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BMC Infectious Diseases, 13.06.2022
Tilføjet 13.06.2022
Abstract
Background
Taenia solium cysticercosis/taeniasis (TSCT) is reported to be endemic in pig producing areas around the world, causing significant disease burden and economic losses.
Methods
This cross-sectional study aimed at assessing Knowledge, Attitudes and Practices (KAP) regarding TSCT in four districts, namely Mbulu, Mpwapwa, Mbinga, and Rungwe in Tanzania. Data on KAP were collected through questionnaire-based interviews and household infrastructure observations.
Results
Knowledge about porcine cysticercosis was good, particularly among pig keepers across the districts. Many participants had heard about the pork tapeworm (T. solium taeniasis), and the knowledge about signs/symptoms and treatment was fair, but the means of transmission and prevention measures were often unknown. Whilst most participants were familiar with epilepsy, no one knew anything about human cysticercosis and the link between cysticercosis and epileptic seizures. A similar trend is reflected through the attitudes toward the low risk perception of cysticercosis infection. Not surprisingly, the risk perception of the infection with the pork tapeworm was low too. Many participants reported not washing their hands before eating or after using the toilet which highlights potential risks for the development of human cysticercosis. Albeit nearly every participant reported using the toilet always, household observations revealed that toilets were either lacking or had no complete walls. Generally, household observations revealed a discrepancy between questionnaire answers on the one hand and the availability of toilet and handwashing facilities and the confinement of pigs on the other hand.
Conclusion
This study demonstrates knowledge gaps and adverse practices which may hinder and/or slow down the control/elimination of T. solium in endemic countries. The study results are also useful for appropriate designing of TSCT health interventions that need to be planned carefully, taking into account the local context and designing TSCT in partnership with the local communities from the beginning to the end applying a One Health approach to allow the possible sustained and best impacts.
Graphical Abstract
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BMC Infectious Diseases, 13.06.2022
Tilføjet 13.06.2022
Abstract
Background
Acute myocardial injury is associated with poor prognosis in respiratory tract infections. We aimed to highlight the differences in prevalence of myocardial injury and its impact on prognosis in patients with COVID-19 compared to those with seasonal influenza.
Methods
This was a single-center prospective cohort study with a historical control group. 300 age-/sex-matched SARS-CoV-2 and seasonal influenza positive patients were enrolled. Myocardial injury was assessed by electrocardiogram (ECG), transthoracic echocardiography and biomarkers including high-sensitivity troponin-I. All patients were followed-up for 30 days after enrollment for all-cause mortalitiy, admission to the intensive care unit (ICU) and mechanical ventilation.
Results
Right ventricular distress was more common in COVID-19 whereas pathological ECG findings and impaired left ventricular function were more prevalent among influenza patients. COVID-19 patients suffered from a higher percentage of hypertension and dyslipidaemia. Contrary to COVID-19, pericardial effusion at admission was associated with poor outcome in the influenza group. Severe course of disease and respiratory failure resulted in significantly higher rates of ICU treatment and mechanical ventilation in COVID-19 patients. Although distribution of myocardial injury was similar, significantly fewer cardiac catheterizations were performed in COVID-19 patients. However, number of cardiac catheterizations was low in both groups. Finally, 30-day mortality was significantly higher in COVID-19 compared to influenza patients.
Conclusions
In adults requiring hospitalization due to COVID-19 or seasonal influenza, cardiovascular risk factors and signs of myocardial distress differ significantly. Furthermore, cardiovascular comorbidities may impair prognosis in COVID-19 patients to a higher degree than in their influenza counterparts.
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BMC Infectious Diseases, 13.06.2022
Tilføjet 13.06.2022
Abstract
Background
The burden of carbapenem resistance is not well studied in the Middle East. We aimed to describe the molecular epidemiology and outcome of carbapenem-resistant Enterobacterales (CRE) infections from several Saudi Arabian Centers.
Methods
This is a multicenter prospective cohort study conducted over a 28-month period. Patients older than 14 years of age with a positive CRE Escherichia coli or Klebsiella pneumoniae culture and a clinically established infection were included in this study. Univariate and multivariable logistic models were constructed to assess the relationship between the outcome of 30-day all-cause mortality and possible continuous and categorical predictor variables.
Results
A total of 189 patients were included. The median patient age was 62.8 years and 54.0% were male. The most common CRE infections were nosocomial pneumonia (23.8%) and complicated urinary tract infection (23.8%) and 77 patients (40.7%) had CRE bacteremia. OXA-48 was the most prevalent gene (69.3%). While 100 patients (52.9%) had a clinical cure, 57 patients (30.2%) had died within 30 days and 23 patients (12.2%) relapsed. Univariate analysis to predict 30-day mortality revealed that the following variables are associated with mortality: older age, high Charlson comorbidity index, increased Pitt bacteremia score, nosocomial pneumonia, CRE bacteremia and diabetes mellitus. In multivariable analysis, CRE bacteremia remained as an independent predictor of 30 day all-cause mortality [AOR and 95% CI = 2.81(1.26–6.24), p = 0.01].
Conclusions
These data highlight the molecular epidemiology and outcomes of CRE infection in Saudi Arabia and will inform future studies to address preventive and management interventions.
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BMC Infectious Diseases, 13.06.2022
Tilføjet 13.06.2022
Abstract
Background
This study determined if non-communicable disease status, HIV status, COVID-19 status and co-habiting were associated with COVID-19 test status in sub-Saharan Africa.
Methods
Data of 5945 respondents age 18-years-old and above from 31 countries in sub-Saharan Africa collected through an online survey conducted between June and December 2020, were extracted. The dependent variable was COVID-19 status (testing positive for COVID-19 and having symptoms of COVID-19 but not getting tested). The independent variables were non-communicable disease status (hypertension, diabetes, cancer, heart conditions, respiratory conditions, depression), HIV positive status, COVID-19 status (knowing a close friend who tested positive for COVID-19 and someone who died from COVID-19) and co-habiting (yes/no). Two binary logistic regression models developed to determine associations between the dependent and independent variables were adjusted for age, sex, employment, sub region and educational status.
Results
Having a close friend who tested positive for COVID-19 (AOR:6.747), knowing someone who died from COVID-19 infection (AOR:1.732), and living with other people (AOR:1.512) were significantly associated with higher odds of testing positive for COVID-19 infection, while living with HIV was associated with significantly lower odds of testing positive for COVID-19 infection (AOR:0.284). Also, respondents with respiratory conditions (AOR:2.487), self-reported depression (AOR:1.901), those who had a close friend who tested positive for COVID-19 infection (AOR:2.562) and who knew someone who died from COVID-19 infection (AOR:1.811) had significantly higher odds of having symptoms of COVID-19 infection but not getting tested.
Conclusion
Non-communicable diseases seem not to increase the risk for COVID-19 positive test while cohabiting seems to reduce this risk. The likelihood that those who know someone who tested positive to or who died from COVID-19 not getting tested when symptomatic suggests there is poor contact tracing in the region. People with respiratory conditions and depression need support to get tested for COVID-19.
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Malte M. Tetens, Ram Dessau, Svend Ellermann-Eriksen, Nanna S. Andersen, Charlotte Sværke Jørgensen, Christian Østergaard, Jacob Bodilsen, David F. Damgaard, Jette Bangsborg, Alex Christian Nielsen, Jens Kjølseth Møller, Lars Haukali Omland, Niels Obel, Anne-Mette Lebech
Clinical Microbiology and Infection, 13.06.2022
Tilføjet 13.06.2022
Clinical guidelines disagree on the diagnostic usefulness of Borrelia burgdorferi (Bb) serum antibodies (serum-Bb) in investigation of Lyme neuroborreliosis (LNB). We investigated the association between serum-Bb and Bb intrathecal antibody index (Bb-AI) and rates of seroconversion and seroreversion after LNB.
Læs mere Tjek på PubMedItziar Chapartegui-González, Nittaya Khakhum, Jacob L. Stockton, Alfredo G. Torres aDepartment of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA bDepartment of Pathology, University of Texas Medical Branch, Galveston, Texas, USA, Igor E. Brodsky
Infection and Immunity, 13.06.2022
Tilføjet 13.06.2022
Chia-Yi Hou
Nature, 13.06.2022
Tilføjet 13.06.2022
Nature Medicine, Published online: 13 June 2022; doi:10.1038/s41591-022-01844-wLeading researchers explain how the COVID-19 pandemic has spurred research on wearables, genomic surveillance, behavioral interventions and drug discovery.
Læs mere Tjek på PubMedInfection, 13.06.2022
Tilføjet 13.06.2022
Abstract
Objectives
To assess the severity of symptoms, duration of infection and viral loads of health-care workers (HCWs) who tested positive for Coronavirus disease 2019 (COVID-19) during Omicron’s prevalence, in regard to vaccination and previous infection.
Methods
During 2 weeks of highest rate of COVID-19 cases in Bosnia and Herzegovina, the positive nasopharyngeal swabs were analysed in 141 HCWs by reverse transcription quantitative PCR, targeting four different genes: RdRp, E, N and nsp14. Uniformed questionnaire was used to collect relevant sociodemographic and epidemiological data from HCWs divided into four groups: unvaccinated/not previously infected (group 1); unvaccinated/previously infected (group 2); vaccinated/not previously infected (group 3); and vaccinated/previously infected (group 4).
Results
We observed that occurrence of fever and smell or taste loss were more frequent in group 1 (86.4% and 25%) and group 3 (76.9% and 19.2%), in comparison to group 2 (64.4% and 6.7%) and group 4 (69.2% and 3.8%), (p = 0.023 and p = 0.003). Although statistically not significant, group 2 (61.9%), group 3 (65.4%), and group 4 (70.8%) experienced negativization within 7 days of positive RT-qPCR test, whereas 51.2% of HCWs from group 1 tested negative later on. There is no significant difference between all four groups regarding Ct values of analysed genes.
Conclusion
During Omicron’s prevalence, the vaccination had less substantial effect on symptomatic disease among HCWs, while fever and loss of smell or taste were considerably less likely to occur upon reinfection. Since viral loads and negativization periods do not seem to significantly vary, irrespective of pre-existing immunity, systemic vaccination and mask-wearing should still be considered among HCWs.
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Fu, K.-Y., Hsieh, M.-L., Chen, J.-A., Hsieh, V. C.-R.
BMJ Open, 13.06.2022
Tilføjet 13.06.2022
Objective
To evaluate medication adherence among patients with hepatitis B-related cirrhosis who developed decompensation and mortality, and to examine the association between medication adherence and patients’ disease outcomes.
Design
In this retrospective case–control study, patients aged over 20 years old and diagnosed with both chronic hepatitis B and cirrhosis from 2007 to 2016 are identified using a population-based medical claims database. Two prognosis endpoints (decompensation and mortality) are used, respectively, to classify subjects into two different case–control sets. Study groups are propensity-score matched. Medication possession ratio (MPR) is used as a measure of treatment adherence for oral antiviral drugs, and conditional logistic regression models are used to estimate the odds of decompensation and mortality after accounting for MPR and other covariates.
Results
Between decompensated and compensated patients, longer term treatment adherence is seen higher in the compensated group versus the decompensated group: 1-year MPR (0.65±0.43 vs 0.57±0.53) and 6-month MPR (0.79±0.52 vs 0.76±0.79). On the contrary, 3-month adherence is higher in the decompensated group (1.00±1.15 vs 0.96±0.79). For patients with and without mortality, drug adherence is ubiquitously higher in the alive group regardless of follow-up length: 1-year MPR (0.62±0.44 vs 0.50±0.51), 6-month MPR (0.78±0.62 vs 0.69±0.72) and 3-month MPR (0.97±0.91 vs 0.96±1.12). After accounting for confounding variables, we find that the likelihood of complicated cirrhosis is significantly lower in more adherent patients and the benefit increases with more persistent adherence (log 1-year MPR OR: 0.75, 95% CI: 0.73 to 0.77). Similar results are observed for the adjusted likelihood of mortality (log 1-year MPR OR: 0.70, 95% CI: 0.68 to 0.72).
Conclusions
Long-term patient adherence to oral antiviral therapy remains inadequate in patients with hepatitis B virus-related cirrhosis. Their adherence to oral antiviral therapy appears to be inversely associated with decompensation and mortality.
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Gonzalez-Cano-Caballero, M., Garcia-Gamez, M., Fernandez-Fernandez, E., Fernandez-Ordonez, E., Cano-Caballero, M. D., Guerra-Marmolejo, C.
BMJ Open, 13.06.2022
Tilføjet 13.06.2022
Introduction
Vaccination is a fundamental intervention in disease prevention; therefore, the advice and recommendations of health professionals have a major influence on the population’s decision to be vaccinated or not. Professionals must have sufficient competencies to carry out their work and recommend vaccination with evidence-based knowledge. The aim is to design and validate a strategy to improve professional competencies in vaccination to positively influence adherence and increase vaccination rates in the population.
Methods and analysis
Training will be designed based on evidence and previous studies and piloted with healthcare providers. To test changes in knowledge, a pretest and post-test will be conducted. To test feasibility, a think-aloud method will be used with participants and triangulated with focus groups using SWOT (strengths, weaknesses, opportunities and threats) analysis. Transfer will be measured using the questionnaire ‘factors for the indirect evaluation of transfer’ and an efficacy questionnaire 11/2 months later; for satisfaction, an ad hoc questionnaire will be used. A summative approach will be used for the analysis of the focus groups and descriptive and bivariate statistics for the questionnaires.
Ethics and dissemination
This study was approved by the Andalusian Research Ethics Committee, Spain (approval number: 0524-N-20). The results will be made available to the public at journal publications and scientific conferences.
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Dat, V. Q., Linh, B. T. K., Kim, G. B.
BMJ Open, 13.06.2022
Tilføjet 13.06.2022
Objective
The goal of this study was to describe the burden of disease and in-hospital mortality among patients admitted to the critical care units (CCUs) in Vietnam.
Design
Retrospective study.
Setting
The whole 1-year data of admissions to CCUs were collected from 34 hospitals from January to December 2018.
Participants
A total of 44 013 episodes of admission to CCUs were analysed.
Primary outcome
We used International Classification of Diseases-11 codes to assess the primary diagnosis associated with admissions and in-hospitals mortality. Years of life lost (YLL) measure was further used to estimate the burden of disease.
Results
The 0–5 years and ≥70 years age groups accounted for 14.8% (6508/44 013) and 26.1% (11 480/44 013) of all admissions, respectively. The most common diagnoses were diseases of the respiratory system (27.8% or 12 255/44 013), followed by unclassified symptoms, signs or clinical findings (13% or 5712/44 013), and diseases of the circulatory system (12.2% or 5380/44 013). Among 28 311 patients with available outcome data, 1681 individuals (5.9%) died during the hospitalisation. The in-hospital mortality rate increased with age, from 2.8% (86/3105) in under 5 years old age group to 23.1% (297/1288) in over 90-year age group. Diseases of the respiratory system was the leading causes of death in term of number of deaths (21.8% or 367/1681 of all deaths). Diagnosis of sepsis was associated with the highest in-hospital mortality (36.8%). The overall YLL under the age of 75 were 1287 per 1000 patients.
Conclusions
CCUs in Vietnam faced wide differences in the burden of diseases. Sufficient infrastructure and adequate multidisciplinary training are essential to ensure the appropriate response to the current needs of population.
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Euden, J., Thomas-Jones, E., Aston, S., Brookes-Howell, L., Carman, J., Carrol, E., Gilbert, S., Howard, P., Hood, K., Inada-Kim, M., Llewelyn, M., McGill, F., Milosevic, S., Niessen, L. W., Nsutebu, E., Pallmann, P., Schmidt, P., Taylor-Robinson, D., Welters, I., Todd, S., French, N., on behalf of the PRONTO team., Clarkstone, Hughes, Meister, Tabner, Barlow, Body, Bradburn, Daniels, Richards, Brain, Walker, Goodacre, Scarborough, O'Shea, James
BMJ Open, 13.06.2022
Tilføjet 13.06.2022
Introduction
Sepsis is a common, potentially life-threatening complication of infection. The optimal treatment for sepsis includes prompt antibiotics and intravenous fluids, facilitated by its early and accurate recognition. Currently, clinicians identify and assess severity of suspected sepsis using validated clinical scoring systems. In England, the National Early Warning Score 2 (NEWS2) has been mandated across all National Health Service (NHS) trusts and ambulance organisations. Like many clinical scoring systems, NEWS2 should not be used without clinical judgement to determine either the level of acuity or a diagnosis. Despite this, there is a tendency to overemphasise the score in isolation in patients with suspected infection, leading to the overprescription of antibiotics and potentially treatment-related complications and rising antimicrobial resistance. The biomarker procalcitonin (PCT) has been shown to be useful in specific circumstances to support appropriate antibiotics prescribing by identifying bacterial infection. PCT is not routinely used in the care of undifferentiated patients presenting to emergency departments (EDs), and the evidence base of its optimal usage is poor. The PROcalcitonin and NEWS2 evaluation for Timely identification of sepsis and Optimal (PRONTO) study is a randomised controlled trial (RCT) in adults with suspected sepsis presenting to the ED to compare standard clinical management based on NEWS2 scoring plus PCT-guided risk assessment with standard clinical management based on NEWS2 scoring alone and compare if this approach reduces prescriptions of antibiotics without increasing mortality.
Methods and analysis
PRONTO is a parallel two-arm open-label individually RCT set in up to 20 NHS EDs in the UK with a target sample size of 7676 participants. Participants will be randomised in a ratio of 1:1 to standard clinical management based on NEWS2 scoring or standard clinical management based on NEWS2 scoring plus PCT-guided risk assessment. We will compare whether the addition of PCT measurement to NEWS2 scoring can lead to a reduction in intravenous antibiotic initiation in ED patients managed as suspected sepsis, with at least no increase in 28-day mortality compared with NEWS2 scoring alone (in conjunction with local standard care pathways). PRONTO has two coprimary endpoints: initiation of intravenous antibiotics at 3 hours (superiority comparison) and 28-day mortality (non-inferiority comparison). The study has an internal pilot phase and group-sequential stopping rules for effectiveness and futility/safety, as well as a qualitative substudy and a health economic evaluation.
Ethics and dissemination
The trial protocol was approved by the Health Research Authority (HRA) and NHS Research Ethics Committee (Wales REC 2, reference 20/WA/0058). In England and Wales, the law allows the use of deferred consent in approved research situations (including ED studies) where the time dependent nature of intervention would not allow true informed consent to be obtained. PRONTO has approval for a deferred consent process to be used. Findings will be disseminated through peer-reviewed journals and presented at scientific conferences.
Trial registration number
ISRCTN54006056.
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Salwa, M., Haque, M. A., Islam, S. S., Islam, M. T., Sultana, S., Khan, M. M. H., Moniruzzaman, S.
BMJ Open, 13.06.2022
Tilføjet 13.06.2022
Objectives
To assess healthcare workers’ (HCWs) compliance with the infection prevention and control (IPC) practices and identify the factors influencing this compliance using the Health Belief Model as the theoretical framework.
Design
Quantitative data from an explanatory sequential mixed-methods study were employed in this research.
Participants and settings
From 17 May to 30 August 2020, 604 physicians and nurses working at six randomly selected tertiary care facilities in Dhaka City in Bangladesh took part in this study.
Primary and secondary outcome measures
Compliance with the WHO’s guidance on IPC measures, as well as the associated factors, was the primary outcome.
Results
A mean compliance score of 0.49 (±0.25) was observed on a 0–1 scale. HCWs were most compliant with the medical mask wearing guidelines (81%) and were least compliant with the high-touch surface decontamination regulations (23%). Compliance with the IPC guidance was significantly associated with increasing age, female sex, working as a nurse, having non-communicable diseases and history of exposure to patients with COVID-19. Perceived benefits (B=0.039, 95% CI 0.001 to 0.076), self-efficacy (B=0.101, 95% CI 0.060 to 0.142) and cues to action (B=0.045, 95% CI 0.002 to 0.088) were positively associated with compliance. Compliance with IPC guidance was 0.061 times greater among participants who reported low perceived barriers compared with those with high perceived barriers.
Conclusion
Overall, compliance with IPC guidance among HCWs was unsatisfactory. As self-efficacy exerted the greatest contribution to compliance, it should be emphasised in any endeavour to improve HCWs’ IPC adherence. Such interventions should also focus on perceived barriers, including unreliability of the information sources, unsafe working places and unavailability of protective equipment and cues to action, including trust in the administration and availability of adequate IPC guidance.
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Shariful Islam, M., AlWajeah, H., Rabbani, M. G., Ferdous, M., Mahfuza, N. S., Konka, D., Silenga, E., Zafar Ullah, A. N.
BMJ Open, 13.06.2022
Tilføjet 13.06.2022
Objectives
To examine the prevalence of and risk factors associated with tobacco smoking in the Gambia.
Design
A nationwide cross-sectional study.
Setting
The Gambia.
Participants
The study participants were both women and men aged between 15 and 49 years old. We included 16,066 men and women in our final analysis.
Data analysis
We analysed data from the Gambia Demographic and Health Survey (DHS), 2019–2020. DHS collected nationally stratified data from local government areas and rural–urban areas. The outcome variable was the prevalence of tobacco smoking. Descriptive analysis, prevalence and logistic regression methods were used to analyse data to identify the potential determinants of tobacco smoking.
Results
The response rate was 93%. The prevalence of current tobacco smoking was 9.92% in the Gambia in 2019–2020, of which, 81% of the consumers smoked tobacco daily. Men (19.3%) smoked tobacco much higher than women (0.65%) (p<0.001). People aged 40–49 years, with lower education, and manual workers were the most prevalent group of smoking in the Gambia (p<0.001).
Men were 33 times more likely to smoke tobacco than women. The chance of consuming smoked tobacco increased with the increase of age (adjusted OR (AOR) 9.08, 95% CI 5.08 to 16.22 among adults aged 40–49 years, p<0.001). The strength of association was the highest among primary educated individuals (AOR 5.35, 95% CI 3.35 to 8.54).
Manual workers (AOR 2.73) and people from the poorest households (AOR 1.86) were the risk groups for smoking. However, place of residency and region were insignificantly associated with smoking in the Gambia.
Conclusions
Men, older people, manual workers, individuals with lower education and lower wealth status were the vulnerable groups to tobacco smoking in the Gambia. Government should intensify awareness programmes on the harmful effects of smoking, and introduce proper cessation support services among tobacco smoking users prioritising these risk groups.
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Carvalho, C. R. R., Chate, R. C., Sawamura, M. V. Y., Garcia, M. L., Lamas, C. A., Cardenas, D. A. C., Lima, D. M., Scudeller, P. G., Salge, J. M., Nomura, C. H., Gutierrez, M. A., Members of the HCFMUSP COVID-19 Study Group, Members of the HCFMUSP Covid-19 Study Group, Araujo, Segurado, Montal, Miethke-Morais, Levin, Perondi, Guedes, Carmo, Lazari, Antonio, Tanaka, Leite, Gomes, Utiyama, Burdmann, Bonfa, Kallas, Sabino, Miguel, Pinna, Kawano, Busatto, Cerri, Fonseca, Souza, Marcilio, Rios, Hallak, Krieger, Ferreira, Marchini, Oliveira, Harima, Batisttella, Yu, M Castro, Rocha, Magri, Mancini, de Jesus, J M Correa, P B Francisco, Rossi, Silva, Imamura, Oliveira, Gouveia, Forlenza, Lotufo, Bento, Nitrini, Damiano, Chammas, Francisco, G Fusco, P Barros-Filho, Mauad, Guimaraes, Avelino-Silva, Filho
BMJ Open, 13.06.2022
Tilføjet 13.06.2022
Objective
This study aimed to propose a simple, accessible and low-cost predictive clinical model to detect lung lesions due to COVID-19 infection.
Design
This prospective cohort study included COVID-19 survivors hospitalised between 30 March 2020 and 31 August 2020 followed-up 6 months after hospital discharge. The pulmonary function was assessed using the modified Medical Research Council (mMRC) dyspnoea scale, oximetry (SpO2), spirometry (forced vital capacity (FVC)) and chest X-ray (CXR) during an in-person consultation. Patients with abnormalities in at least one of these parameters underwent chest CT. mMRC scale, SpO2, FVC and CXR findings were used to build a machine learning model for lung lesion detection on CT.
Setting
A tertiary hospital in Sao Paulo, Brazil.
Participants
749 eligible RT-PCR-confirmed SARS-CoV-2-infected patients aged ≥18 years.
Primary outcome measure
A predictive clinical model for lung lesion detection on chest CT.
Results
There were 470 patients (63%) that had at least one sign of pulmonary involvement and were eligible for CT. Almost half of them (48%) had significant pulmonary abnormalities, including ground-glass opacities, parenchymal bands, reticulation, traction bronchiectasis and architectural distortion. The machine learning model, including the results of 257 patients with complete data on mMRC, SpO2, FVC, CXR and CT, accurately detected pulmonary lesions by the joint data of CXR, mMRC scale, SpO2 and FVC (sensitivity, 0.85±0.08; specificity, 0.70±0.06; F1-score, 0.79±0.06 and area under the curve, 0.80±0.07).
Conclusion
A predictive clinical model based on CXR, mMRC, oximetry and spirometry data can accurately screen patients with lung lesions after SARS-CoV-2 infection. Given that these examinations are highly accessible and low cost, this protocol can be automated and implemented in different countries for early detection of COVID-19 sequelae.
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Tan, C. W., Cameron, M., Arlachov, Y., Bastounis, A., Bishop, S., Czernicki, M., Drummond, A., Fakis, A., Pasku, D., Sahota, O.
BMJ Open, 13.06.2022
Tilføjet 13.06.2022
Introduction
Vertebral fragility fractures (VFFs) are the most common type of osteoporotic fracture found in older people, resulting in increasing morbidity and excess mortality. These fractures can cause significant pain, requiring admission to hospital. Vertebroplasty (VP) is effective in reducing pain and allowing early mobilisation in hospitalised patients. However, it may be associated with complications such as cement leakage, infection, bleeding at the injection site and fracture of adjacent vertebrae. It is also costly and not readily accessible in many UK hospitals.
A recent retrospective study reported that spinal medial branch nerve block (MBNB), typically used to treat facet arthropathy, had similar efficacy in terms of pain relief compared with VP for the treatment of painful VFF. However, to date, no study has prospectively compared MBNB to VP. We therefore propose a prospective feasibility randomised controlled trial (RCT) to compare the role of MBNB to VP, in hospitalised older patients.
Method
A parallel, two-arm RCT with participants allocated on a 1:1 ratio to either standard care-VP or MBNB in hospitalised patients aged over 70 with acute osteoporotic vertebral fractures. Follow-up will be at weeks 1, 4 and 8 post intervention. The primary objective is to determine the feasibility and design of a future trial, including specific outcomes of recruitment, adherence to randomisation and safety. Embedded within the trial will be a health economic evaluation to understand resource utilisation and implications of the intervention and a qualitative study of the experiences and insights of trial participants and clinicians. Secondary outcomes will include pain scores, analgesia requirements, resource use and quality of life data.
Ethics and dissemination
Ethical approval was granted by the Yorkshire & the Humber Research Ethics Committee (reference 21/YH/0065). AVERT (Acute VertEbRal AugmentaTion) has received approval by the Health Research Authority (reference IRAS 293210) and is sponsored by Nottingham University Hospitals NHS Trust (reference 21HC001). Recruitment is ongoing. Results will be presented at relevant conferences and submitted to appropriate journals for publication on completion.
Trial registration number
ISRCTN18334053.
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Pollock, A., DCruz, K., Scheinberg, A., Botchway, E., Harms, L., Amor, D. J., Anderson, V., Bonyhady, B., Knight, S.
BMJ Open, 13.06.2022
Tilføjet 13.06.2022
Objectives
COVID-19 has led to rapid changes in rehabilitation service provision for young people living with traumatic brain and/or spinal cord injury. The aim of this project was to understand the experiences of rehabilitation service providers during the acute response stage of the COVID-19 pandemic. Specifically, we aimed to identify innovative approaches to meeting the ongoing needs of young people with traumatic brain and/or spinal cord injury during this time.
Setting
This study was conducted at a research institute and involved remote interviews with key informants around Australia and internationally.
Participants
Key informants from 11 services supporting children and/or adolescents with traumatic brain injury and/or spinal cord injury were interviewed using a semistructured interview guide. Interviews were transcribed and analysed using inductive thematic analysis.
Results
Three key themes emerged: (1) recognising and responding to the experiences of families during the pandemic, (2) the impact of greater use of telehealth on care delivery, and (3) realising opportunities to enhance family-centred care.
Conclusions
These themes capture shifting perspectives and process changes relevant to longer term practice. Research findings suggest opportunities for future service development, enabling service delivery that is more family centred, flexible and efficient in meeting the needs of families. Understanding these experiences and the changed nature of service delivery provides important insights with implications for future service improvement.
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Julia E. Koller, Karoline Villinger, Nadine C. Lages, Pilvikki Absetz, Melanie Bamert, Cátia Branquinho, Lourdes Chaves-Avilés, Panagiota Dimitropoulou, Ana Lucía Fernández-Fernández, Margarida Gaspar de Matos, Inguna Griskevica, Benicio Gutiérrez-Doña, Nelli Hankonen, Jennifer Inauen, Dimitrinka Jordanova Peshevska, Angelos P. Kassianos, Jelena Kolsenikova, Meta Lavrič, Tamara Mitanovska, Efrat Neter, Vita Poštuvan, Ingrida Trups-Kalne, Jorge Vargas-Carmiol, Harald T. Schupp, Britta Renner
International Journal of Infectious Diseases, 13.06.2022
Tilføjet 13.06.2022
The outbreak of COVID-19 has caused an international health emergency with large waves of infections (Johns Hopkins University, https://coronavirus. jhu.edu) and severely burdened health and economic systems (e.g., Sarkodie & Owusu, 2021). Governments worldwide have tried to control the outbreak by implementing various containment and mitigation strategies. In spring 2020, many governments intensified their efforts to slow down the spread of COVID-19 and reduce its impact on public health, the economy, and society.
Læs mere Tjek på PubMedJohn C. Lam, Raynell Lang, William Stokes
Clinical Microbiology and Infection, 13.06.2022
Tilføjet 13.06.2022
Bacterial prostatitis is a highly prevalent infection responsible for significant morbidity among men. The diagnosis and treatment for bacterial prostatitis remains complicated. The difficulty in diagnosis is in part owing to the paucity of high quality evidence that guides a clinician’s physical examination and informs interpretation of laboratory data in confirming patients’ history. Treatment is challenging due to the few antimicrobials capable of prostate penetration, growing antimicrobial resistance limiting effective treatment options, and the high risk of recurrence.
Læs mere Tjek på PubMedDavid S.Y. Ong, Ga-Lai M. Chong, Roy F. Chemaly, Olaf L. Cremer
Clinical Microbiology and Infection, 12.06.2022
Tilføjet 13.06.2022
Cytomegalovirus (CMV) infection is a well-recognized complication of solid organ and hematopoietic cell transplantation. However, CMV infection also occurs in patients with human immunodeficiency virus (HIV) infection, previously immunocompetent intensive care unit (ICU) patients, and individuals on immunosuppressive medications for various underlying diseases.
Læs mere Tjek på PubMedRujittika Mungmunpuntipantip, Viroj Wiwanitkit
Clinical Microbiology and Infection, 12.06.2022
Tilføjet 13.06.2022
We would like to correspond on the publication “Heterologous gam-covid-vac (sputnik V) / mRNA-1273 (moderna) vaccination induces a stronger humoral response than homologous sputnik V in a real-world data analysis [1]”. When compared to the homologous SpV/SpV immunisation, Pereson et al. found that the heterologous SpV/Mod combination against SARS-CoV-2 is well tolerated and greatly boosts humoral immune response [1]. We concur that COVID-19 immunisation, in whatever form, can provide protection and has clinical benefits.
Læs mere Tjek på PubMedNicola Luigi Bragazzi, Jude Dzevela Kong, Naim Mahroum, Christina Tsigalou, Rola Khamisy‐Farah, Manlio Converti, Jianhong Wu
Journal of Medical Virology, 13.06.2022
Tilføjet 13.06.2022
Piotr Kuśnierczyk
Frontiers in Immunology, 26.10.2022
Tilføjet 13.06.2022
To be, or not to be, that is the question. (William Shakespeare, Hamlet)Endoplasmic reticulum aminopeptidases 1 and 2 (ERAP1 and ERAP2, respectively) play a role in trimming peptides that are too long to be bound and presented by class I HLA (HLA-I) molecules to CD8+ T cells. They may also affect the HLA-I-presented peptide repertoire by overtrimming potential epitopes. Both enzymes may also be released from the cell to cleave cytokine receptors and regulate blood pressure. Both enzymes are polymorphic, which affects their expression, specificity, and activity, resulting in their role in diseases associated with HLA-I. In this brief review, we concentrate on ERAP2, less investigated because of its lack in laboratory mice and 25% of humans, as well as a lower polymorphism. ERAP2 was found to be associated with several diseases and to influence ERAP1 effects. It was discovered recently that the defective ERAP2 gene, not encoding functional aminopeptidase, may nevertheless, during viral infections, produce a truncated protein isoform of unknown function, possibly interfering with ERAP1 and full-length ERAP2 by heterodimer formation. The disease associations of ERAP2, alone or in combination with ERAP1, are reviewed.
Læs mere Tjek på PubMedJodie Langbeen, Alexander Dumoulin, Steven Vervaeke, Laetitia Missiaen, Dirk Vogelaers, Stijn Blot
Clinical Microbiology and Infection, 12.06.2022
Tilføjet 13.06.2022
With great interest we have read the comprehensive and clinical practice driven narrative review by Davis JS et al. “How I manage a patient with MRSA bacteraemia”.1 We would like to highlight the possibility of further optimizing vancomycin administration through continuous infusion, which is not mentioned in the paper. In our opinion, there is accumulating evidence for preferring continuous infusion of vancomycin (CIV) over intermittent infusion of the drug (IIV).
Læs mere Tjek på PubMedCuster B, Grebe E, Buccheri R, et al.
Journal of Infectious Diseases, 11.06.2022
Tilføjet 12.06.2022
AbstractBackgroundExcept for public health case reports, the incidence of Zika virus (ZIKV), chikungunya virus (CHIKV) and dengue virus (DENV) infection are not available to assess the potential blood transfusion safety threat in Brazil.MethodsPools of 6 donation samples (MP6) left over from HIV, HBV, and HCV nucleic acid testing were combined to create MP18 pools (3 MP6 pools). Samples were tested using the Grifols triplex ZIKV, CHIKV and DENV real-time transcription mediated amplification assay to estimate prevalence of RNAemia, incidence, and to compare these results to case reports in São Paulo, Belo Horizonte, Recife and Rio de Janeiro, from April 2016 – June 2019.ResultsZIKV, CHIKV and DENV RNAemia were found from donors who donated without overt symptoms of infection that would have led to deferral. The highest RNAemic donation prevalence was (1.2%, 95% CI 0.8–1.9) for DENV in Belo Horizonte in May 2019. Arbovirus infections varied by location, time of year, and were not always aligned with annual arbovirus outbreak seasons in different regions of the country.ConclusionsTesting donations for arboviruses in Brazil can contribute to public health. Transfusion recipients were likely exposed to ZIKV, CHIKV, DENV viremic blood components during the study period.
Læs mere Tjek på PubMedDickey BL, Giuliano AR, Sirak B, et al.
Journal of Infectious Diseases, 9.06.2022
Tilføjet 12.06.2022
AbstractHPV-related oropharyngeal cancer (OPC) incidence is increasing among men. Biomarkers that can identify oral HPV 16/18 infections likely to persist, the obligate precursor for HPV-OPC, are needed. Control of oral co-infections, including Epstein-Barr virus (EBV), could serve as a biomarker of immune competence and the ability to control oral HPV. We assessed the association between oral EBV and oral HPV 16/18 persistence among 63 men in the HIM Study who tested HPV16/18 positive. Detection of oral EBV was significantly associated with oral HPV 16/18 ≥ 12-month persistence and deserves evaluation as a biomarker for oral HPV persistence and related OPC.
Læs mere Tjek på PubMedBazzicalupo A.
FEMS Microbiology Reviews, 8.06.2022
Tilføjet 12.06.2022
AbstractIn this review I explore the pervasive but underappreciated role of local adaptation in Fungi. It has been difficult historically to study local adaptation in Fungi because of the limited understanding of fungal species and their traits, but new hope has been offered with technological advances in sequencing. The filamentous nature of Fungi invalidates some assumptions made in evolution because of their ability to exist as multinucleate entities with genetically different nuclei sharing the same cytoplasm. Many insights on local adaptation have come from studying Fungi, and much of the empirical evidence gathered about local adaptation in the context of host-pathogen interactions comes from studying fungal virulence genes, drug resistance, and environmental adaptation. Together, these insights paint a picture of the variety of processes involved in fungal local adaptation and their connections to the unusual cell biology of Fungi (multinucleate, filamentous habit), but there is much that remains unknown, with major gaps in our knowledge of fungal species, their phenotypes, and the ways by which they adapt to local conditions.
Læs mere Tjek på PubMedWang M, Buist G, van Dijl J.
FEMS Microbiology Reviews, 8.06.2022
Tilføjet 12.06.2022
AbstractStaphylococcus aureus is an important human and livestock pathogen that is well-protected against environmental insults by a thick cell wall. Accordingly, the wall is a major target of present-day antimicrobial therapy. Unfortunately, S. aureus has mastered the art of antimicrobial resistance, as underscored by the global spread of methicillin-resistant S. aureus (MRSA). The major cell wall component is peptidoglycan. Importantly, the peptidoglycan network is not only vital for cell wall function, but it also represents a bacterial Achilles’ heel. In particular, this network is continuously opened by no less than 18 different peptidoglycan hydrolases (PGHs) encoded by the S. aureus core genome, which facilitate bacterial growth and division. This focuses attention on the specific functions executed by these enzymes, their subcellular localization, their control at the transcriptional and post-transcriptional levels, their contributions to staphylococcal virulence and their overall importance in bacterial homeostasis. As highlighted in the present review, our understanding of the different aspects of PGH function in S. aureus has been substantially increased over recent years. This is important because it opens up new possibilities to exploit PGHs as innovative targets for next-generation antimicrobials, passive or active immunization strategies, or even to engineer them into effective antimicrobial agents.
Læs mere Tjek på PubMedLissens M, Joos M, Lories B, et al.
FEMS Microbiology Reviews, 8.06.2022
Tilføjet 12.06.2022
AbstractInterference with public good cooperation provides a promising novel antimicrobial strategy since social evolution theory predicts that resistant mutants will be counter-selected if they share the public benefits of their resistance with sensitive cells in the population. Although this hypothesis is supported by a limited number of pioneering studies, an extensive body of more fundamental work on social evolution describes a multitude of mechanisms and conditions that can stabilize public behaviour, thus potentially allowing resistant mutants to thrive. In this paper we theorize on how these different mechanisms can influence the evolution of resistance against public good inhibitors. Based hereon, we propose an innovative 5-step screening strategy to identify novel evolution-proof public good inhibitors, which involves a systematic evaluation of the exploitability of public goods under the most relevant experimental conditions, as well as a careful assessment of the most optimal way to interfere with their action. Overall, this opinion paper is aimed to contribute to long-term solutions to fight bacterial infections.
Læs mere Tjek på PubMedJungmi Chae, Bongyoung Kim, Dong-Sook Kim
International Journal of Infectious Diseases, 12.06.2022
Tilføjet 12.06.2022
: The Korean government published the first National Action Plan (NAP) on AMR in August 2016, followed by a second plan in November 2021. The objective of this study was to analyze changes in antibiotic use patterns after implementation of the NAP in South Korea.
Læs mere Tjek på PubMedInfection, 11.06.2022
Tilføjet 12.06.2022
Abstract
Purpose
Fosfomycin trometamol has been recommended as first-line bactericidal antibiotic for urinary tract infections in pregnant women since 2015 in France. However, studies assessing fosfomycin safety in pregnancy are sparse. This study aimed to assess the risk of major Congenital Anomaly (CA) after fosfomycin exposure during the first trimester of pregnancy.
Methods
We performed a comparative study in EFEMERIS, the French database including expecting mothers covered by the French Health Insurance System of Haute-Garonne from July 1st, 2004 to December 31th, 2018. EFEMERIS contains prescribed and dispensed reimbursed medications during pregnancy and pregnancy outcomes. Logistic regressions have been conducted to compare three groups: (1) pregnancies exposed at least once to fosfomycin; (2) pregnancies exposed at least once to nitrofurantoin; and (3) pregnancies exposed neither to fosfomycin nor to nitrofurantoin, another antibiotic prescribed for urinary infections, before and during pregnancy.
Results
A total of 2724 (2.0%) pregnant women received at least one fosfomycin prescription during the first trimester, 650 (0.5%) received nitrofurantoin during the first trimester, and 133,502 (97.5%) pregnant women were not exposed to fosfomycin nor to nitrofurantoin. First trimester pregnancy exposure to fosfomycin was not associated with an increased risk of major CA, compared to first trimester exposure to nitrofurantoin (2.0% versus 2.5%; ORa = 0.80 [0.44–1.47]), or to pregnancies unexposed to fosfomycin and nitrofurantoin (2.0% versus 2.1%; ORa = 0.97 [0.73–1.30]).
Conclusion
This is the first large comparative study assessing fosfomycin safety in pregnancy. It does not exhibit an increased risk of major CA after fosfomycin exposure during the first trimester of pregnancy.
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Malaria Journal, 11.06.2022
Tilføjet 12.06.2022
Abstract
The World Health Organization (WHO) recommends surveillance of molecular markers of resistance to anti-malarial drugs. This is particularly important in the case of mass drug administration (MDA), which is endorsed by the WHO in some settings to combat malaria. Dihydroartemisinin-piperaquine (DHA-PPQ) is an artemisinin-based combination therapy which has been used in MDA. This review analyses the impact of MDA with DHA-PPQ on the evolution of molecular markers of drug resistance. The review is split into two parts. Section I reviews the current evidence for different molecular markers of resistance to DHA-PPQ. This includes an overview of the prevalence of these molecular markers in Plasmodium falciparum Whole Genome Sequence data from the MalariaGEN Pf3k project. Section II is a systematic literature review of the impact that MDA with DHA-PPQ has had on the evolution of molecular markers of resistance. This systematic review followed PRISMA guidelines. This review found that despite being a recognd surveillance tool by the WHO, the surveillance of molecular markers of resistance following MDA with DHA-PPQ was not commonly performed. Of the total 96 papers screened for eligibility in this review, only 20 analysed molecular markers of drug resistance. The molecular markers published were also not standardized. Overall, this warrants greater reporting of molecular marker prevalence following MDA implementation. This should include putative pfcrt mutations which have been found to convey resistance to DHA-PPQ in vitro.
Læs mere Tjek på PubMedMalaria Journal, 11.06.2022
Tilføjet 12.06.2022
Abstract
Background
Malaria is a major cause of morbidity and mortality globally, especially in sub-Saharan Africa. Widespread resistance to pyrethroids threatens the gains achieved by vector control. To counter resistance to pyrethroids, third-generation indoor residual spraying (3GIRS) products have been developed. This study details the results of a multi-country cost and cost-effectiveness analysis of indoor residual spraying (IRS) programmes using Actellic®300CS, a 3GIRS product with pirimiphos-methyl, in sub-Saharan Africa in 2017 added to standard malaria control interventions including insecticide-treated bed nets versus standard malaria control interventions alone.
Methods
An economic evaluation of 3GIRS using Actellic®300CS in a broad range of sub-Saharan African settings was conducted using a variety of primary data collection and evidence synthesis methods. Four IRS programmes in Ghana, Mali, Uganda, and Zambia were included in the effectiveness analysis. Cost data come from six IRS programmes: one in each of the four countries where effect was measured plus Mozambique and a separate programme conducted by AngloGold Ashanti Malaria Control in Ghana. Financial and economic costs were quantified and valued. The main indicator for the cost was cost per person targeted. Country-specific case incidence rate ratios (IRRs), estimated by comparing IRS study districts to adjacent non-IRS study districts or facilities, were used to calculate cases averted in each study area. A deterministic analysis and sensitivity analysis were conducted in each of the four countries for which effectiveness evaluations were available. Probabilistic sensitivity analysis was used to generate plausibility bounds around the incremental cost-effectiveness ratio estimates for adding IRS to other standard interventions in each study setting as well as jointly utilizing data on effect and cost across all settings.
Results
Overall, IRRs from each country indicated that adding IRS with Actellic®300CS to the local standard intervention package was protective compared to the standard intervention package alone (IRR 0.67, [95% CI 0.50–0.91]). Results indicate that Actellic®300CS is expected to be a cost-effective (> 60% probability of being cost-effective in all settings) or highly cost-effective intervention across a range of transmission settings in sub-Saharan Africa.
Discussion
Variations in the incremental costs and cost-effectiveness likely result from several sources including: variation in the sprayed wall surfaces and house size relative to household population, the underlying malaria burden in the communities sprayed, the effectiveness of 3GIRS in different settings, and insecticide price. Programmes should be aware that current recommendations to rotate can mean variation and uncertainty in budgets; programmes should consider this in their insecticide-resistance management strategies.
Conclusions
The optimal combination of 3GIRS delivery with other malaria control interventions will be highly context specific. 3GIRS using Actellic®300CS is expected to deliver acceptable value for money in a broad range of sub-Saharan African malaria transmission settings.
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Malaria Journal, 11.06.2022
Tilføjet 12.06.2022
Abstract
Background
To sustain high universal Long-Lasting Insecticidal Nets (LLINs) coverage, affordable nets that provide equivalent or better protection than standard LLINs, are required. Test facilities evaluating new LLINs require compliance to Good Laboratory Practice (GLP) standards to ensure the quality and integrity of test data. Following GLP principles allows for the reconstruction of activities during the conduct of a study and minimizes duplication of efficacy testing. This case study evaluated the efficacy of two LLINs: SafeNet NF® and SafeNet® LLIN.
Methods
The study was conducted according to GLP principles and followed World Health Organization guidelines for evaluating LLINs. The LLINs were assessed in experimental huts against wild, pyrethroid-resistant Anopheles arabiensis mosquitoes. Nets were either unwashed or washed 20 times and artificially holed to simulate a used torn net. Blood-feeding inhibition and mortality were compared with a positive control (Interceptor® LLIN) and an untreated net.
Results
Mosquito entry in the huts was reduced compared to negative control for the unwashed SafeNet NF, washed Safenet LLIN and the positive control arms. Similar exiting rates were found for all the treatment arms. Significant blood-feeding inhibition was only found for the positive control, both when washed and unwashed. All insecticide treatments induced significantly higher mortality compared to an untreated net. Compared to the positive control, the washed and unwashed SafeNet NF® resulted in similar mortality. For the SafeNet® LLINs the unwashed net had an equivalent performance, but the mortality for the washed net was significantly lower than the positive control.
Internal audits of the study confirmed that all critical phases complied with Standard Operating Procedures (SOPs) and the study plan. The external audit confirmed that the study complied with GLP standards.
Conclusions
SafeNet NF® and SafeNet® LLIN offered equivalent protection to the positive control (Interceptor® LLIN). However, further research is needed to investigate the durability, acceptability, and residual efficacy of these nets in the community. This study demonstrated that GLP-compliant evaluation of LLINs can be successfully conducted by African research institutions.
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Sawai Singh Rathore, Sharvi Oberoi, Jonathan Hilliard, Ritesh Raja, Noman Khurshid Ahmed, Yogesh Vishwakarma, Kinza Iqbal, Chandani Kumari, Felipe Velasquez‐Botero, María Alejandra Nieto‐Salazar, Guillermo Andrés Moreno Cortes, Edwin Akomaning, Islam elFatih Mohamed Musa
Tropical Medicine & International Health, 11.06.2022
Tilføjet 12.06.2022
Mariёlle Kloek, Caroline A. Bulstra, Sungai T. Chabata, Elizabeth Fearon, Isaac Taramusi, Sake J. de Vlas, Frances M. Cowan, Jan A. C. Hontelez
Tropical Medicine & International Health, 10.06.2022
Tilføjet 12.06.2022
Ritah F. Mutagonda, Hellen Siril, Sylvia Kaaya, Theresia Amborose, Tausi Haruna, Aisa Mhalu, David Urassa, Expeditho Mtisi, Candida Moshiro, Edith Tarimo, Gladys Reuben Mahiti, Agape Minja, Magreth Somba, Francis August, Ferdinand Mugusi
Tropical Medicine & International Health, 10.06.2022
Tilføjet 12.06.2022