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Jinlv Qin, Guizuo Wang, Dong Han
International Journal of Infectious Diseases, 13.06.2022
Tilføjet 14.06.2022
The PLOS ONE Editors
PLoS One Infectious Diseases, 13.06.2022
Tilføjet 13.06.2022
Akiko Hirotsu, Mariko Miyao, Kenichiro Tatsumi, Tomoharu Tanaka
PLoS One Infectious Diseases, 13.06.2022
Tilføjet 13.06.2022
by Akiko Hirotsu, Mariko Miyao, Kenichiro Tatsumi, Tomoharu Tanaka
Septic patients commonly present with central nervous system (CNS) disorders including impaired consciousness and delirium. Today, the main mechanism regulating sepsis-induced cerebral disorders is believed to be neuroinflammation. However, it is unknown how another component of the CNS, the spinal cord, is influenced during sepsis. In the present study, we intraperitoneally injected mice with lipopolysaccharide (LPS) to investigate molecular and immunohistochemical changes in the spinal cord of a sepsis model. After LPS administration in the spinal cord, pro-inflammatory cytokines including interleukin (IL)-1β, IL-6, and tumor necrosis factor alpha mRNA were rapidly and drastically induced. Twenty-four-hour after the LPS injection, severe neuronal ischemic damage spread into gray matter, especially around the anterior horns, and the anterior column had global edematous changes. Immunostaining analyses showed that spinal microglia were significantly activated and increased, but astrocytes did not show significant change. The current results indicate that sepsis induces acute neuroinflammation, including microglial activation and pro-inflammatory cytokine upregulation in the spinal cord, causing drastic neuronal ischemia and white matter edema in the spinal cord.
Læs mere Tjek på PubMedSimanta Roy, Mohammad Azmain Iktidar, Sreshtha Chowdhury, A. M. Khairul Islam, Auditia Deb, Shresta Chowdhury, Shahidur Rahman, Madhuritu Bhadra Medha, Antara Das Gupta, Afia Tasnim, Rifat Ara, Mohammad Delwer Hossain Hawlader
PLoS One Infectious Diseases, 13.06.2022
Tilføjet 13.06.2022
by Simanta Roy, Mohammad Azmain Iktidar, Sreshtha Chowdhury, A. M. Khairul Islam, Auditia Deb, Shresta Chowdhury, Shahidur Rahman, Madhuritu Bhadra Medha, Antara Das Gupta, Afia Tasnim, Rifat Ara, Mohammad Delwer Hossain Hawlader
Following the worldwide COVID-19 pandemic, individuals have begun to take preventive measures to avoid exposure. Among the precautionary measures, facemask was mostly emphasized. This study aimed to determine the prevalence of dermatological symptoms linked with face mask usage and explore other associated factors. This cross-sectional survey was conducted throughout all eight divisions of Bangladesh. 1297 people were approached using a fixed-step procedure on a random route sample where 803 fulfilled the inclusion criteria. The overall prevalence of dermatological manifestation in this study was 40.85%. The common dermatological manifestations due to facemasks use were acne (26%), allergy symptoms (24%), traumatic symptoms (24%), and other symptoms (26%). Two important frequently reported risk factors were previous history of skin diseases and obesity. Females were more likely to have acne (CI: 1.199, 3.098; p = .007) and allergy issues (CI: 1.042, 2.359; p = .031). N95 and KN95 masks were more likely to produce allergic symptoms, while surgical mask users were more likely to develop acne. Acne was prevalent more than twice (CI: 1.42, 4.26; p = 0.001) in persons with a COVID-19 infection history. Further exploration is required to find out the reason. Surgical mask users reported more complaints than other types of masks, and prolonged use caused more skin symptoms. Modifications in the pattern of facemask usage and planning for work recesses might also be advised to provide for a pause from uninterrupted facemask use.
Læs mere Tjek på PubMedChristos Papaneophytou, Andria Nicolaou, Myrtani Pieri, Vicky Nicolaidou, Eleftheria Galatou, Yiannis Sarigiannis, Markella Pantelidou, Pavlos Panayi, Theklios Thoma, Antonia Stavraki, Xenia Argyrou, Tasos Kalogiannis, Kyriacos Yiannoukas, Christos C. Petrou, Kyriacos Felekkis
PLoS One Infectious Diseases, 13.06.2022
Tilføjet 13.06.2022
by Christos Papaneophytou, Andria Nicolaou, Myrtani Pieri, Vicky Nicolaidou, Eleftheria Galatou, Yiannis Sarigiannis, Markella Pantelidou, Pavlos Panayi, Theklios Thoma, Antonia Stavraki, Xenia Argyrou, Tasos Kalogiannis, Kyriacos Yiannoukas, Christos C. Petrou, Kyriacos Felekkis
Monitoring the levels of IgG antibodies against the SARS-CoV-2 is important during the coronavirus disease 2019 (COVID-19) pandemic, to plan an adequate and evidence-based public health response. After this study we report that the plasma levels of IgG antibodies against SARS-CoV-2 spike protein were higher in individuals with evidence of prior infection who received at least one dose of either an mRNA-based vaccine (Comirnaty BNT162b2/Pfizer-BioNTech or Spikevax mRNA-1273/Moderna) or an adenoviral-based vaccine (Vaxzervia ChAdOx1 nCoV-19 /Oxford-Astra Zeneca) (n = 39) compared to i) unvaccinated individuals with evidence of prior infection with SARS-CoV-2 (n = 109) and ii) individuals without evidence of prior infection with SARS-CoV-2 who received one or two doses of one of the aforementioned vaccines (n = 342). Our analysis also revealed that regardless of the vaccine technology (mRNA-based and adenoviral vector-based) two doses achieved high anti- SARS-CoV-2 IgG responses. Our results indicate that vaccine-induced responses lead to higher levels of IgG antibodies compared to those produced following infection with the virus. Additionally, in agreement with previous studies, our results suggest that among individuals previously infected with SARS-CoV-2, even a single dose of a vaccine is adequate to elicit high levels of antibody response.
Læs mere Tjek på PubMedRongrong Lin, Qi Zhang, Li Yin, Yiwen Zhang, Qilin Yang, Kai Liu, Yingdian Wang, Shengcheng Han, Huixin Zhao, Heping Zhao
PLoS One Infectious Diseases, 13.06.2022
Tilføjet 13.06.2022
by Rongrong Lin, Qi Zhang, Li Yin, Yiwen Zhang, Qilin Yang, Kai Liu, Yingdian Wang, Shengcheng Han, Huixin Zhao, Heping Zhao
Bacillus subtilis strain Z15 (BS-Z15) was isolated from the cotton field of Xinjiang, China, and characterized as an effective biocontrol agent antagonizing plant pathogen Verticillium dahliae 991 (VD-991). However, the chemical substance produced by BS-Z15 for resistance to VD-991 remains elusive. Here, a serial purification methods including HCl precipitation, organic solvent extraction, and separation by semi-preparative High-Performance Liquid Chromatography were performed to obtain a single compound about 3.5 mg/L from the fermentation broth of BS-Z15, which has an antifungal activity against VD-991. Moreover, Fourier Transform Infrared spectrum, Nuclear Magnetic Resonance Spectroscopy, and Tandem Mass Spectrometry analyses were carried out to finally confirm that the active compound from BS-Z15 is a mycosubtilin homologue with C17 fatty acid chain. Genomic sequence prediction and PCR verification further showed that the BS-Z15 genome contains the whole mycosubtilin operon comprising four ORFs: fenF, mycA, mycB, and mycC, and the expression levels of mycA-N, mycB-Y and mycC-N reached a peak at 32-h fermentation. Although mycosubtilin homologue at 1 μg/mL promoted the germination of cotton seed, that with high concentration at 10 μg/mL had no significant effect on seed germination, plant height and dry weight. Furthermore, mycosubtilin homologue sprayed at 10 μg/mL on two-week-old cotton leaves promotes the expression of pathogen-associated genes and gossypol accumulation, and greatly decreases VD-991 infection in cotton with disease index statistics. This study provides an efficient purification strategy for mycosubtilin homologue from BS-Z15, which can potentially be used as a biocontrol agent for controlling verticillium wilt in cotton.
Læs mere Tjek på PubMedSamuel D. Mason, Samuel C. R. Sherratt, Samantha M. Kruguer, Michael Muthersbaugh, Jonathan P. Harris, Wayne C. Gatlin, Justin D. Topp, Gregory S. Keller
PLoS One Infectious Diseases, 13.06.2022
Tilføjet 13.06.2022
by Samuel D. Mason, Samuel C. R. Sherratt, Samantha M. Kruguer, Michael Muthersbaugh, Jonathan P. Harris, Wayne C. Gatlin, Justin D. Topp, Gregory S. Keller
Habitat fragmentation and heterogeneity transform otherwise contiguous tracks of forest into smaller patches in the northeastern U.S. and likely impact abundances, movement patterns, and disease transmission pathways for small-mammal communities at multiple scales. We sought to determine the structure of a small-mammal community in terms of mammal abundance and infection prevalence of Borrelia burgdorferi sensu stricto (s.s.), Anaplasma phagocytophilum, and Babesia microti within a fragmented landscape in Essex County, Massachusetts, USA. We studied communities at multiple spatial scales, including vegetation, edge type, and landscape (including 200-m, 500-m, and 1000-m radii) scales. A total of 16 study sites were chosen to represent four edge types: interior forest, pasture edge, natural edge, and residential edge. At each site, we trapped small mammals and conducted vegetation surveys and GIS analysis. Upon capture, a tissue sample was collected to analyze for presence of pathogens. Northern short-tailed shrew (Blarina brevicauda) abundance did not differ based on edge type, whereas abundance of the white-footed mouse (Peromyscus leucopus) was greatest at pasture edges, although the relationship was relatively weak. White-footed mouse abundance was negatively associated with amount of forested area within a 500-m radius, whereas northern short-tailed shrew abundance demonstrated a positive relationship with fragmentation indices at the 200-m radius. White-footed mice captured at interior-forest habitat were more likely be infected with B. burgdorferi (s.s.) than individuals from edge habitat. Greater prevalence of B. burgdorferi infection of white-footed mice in forest interiors compared to edge habitats counters previous studies. Reasons for this and implications are discussed.
Læs mere Tjek på PubMedRonald A. Brooks, Omar Nieto, Martin Santillan Jr., Amanda Landrian, Anne E. Fehrenbacher, Alejandra Cabral
PLoS One Infectious Diseases, 13.06.2022
Tilføjet 13.06.2022
by Ronald A. Brooks, Omar Nieto, Martin Santillan Jr., Amanda Landrian, Anne E. Fehrenbacher, Alejandra Cabral
Background HIV infections disproportionately impact Latino gay and bisexual men (GBM) in the United States. Pre-Exposure Prophylaxis (PrEP) is a proven prevention strategy that can help reduce new HIV infections in this population. Unfortunately, PrEP adoption and persistence among Latino GBM remain low. The added benefits of using PrEP experienced by Latino GBM can provide important insights to inform the development of PrEP messaging to motivate this population to explore and consider PrEP as an appropriate and acceptable HIV prevention tool. Methods We conducted in-depth interviews with Latino GBM PrEP users to explore positive feelings and emotions, and additional benefits gained from using PrEP. Data were analyzed using thematic analysis. Results A total of 29 Latino GBM completed the study interview. The average age of participants was 30 years, and the mean length of time using PrEP was 17.1 months. Five themes were constructed from the data representing the additional benefits gained by Latino GBM PrEP users, and included: (1) reduced fear, anxiety, and stress about HIV, HIV testing, and sex; (2) feeling empowered and in control of their HIV risk; (3) greater awareness of sexual risk behaviors and sexual health; (4) greater sexual exploration and pleasure, and comfort having condomless sex; and (5) a greater connection to community and a feeling of contributing to the elimination of HIV. Conclusions The added benefits identified in this study represent a range of social, emotional, and psychological benefits that Latino GBM experience while using PrEP. They speak to the complementary benefits that PrEP can bring to Latino GBM who decide to use the medication, that go beyond HIV prevention. These findings can inform the development of future PrEP messaging to help improve motivation for PrEP uptake and persistent use among Latino GBM.
Læs mere Tjek på PubMedNatthaya Chuaypen, Surachate Siripongsakun, Pantajaree Hiranrat, Natthaporn Tanpowpong, Anchalee Avihingsanon, Pisit Tangkijvanich
PLoS One Infectious Diseases, 13.06.2022
Tilføjet 13.06.2022
by Natthaya Chuaypen, Surachate Siripongsakun, Pantajaree Hiranrat, Natthaporn Tanpowpong, Anchalee Avihingsanon, Pisit Tangkijvanich
Significant liver fibrosis regression occurs after hepatitis C virus (HCV) therapy. However, the impact of direct-acting antivirals (DAAs) on steatosis is less clear. This study was aimed at evaluating serial fibrosis and steatosis alterations in patients with HCV genotype 1, who achieved sustained virological response (SVR). We enrolled 55 HCV mono-infected and 28 HCV/HIV co-infected patients receiving elbasvir/grazoprevir from a clinical trial. Fibrosis and steatosis were assessed at baseline, follow-up week-24 (FUw24) and week-72 (FUw72) by magnetic resonance elastography (MRE) and proton density fat fraction (PDFF), respectively. Patatin-like phospholipase domain-containing protein 3 (PNPLA3) rs738409, transmembrane six superfamily member 2 (TM6SF2) rs58542926 and membrane bound O-acyltransferase domain-containing 7 (MBOAT7) rs641738 polymorphisms were determined by allelic discrimination. Overall, mean MRE decreased significantly from baseline to FUw24 and FUw72. At FUw72, patients with baseline F2-F4 had higher rate of ≥30% MRE decline compared with individuals with baseline F0-F1 (30.2%vs.3.3%, P = 0.004). In multivariate analysis, significant fibrosis was associated with MRE reduction. The prevalence of steatosis (PDFF≥5.2%) at baseline was 21.7%. Compared to baseline, there were 17 (20.5%) patients with decreased PDFF values at FUw72 (
Læs mere Tjek på PubMedMayara Louise Torres, David Palma Díaz, Alba Oliver-Parra, Joan-Pau Millet, Delfí Cosialls, Montserrat Guillaumes, Cristina Rius, Hugo Vásquez-Vera
PLoS One Infectious Diseases, 13.06.2022
Tilføjet 13.06.2022
by Mayara Louise Torres, David Palma Díaz, Alba Oliver-Parra, Joan-Pau Millet, Delfí Cosialls, Montserrat Guillaumes, Cristina Rius, Hugo Vásquez-Vera
Background Residents of Nursing Homes (NHs) have suffered greater impacts from the COVID-19 pandemic. However, the rates of COVID-19 in these institutions are heterogeneously distributed. Describing and understanding the structural, functional, and socioeconomic differences between NHs is extremely important to avoid new outbreaks. Objectives Analyze inequalities in the cumulative incidences (CIs) and in the mortality rates (MRs) due to COVID-19 in the NHs of Barcelona based on the characteristics of the NHs. Methods Exploratory ecological study of 232 NHs. The dependent variables were the cumulative incidence and mortality rate due to COVID-19 in NHs between March and June 2020. Structural variables of the NHs were evaluated such as neighborhood socioeconomic position (SEP), isolation and sectorization capacity, occupancy, overcrowding and ownership. Results The cumulative incidence and mortality rate were higher in the low SEP neighborhoods and lower in those of high SEP neighborhoods. Regarding the isolation and sectorization capacity, Type B NHs had a higher risk of becoming infected and dying, while Type C had a lower risk of dying than Type A. Greater overcrowding was associated with greater morbidity and mortality, and higher occupancy was associated with higher incidence. The risk of becoming infected and dying in public NHs was significantly higher than for-profit NH. Conclusions The social components together with the functional and infrastructure characteristics of the NHs influence the cumulative incidence and the mortality rate by COVID-19. It is necessary to redefine the care model in the NHs to guarantee the health of the residents.
Læs mere Tjek på PubMedAyan Saha, Kay Kay Shain Marma, Afrah Rashid, Nowshin Tarannum, Srabanty Das, Tonmoy Chowdhury, Nusrat Afrin, Prashanta Chakraborty, Md. Emran, H. M. Hamidullah Mehedi, Mohammad Imdad Hussain, Ashim Barua, Sabuj Kanti Mistry
PLoS One Infectious Diseases, 13.06.2022
Tilføjet 13.06.2022
by Ayan Saha, Kay Kay Shain Marma, Afrah Rashid, Nowshin Tarannum, Srabanty Das, Tonmoy Chowdhury, Nusrat Afrin, Prashanta Chakraborty, Md. Emran, H. M. Hamidullah Mehedi, Mohammad Imdad Hussain, Ashim Barua, Sabuj Kanti Mistry
Background In developing countries like Bangladesh, self-medication has become a predicament associated with health risks and clinical complications. To date, no studies have been conducted on the practice of self-medication among the indigenous population living in Chittagong Hill Tract (CHT). Objectives This study was aimed to determine the prevalence of self-medication and analyzing the factors associated with it among the indigenous population in CHT. Methods This cross-sectional study was conducted from late October to early December 2020; among different indigenous group populations residing in the three districts of CHT aged 18 or more. A pre-tested and semi-structured questionnaire was developed to collect data on socio-demographic characteristics, health status, frequency of self-medication, reasons for self-medication in last one year, as well as other variables. Multivariate logistic regression was performed to assess associated factors with self-medication. Results A total of 1350 people from different indigenous populations were interviewed, among whom 49.9% practiced self-medication. The rate of self-prescribed antibiotics usage (80.9%) was significantly higher compared to other drugs. Self-prescribed medications were mostly used for diarrhea and food poisoning (60.6%), cough, cold and fever (51.4%), and headache (51.4%). A common source of self-prescribed medicines was community or retail pharmacy and the most reported reason for self-prescribed medication was the long-distance of healthcare facilities from home. Conclusion The prevalence of self-medication is substantially high among indigenous people and the effect is alarming. Particular concern is the misuse of antibiotics and analgesic drugs. Increasing awareness among the population of the negative effect of self-medication and implementation of proper policies and actions are urgently needed to prevent self-medication among indigenous population in Bangladesh.
Læs mere Tjek på PubMedYasir Bin Nisar, Samira Aboubaker, Shams El Arifeen, Shabina Ariff, Narendra Arora, Shally Awasthi, Adejumoke Idowu Ayede, Abdullah H. Baqui, Ashish Bavdekar, Melkamu Berhane, Temsunaro Rongsen Chandola, Abadi Leul, Salim Sadruddin, Antoinette Tshefu, Robinson Wammanda, Assaye Nigussie, Lee Pyne-Mercier, Luwei Pearson, Neal Brandes, Steve Wall, Shamim A. Qazi, Rajiv Bahl
PLoS One Infectious Diseases, 13.06.2022
Tilføjet 13.06.2022
by Yasir Bin Nisar, Samira Aboubaker, Shams El Arifeen, Shabina Ariff, Narendra Arora, Shally Awasthi, Adejumoke Idowu Ayede, Abdullah H. Baqui, Ashish Bavdekar, Melkamu Berhane, Temsunaro Rongsen Chandola, Abadi Leul, Salim Sadruddin, Antoinette Tshefu, Robinson Wammanda, Assaye Nigussie, Lee Pyne-Mercier, Luwei Pearson, Neal Brandes, Steve Wall, Shamim A. Qazi, Rajiv Bahl
Introduction Research on simplified antibiotic regimens for outpatient treatment of ‘Possible Serious Bacterial Infection’ (PSBI) and the subsequent World Health Organization (WHO) guidelines provide an opportunity to increase treatment coverage. This multi-country implementation research initiative aimed to learn how to implement the WHO guideline in diverse contexts. These experiences have been individually published; this overview paper provides a summary of results and lessons learned across sites. Methods summary A common mixed qualitative and quantitative methods protocol for implementation research was used in eleven sites in the Democratic Republic of Congo (Equateur province), Ethiopia (Tigray and Oromia regions), India (Haryana, Himachal Pradesh, Maharashtra, and Uttar Pradesh states), Malawi (Central Region), Nigeria (Kaduna and Oyo states), and Pakistan (Sindh province). Key steps in implementation research were: i) policy dialogue with the national government and key stakeholders, ii) the establishment of a ‘Technical Support Unit’ with the research team and district level managers, and iii) development of an implementation strategy and its refinement using an iterative process of implementation, programme learning and evaluation. Results summary All sites successfully developed and evaluated an implementation strategy to increase coverage of PSBI treatment. During the study period, a total of 6677 young infants from the study catchment area were identified and treated at health facilities in the study area as inpatients or outpatients among 88179 live births identified. The estimated coverage of PSBI treatment was 75.7% (95% CI 74.8% to 78.6%), assuming a 10% incidence of PSBI among all live births. The treatment coverage was variable, ranging from 53.3% in Lucknow, India to 97.3% in Ibadan, Nigeria. The coverage of inpatient treatment ranged from 1.9% in Zaria, Nigeria, to 33.9% in Tigray, Ethiopia. The outpatient treatment coverage ranged from 30.6% in Pune, India, to 93.6% in Zaria, Nigeria. Overall, the case fatality rate (CFR) was 14.6% (95% CI 11.5% to 18.2%) for 0-59-day old infants with critical illness, 1.9% (95% CI 1.5% to 2.4%) for 0-59-day old infants with clinical severe infection and 0.1% for fast breathing in 7–59 days old. Among infants treated as outpatients, CFR was 13.7% (95% CI 8.7% to 20.2%) for 0-59-day old infants with critical illness, 0.9% (95% CI 0.6% to 1.2%) for 0-59-day old infants with clinical severe infection, and 0.1% for infants 7–59 days old with fast breathing. Conclusion Important lessons on how to conduct each step of implementation research, and the challenges and facilitators for implementation of PSBI management guideline in routine health systems are summarised and discussed. These lessons will be used to introduce and scale-up implementation in relevant Low- and middle-income countries.
Læs mere Tjek på PubMedOral Capps Jr.
PLoS One Infectious Diseases, 13.06.2022
Tilføjet 13.06.2022
by Oral Capps Jr.
Using polynomial distributed lag (PDL) models, the impacts of macroeconomic factors relating to economic, financial, and sociological stress and designed to be short-run predictors of U.S. economic performance are identified and assessed concerning participation in key food assistance programs (SNAP, WIC, and NSLP). The econometric analysis covers the period October 1999 to September 2020. The impact of COVID-19 on participation in these programs also is quantified. Based on the parameter estimates obtained from the econometric PDL models, ex-ante forecasts of participation in the SNAP, WIC, and NSLP subsequently are made and evaluated over the period October 2020 to August 2021. The empirical results show that different sets of macroeconomic drivers affect participation levels across the respective food assistance programs. No macroeconomic factor is common across SNAP, WIC, and NSLP participation. Changes in macroeconomic conditions which influence SNAP, WIC and NSLP participation are not just contemporaneous but also affect participation levels anywhere from 1 month to 12 months later. Importantly, this research allows not only the determination of the macroeconomic factors which affect program participation but also allows the determination of the ability of the respective models to forecast program participation. As such, the Food and Nutrition Service will be in better position to assess program needs as well as to forecast program participation levels to minimize errors in the budgetary process.
Læs mere Tjek på PubMedBMC 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
Læs mere Tjek på PubMed
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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BMC Infectious Diseases, 13.06.2022
Tilføjet 13.06.2022
Abstract
Background
Tuberculosis is a bacterial infection involving multiple organs and systems. Its hematological presentation mainly includes anemia and leukocytosis. Evans syndrome is a rare autoimmune disease characterized by autoimmune hemolytic anemia, immune thrombocytopenia, and neutropenia, with positive results for the direct Coombs test and platelet antibodies. The cooccurrence of tuberculosis and Evans syndrome is rarely reported.
Case presentation
A 69-year-old female presented with a fever and shortness of breath. Her chest computerized tomography scan showed extensive miliary nodules in the bilateral lung fields. She rapidly developed respiratory failure that required endotracheal intubation and mechanical ventilation. The acid-fast bacilli sputum smear results indicated a grade of 3+. Later on, blood testing revealed hemolytic anemia, a positive direct Coombs test result, and the presence of the platelet antibody IgG. This patient was diagnosed as having disseminated pulmonary tuberculosis and Evans syndrome. She successfully recovered after treatment with antituberculosis drugs and glucocorticoids.
Conclusions
Tuberculosis can occur together with Evans syndrome. Affected patients should receive both antituberculosis and immunosuppressive drugs.
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BMC Infectious Diseases, 13.06.2022
Tilføjet 13.06.2022
Abstract
Background
The SARS-COV2 pandemic has been ongoing worldwide since at least 2 years. In severe cases, this infection triggers acute respiratory distress syndrome and quasi-systemic damage with a wide range of symptoms. Long-term physical and psychological consequences of this infection are therefore naturally present among these patients. The aim of this study was to describe the state of health of these patients at 6 (M6) and 12 months (M12) after infection onset, and compare quality-of-life (QOL) and fatigue at these time-points.
Methods
A prospective cohort study was set up at Reims University Hospital. Patients were clinically assessed at M6 and M12. Three scores were calculated to describe patient’s status: the modified Medical Research Council score (mMRC) used to determine dyspnoea state, the Fatigue Severity Scale (FSS) and the Short Form 12 (SF12) that was carried out to determine the QOL both mentally and physically (MCS12 and PCS12). Descriptive analysis and comparison of scores between M6 and M12 were made.
Results
120 patients completed both follow-up consultations. Overall, about 40% of the patients presented dyspnoea symptoms. The median mMRC score was 1 Interquartile ranges (IQR) = [0–2] at the two assessment. Concerning FSS scores, 35% and 44% of patients experienced fatigue at both follow-ups. The two scores of SF12 were lower than the general population standard scores. The mean PCS12 score was 42.85 (95% confidence interval (95% CI [41.05–44.65])) and mean MCS12 score of 46.70 (95% CI [45.34–48.06]) at 6 months. At 12 months, the mean PCS12 score was 42.18 (95% confidence interval (95% CI [40.46–43.89])) and mean MCS12 score of 47.13 (95% CI [45.98–48.28]). No difference was found between SF12 scores at 6 and 12 months.
Conclusions
This study pinpoints the persistence of fatigue and a low mental and physical QOL compared to population norms even after 1 year following infection. It also supports the claims of mental or psychological alterations due to infection by this new virus, hence a lower overall QOL in patients.
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BMC Infectious Diseases, 13.06.2022
Tilføjet 13.06.2022
Abstract
Background
The impact of the variant of concern (VOC) Alpha on the severity of COVID-19 has been debated. We report our analysis in France.
Methods
We conducted an exposed/unexposed cohort study with retrospective data collection, comparing patients infected by VOC Alpha to contemporaneous patients infected by historical lineages. Participants were matched on age (± 2.5 years), sex and region of hospitalization. The primary endpoint was the proportion of hospitalized participants with severe COVID-19, defined as a WHO-scale > 5 or by the need of a non-rebreather mask, occurring up to day 29 after admission. We used a logistic regression model stratified on each matched pair and accounting for factors known to be associated with the severity of the disease.
Results
We included 650 pairs of patients hospitalized between Jan 1, 2021, and Feb 28, 2021, in 47 hospitals. Median age was 70 years and 61.3% of participants were male. The proportion of participants with comorbidities was high in both groups (85.0% vs 90%, p = 0.004). Infection by VOC Alpha was associated with a higher odds of severe COVID-19 (41.7% vs 38.5%—aOR = 1.33 95% CI [1.03–1.72]).
Conclusion
Infection by the VOC Alpha was associated with a higher odds of severe COVID-19.
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BMC Infectious Diseases, 13.06.2022
Tilføjet 13.06.2022
Abstract
Background
Passive immunization against SARS-CoV-2 limits viral burden and death from COVID-19; however, it poses a theoretical risk of disease exacerbation through antibody-dependent enhancement (ADE). ADE after anti-SARS-CoV2 antibody treatment has not been reported, and therefore the potential risk and promoting factors remain unknown.
Case presentation
A 75-year-old female was admitted to the emergency room with recurrent, unexplained bruises and leukocytopenia, anemia, and thrombocytopenia. Evaluation of a bone marrow biopsy established the diagnosis of an acute promyelocytic leukemia (APL). SARS-CoV-2 RT-PCR testing of nasal and throat swabs on admission was negative. During the routine SARS-CoV-2 testing of inpatients, our patient tested positive for SARS-CoV-2 on day 14 after admission without typical COVID-19 symptoms. Due to disease- and therapy-related immunosuppression and advanced age conferring a high risk of progressing to severe COVID-19, casirivimab and imdevimab were administered as a preemptive approach. The patient developed immune activation and cytokine release syndrome (CRS) occurring within four hours of preemptive anti-SARS-CoV2 antibody (casirivimab/imdevimab) infusion. Immune activation and CRS were evidenced by a rapid increase in serum cytokines (IL-6, TNFα, IL-8, IL-10), acute respiratory insufficiency, and progressive acute respiratory distress syndrome.
Discussion and conclusion
The temporal relationship between therapeutic antibody administration and the rapid laboratory, radiological, and clinical deterioration suggests that CRS was an antibody-related adverse event, potentially exacerbated by APL treatment-mediated differentiation of leukemic blasts and promyelocytes. This case highlights the need for careful assessment of life-threatening adverse events after passive SARS-CoV-2 immunization, especially in the clinical context of patients with complex immune and hematological landscapes.
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BMC Infectious Diseases, 13.06.2022
Tilføjet 13.06.2022
Abstract
Background
Bronchiolitis, the most common cause of hospitalization in infancy has not yet a definitive treatment. This study was conducted to assess the effect of Zinc and vitamin D on treatment of infants with bronchiolitis.
Methods
In this double blind, randomized clinical trial, 94 infants aged 2 to 23 months, admitted in Mousavi Hospital in Zanjan, Iran, with the diagnosis of acute bronchiolitis were randomly assigned into 3 groups. The control group was only treated with hypertonic saline. The two case groups received either 100 unit/kg/day of Vitamin D or 20 mg/day of zinc in addition to hypertonic saline. Wheezing, duration of hospital stay, cough, cyanosis, respiratory distress and the respiratory rate in the first, third and seventh day of hospitalization were evaluated.
Results
There was no significant difference between groups in terms of age, sex, weight, passive smoking, wheezing, oxygen saturation, cyanosis and type of delivery. On the third day of hospitalization, the respiratory rate/min in the control group, the groups receiving vitamin D and zinc were 45.2 ± 10.7, 37.8 ± 3.9 and 41.1 ± 9.1 respectively and the result of repeated measure analysis didn’t show any significant difference between the 3 groups (P = 0.562). Duration of hospitalization in the group receiving Vitamin D or zinc and in controls were 4.2 ± 2.6, 4.4 ± 2.2 and 5.1 ± 2.4 days respectively and this difference was not significant. Zinc receiving patients did not differ from the control group regarding to respiratory rate, cyanosis and wheezing.
Conclusion
Vitamin D or zinc administration was not effective in reducing respiratory rate in children with bronchiolitis.
Trial registration This project was approved by the Institutional Ethics Committee (IR, ZUMS.REC.1396.50), and registered on IRCT (IRCT20131217015835N7).
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BMC Infectious Diseases, 13.06.2022
Tilføjet 13.06.2022
Abstract
Background
To prevent nosocomial transmission of SARS-CoV-2, infection prevention control (IPC) measures are implemented for patients with symptoms compatible with COVID-19 until reliable test results are available. This delays admission to the most appropriate ward based on the medical condition. SARS-CoV-2 rapid antigen detection (RAD) tests and point-of-care (POC) rapid RT-PCR (VitaPCR) were introduced at emergency department (ED) at Skåne University Hospital, Sweden in late 2020, but the consequence on patient flow and targeted admission is unknown.
Methods
Patients presenting at the emergency department of a referral hospital (N = 2940) between 13-Nov-2020 and 12-Jan-2021 were included. The study period was delimited into three periods by the introduction of RAD tests and the VitaPCR. Participant data was collected from hospital records, and outcome variables were Length-of-Stay (LoS), intrahospital transfers and targeted admission to COVID-19 ward.
Results
Compared to baseline (RT-PCR only), RAD tests reduced ED Length-of-Stay (LoS) for participants with positive tests. Negative VitaPCR results reduced mean hospital LoS by 1.5 (95% CI 0.3–2.7) days and admissions to COVID-19 wards from 34.5 (95% CI 28.9–40.5) to 14.7 (95% CI 11.1–19.1) per 100 admissions and reduced transfers between hospital wards in the first 5 days from 50.0 (95% CI 45.0–55.0) to 34.0 (95% CI 30.3–37.9) per 100 admissions.
Conclusion
RAD tests enabled prompt detection of SARS-CoV-2 infection which had pronounced effects on LoS at the ED. Negative VitaPCR enabled cessation of IPC measures and a negative test was associated with increased targeted admissions, reduced intrahospital transfers and shorter LoS at the hospital.
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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.
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