i.d) or 5 days of nitrofurantoin 100 mg t.i.d. A total sample of 1120 patients was calculated. The primary endpoint is clinical effectiveness at day 7, defined as cure of symptoms reported by the patients in a diary including four symptoms: dysuria, urgency, frequency and suprapubic pain, which will be scored on a 4-point severity scale (not present/mild/moderate/severe). Follow-up visits are scheduled at days 7 (phone call), 14 and 28 for assessing evolution. Urine samples will be collected in the three on-site visits and urine cultures performed. If positive, antibiograms for the three antibiotics studied will be performed. Bacterial eradication will be measured at days 14 and 28.
Ethics and dissemination
The study was approved by the Ethical Board of IDIAP Jordi Gol (reference number: 21/173-AC) and Spanish Agency of Medicines and Medical Devices. The findings of this trial will be disseminated through research conferences and peer-review journals.
Trial registration number
NCT04959331; EudraCT Number: 2021-001332-26.
Time schedule
January 2022 to April 2023.
Læs mere Tjek på PubMedFriedrichs, J., Seide, S., Vey, J., Zimmermann, S., Hardt, J., Kleeff, J., Klose, J., Michalski, C. W., Kieser, M., Pilz, M., Ronellenfitsch, U.
BMJ Open, 25.11.2021
Tilføjet 25.11.2021
Objective
To assess the relative contribution of intravenous antibiotic prophylaxis, mechanical bowel preparation, oral antibiotic prophylaxis, and combinations thereof towards the reduction of surgical site infection (SSI) incidence in elective colorectal resections.
Methods and analysis
A systematic search of randomised controlled trials comparing interventions to reduce SSI incidence will be conducted with predefined search terms in the following databases: MEDLINE, LILACS, Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews (CDSR). Additionally, several online databases will be searched for ongoing trials, and conference proceedings and reference lists of retrieved articles will be hand searched. The title–abstract screening will be partly performed by means of a semiautomated supervised machine learning approach, which will be trained on a subset of the identified titles and abstracts identified through traditional screening methods.
The primary analysis will be a multicomponent network meta-analysis, as we expect to identify studies that investigate combinations of interventions (eg, mechanical bowel preparation combined with oral antibiotics) as well as studies that focus on individual components (mechanical bowel preparation or oral antibiotics). By means of a multicomponent network meta-analysis, we aim at estimating the effects of the separate components along the effects of the observed combinations. To account for between-trial heterogeneity, a random-effect approach will be combined with inverse variance weighting for estimation of the treatment effects. Associated 95% CIs will be calculated as well as the ranking for each component in the network using P scores. Results will be visualised by network graphics and forest plots of the overall pairwise effect estimates. Comparison-adjusted funnel plots will be used to assess publication bias.
Ethics and dissemination
Ethical approval by the Ethical Committee of the Medical Faculty of the Martin-Luther-University Halle-Wittenberg (ID of approval: 2021–148). Results shall be disseminated directly to decision-makers (eg, surgeons, gastroenterologists, wound care specialists) by means of publication in peer-reviewed journals, presentation at conferences and through the media (eg, radio, TV, etc).
PROSPERO registration number
CRD42021267322.
Læs mere Tjek på PubMedHou, W.-H., Kuo, K. N., Chen, M.-J., Chang, Y.-M., Tsai, H.-W., Chan, D.-C., Su, C.-T., Han, D.-S., Shen, H.-N., Li, C.-Y.
BMJ Open, 25.11.2021
Tilføjet 25.11.2021
Objective
Health literacy (HL) is the degree of individuals’ capacity to access, understand, appraise and apply health information and services required to make appropriate health decisions. This study aimed to establish a predictive algorithm for identifying community-dwelling older adults with a high risk of limited HL.
Design
A cross-sectional study.
Setting
Four communities in northern, central and southern Taiwan.
Participants
A total of 648 older adults were included. Moreover, 85% of the core data set was used to generate the prediction model for the scoring algorithm, and 15% was used to test the fitness of the model.
Primary and secondary outcome measures
Pearson’s 2 test and multiple logistic regression were used to identify the significant factors associated with the HL level. An optimal cut-off point for the scoring algorithm was identified on the basis of the maximum sensitivity and specificity.
Results
A total of 350 (54.6%) patients were classified as having limited HL. We identified 24 variables that could significantly differentiate between sufficient and limited HL. Eight factors that could significantly predict limited HL were identified as follows: a socioenvironmental determinant (ie, dominant spoken dialect), a health service use factor (ie, having family doctors), a health cost factor (ie, self-paid vaccination), a heath behaviour factor (ie, searching online health information), two health outcomes (ie, difficulty in performing activities of daily living and requiring assistance while visiting doctors), a participation factor (ie, attending health classes) and an empowerment factor (ie, self-management during illness). The scoring algorithm yielded an area under the curve of 0.71, and an optimal cut-off value of 5 represented moderate sensitivity (62.0%) and satisfactory specificity (76.2%).
Conclusion
This simple scoring algorithm can efficiently and effectively identify community-dwelling older adults with a high risk of limited HL.
Læs mere Tjek på PubMedJohnson, R. M., Crifasi, C., Anderson Goodell, E. M., Wisniowski, A., Sakshaug, J. W., Thrul, J., Owens, M.
BMJ Open, 25.11.2021
Tilføjet 25.11.2021
Objectives
We investigated the association between gun ownership and perceptions about COVID-19 among Texas adults as the pandemic emerged. We considered perceived likelihood that the pandemic would lead to civil unrest, perceived importance of taking precautions to prevent transmission and perceptions that the threat of COVID-19 has been exaggerated.
Methods
Data were collected from 5 to 12 April 2020, shortly after Texas’ stay-at-home declaration. We generated a sample using random digit dial methods for a telephone survey (n=77, response rate=8%) and by randomly selecting adults from an ongoing panel to complete the survey online (n=1120, non-probability sample). We conducted a logistic regression to estimate differences in perceptions by gun ownership. To account for bias associated with use of a non-probability sample, we used Bayesian data integration and ran linear regression models to produce more accurate measures of association.
Results
Among the 60% of Texas adults who reported gun ownership, estimates of past 7-day gun purchases, ammunition purchases and gun carrying were 15% (n=78), 20% (n=100) and 24% (n=130), respectively. We found no evidence of an association between gun ownership with perceived importance of taking precautions to prevent transmission or with perceived likelihood of civil unrest. Results from the logistic regression (OR 1.27, 95% CI 0.99 to 1.63) and the linear regression (β=0.18, 95% CI 0.07 to 0.29) suggest that gun owners may be more likely to believe the threat of COVID-19 was exaggerated.
Conclusions
Compared with those without guns, gun owners may have been inclined to downplay the threat of COVID-19 early in the pandemic.
Læs mere Tjek på PubMedKaren O’Leary
Nature, 25.11.2021
Tilføjet 25.11.2021
Nature Medicine, Published online: 25 November 2021; doi:10.1038/d41591-021-00071-z
An anti-tick mRNA vaccine shows promise in guinea pigs, causing early detachment and reduced transmission of Lyme disease–causing pathogens.
Læs mere Tjek på PubMedFulvio Alexandre Scorza, Josef Finsterer
Clinical Microbiology and Infection, 25.11.2021
Tilføjet 25.11.2021
We read with interest the article by Shasha et al. about real world safety data for the Pfizer vaccine BNT162b2 in a large cohort of 394609 participants [1]. Four diagnoses, respectively symptoms were used as outcome parameters, Bell’s palsy, herpes zoster, Guillain-Barre syndrome (GBS), and numbness and tingling [1]. It was found that numbness and tingling occurred more frequently among vaccinees than in controls but not the other three outcome variables. [1]. It is the merit of this study, that at least a small spectrum of possible adverse reactions were addressed, but concerns remain.
Læs mere Tjek på PubMedEric J. Rubin, Lindsey R. Baden, Stephen Morrissey
New England Journal of Medicine, 24.11.2021
Tilføjet 25.11.2021
Laith J. Abu-Raddad, Hiam Chemaitelly, Roberto Bertollini
New England Journal of Medicine, 24.11.2021
Tilføjet 25.11.2021
William J. Murphy, Dan L. Longo
New England Journal of Medicine, 24.11.2021
Tilføjet 25.11.2021
BMC Infectious Diseases, 24.11.2021
Tilføjet 25.11.2021
Abstract
Background
We investigate the long-term effects of SARS-CoV on patients’ lung and immune systems 15 years post-infection. SARS-CoV-2 pandemic is ongoing however, another genetically related beta-coronavirus SARS-CoV caused an epidemic in 2003–2004.
Methods
We enrolled 58 healthcare workers from Peking University People’s Hospital who were infected with SARS-CoV in 2003. We evaluated lung damage by mMRC score, pulmonary function tests, and chest CT. Immune function was assessed by their serum levels of globin, complete components, and peripheral T cell subsets. ELISA was used to detect SARS-CoV-specific IgG antibodies in sera.
Results
After 15 years of disease onset, 19 (36.5%), 8 (34.6%), and 19 (36.5%) subjects had impaired DL (CO), RV, and FEF25–75, respectively. 17 (30.4%) subjects had an mMRC score ≥ 2. Fourteen (25.5%) cases had residual CT abnormalities. T regulatory cells were a bit higher in the SARS survivors. IgG antibodies against SARS S-RBD protein and N protein were detected in 11 (18.97%) and 12 (20.69%) subjects, respectively. Subgroup analysis revealed that small airway dysfunction and CT abnormalities were more common in the severe group than in the non-severe group (57.1% vs 22.6%, 54.5% vs 6.1%, respectively, p < 0.05).
Conclusions
SARS-CoV could cause permanent damage to the lung, which requires early pulmonary rehabilitation. The long-lived immune memory response against coronavirus requires further studies to assess the potential benefit.
Trial registration ClinicalTrials.gov, NCT03443102. Registered prospectively on 25 January 2018
Læs mere Tjek på PubMedBMC Infectious Diseases, 24.11.2021
Tilføjet 25.11.2021
Abstract
Background
Splenectomized patients are at an increased risk for overwhelming post-splenectomy infections typically with encapsulated bacteria. The clinical association between splenectomy and lymph-node tuberculosis is unclear.
Case presentation
We describe a rare case of disseminated tuberculous lymphadenitis in an 18-year-old woman with history of splenectomy because of hereditary sherocytosis. She was admitted with enlargement of bilateral-cervical and left-axillary lymph nodes and fever. A diagnosis of probable tuberculosis was made based on the findings of fine-needle aspiration. Histology showed granulomas and extensive caseous necrosis, with the site of puncture located at an enlarged lymph node on the right side. The diagnosis was confirmed via nucleic-acid amplification tests following excisional biopsy of the left axillary lymph node. Disseminated tuberculous lymphadenitis was localized in the bilateral neck, right lung hilum, left sub-axillary region, and mediastinum, as detected from contrast-enhanced computed tomography of the neck.
Conclusions
Mycobacterium tuberculosis infection should be considered in children and adolescents with extensive enlargement of lymph nodes after splenectomy.
Læs mere Tjek på PubMedBMC Infectious Diseases, 24.11.2021
Tilføjet 25.11.2021
Abstract
Background
Vancomycin is a commonly used antibiotic in critically ill patients for various indications. Critical illness imposes pharmacokinetic-pharmacodynamics challenges, which makes optimizing vancomycin in this population cumbersome. Data are scarce on the clinical impact of time to therapeutic trough levels of vancomycin in critically ill patients. This study aims to evaluate the timing to achieve therapeutic trough level of vancomycin on 30-day mortality in critically ill patients.
Method
A retrospective cohort study was conducted for all adult critically ill patients with confirmed Gram-positive infection who received IV vancomycin between January 1, 2017, and December 31, 2020. We compared early (< 48 h) versus late (≥ 48 h) attainment of vancomycin therapeutic trough levels. The primary outcome was the 30-day mortality in critically ill patients. Secondary outcomes were the development of resistant organisms, microorganisms eradication within 4–5 days of vancomycin initiation, acute kidney injury (AKI), and length of stay (LOS). Propensity score-matched (1:1 ratio) used based on patient’s age, serum creatinine, and albumin values at baseline.
Results
A total of 326 patients were included; 110 patients attained the therapeutic trough levels within 48 h of vancomycin initiation. Late achievement of the therapeutic trough levels was associated with higher 30-day mortality (HR: 2.54; 95% CI [1.24–5.22]; p = 0.01). Additionally, patients who achieved therapeutic trough levels of vancomycin late were more likely to develop AKI (OR = 2.59; 95% CI [1.01–6.65]; p = 0.04). Other outcomes were not statistically significant between the two groups.
Conclusion
Early achievement of vancomycin therapeutic levels in patients with confirmed Gram-positive infection was associated with possible survival benefits.
Læs mere Tjek på PubMedZhen Zhang, Jianying Liang, Ruoqu Wei, Xiaobo Feng, Lei Wang, Liuhui Wang, Piaoping Zhao, Hong Yu, Yan Gu, Zhirong Yao
Lancet Infectious Diseases, 25.11.2021
Tilføjet 25.11.2021
Cutaneous infection by Balamuthia mandrillaris is a rare condition that is sometimes complicated by life-threatening CNS involvement. It often evades timely diagnosis due to its rarity and non-specific clinical manifestations. Patients can be either immunocompetent or immunocompromised. It is probably transmitted via inhalation or inoculation through broken skin, and then spreads to the brain and other organs through haematogenous spread. It is important for clinicians to be aware of this disease because rapid diagnosis and subsequent therapy has, in some cases, been associated with survival.
Læs mere Tjek på PubMedZia, N., Ibrahim, M. I. M., Adheir, F., Babar, Z.-U.-D.
BMJ Open, 24.11.2021
Tilføjet 24.11.2021
Objectives
To identify priority medicines policy issues, including the ‘use’ and ‘access to medicines’ in Qatar.
Design
In this qualitative study, general inductive method was used and semi-structured exploratory interviews conducted.
Setting
Stakeholders from a broad range of academic and healthcare practitioners in Qatar.
Participants
Exploratory, semi-structured interviews were conducted with 21 stakeholders throughout Qatar. The inclusion criteria include (a) participants working or involved in the Qatar’s healthcare system, (b) participants having experience or working knowledge of medicine policy documents, different facets of it, use of medicines and access to medicines, (c) as well as participants well versed in the English language. It was intended to cover stakeholders from a broad range of healthcare and policy institutions in Qatar.
Primary and secondary outcome measures
All participants were involved in semi-structured, audio-recorded interviews, which were then transcribed verbatim, coded into NVivo V.12 and followed by thematic analysis to identify the common themes. Perceptions, experiences and opinions regarding Qatar’s medicines policy issues were recorded.
Results
This study found challenges related to the availability of pharmaceuticals in Qatar, including medicines registration process. There is no comprehensive national medicines policy in Qatar, however, there are a number of rules, regulations, policies and procedures in place. The community pharmacy services provided are mostly ‘traditional’ with less emphasis on pharmacists’ extended roles and/or cognitive services. The study identifies several areas for improvement including extending the role of the pharmacist, improve the prescribing of antibiotics, medicines compliance and counselling for consumers, pharmacovigilance, implementation of generic medicines policies, as well as the need for a national health record database.
Conclusions
The findings suggest that in the last 20 years, Qatar has moved towards advancing healthcare; however, there are gaps and opportunities. The strategies need to be developed to resolve access to medicines issues, the priority being medicines registration, import and so on. With the rise of chronic diseases and a growing population, there is also a need to work to improve medicines adherence among patients.
A national medicines policy should be developed through a consultative broad-based process in which prescribers, physicians, pharmacists and healthcare professionals be given a chance to contribute.
Læs mere Tjek på PubMedAssefa, N., Regassa, L. D., Teklemariam, Z., Oundo, J., Madrid, L., Dessie, Y., Scott, J.
BMJ Open, 24.11.2021
Tilføjet 24.11.2021
Objective
We conducted serosurveillance of anti-SARS-CoV-2 antibodies among pregnant women attending their first antenatal care.
Setting
The surveillance was set in one referral hospital in Harar, one district hospital and one health centre located in Haramaya district in rural eastern Ethiopia.
Participants
We collected questionnaire data and a blood sample from 3312 pregnant women between 1 April 2020 and 31 March 2021. We selected 1447 blood samples at random and assayed these for anti-SARS-CoV-2 antibodies at Hararghe Health Research laboratory using WANTAI SARS-CoV-2 Rapid Test for total immunoglobulin.
Outcome
We assayed for anti-SARS-CoV-2 antibodies and temporal trends in seroprevalence were analysed with a 2 test for trend and multivariable binomial regression.
Results
Among 1447 sera tested, 83 were positive for anti-SARS-CoV-2 antibodies giving a crude seroprevalence of 5.7% (95% CI 4.6% to 7.0%). Of 160 samples tested in April–May 2020, none was seropositive; the first seropositive sample was identified in June and seroprevalence rose steadily thereafter (2 test for trend, p=0.003) reaching a peak of 11.8% in February 2021. In the multivariable model, seroprevalence was approximately 3% higher in first-trimester mothers compared with later presentations, and rose by 0.75% (95% CI 0.31% to 1.20%) per month of calendar time.
Conclusions
This clinical convenience sample illustrates the dynamic of the SARS-CoV-2 epidemic in pregnant women in eastern Ethiopia; infection was rare before June 2020 but it spread in a linear fashion thereafter, rather than following intermittent waves, and reached 10% by the beginning of 2021. After 1 year of surveillance, most pregnant mothers remained susceptible.
Læs mere Tjek på PubMedWard, T., Glaser, A., Johnsen, A., Xu, F., Hall, I., Pellis, L.
BMJ Open, 24.11.2021
Tilføjet 24.11.2021
Objectives
Importations of novel variants of concern (VOC), particularly B.1.617.2, have become the impetus behind recent outbreaks of SARS-CoV-2. Concerns around the impact on vaccine effectiveness, transmissibility and severity are now driving the public health response to these variants. This paper analyses the patterns of growth in hospitalisations and confirmed cases for novel VOCs by age groups, geography and ethnicity in the context of changing behaviour, non-pharmaceutical interventions (NPIs) and the UK vaccination programme. We seek to highlight where strategies have been effective and periods that have facilitated the establishment of new variants.
Design
We have algorithmically linked the most complete testing and hospitalisation data in England to create a data set of confirmed infections and hospitalisations by SARS-CoV-2 genomic variant. We have used these linked data sets to analyse temporal, geographic and demographic distinctions.
Setting and participants
The setting is England from October 2020 to July 2021. Participants included all COVID-19 tests that included RT-PCR CT gene target data or underwent sequencing and hospitalisations that could be linked to these tests.
Methods
To calculate the instantaneous growth rate for VOCs we have developed a generalised additive model fit to multiple splines and varying day of the week effects. We have further modelled the instantaneous reproduction number Rt for the B.1.1.7 and B.1.617.2 variants and included a doubly interval censored model to temporally adjust the confirmed variant cases.
Results
We observed a clear replacement of the predominant B.1.1.7 by the B.1.617.2 variant without observing sustained exponential growth in other novel variants. Modelled exponential growth of RT PCR gene target triple-positive cases was initially detected in the youngest age groups, although we now observe across all ages a very small doubling time of 10.7 (95% CI 9.1 to 13.2) days and 8 (95% CI 6.9 to 9.1) days for cases and hospitalisations, respectively. We observe that growth in RT PCR gene target triple-positive cases was first detected in the Indian ethnicity group in late February, with a peak of 0.06 (95% CI 0.07 to 0.05) in the instantaneous growth rate, but is now maintained by the white ethnicity groups, observing a doubling time of 6.8 (95% CI 4.9 to 11) days. Rt analysis indicates a reproduction number advantage of 0.45 for B.1.617.2 relative to B.1.1.7, with the Rt value peaking at 1.85 for B.1.617.2.
Conclusions
Our results illustrate a clear transmission advantage for the B.1.617.2 variant and the growth in hospitalisations illustrates that this variant is able to maintain exponential growth within age groups that are largely doubly vaccinated. There are concerning signs of intermittent growth in the B.1.351 variant, reaching a 28-day doubling time peak in March 2021, although this variant is presently not showing any evidence of a transmission advantage over B.1.617.2. Step 1b of the UK national lockdown easing was sufficient to precipitate exponential growth in B.1.617.2 cases for most regions and younger adult age groups. The final stages of NPI easing appeared to have a negligible impact on the growth of B.1.617.2 with every region experiencing sustained exponential growth from step 2. Nonetheless, early targeted local NPIs appeared to markedly reduced growth of B.1.617.2. Later localised interventions, at a time of higher prevalence and greater geographic dispersion of this variant, appeared to have a negligible impact on growth.
Læs mere Tjek på PubMedInfection, 1.12.2021
Tilføjet 24.11.2021
Abstract
Cydnidae bug (also termed the burrowing bug) are arthropods of the order Hemiptera, that are recognized by their morphological adaptations for digging. They release an odorous substance from special glands that serve as self-defense, causing pigmented macules when in contact with human skin, especially during the rainy season. Knowledge of this rarely described condition can help avoid unnecessary investigation(s).
Læs mere Tjek på PubMedInfection, 1.12.2021
Tilføjet 24.11.2021
Abstract
Purpose
This article shows reports of the clinical–epidemiological characteristics and serological screening in patients assisted by a reference center for PCM care, University Hospital Cassiano Antonio Moraes, Federal University of Espirito Santo, Brazil.
Methods
The patient’s sera with PCM were analyzed by DID test at the beginning and the end treatment. Clinical and demographic data were also collected to characterize the sample.
Results
One hundred patients with a suspected diagnosis of PCM were evaluated. Serology by DID test was used as a screen in all patients. The test was positive for 79 patients (72 for Paracoccidioides brasiliensis and 7 for Paracoccidioides lutzii). Serology was negative in 21 sera, although all of them were diagnosed PCM by histopathologic or direct exam. Serological follow-up was performed during the treatment of all patients. After treatment, 58(58%) had negative serology and 33(33%) low levels of antibodies (≤ 1:16).
Conclusion
Our results indicate the importance of the DID test for the screening and monitoring of PCM and that the incidence of P. lutzii might be greater than expected in areas where it is not the predominant PCM species. Therefore, this article may contribute to improving the knowledge and clinical management about this disease.
Læs mere Tjek på PubMedMalaria Journal, 24.11.2021
Tilføjet 24.11.2021
Abstract
Background
Though most of Panamá is free from malaria, localized foci of transmission persist, including in the Guna Yala region. Government-led entomological surveillance using an entomological surveillance planning tool (ESPT) sought to answer programmatically-relevant questions that would enhance the understanding of both local entomological drivers of transmission and gaps in protection that result in persisting malaria transmission to guide local vector control decision-making.
Methods
The ESPT was used to design a sampling plan centered around the collection of minimum essential indicators to investigate the relevance of LLINs and IRS in the communities of Permé and Puerto Obaldía, Guna Yala, as well as to pinpoint any remaining spaces and times where humans are exposed to Anopheles bites (gaps in protection). Adult Anopheles were collected at three time points via human landing catches (HLCs), CDC Light Traps (LT), and pyrethrum spray catches (PSCs) during the rainy and dry seasons. Mosquitoes were identified to species via molecular methods. Insecticide susceptibility testing of the main vector species to fenitrothion was conducted.
Results
In total, 7537 adult Anopheles were collected from both sites. Of the 493 specimens molecularly confirmed to species, two thirds (n = 340) were identified as Nyssorhynchus albimanus, followed by Anopheles aquasalis. Overall Anopheles human biting rates (HBRs) were higher outdoors than indoors, and were higher in Permé than in Puerto Obaldía: nightly outdoor HBR ranged from 2.71 bites per person per night (bpn) (Puerto Obaldía), to 221.00 bpn (Permé), whereas indoor nightly HBR ranged from 0.70 bpn (Puerto Obaldía) to 81.90 bpn (Permé). Generally, peak biting occurred during the early evening. The CDC LT trap yields were significantly lower than that of HLCs and this collection method was dropped after the first collection. Pyrethrum spray catches resulted in only three indoor resting Anopheles collected. Insecticide resistance (IR) of Ny. albimanus to fenitrothion was confirmed, with only 65.5% mortality at the diagnostic time.
Conclusion
The early evening exophagic behaviour of Anopheles vectors, the absence of indoor resting behaviours, and the presence of resistance to the primary intervention insecticide demonstrate limitations of the current malaria strategy, including indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs), and point to both gaps in protection and to the drivers of persisting malaria transmission in Guna Yala. These findings highlight the need for continued and directed entomological surveillance, based on programmatic questions, that generates entomological evidence to inform an adaptive malaria elimination strategy.
Læs mere Tjek på PubMedDario Tartaglia, Federico Coccolini, Alessio Mazzoni, Silvia Strambi, Enrico Cicuttin, Camilla Cremonini, Giacomo Taddei, Adolfo Gabriele Puglisi, Clara Ugolini, Iosè Di Stefano, Fulvio Basolo, Massimo Chiarugi
International Journal of Infectious Diseases, 24.11.2021
Tilføjet 24.11.2021
Zoltán Vokó, Zoltán Kiss, György Surján, Orsolya Surján, Zsófia Barcza, Bernadett Pályi, Eszter Formanek-Balku, Gergő Attila Molnár, Róbert Herczeg, Attila Gyenesei, Attila Miseta, Lajos Kollár, István Wittmann, Cecília Müller, Miklós Kásler
Clinical Microbiology and Infection, 24.11.2021
Tilføjet 24.11.2021
The Hungarian vaccination campaign was conducted with five different vaccines during the third wave of the Covid-19 pandemic in 2021. This observational study (HUN-VE: Hungarian Vaccine Effectiveness) estimated vaccine effectiveness against SARS-CoV-2 infection and Covid-19 related mortality in 3.7 million vaccinated individuals.
Læs mere Tjek på PubMedYael Shachor-Meyouhas, Khetam Hussein, Halima Dabaja-Younis, Moran Szwarcwort-Cohen, Ronit Almog, Avi Weissman, Michal Mekel, Gila Hyams, Nethanel A. Horowitz, Vardit Gepstein, Itamar Netzer, Hagar Cohen Saban, Neta Petersiel, Jalal Tarabeia, Michael Halberthal
Clinical Microbiology and Infection, 24.11.2021
Tilføjet 24.11.2021
We evaluated antibody response to the BNT162B2 vaccine among healthcare workers (HCWs) to identify factors associated with decreased immunogenicity.
Læs mere Tjek på PubMed