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Milad Heidari Nia, Mohsen Rokni, Shekoufeh Mirinejad, Maryam Kargar, Sara Rahdar, Saman Sargazi, Mohammad Sarhadi, Ramin Saravani
Journal of Medical Virology, 25.11.2021
Tilføjet 26.11.2021
Jian Yu, Shanshan Sun, Qianqian Tang, Chengzhuo Wang, Liangchen Yu, Lulu Ren, Jun Li, Zhenhua Zhang
Journal of Medical Virology, 25.11.2021
Tilføjet 26.11.2021
Julia Sanchez-Garrido, David Ruano-Gallego, Jyoti S. Choudhary, Gad Frankel
Trends in Microbiology, 25.11.2021
Tilføjet 26.11.2021
Type III secretion system (T3SS) effectors are key virulence factors that underpin the infection strategy of many clinically important Gram-negative pathogens, including Salmonella enterica, Shigella spp., enteropathogenic and enterohemorrhagic Escherichia coli and their murine equivalent, Citrobacter rodentium. The cellular processes or proteins targeted by the effectors can be common to multiple pathogens or pathogen-specific. The main approach to understanding T3SS-mediated pathogenesis has been to determine the contribution of one effector at a time, with the aim of piecing together individual functions and unveiling infection mechanisms.
Læs mere Tjek på PubMedBMC Infectious Diseases, 25.11.2021
Tilføjet 26.11.2021
Abstract
Background
Increasing numbers of tick-borne pathogens are being discovered, including those that infect humans. However, reports on co-infections caused by two or more tick-borne pathogens are scarce.
Case presentation
A 38-year-old male farmer was bitten by a hard tick, presented with fever (37.7 °C), severe headache and ejection vomiting. Lumbar puncture was performed in the lateral decubitus. The cerebrospinal fluid (CSF) was clear, and analysis showed severe increased pressure (320 mm H2O), mild leukocytosis (126.0 × 106/L, mononuclear cells accounting for 73%) and elevated total protein concentration (0.92 g/L). Bacterial cultures of CSF and blood were negative. The diagnosis of Rickettsia raoultii and Tacheng tick virus 1 (TcTV-1) co-infection was confirmed by amplifying four rickettsial genetic markers and the partial small (S) RNA segment of TcTV-1 from the patient’s blood. The patient gradually recovered after treatment with levofloxacin and ribavirin.
Conclusions
This is the first reported co-infection case with fever and meningitis caused by R. raoultii and TcTV-1. It is vital to screen for multiple pathogens in tick-bitten patients, especially in those with severe complex symptoms.
Læs mere Tjek på PubMedBMC Infectious Diseases, 25.11.2021
Tilføjet 26.11.2021
Abstract
Background
Nucleic acid-based amplification tests (NAAT), above all (q)PCR, have been applied for the detection of Mycobacterium leprae in leprosy cases and household contacts with subclinical infection. However, their application in the field poses a range of technical challenges. Loop-mediated isothermal amplification (LAMP), as a promising point-of-care NAAT does not require sophisticated laboratory equipment, is easy to perform, and is applicable for decentralized diagnosis at the primary health care level. Among a range of gene targets, the M. leprae specific repetitive element RLEP is regarded as highly sensitive and specific for diagnostic applications.
Methods
Our group developed and validated a dry-reagent-based (DRB) RLEP LAMP, provided product specifications for customization of a ready-to-use kit (intended for commercial production) and compared it against the in-house prototype. The assays were optimized for application on a Genie® III portable fluorometer. For technical validation, 40 “must not detect RLEP” samples derived from RLEP qPCR negative exposed and non-exposed individuals, as well as from patients with other conditions and a set of closely related mycobacterial cultures, were tested together with 25 “must detect RLEP” samples derived from qPCR confirmed leprosy patients. For clinical validation, 150 RLEP qPCR tested samples were analyzed, consisting of the following categories: high-positive samples of multibacillary (MB) leprosy patients (> 10.000 bacilli/extract), medium-positive samples of MB leprosy patients (1.001–10.000 bacilli/extract), low-positive samples of MB leprosy patients (1–1.000 bacilli/extract), endemic controls and healthy non-exposed controls; each n = 30.
Results
Technical validation: both LAMP formats had a limit of detection of 1.000 RLEP copies, i.e. 43–27 bacilli, a sensitivity of 92% (in-house protocol)/100% (ready-to-use protocol) and a specificity of 100%. Reagents were stable for at least 1 year at 22 °C. Clinical validation: Both formats showed a negativity rate of 100% and a positivity rate of 100% for high-positive samples and 93–100% for medium positive samples, together with a positive predictive value of 100% and semi-quantitative results. The positivity rate for low-positive samples was 77% (in-house protocol)/43% (ready-to-use protocol) and differed significantly between both formats.
Conclusions
The ready-to-use RLEP DRB LAMP assay constitutes an ASSURED test ready for field-based evaluation trials aiming for routine diagnosis of leprosy at the primary health care level.
Læs mere Tjek på PubMedBMC Infectious Diseases, 25.11.2021
Tilføjet 26.11.2021
Abstract
Background
The first confirmed cases of COVID-19 in Iran were reported in Qom city. Subsequently, the neighboring provinces and gradually all 31 provinces of Iran were involved. This study aimed to investigate the case fatility rate, basic reproductive number in different period of epidemic, projection of daily and cumulative incidence cases and also spatiotemporal mapping of SARS-CoV-2 in Alborz province, Iran.
Methods
A confirmed case of COVID-19 infection was defined as a case with a positive result of viral nucleic acid testing in respiratory specimens. Serial interval (SI) was fitted by gamma distribution and considered the likelihood-based R0 using a branching process with Poisson likelihood. Seven days average of cases, deaths, doubling times and CFRs used to draw smooth charts. kernel density tool in Arc GIS (Esri) software has been employed to compute hot spot area of the study site.
Results
The maximum-likelihood value of R0 was 2.88 (95%, CI: 2.57–3.23) in the early 14 days of epidemic. The case fatility rate for Alborz province (Iran) on March 10, was 8.33% (95%, CI:6.3–11), and by April 20, it had an increasing trend and reached 12.9% (95%,CI:11.5–14.4). The doubling time has been increasing from about two days and then reached about 97 days on April 20, 2020, which shows the slowdown in the spread rate of the disease. Also, from March 26 to April 2, 2020 the whole Geographical area of Karj city was almost affected by SARS-CoV-2.
Conclusions
The R0 of COVID-19 in Alborz province was substantially high at the beginning of the epidemic, but with preventive measures and public education and GIS based monitoring of the cases,it has been reduced to 1.19 within two months. This reduction highpoints the attainment of preventive measures in place, however we must be ready for any second epidemic waves during the next months.
Læs mere Tjek på PubMedBMC Infectious Diseases, 25.11.2021
Tilføjet 26.11.2021
Abstract
Background
Human granulocytic anaplasmosis (HGA) is a systemic inflammatory response caused by the rickettsial bacterium Anaplasma phagocytophilum. Rhabdomyolysis and acute kidney injury (AKI) are rare complications of HGA. Here, we report a case of HGA concurrent with rhabdomyolysis and AKI in an elderly patient.
Case presentation
An 84-year old woman with a medical history of hypertension was hospitalised after two days of fever, dizziness, whole body pain, and general weakness. Laboratory investigations showed severe thrombocytopenia, leukopenia, impaired renal function, and elevated cardiac enzyme and myoglobin levels. On the day after admission, peripheral blood smear revealed morula inclusions in neutrophils, a suggestive finding of HGA. Real-time polymerase chain reaction (PCR) results indicated the presence of A. phagocytophilum. Antibiotics were de-escalated to doxycycline monotherapy. After 10 days of antibiotic treatment, laboratory tests showed complete recovery from HGA complicated with rhabdomyolysis and AKI.
Conclusions
HGA can lead to serious complications in patients with associated risk factors. Therefore, in patients with HGA accompanied by rhabdomyolysis, management with antibiotics and hydration should be initiated immediately, and not delayed until diagnostic confirmation.
Læs mere Tjek på PubMedAdam K Wheatley, Jennifer A Juno
Lancet Infectious Diseases, 26.11.2021
Tilføjet 26.11.2021
The clinical development and global rollout of highly effective vaccines against SARS-CoV-2 has been unprecedentedly rapid. Nevertheless, viral evolution has continued at pace to the extent that questions are being raised about the continued effectiveness of first-generation vaccines in the face of variants of concern (VOCs). In particular, the rise of the delta variant (B.1.617.2) to become the dominant virus in most of the world has spurred efforts to assess vaccine effectiveness against VOCs and to understand the associated immune mechanisms of protection.
Læs mere Tjek på PubMedRamachandran Thiruvengadam, Amit Awasthi, Guruprasad Medigeshi, Sankar Bhattacharya, Shailendra Mani, Sridhar Sivasubbu, Tripti Shrivastava, Sweety Samal, Deepika Rathna Murugesan, Bapu Koundinya Desiraju, Pallavi Kshetrapal, Rajesh Pandey, Vinod Scaria, Praveen Kumar Malik, Juhi Taneja, Akshay Binayke, Tarini Vohra, Aymaan Zaheer, Deepak Rathore, Naseem Ahmad Khan, Heena Shaman, Shubbir Ahmed, Rajesh Kumar, Suprit Deshpande, Chandru Subramani, Nitya Wadhwa, Nimesh Gupta, Anil K Pandey, Jayanta Bhattacharya, Anurag Agrawal, Sudhanshu Vrati, Shinjini Bhatnagar, Pramod Kumar Garg, Department of Biotechnology India Consortium for COVID-19 research
Lancet Infectious Diseases, 26.11.2021
Tilføjet 26.11.2021
The ChAdOx1 nCoV-19 vaccine remained effective against moderate-to-severe COVID-19, even during a surge that was dominated by the highly transmissible delta variant of SARS-CoV-2. Spike-specific T-cell responses were maintained against the delta variant. Such cellular immune protection might compensate for waning humoral immunity.
Læs mere Tjek på PubMedSabine Kleinert, Richard Horton
Lancet, 7.10.2021
Tilføjet 26.11.2021
In 2018, The Lancet published a Series on pathology and laboratory medicine (PALM) in low-income and middle-income countries that summarised the dismal neglect of the laboratory and test-based diagnostic capabilities and availability in many countries.1–3 The Series served as the starting point for discussions on the importance of PALM to achieve high-quality universal health coverage and suggested ways to overcome barriers. It became clear that much more work in this area is needed to draw attention to this long-standing gap in the global health agenda.
Læs mere Tjek på PubMedPascale Ondoa, Linda Oskam, Marguerite Massinga Loembe, Iruka N Okeke
Lancet, 7.10.2021
Tilføjet 26.11.2021
The Lancet Commission on diagnostics1 highlights how 35–62% of the populations in low-income and middle-income countries (LMICs) do not have access to the diagnostic resources essential for six common medical conditions, with most unmet needs at community level. The Commission suggests that an evidence-based essential diagnostics list (EDL) and technological advances will help accelerate access to diagnostics in the context of the synergistic global health priorities of universal health coverage, COVID-19, antimicrobial resistance (AMR), and global health security.
Læs mere Tjek på PubMedRichard Horton
Lancet, 27.11.2021
Tilføjet 26.11.2021
The most dangerous threat to health and health equity today is anti-globalism—a denial of evidence pointing to the intrinsic interdependence of human beings; a refusal to accept the transnational nature of risks to our wellbeing; and an antipathy to institutions and individuals promoting cosmopolitan values. Anti-globalism lies behind the failure of governments to accelerate actions to address the climate crisis, is responsible for the failure of nations to coordinate their responses to the COVID-19 pandemic, and underlies the savage xenophobia directed towards those fleeing conflict and repression.
Læs mere Tjek på PubMedRichard Lane
Lancet, 27.11.2021
Tilføjet 26.11.2021
“Our core aim is to build laboratory systems to address the health agenda as defined by Africa”, says Pascale Ondoa, who for the past 5 years has been Director of Science and New Initiatives at the African Society for Laboratory Medicine (ASLM). Part of this role is to direct technical advice and provide leadership to help shape health strategy and laboratory medicine improvement at the country level. “A lot of our work involves the coordination of partners and experts, so that investments from agencies like PEPFAR, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Fleming Fund, and others generate substantial and sustainable impact.
Læs mere Tjek på PubMedAndrew Green
Lancet, 27.11.2021
Tilføjet 26.11.2021
>In late September, 2021, US President Joe Biden tapped John Nkengasong to lead the US President's Emergency Plan for AIDS Relief (PEPFAR). If approved for the role as Ambassador-at-Large and Coordinator of US Government Activities to Combat HIV/AIDS Globally, Nkengasong will inherit a programme at a point of inflection. PEPFAR has been leaderless since Deborah Birx decamped in February, 2020, to coordinate the White House's COVID-19 response under the administration of Donald Trump. She left PEPFAR ahead of the findings from UNAIDS in July, 2020, that highlighted uneven progress towards 2020 milestones in the global bid to end the AIDS epidemic by 2030.
Læs mere Tjek på PubMedJallicia Jolly
Lancet, 27.11.2021
Tilføjet 26.11.2021
Lana is a young Black woman living with HIV in Kingston, Jamaica. A mother of young children, she was concerned about what COVID-19 would mean for her pre-existing diagnosis. During the COVID-19 pandemic she has struggled to find psychosocial support groups, consistent access to antiretrovirals, and employment opportunities to maintain her health and support herself and her family. Pam, a middle-aged HIV-positive woman in Detroit, MI, USA, is a caregiver and local HIV organiser who provides emotional and social support to other newly diagnosed people.
Læs mere Tjek på PubMedKathy Smith, William Brooks, Jean Challiner, Enid Povey
Lancet, 27.11.2021
Tilføjet 26.11.2021
COVID-19 has accelerated the proportion of digital patient consultations across community and hospital settings, bringing both challenge and opportunity to health-care organisations and their staff. Within our own work, one such opportunity was the increased ability to record and review consultation audio, benefiting not just organisational quality assurance and complaint and incident investigation but also providing meaningful feedback to support clinicians’ continuous professional development.
Læs mere Tjek på PubMedYap Boum
Lancet, 27.11.2021
Tilføjet 26.11.2021
In their Perspective,1 N Hélène Sawadogo and colleagues highlight the challenges of mobile health care in Africa with the MOS@N project, which provided medical support to pregnant women but ran out of funding 3 years into operation. Securing longer-term funding to sustain mobile health is a challenge in Africa.2 Social innovations such as BIMA (Ghana), AccesAfya (Kenya), Idocta (Cameroon), and Healthforce (South Africa) use telemedicine to improve access to quality health care but have not managed to scale up.
Læs mere Tjek på PubMedN Hélène Sawadogo, Hamidou Sanou, Jeremy A Greene, Vincent Duclos
Lancet, 27.11.2021
Tilføjet 26.11.2021
Daniel Caldeira, Fausto J Pinto
Lancet, 27.11.2021
Tilføjet 26.11.2021
Ioannis Katsoularis and colleagues1 found that COVID-19 is a risk factor for myocardial infarction and stroke through self-controlled case series evaluation, a method that has been used to establish the risk of myocardial infarction associated with influenza infection.2,3 Regarding myocardial infarction, as the investigators recognised, one of the possible limitations of this research is the inaccurate diagnosis and codification of myocardial injury or myocarditis as myocardial infarction, particularly because the current myocardial infarction definition (and diagnostic methods) differ from the definition at the time of the registry outcome validation study.
Læs mere Tjek på PubMedIoannis Katsoularis, Osvaldo Fonseca-Rodríguez, Paddy Farrington, Krister Lindmark, Anne-Marie Fors Connolly
Lancet, 27.11.2021
Tilføjet 26.11.2021
We thank Daniel Caldeira and Fausto Pinto for their comments regarding our study1 focusing on COVID-19 and myocardial infarction. We did acknowledge the difficulties in distinguishing between different types of myocardial injuries in the discussion. The International Classification of Diseases versions 9 and 10 unfortunately do not distinguish between ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI), which is a limitation of our study.
Læs mere Tjek på PubMedKenneth A Fleming, Susan Horton, Michael L Wilson, Rifat Atun, Kristen DeStigter, John Flanigan, Shahin Sayed, Pierrick Adam, Bertha Aguilar, Savvas Andronikou, Catharina Boehme, William Cherniak, Annie NY Cheung, Bernice Dahn, Lluis Donoso-Bach, Tania Douglas, Patricia Garcia, Sarwat Hussain, Hari S Iyer, Mikashmi Kohli, Alain B Labrique, Lai-Meng Looi, John G Meara, John Nkengasong, Madhukar Pai, Kara-Lee Pool, Kaushik Ramaiya, Lee Schroeder, Devanshi Shah, Richard Sullivan, Bien-Soo Tan, Kamini Walia
Lancet, 7.10.2021
Tilføjet 26.11.2021
At the end of 2019, the first reports of a new respiratory virus appeared in China. The subsequent COVID-19 pandemic has affected every person, in every country, in the world. One early lesson was the crucial importance of timely accurate diagnosis. A second lesson was the widespread scarcity of such diagnostic capacity and capability.
Læs mere Tjek på PubMedMalaria 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
Garcia-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.
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