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32 emner vises.
Emerging Infectious Diseases, 7.02.2022
Tilføjet 7.02.2022
Han, S., Zhuang, Q., Chiang, J., Tan, S. H., Chua, G. W. Y., Xie, C., Chua, M. L. K., Soon, Y. Y., Yang, V. S.
BMJ Open, 7.02.2022
Tilføjet 7.02.2022
Background
The COVID-19 has caused significant mortality and morbidity across the globe. Patients with cancer are especially vulnerable given their immunocompromised state. We aimed to determine the proportion of COVID-19 patients with cancer, their severity and mortality outcomes through a systematic review and meta-analysis (MA).
Methods
Systematic review was performed through online databases, PubMed, Medline and Google Scholar, with keywords listed in the Methods section (1 November 2019–31 December 2020). Studies with clinical outcomes of at least 10 COVID-19 patients and at least one with a diagnosis of cancer were included. The studies for MA were assessed with PRISMA guidelines and appraised with Newcastle-Ottawa Scale. The data were pooled using a random-effects model using STATA software. The main outcomes were planned before data collection, including proportion of patients with cancer among COVID-19 populations, relative risk (RR) of severe outcomes and death of patients with cancer compared with general COVID-19 patients.
Results
We identified 57 case series (63 413 patients), with 230 patients with cancer with individual patient data (IPD). We found that the pooled proportion of cancer among COVID-19 patients was 0.04 (95% CI 0.03 to 0.05, I2=97.69%, p<0.001). The pooled RR of death was 1.44 (95% CI 1.19 to 1.76) between patients with cancer and the general population with COVID-19 infection. The pooled RR of severe outcome was 1.49 (95% CI 1.18 to 1.87) between cancer and general COVID-19 patients. The presence of lung cancer and stage IV cancer did not result in significantly increased RR of severe outcome. Among the available IPD, only age and gender were associated with severe outcomes.
Conclusion
Patients with cancer were at a higher risk of severe and death outcomes from COVID-19 infection as compared with general COVID-19 populations. Limitations of this study include publication bias. A collaborative effort is required for a more complete database.
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Acharya, K., Dharel, D., Subedi, R. K., Bhattarai, A., Paudel, Y. R.
BMJ Open, 7.02.2022
Tilføjet 7.02.2022
Objective
This study was conducted to compare full vaccination coverage and its inequalities (by maternal education and household wealth quintile).
Design
This further analysis was based on the data from national-level cross-sectional Demographic and Health Survey (DHS) from six countries in South Asia.
Setting
We used most recent DHS data from six South Asian countries: Nepal, India, Pakistan, Bangladesh, Afghanistan and the Maldives. The sample size of children aged 12–23 months ranged from 6697 in the Maldives to 628 900 in India.
Primary and secondary outcome measures
To measure absolute and relative inequalities of vaccination coverage, we used regression-based inequality measures, slope index of inequality (SII) and the relative index of inequality (RII), respectively, by maternal education and wealth quintile.
Results
Full vaccination coverage was the highest in Bangladesh (84%) and the lowest in Afghanistan (46%), with an average of 61.5% for six countries. Pakistan had the largest inequalities in coverage both by maternal education (SII: –50.0, RII: 0.4) and household wealth quintile (SII: –47.1, RII: 0.5). Absolute inequalities were larger by maternal education compared with wealth quintile in four of the six countries. The relative index of inequality by maternal education was lower in Pakistan (0.5) and Afghanistan (0.5) compared with Nepal (0.7), India (0.7) and Bangladesh (0.7) compared with rest of the countries. By wealth quintiles, RII was lower in Pakistan (0.5) and Afghanistan (0.6) and higher in Nepal (0.9) and Maldives (0.9).
Conclusions
The full vaccination coverage in 12–23 months old children was below 85% in all six countries. Inequalities by maternal education were more profound than household wealth-based inequalities in four of six countries studied, supporting the benefits of maternal education to improve child health outcome.
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Hussen, R., Zenebe, W. A., Mamo, T. T., Shaka, M. F.
BMJ Open, 7.02.2022
Tilføjet 7.02.2022
Objective
This study was aimed to identify determinants of HIV infection among children born from mothers on the prevention of mother to child transmission (PMTCT) programme in Southern Ethiopia. It was designed to explore the main contributors to the considerable transmission rate of HIV from mother to child.
Setting and design
A multicentre facility-based unmatched case–control study was conducted using 27 health facilities providing PMTCT service in Southern Ethiopia.
Participants
Out of 307 (62 cases and 245 controls) expected to participate in this study, a total of 290 mother–child pairs of 58 cases and 232 controls have completed the interview. Cases were children born to mothers on PMTCT programme and with DNA PCR or antibody HIV positive test result at ≤24 months of age. Controls were children born to mothers on PMTCT programme and with DNA PCR or antibody HIV negative test result at ≤24 months of age.
Result
Data were collected from the mother and record and analysed using SPSS V.20. Logistic regression analysis was done for statistical association and the significance of association was declared at a p value of <0.05. Rural residence (adjusted OR (AOR): 4.15, 95% CI: (1.57 to 10.97)), knowing serostatus during current pregnancy (AOR: 5.11, 95% CI: (1.33 to 19.69)), home delivery (AOR: 6.00, 95% CI: (2.310 to 15.593)), poor partner involvement (AOR: 5.95, 95% CI: 1.91 to 18.53)), poor adherence, late enrolment of the child for ARV prophylaxis (AOR: 4.89, 95% CI: 1.34 to 17.88)), mixed breastfeeding practice (AOR: 10.36, 95% CI: (3.10 to 34.60)) and failure to be on cotrimoxazole therapy (AOR: 7.56, 95% CI: 2.07 to 27.61)) were factors significantly associated with MTCT.
Conclusion
The finding implies that more needs to be done on rural residents, strengthening screening for HIV before pregnancy, encouraging male involvement, early enrolment of child for ARV prophylaxis, avoiding mixed breast feeding and putting newborn on cotrimoxazole therapy.
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Donaldson, S. R., Radley, A., Dillon, J. F.
BMJ Open, 7.02.2022
Tilføjet 7.02.2022
Introduction
Hepatitis C virus (HCV) is a strongly stigmatised disease as it is framed within the context of injecting substance use. HCV provides the identity of ‘dirty’ or ‘junky’, with perceptions by others being beyond the control of the individual. People who experience problematic substance use are often viewed as being outside acceptable social behaviours, thus viewed as having tainted identities or second-class citizens. It is suggested that to recover from substance use, people should move towards social networks where substance use is not the norm and there is greater recovery support. The social identity model of recovery advocates that the mechanism to do this is by developing a new identity. It is unclear what catalysts provide this change in identity. This systematic review aims to describe actions, interventions and treatments that provide the opportunity for new identities and considers evidence that supports the hypothesis that curing HCV with direct acting antivirals may provide this opportunity.
Methods and analysis
Methods are informed by the Preferred Reporting Items for Systematic reviews and Meta-Analysis statement. Seven electronic peer-reviewed and four grey literature sources were identified and preliminary searches have been conducted. The inclusion and exclusion criteria are broad to capture activities that result in a change in identity, recovery from substance use, quality of life, life satisfaction or the opportunity for the individual to reclaim their place in society (citizenship). Qualitative and quantitative literature are eligible. Papers will be assessed against standardised criteria and checked independently and in duplicate. A narrative synthesis of the findings will be reported, structured around intervention type, population context and outcomes.
Ethics and dissemination
This systematic review will be based on studies that have already been conducted and therefore no ethical approvals are required. The resulting findings will be submitted to an international peer-reviewed journal and disseminated at relevant research conferences.
PROSPERO registration number
CRD42020209447.
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Erchick, D. J., Zapf, A. J., Baral, P., Edwards, J., Mehta, S. H., Solomon, S. S., Gibson, D. G., Agarwal, S., Labrique, A. B.
BMJ Open, 7.02.2022
Tilføjet 7.02.2022
Introduction
SARS-CoV-2 has disproportionately affected disadvantaged communities across the USA. Risk perceptions for social interactions and essential activities during the COVID-19 pandemic may vary by sociodemographic factors.
Methods
We conducted a nationally representative online survey of 1592 adults in the USA to understand risk perceptions related to transmission of COVID-19 for social (eg, visiting friends) and essential activities (eg, medical visits or returning to work). We assessed relationships for activities using bivariate comparisons and multivariable logistic regression modelling, between responses of safe and unsafe, and participant characteristics. Data were collected and analysed in 2020.
Results
Among 1592 participants, risk perceptions of unsafe for 13 activities ranged from 29.2% to 73.5%. Large gatherings, indoor dining and visits with elderly relatives had the highest proportion of unsafe responses (>58%), while activities outdoor, accessing healthcare and going to the grocery store had the lowest (<36%). Older respondents were more likely to view social gatherings and indoor activities as unsafe but less likely for other activities, such as going to the grocery store and accessing healthcare. Compared with white/Caucasian respondents, black/African-American and Hispanic/Latino respondents were more likely to view activities such as dining and visiting friends outdoor as unsafe. Generally, men versus women, Republicans versus Democrats and independents, and individuals with higher versus lower income were more likely to view activities as safe.
Conclusion
Evidence-based interventions should be tailored to sociodemographic differences in risk perception, access to information and health behaviours when implementing efforts to control the COVID-19 pandemic.
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Elias, M. A., Van Damme, W., Wouters, E.
BMJ Open, 7.02.2022
Tilføjet 7.02.2022
Objective
To explore the accessibility and quality of existing haemodialysis services in an urban setting.
Setting
The study was conducted in Bangalore city, India.
Participants
A total of 28 stakeholders including 2 nephrologists, 7 duty doctors, 13 dialysis technicians and 6 patients on long-term haemodialysis were selected from 20 dialysis centres in Bangalore city.
Design and methods
Qualitative study using in-depth interviews. A thematic analysis was done using the Availability, Accessibility, Acceptability and Quality Framework of WHO and the Bruce’s Quality of Care Framework.
Results
The study found several gaps with regard to the access and quality of existing services for patients with end-stage kidney disease (ESKD). The charges for dialysis sessions across settings displayed a wide variance. Patients often started dialysis services in private and later shifted to government and non-governmental organisations-run centres and reduced the number of weekly dialysis sessions due to financial constraints. Most standalone dialysis centres did not have the facilities to manage any emergencies. Most centres did not admit patients with hepatitis or HIV. The quality of care in dialysis centres seemed to be variable and most centres were managed solely by dialysis technicians. There were no psychosocial interventions available to the patients irrespective of the settings. Cost-cutting practices such as employing underqualified technicians, reusing dialysis equipment and using substandard water for dialysis were common.
Conclusion
The study highlights the need for more financial and personnel investments in ESKD care in India to ensure optimal care for the growing patient population. The study points towards the need for comprehensive management practices, including diet counselling and psychosocial support. While there are comprehensive guidelines on the establishment and management of dialysis services, more policy attention needs to be on effective implementation of these, to ensure better accessibility and quality of existing services.
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Cuninghame, S., Gorsky, K., Francoeur, C., Withington, D., Burry, L., Jerath, A., Slessarev, M.
BMJ Open, 7.02.2022
Tilføjet 7.02.2022
Introduction
The COVID-19 pandemic has renewed interest in the use of inhaled anaesthetics for sedation of ventilated critically ill patients. Preliminary data show that inhaled anaesthetics reduce lung inflammation, time to extubation and intensive care unit length of stay compared with intravenous sedatives. However, the impact of inhaled anaesthetics on cognitive and psychiatric outcomes is not well described in this setting. Randomised controlled trials are underway to establish if inhaled anaesthetics affect these and other patient and health system outcomes. Our aim is to summarise the known effects of inhaled sedatives on cognitive and psychiatric outcomes.
Methods and analysis
In this systematic review, we will use MEDLINE, EMBASE, and PsycINFO to identify studies from 1970 to 2021 that assessed cognitive and psychiatric outcomes in critically ill adult patients sedated with inhaled anaesthetics. We will include case series, observational and cohort studies and randomised controlled trials. We will exclude case studies due to the heterogeneity of reporting in these studies. For randomised controlled trials comparing inhaled to intravenous sedation, we will report cognitive and psychiatric outcomes for both study arms. Studies will be selected based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Data will be extracted using a standardised data extraction tool by two independent reviewers. Studies will be assessed for bias using the Cochrane risk of bias tool for randomised controlled trials, or the Newcastle-Ottawa Scale for cohort and case–control studies. Findings will be reported according to outcome and descriptive statistics will be used to illustrate findings in a narrative fashion.
Ethics and dissemination
The systematic review uses published data and therefore does not require ethics approval. Results will be disseminated via publication in peer-reviewed journals and presentation at conferences related to the field.
PROSPERO registration number
CRD42021236455.
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Lima, C. N. C., Abreu, I. N., Rodrigues, E. P. S., Freitas, V. d. O., Botelho, B. J. S., Souza, S. L., Cayres-Vallinoto, I., Guerreiro, J. F., Ishak, R., Vallinoto, A. C. R.
BMJ Open, 7.02.2022
Tilføjet 7.02.2022
Objectives
The emergence of SARS-CoV-2 and its pandemic spread generated serious concern about the impact of the infection on vulnerable indigenous populations of the Brazilian Amazon. Thus, this study aimed to perform a seroepidemiological survey of anti-SARS-CoV-2 antibodies in those populations.
Setting
Six indigenous ethnic groups living in the State of Pará (Northern Brazil) were investigated. The villages of Xikrin do Bacajá, Assurini, Araweté, Parakanã, Munduruku and Kararaô were visited from October 2020 to January 2021.
Design and participants
We performed a cross-sectional study to investigate the prevalence of anti-spike (S1) IgG antibodies. Plasma was tested for the presence of anti-SARS-CoV-2 IgM and IgG antibodies using two assays (a lateral flow rapid test and an ELISA). A total of 1185 individuals of both sexes were enrolled in the study.
Results
The prevalences of IgM and IgG antibodies were 6.9% and 68.1%, respectively, ranging from 0% to 79.6%, with significant differences (p<0.001) between age groups in three communities (Araweté, Xikrin and Munduruku) and a virulence rate of 0.86%. The overall IgG prevalence obtained by rapid tests and ELISAs were similar, and the agreement of the results between the two tests was 80%, which was classified as good (kappa=0.4987; p<0.001; sensitivity of 82.1% and specificity of 71.6%). Herd immunity was probably attained, similar to that found in other communities of the Amazon.
Conclusions
SARS-CoV-2 spread rapidly among the indigenous populations investigated, but it had a low mortality rate. It is necessary to expand serological investigations to other communities in the Amazon region of Brazil.
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Gadsby, E. W., Christie-de Jong, F., Bhopal, S., Corlett, H., Turner, S.
BMJ Open, 7.02.2022
Tilføjet 7.02.2022
Objective
To capture the extent and impact of changes in the delivery of child health services in the UK, resulting from the SARS-CoV-2 pandemic response, from the perspectives of a range of child healthcare providers.
Setting
National Health Service commissioned/delivered healthcare services in two regional settings in the UK: North of Scotland (NOS) and North East and North Cumbria (NENC) in England.
Participants
Purposive sample of 39 child healthcare professionals including paediatricians, community/specialist nurses, allied health professionals and mental health professionals, from across the two regions (22 in NOS, 17 in NENC).
Methods
Semistructured qualitative interviews conducted via telephone between June and October 2020, fully transcribed and analysed in NVivo V.11 using thematic analysis.
Results
Extensive changes across a range of paediatric services were rapidly implemented to support the pandemic response and ongoing healthcare delivery. New ways of working emerged, principally to control the spread of the virus. Keeping users and their families out of hospital was an urgent driver for change. The changes had considerable impact on the health and well-being of staff with many experiencing radical changes to their working conditions and roles. However, there were some positive changes noted: some practitioners felt empowered and listened to by decision makers; some of the usual bureaucratic barriers to change were lifted; staff saw improved collaboration and joint working across the system; and some new ways of working were seen to be more efficient. Interviewees perceived the implications for children and their families to be profound, particularly with regard to self-care, relationships with practitioners and timely access to services.
Conclusions
Despite the challenges experienced by staff, the pandemic provided an opportunity for positive, lasting change. It is vital to capitalise on this opportunity to benefit patient outcomes and to ‘build back’ services in a more sustainable way.
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Gils, T., Lynen, L., Muhairwe, J., Mashaete, K., Lejone, T. I., Joseph, P., Ngubane, T., Keter, A. K., Reither, K., van Heerden, A.
BMJ Open, 7.02.2022
Tilføjet 7.02.2022
Introduction
Although the advanced HIV disease (AHD) care package reduces morbidity and mortality in people with AHD (defined in people living with HIV as WHO stage 3 or 4, CD4 count <200 cells/µL or age <5 years), it is barely implemented in many countries. A novel point-of-care CD4 test rapidly identifies AHD. We evaluate the feasibility of implementing the AHD care package as part of community-based HIV/tuberculosis services.
Methods and analysis
This two-phased study is guided by the Medical Research Council framework for evaluation of complex interventions. Stage 1 is a stakeholder consultation to define tools and indicators to assess feasibility of the AHD care package. Stage 2 is the implementation of the AHD care package during a facility-based tuberculosis diagnostic accuracy study in high-burden HIV/tuberculosis settings. Consenting adults with tuberculosis symptoms in two sites in Lesotho and South Africa are eligible for inclusion. HIV-positive participants are included in the feasibility study and are offered a CD4 test, a tuberculosis-lipoarabinomannan assay and those with CD4 count of ≤200 cells/µL a cryptococcal antigen lateral flow assay. Participants are referred for clinical management following national guidelines. The evaluation includes group discussions, participant observation (qualitative strand) and a semistructured questionnaire to assess acceptability among implementers. The quantitative strand also evaluates process compliance (process rating and process cascade) and early outcomes (vital and treatment status after twelve weeks). Thematic content analysis, descriptive statistics and data triangulation will be performed.
Ethics and dissemination
The National Health Research and Ethics Committee, Lesotho, the Human Sciences Research Council Research Ethics Committee and Provincial Department of Health, South Africa and the Ethikkommission Nordwest- und Zentralschweiz, Switzerland, approved the protocol. Dissemination will happen locally and internationally at scientific conferences and in peer-reviewed journals.
Trial registration number
NCT04666311.
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Murray, E., Goodfellow, H., Bindman, J., Blandford, A., Bradbury, K., Chaudhry, T., Fernandez-Reyes, D., Gomes, M., Hamilton, F. L., Heightman, M., Henley, W., Hurst, J. R., Hylton, H., Linke, S., Pfeffer, P., Ricketts, W., Robson, C., Singh, R., Stevenson, F. A., Walker, S., Waywell, J.
BMJ Open, 7.02.2022
Tilføjet 7.02.2022
Introduction
Long COVID-19 is a distressing, disabling and heterogeneous syndrome often causing severe functional impairment. Predominant symptoms include fatigue, cognitive impairment (‘brain fog’), breathlessness and anxiety or depression. These symptoms are amenable to rehabilitation delivered by skilled healthcare professionals, but COVID-19 has put severe strain on healthcare systems. This study aims to explore whether digitally enabled, remotely supported rehabilitation for people with long COVID-19 can enable healthcare systems to provide high quality care to large numbers of patients within the available resources. Specific objectives are to (1) develop and refine a digital health intervention (DHI) that supports patient assessment, monitoring and remote rehabilitation; (2) develop implementation models that support sustainable deployment at scale; (3) evaluate the impact of the DHI on recovery trajectories and (4) identify and mitigate health inequalities due to the digital divide.
Methods and analysis
Mixed-methods, theoretically informed, single-arm prospective study, combining methods drawn from engineering/computer science with those from biomedicine. There are four work packages (WP), one for each objective. WP1 focuses on identifying user requirements and iteratively developing the intervention to meet them; WP2 combines qualitative data from users with learning from implementation science and normalisation process theory, to promote adoption, scale-up, spread and sustainability of the intervention; WP3 uses quantitative demographic, clinical and resource use data collected by the DHI to determine illness trajectories and how these are affected by use of the DHI; while WP4 focuses on identifying and mitigating health inequalities and overarches the other three WPs.
Ethics and dissemination
Ethical approval obtained from East Midlands – Derby Research Ethics Committee (reference 288199). Our dissemination strategy targets three audiences: (1) Policy makers, Health service managers and clinicians responsible for delivering long COVID-19 services; (2) patients and the public; (3) academics.
Trial registration number
Research Registry number: researchregistry6173.
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Nicole L. Welch, Meilin Zhu, Catherine Hua, Juliane Weller, Marzieh Ezzaty Mirhashemi, Tien G. Nguyen, Sreekar Mantena, Matthew R. Bauer, Bennett M. Shaw, Cheri M. Ackerman, Sri Gowtham Thakku, Megan W. Tse, Jared Kehe, Marie-Martine Uwera, Jacqueline S. Eversley, Derek A. Bielwaski, Graham McGrath, Joseph Braidt, Jeremy Johnson, Felecia Cerrato, Gage K. Moreno, Lydia A. Krasilnikova, Brittany A. Petros, Gabrielle L. Gionet, Ewa King, Richard C. Huard, Samantha K. Jalbert, Michael L. Cleary, Nicholas A. Fitzgerald, Stacey B. Gabriel, Glen R. Gallagher, Sandra C. Smole, Lawrence C. Madoff, Catherine M. Brown, Matthew W. Keller, Malania M. Wilson, Marie K. Kirby, John R. Barnes, Daniel J. Park, Katherine J. Siddle, Christian T. Happi, Deborah T. Hung, Michael Springer, Bronwyn L. MacInnis, Jacob E. Lemieux, Eric Rosenberg, John A. Branda, Paul C. Blainey, Pardis C. Sabeti, Cameron Myhrvold
Nature, 7.02.2022
Tilføjet 7.02.2022
Nature Medicine, Published online: 07 February 2022; doi:10.1038/s41591-022-01734-1A microfluidic CRISPR-based platform enables multiplexed and high-throughput identification of a wide range of respiratory viruses, including the ability to identify specific SARS-CoV-2 variants such as Delta and Omicron.
Læs mere Tjek på PubMedInfection, 7.02.2022
Tilføjet 7.02.2022
Abstract
Purpose
The rollout of COVID-19 vaccines began in India in January 2021, with healthcare professionals being the first to receive vaccination. The purpose of this research was to study the incidence and severity of COVID-19 infections among Indian doctors, following vaccination with ChAdOx1 nCoV-19 or BBV152.
Methods
We conducted an online voluntary survey among Indian doctors who received one or two doses of ChAdOx1 nCoV-19 or BBV152. Questions pertaining to the incidence and severity of COVID-19 infection following vaccination were asked. Data thus obtained were analysed.
Results
9146 doctors were included in this study. 8301 of these received ChAdOx1 nCoV-19, while 845 received BBV152. 2842 (31.07%) respondents reported having a COVID-19 infection following vaccination. Presence of pre-existing medical comorbidities was associated with a higher incidence, while prior COVID-19 infection and two doses of either vaccine were associated with a lower incidence of COVID-19 infection post-vaccination. Exposure to COVID-19 patients on a daily basis did not increase the incidence of COVID-19 infection among doctors who were vaccinated. Increasing age, male gender, presence of pre-existing medical comorbidities, and daily exposure to COVID-19 patients were associated with increased severity of COVID-19 infection after vaccination. Two doses of either vaccine resulted in less severity of disease compared to one dose.
Conclusion
ChAdOx1 nCoV-19 and BBV152 confer immunity against severe forms of COVID-19 infections. COVID-19 infections prior to vaccination result in a lower incidence of breakthrough infection. Presence of pre-existing medical comorbidities is associated with increased incidence and severity of breakthrough infections.
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Yonatan Oster, Shmuel Benenson, Ran Nir-Paz, Inon Buda, Matan J. Cohen
Clinical Microbiology and Infection, 7.02.2022
Tilføjet 7.02.2022
In August 2021, six months following a mass vaccination of the Israeli population by the two-dose BNT162b2 mRNA vaccine, a surge of COVID-19 infections, mostly by the Delta variant, appeared also among the vaccinated. In response, the Israeli Ministry of Health initiated a booster (third dose) vaccination program. We assessed the protective effect of the third dose among healthcare workers (HCW).
Læs mere Tjek på PubMedYan Xie, Evan Xu, Benjamin Bowe, Ziyad Al-Aly
Nature, 7.02.2022
Tilføjet 7.02.2022
Nature Medicine, Published online: 07 February 2022; doi:10.1038/s41591-022-01689-3Individuals with COVID-19 are at increased long-term risk for a wide range of cardiovascular disorders, even for individuals who were not hospitalized during the acute phase of the infection.
Læs mere Tjek på PubMedCarlos Fabricio Assunção da Silva, Mayara Costa Silva, Alex Mota dos Santos, Anderson Paulo Rudke, Cristine Vieira do Bonfim, Gabriela Tobias Portis, Pedro Monteiro de Almeida Junior, Maria Beatriz de Santana Coutinho
Tropical Medicine & International Health, 7.02.2022
Tilføjet 7.02.2022
Muhammad Shahzad, Huan Chen, Tasleem Akhtar, Ali Rafi, Muhammad Shoaib Zafar, Yong‐Tang Zheng
Journal of Medical Virology, 7.02.2022
Tilføjet 7.02.2022
Hüseyin Gümüş, Tuğba Erat, İrfan Öztürk, Abit Demir, Ismail Koyuncu
Journal of Medical Virology, 7.02.2022
Tilføjet 7.02.2022
Bagnu Dundar, Kadriye Karahangil, Cagri Serdar Elgormus, Hatice Nur Halipci Topsakal
Journal of Medical Virology, 7.02.2022
Tilføjet 7.02.2022
Charles B. Stauft, Prabhuanand Selvaraj, Christopher Z. Lien, Matthew F. Starost, Tony T. Wang
Journal of Medical Virology, 7.02.2022
Tilføjet 7.02.2022
BMC Infectious Diseases, 5.02.2022
Tilføjet 6.02.2022
Abstract
Background
The city of Manaus, north Brazil, was stricken by a second epidemic wave of SARS-CoV-2 despite high seroprevalence estimates, coinciding with the emergence of the Gamma (P.1) variant. Reinfections were postulated as a partial explanation for the second surge. However, accurate calculation of reinfection rates is difficult when stringent criteria as two time-separated RT-PCR tests and/or genome sequencing are required. To estimate the proportion of reinfections caused by Gamma during the second wave in Manaus and the protection conferred by previous infection, we identified anti-SARS-CoV-2 antibody boosting in repeat blood donors as a mean to infer reinfection.
Methods
We tested serial blood samples from unvaccinated repeat blood donors in Manaus for the presence of anti-SARS-CoV-2 IgG antibodies using two assays that display waning in early convalescence, enabling the detection of reinfection-induced boosting. Donors were required to have three or more donations, being at least one during each epidemic wave. We propose a strict serological definition of reinfection (reactivity boosting following waning like a V-shaped curve in both assays or three spaced boostings), probable (two separate boosting events) and possible (reinfection detected by only one assay) reinfections. The serial samples were used to divide donors into six groups defined based on the inferred sequence of infection and reinfection with non-Gamma and Gamma variants.
Results
From 3655 repeat blood donors, 238 met all inclusion criteria, and 223 had enough residual sample volume to perform both serological assays. We found 13.6% (95% CI 7.0–24.5%) of all presumed Gamma infections that were observed in 2021 were reinfections. If we also include cases of probable or possible reinfections, these percentages increase respectively to 22.7% (95% CI 14.3–34.2%) and 39.3% (95% CI 29.5–50.0%). Previous infection conferred a protection against reinfection of 85.3% (95% CI 71.3–92.7%), decreasing to respectively 72.5% (95% CI 54.7–83.6%) and 39.5% (95% CI 14.1–57.8%) if probable and possible reinfections are included.
Conclusions
Reinfection by Gamma is common and may play a significant role in epidemics where Gamma is prevalent, highlighting the continued threat variants of concern pose even to settings previously hit by substantial epidemics.
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BMC Infectious Diseases, 5.02.2022
Tilføjet 6.02.2022
Abstract
Background
Schistosomiasis is one of the most contagious parasitic diseases affecting humans; however, glomerular injury is a rare complication mainly described with Schistosoma mansoni infection. We report a case of membranous nephropathy associated with Schistosoma japonicum infection in a Chinese man.
Case presentation
A 51-year-old Chinese male with a long history of S. japonicum infection presented to the hospital with a slowly progressing severe lower limb edema and foaming urine for over 5 months. Serum S. japonicumantigen test was positive and immunohistochemistry showed that the glomeruli were positive for the antigens. The renal pathologic diagnosis was stage III membranous nephropathy. The patient was treated with glucocorticoid, praziquantel, and an angiotensin-converting enzyme inhibitor. The edema in both lower limbs disappeared within 2 weeks, but his renal function declined progressively and proteinuria persisted after 5 months of therapy.
Conclusions
Different classes of schistosomal glomerulopathy have completely different clinical manifestation and prognosis. Therefore, efforts should focus on alleviating symptoms, prevention, and early detection. S. japonicumassociated with membranous nephropathy may show a good curative effect and prognosis. However, it is necessary to monitor the renal function in such patients.
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BMC Infectious Diseases, 5.02.2022
Tilføjet 6.02.2022
Abstract
Background
In the pediatric population, severe Clostridioides difficile infection (CDI) sometimes occurs, but most cases are asymptomatic. The asymptomatic carriage rate in pediatric populations is reportedly higher than in the adult population. It is difficult to diagnose CDI, even if C. difficile is detected in children with diarrhea. This study aimed to evaluate the positivity rate of toxigenic C. difficile in the pediatric population with diarrhea.
Methods
We collected and retrospectively analyzed gastrointestinal pathogen multiplex PCR results of 960 patients to estimate the positivity rate of toxigenic C. difficile in pediatric populations aged between 0 and 18 years.
Results
The overall rate of C. difficile toxin B positivity was 10.1% in the stool samples. The positivity rate peaked in 1-year-old infants (29/153, 19.0%) and continually decreased thereafter. The positivity rate we observed was lower than the rates described in the literature. Remarkably, no C. difficile was detected in neonates. Antibiotic usage was inversely related to the positivity rate, especially in infants < 2 years of age. The odds ratio of antibiotics was 0.44 (95% confidence interval (CI) 0.28–0.68; P < 0.001). The presence of concomitant gastrointestinal pathogens was not associated with toxigenic C. difficile positivity.
Conclusions
Even though toxigenic C. difficile infection is neither an important nor a common cause of pediatric diarrhea, children can spread it to adults at risk of developing CDI. The pediatric population can act as hidden reservoirs for pathogenic strains in the community.
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BMC Infectious Diseases, 5.02.2022
Tilføjet 6.02.2022
Abstract
Background
Congenital syphilis is preventable through timely access to prenatal care, syphilis screening and treatment of pregnant women diagnosed as infected. In 2018, California had the second highest number of congenital syphilis cases in the United States (U.S.), a nearly twofold increase in cases since 2014. This study assessed gaps in preventing congenital syphilis in the high morbidity region of Kern County, California.
Methods
Between May 2018 and January 2019, we conducted five focus group discussions with pregnant/postpartum women and ten semi-structured interviews with prenatal care providers in Kern County. Focus group and interview data were recorded, transcribed, and analyzed to identify emergent themes pertaining to facilitators and barriers at each step (prenatal care, syphilis screening and treatment) in the congenital syphilis prevention cascade.
Results
Gaps in congenital syphilis prevention discussed in focus group discussions with pregnant/postpartum women were related to limited prenatal care access, social-, economic-, and cultural-barriers, and substance use and co-occurring intimate partner/domestic violence. The gaps identified from interviews with prenatal care providers included social economic vulnerabilities of pregnant women and stigma and shame around the vulnerabilities, distrust in medical system, prenatal substance use, limited prenatal substance use disorder treatment facilities, and inadequate provider training on context-specific congenital syphilis management strategies. Gaps in partner notification, screening and treatment for syphilis were brought up by pregnant/postpartum women and prenatal care providers.
Conclusions
Congenital syphilis continues to increase in Kern County and throughout the U.S. In high syphilis morbidity areas, comprehensive and tailored public health approaches addressing setting-specific gaps in prenatal screening and treatment are needed.
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BMC Infectious Diseases, 5.02.2022
Tilføjet 6.02.2022
Abstract
Background
Both CMV and Rubella virus infections are associated with the risk of vertical transmission, fetal death or congenital malformations. In Angola, there are no reports of CMV and Rubella studies. Therefore, our objectives were to study the seroprevalence of anti-CMV and anti-Rubella antibodies in pregnant women of Luanda (Angola), identify the risk of primary infection during pregnancy and evaluate the socio-demographic risk factors associated with both infections.
Methods
A prospective cross-sectional study was conducted from August 2016 to May 2017. Specific anti-CMV and anti-Rubella antibodies were quantified by electrochemiluminescence and demographic and clinical data were collected using standardized questionnaire. Bivariate and multivariate logistic regression analysis were used to quantify the effect of clinical and obstetric risk factors on virus seroprevalence.
Results
We recruited 396 pregnant women aged from 15 to 47. Among them, 335 (84.6%) were immune to both CMV and Rubella virus infections, while 8 (2.0%) had active CMV infection and 4 (1.0%) active RV infection but none had an active dual infection. Five women (1.2%) were susceptible to only CMV infection, 43 (10.9%) to only RV infection, and 1 (0.3) to both infections. Multivariate analysis showed a significant association between Rubella virus infection and number of previous births and suffering spontaneous abortion.
Conclusions
Overall, this study showed that there is a high prevalence of anti-CMV and anti-Rubella antibodies in pregnant women in Luanda. It also showed that a small but important proportion of pregnant women, about 11%, are at risk of primary infection with rubella during pregnancy. This emphasizes the need for vaccination.
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BMC Infectious Diseases, 5.02.2022
Tilføjet 6.02.2022
Abstract
Background
Addiction medicine consultation and medications for opioid use disorder are shown to improve outcomes for patients hospitalized with infective endocarditis associated with injection drug use. Existing studies describe settings where addiction medicine consultation and initiation of medications for opioid use disorder are not commonplace, and rates of antibiotic therapy completion are infrequently reported. This retrospective study sought to quantify antibiotic completion outcomes in a setting where these interventions are routinely implemented.
Methods
Medical records of patients hospitalized with a diagnosis of bacteremia or infective endocarditis at an urban hospital between October 1, 2015 and December 31, 2017 were screened for active injection drug use within 6 months of hospitalization and infective endocarditis. Demographic and clinical parameters, receipt of antibiotics and medications for opioid use disorder, and details of re-hospitalizations within 1 year of discharge were recorded.
Results
Of 567 subjects screened for inclusion, 47 had infective endocarditis and active injection drug use. Addiction medicine consultation was completed for 41 patients (87.2%) and 23 (48.9%) received medications for opioid use disorder for the entire index admission. Forty-three patients (91.5%) survived to discharge, of which 28 (59.6%) completed antibiotic therapy. Twenty-nine survivors (67.4%) were re-hospitalized within 1 year due to infectious complications of injection drug use.
Conclusions
Among patients admitted to a center with routine addiction medicine consultation and initiation of medications for opioid use disorder, early truncation of antibiotic therapy and re-hospitalization were commonly observed.
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Haiqian Yang, Xiaojing Jia, Yejun Han
Trends in Microbiology, 5.02.2022
Tilføjet 6.02.2022
Many biosynthetic processes, either in vivo or in vitro, involve redox reactions catalyzed by oxidoreductases – which depend on coenzymes as electron carriers. Redox balance is regulated mainly by coenzymes NAD(P)+ and NAD(P)H and is essential for biosynthesis. New techniques for the regulation and regeneration of coenzymes have recently advanced our understanding of, and demonstrated promising applications in, synthetic biology.
Læs mere Tjek på PubMedNurul I. Wirusanti, Megan T. Baldridge, Vanessa C. Harris
Trends in Microbiology, 5.02.2022
Tilføjet 6.02.2022
The interferon (IFN) response is the major early innate immune response against invading viral pathogens and is even capable of mediating sterilizing antiviral immunity without the support of the adaptive immune system. Cumulative evidence suggests that the gut microbiota can modulate IFN responses, indirectly determining virological outcomes. This review outlines our current knowledge of the interactions between the gut microbiota and IFN responses and dissects the different mechanisms by which the gut microbiota may alter IFN expression to diverse viral infections.
Læs mere Tjek på PubMedDe Almeida, Sergio M.; Rotta, Indianara; Tang, Bin; Umlauf, Anya; Vaida, Florin; Cherner, Mariana; Franklin, Donald; Letendre, Scott; Ellis, Ronald J.; the HNRC Group
Journal of Acquired Immune Deficiency Syndromes, 26.01.2022
Tilføjet 6.02.2022
Background:
We hypothesized that the induction of monocyte activation biomarkers, especially soluble urokinase-type plasminogen activator receptor (suPAR) and interferon γ-inducible protein 10 (IP-10), is lower in HIV-1C than HIV-1B owing to a defective Tat cysteine dimotif (C30S).
Methods:
A total of 68 paired cerebrospinal fluid (CSF) and blood samples from persons with HIV (PWH), free of CNS opportunistic infections, from a Southern Brazil outpatient HIV clinic were evaluated; HIV-1B subtype (n= 27), HIV-1C (n=26), other (n=15), and 19 HIV-negative controls. The levels of SuPAR, IP-10, neopterin, and β2 microglobulin (β2m) in the CSF and serum were quantified using different immunoassays.
Results:
Overall, in PWH, increases in CSF suPAR, CSF/serum suPAR, and CSF/serum β2m correlated with worse working memory deficits (r= 0.303, 0.353, and 0.289, respectively, all p<0.05). The medians of IP-10, suPAR, neopterin, and β2m in CSF and serum, as well as the CSF/serum ratio and suPAR index were comparable between the HIV-1B and HIV-1C subtypes. CSF IP-10 and neopterin, and serum IP-10 and suPAR levels were higher in PWH than the HIV-negative controls (p=0.015, p=0.001, p<0.0001, and p<0.001, respectively). Serum β2m level was higher in HIV-associated dementia (HAD) than neuropsychologically normal (NP-NML) or asymptomatic (ANI) (p= 0.024).
Discussion:
We observed that higher levels of CSF suPAR and the suPAR quotient correlated with worse working memory deficit. Elevated levels of monocyte activation were similar in both HIV-1 B and C subtypes, providing no evidence of reduced neuropathogenicity of HIV-1 subtype C Tat compared to subtype B.
Corresponding Author: Sérgio Monteiro de Almeida, MD, PhD, Complexo Hospital de Clínicas–UFPR, Seção de Virologia, Setor Análises Clínicas, Rua Padre Camargo, 280, Curitiba, PR, Brasil, 80060-240, Email: sergio.ma@ufpr.br, Telephone/Fax: +55 (41) 3360-7974
Conflicts of Interest and Source of Funding: The authors declare that there are no conflicts of interest regarding the publication of this article. This research was supported by NIH R21 MH76651 (principal investigators: R. Ellis, S. de Almeida), Ministério da Ciência e Tecnologia/Conselho Nacional de Desenvolvimento Científico e Tecnológico, MCT/CNPq-Universal 014/2008, Brazil (Almeida, Sergio M).
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedWei-Ming Watson, C.; Kamalyan, Lily; Tang, Bin; Hussain, Mariam A.; Cherner, Mariana; Mindt, Monica Rivera; Byrd, Desiree A.; Franklin, Donald R.; Collier, Ann C.; Clifford, David B.; Gelman, Benjamin; Morgello, Susan; McCutchan, J. Allen; Ellis, Ronald J.; Grant, Igor; Heaton, Robert K.; Marquine, María J.; for the CHARTER Group
Journal of Acquired Immune Deficiency Syndromes, 26.01.2022
Tilføjet 6.02.2022
Background:
To examine longitudinal neurocognitive decline among Latino, non-Latino Black, and non-Latino White people with HIV (PWH) and factors that might explain ethnic/racial disparities in neurocognitive decline.
Methods:
499 PWH (13.8% Latino, 42.7% Black, 43.5% White; baseline age: M=43.5) from the CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) study completed neurocognitive, neuromedical, and laboratory assessments every 6–12 months with up to five years of follow-up. Longitudinal neurocognitive change was determined via published regression-based norms. Survival analyses investigated the relationship between ethnicity/race and neurocognitive change, and baseline and time-dependent variables that might explain ethnic/racial disparities in neurocognitive decline, including socio-demographic, HIV-disease, medical, psychiatric, and substance use characteristics.
Results:
In Cox proportional hazard models, hazard ratios for neurocognitive decline were increased for Latino compared to White PWH (HR=2.25, 95% CI=1.35–3.73, p=0.002), and Latino compared to Black PWH (HR=1.86, 95% CI=1.14–3.04, p=0.013), with no significant differences between Black and White PWH (p=0.40). Comorbidities, including cardiometabolic factors and more severe neurocognitive comorbidity classification, accounted for 33.6% of the excess hazard for Latino compared to White PWH, decreasing the hazard ratio associated with Latino ethnicity (HR=1.83, 95% CI=1.06–3.16, p=0.03), but did not fully account for elevated risk of decline.
Conclusion:
Latino PWH may be at higher risk of early neurocognitive decline compared to Black and White PWH. Comorbidities accounted for some, but not all, of this increased risk among Latino PWH. Future research examining institutional, sociocultural, and biomedical factors, including structural discrimination and age-related biomarkers, may further explain the observed disparities.
Corresponding author: María J. Marquine, Ph.D., Departments of Medicine and Psychiatry, UCSD School of Medicine | 9500 Gilman Drive | La Jolla, CA 92093| Phone: 858-534-6748 | Fax: 858-822-6151 | Email: mmarquine@health.ucsd.edu
Conflicts of Interest and Source of Funding: The CNS HIV Anti-Retroviral Therapy Effects Research was supported by NIH awards N01 MH22005, HHSN271201000036C, HHSN271201000030C and R01 MH107345. Other support include the following NIH grants: T32-DA031098 (C.W.-M.W., M.A.H.), T32 AA013525 (L.K.), K23MH105297 (M.J.M.), and P30AG059299 (M.J.M). The authors declare no conflicts of interest.
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedKobayashi, Miwako; Matanock, Almea; Xing, Wei; Adih, William K.; Li, Jianmin; Gierke, Ryan; Almendares, Olivia; Reingold, Arthur; Alden, Nisha; Petit, Susan; Farley, Monica M.; Harrison, Lee H.; Holtzman, Corinne; Baumbach, Joan; Thomas, Ann; Schaffner, William; McGee, Lesley; Pilishvili, Tamara
Journal of Acquired Immune Deficiency Syndromes, 26.01.2022
Tilføjet 6.02.2022
Background:
People with HIV (PWH) are at increased risk for invasive pneumococcal disease (IPD). 13-valent pneumococcal conjugate vaccine (PCV13) was recommended for use in U.S. children in 2010 and for PWH aged ≥19 years in 2012. We evaluated population-level impact of PCV13 on IPD among PWH and non-PWH aged ≥19 years.
Methods:
We identified IPD cases from 2008 to 2018 through the Active Bacterial Core surveillance platform. We estimated IPD incidence using the National HIV Surveillance System and U.S. Census Bureau data. We measured percent changes in IPD incidence from 2008–2009 to 2017–2018 by HIV status, age-group, and vaccine serotype group, including serotypes in recently licensed 15-valent (PCV15) and 20-valent (PCV20) PCVs.
Results:
In 2008–2009 and 2017–2018, 8.4% (552/6,548) and 8.0% (416/5,169) of adult IPD cases were among PWH, respectively. Compared to non-PWH, a larger proportion of IPD cases among PWH were in adults aged 19–64 years (94.7–97.4% vs. 56.0–60.1%) and non-Hispanic blacks (62.5–73.0% vs. 16.7–19.2%). Overall and PCV13-type IPD incidence in PWH declined by 40.3% (95% CI: -47.7 to -32.3) and 72.5% (95% CI: -78.8 to -65.6), respectively. In 2017–2018, IPD incidence was 16.8 (overall) and 12.6 (PCV13-type) times higher in PWH compared to non-PWH; PCV13, PCV15/non-PCV13, and PCV20/non-PCV15 serotypes comprised 21.5%, 11.2% and 16.5% of IPD in PWH, respectively.
Conclusions:
Despite reductions post PCV13 introduction, IPD incidence among PWH remained substantially higher than among non-PWH. Higher-valent PCVs provide opportunities to reduce remaining IPD burden in PWH.
Corresponding Author: Miwako Kobayashi Centers for Disease Control and Prevention, Atlanta, UNITED STATES
W.S. served as a consultant for VBI Vaccines. L.H.H served as a consultant for GSK, Merck, Pfizer, and Sanofi Pasteur. The remaining authors have no conflicts of interest to disclose.
* co-first authors
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