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Boucau J, Uddin R, Marino C, et al.
Clinical Infectious Diseases, 23.06.2022
Tilføjet 24.06.2022
AbstractWe enrolled seven individuals with recurrent symptoms or antigen test conversion following nirmatrelvir-ritonavir treatment. High viral loads (median 6.1 log10 copies/mL) were detected after rebound for a median of 17 days after initial diagnosis. Three had culturable virus for up to 16 days after initial diagnosis. No known resistance-associated mutations were identified.
Læs mere Tjek på PubMedBouton T, Atarere J, Turcinovic J, et al.
Clinical Infectious Diseases, 23.06.2022
Tilføjet 24.06.2022
AbstractBackgroundIn January 2022, United States guidelines shifted to recommend isolation for 5 days from symptom onset, followed by 5 days of mask wearing. However, viral dynamics and variant and vaccination impact on culture conversion are largely unknown.MethodsWe conducted a longitudinal study on a university campus, collecting daily anterior nasal swabs for at least 10 days for RT-PCR and culture, with antigen rapid diagnostic testing (RDT) on a subset. We compared culture positivity beyond day 5, time to culture conversion, and cycle threshold trend when calculated from diagnostic test, from symptom onset, by SARS-CoV-2 variant, and by vaccination status. We evaluated sensitivity and specificity of RDT on days 4-6 compared to culture.ResultsAmong 92 SARS-CoV-2 RT-PCR positive participants, all completed the initial vaccine series, 17 (18.5%) were infected with Delta and 75 (81.5%) with Omicron. Seventeen percent of participants had positive cultures beyond day 5 from symptom onset with the latest on day 12. There was no difference in time to culture conversion by variant or vaccination status. For 14 sub-study participants, sensitivity and specificity of day 4-6 RDT were 100% and 86% respectively.ConclusionsThe majority of our Delta- and Omicron-infected cohort culture-converted by day 6, with no further impact of booster vaccination on sterilization or cycle threshold decay. We found that rapid antigen testing may provide reassurance of lack of infectiousness, though guidance to mask for days 6-10 is supported by our finding that 17% of participants remained culture positive after isolation.
Læs mere Tjek på PubMedOhlsen E, Yankey D, Pezzi C, et al.
Clinical Infectious Diseases, 23.06.2022
Tilføjet 24.06.2022
AbstractThe National Immunization Survey Adult COVID Module used a random-digit-dialed phone survey during April 22, 2021–January 29, 2022 to quantify COVID-19 vaccination, intent, attitudes, and barriers by detailed race/ethnicity, interview language, and nativity. Foreign-born respondents overall and within racial/ethnic categories had higher vaccination coverage (80.9%), higher intent to be vaccinated (4.2%), and lower hesitancy towards COVID-19 vaccination (6.0%) than US-born respondents (72.6%, 2.9%, and 15.8%, respectively). Vaccination coverage was significantly lower for certain subcategories of national origin or heritage (e.g., Jamaican (68.6%), Haitian (60.7%), Somali (49.0%) in weighted estimates). Respondents interviewed in Spanish had lower vaccination coverage than interviewees in English but higher intent to be vaccinated and lower reluctance. Collection and analysis of nativity, detailed race/ethnicity and language information allow identification of disparities among racial/ethnic subgroups. Vaccination programs could use such information to implement culturally and linguistically appropriate focused interventions among communities with lower vaccination coverage.
Læs mere Tjek på PubMedGoodman K, Baghdadi J, Magder L, et al.
Clinical Infectious Diseases, 23.06.2022
Tilføjet 24.06.2022
ABSTRACTBackgroundEmpiric antibiotic use among hospitalized U.S. adults is largely undescribed. Identifying factors associated with broad-spectrum empiric therapy may inform antibiotic stewardship interventions and facilitate benchmarking.MethodsWe performed a retrospective cohort study of adults discharged in 2019 from 928 hospitals in the Premier Healthcare Database. “Empiric” Gram-negative antibiotics were defined by administration before Day 3 of hospitalization. Multivariable logistic regression models with random-effects by hospital were used to evaluate associations between patient and hospital characteristics and empiric receipt of broad-spectrum, compared to narrow-spectrum, Gram-negative antibiotics.Results2,928,657 of 8,017,740 (37%) hospitalized adults received empiric Gram-negative antibiotics. Among 1,781,306 who received broad-spectrum therapy, 30% did not have a common infectious syndrome present-on-admission (pneumonia, urinary tract infection, sepsis, or bacteremia), or surgery or an ICU stay in the empiric window. Holding other factors constant, males were 22% more likely (aOR 1.22, 95% CI: 1.22–1.23), and all non-White racial groups were 6%-13% less likely (aOR range: 0.87–0.94), to receive broad-spectrum therapy. There were significant prescribing differences by region, with the highest adjusted odds of broad-spectrum therapy in the U.S. West South Central. Even after model adjustment, there remained substantial inter-hospital variability: among patients receiving empiric therapy, the probability of receiving broad-spectrum antibiotics varied as much as 34 + percentage-points due solely to the admitting hospital (95% interval of probabilities: 43% - 77%).ConclusionsEmpiric Gram-negative antibiotic use is highly variable across U.S. regions, and there is high, unexplained inter-hospital variability. Sex and racial disparities in the receipt of broad-spectrum therapy warrant further investigation.
Læs mere Tjek på PubMedTemte J, Barlow S, Temte E, et al.
Clinical Infectious Diseases, 23.06.2022
Tilføjet 24.06.2022
AbstractBackgroundConcurrent detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and another respiratory virus in individuals can document contemporaneous circulation. We used an ongoing, community-based study of school-aged children and their households to evaluate SARS-CoV-2 co-detections with other respiratory viruses in a non-medically attended population over a two-year period.MethodsHousehold enrollment was predicated on an acute respiratory illness in a child residing in that household who was also a kindergarten through 12th grade student in the participating school district. Demographic, symptom and household composition data, and self-collected nasal specimens were obtained on the recruitment day, and 7 and 14 days later, from the index child and all other household members. All specimens were tested for SARS-CoV-2/influenza A/B by RT-PCR. Day 0 specimens from the index children were simultaneously tested for 17 viruses using a commercial respiratory pathogen panel (RPP). To assess viral co-detections involving SARS-CoV-2, all household specimens were tested via RPP if the index child’s Day 0 specimen tested positive to any of the 17 viral targets in RPP and any household member tested positive for SARS-CoV-2.ResultsOf 2,109 participants (497 index children in 497 households with 1,612 additional household members), two (0.1%) were positive for both SARS-CoV-2 and influenza A; an additional 11 (0.5%) were positive for SARS-CoV-2 and another RPP-covered respiratory virus. Co-detections predominantly affected school-aged children (12 out of 13 total) and were noted in 11 of 497 households.ConclusionsSARS-CoV-2 co-detections with other respiratory viruses were uncommon and predominated in school-aged children.
Læs mere Tjek på PubMedJunho Cho, William F. C. Rigby, Ambrose L. Cheung
PLoS One Infectious Diseases, 23.06.2022
Tilføjet 23.06.2022
by Junho Cho, William F. C. Rigby, Ambrose L. Cheung
Patients with cystic fibrosis (CF) often suffer recurrent bronchial bacterial infections that lead to deterioration of lung function over time. The infections in CF patients are often due to S. aureus and P. aeruginosa that colonize the airways. Significantly, methicillin-resistant S. aureus (MRSA) makes it challenging for treatment in CF patients due to its feature of multiple antibiotic resistance. In bronchial airways, cationic antimicrobial peptides are often present in mucosa cells, neutrophils, and macrophages that interfere with bacterial proliferation. The major mechanism for resistance to the bactericidal activity of cationic peptides in S. aureus is mediated by the GraRS two-component system that activates expression of MprF and DltABCD to increase surface positive charge to repel interactions with cationic peptides. We recently found that VraG, a membrane permease component of the VraFG efflux pumps, harbors a long 200-residue extracellular loop (EL) that utilizes K380 to interact with the negatively charged 9-residue extracellular loop of the membrane sensor GraS to control mprF expression in a community-acquired MRSA strain JE2. In this study, we extended this observation to a CF MRSA strain CF32A1 where we affirmed that the EL loop of VraG controls GraS-mediated signal transduction; however, in contrast to community acquired MRSA strain JE2, the CF MRSA strain CF32A1 requires both K380 and K388 in the EL of VraG to properly modulate signal transduction mediated by GraS. This effect was not attributable to the several single nucleotide polymorphisms that exist between VraG and GraS in the two MRSA strains.
Læs mere Tjek på PubMedMuluneh Ademe, Tadesse Kebede, Solomon Teferra, Melkam Alemayehu, Friehiwot Girma, Tamrat Abebe
PLoS One Infectious Diseases, 23.06.2022
Tilføjet 23.06.2022
by Muluneh Ademe, Tadesse Kebede, Solomon Teferra, Melkam Alemayehu, Friehiwot Girma, Tamrat Abebe
Introduction Neurotropic pathogens such as Toxoplasma gondii (T. gondii) which result in chronic infections in the brain are associated with mental illnesses. In view of this, a growing body of literature has revealed the possible interaction of schizophrenia and T. gondii infection. Method A case-control study was conducted from February 2018 to January 2019 among 47 Schizophrenia patients and 47 age and sex-matched controls. Data was collected using a structured questionnaire. Serum was used for serological analysis of anti-T. gondii IgG and IgM antibodies through chemiluminescent immunoassay. Proportions and mean with standard deviations (SD) were used as descriptive measures and variables with p-values
Læs mere Tjek på PubMedJessica Mooney, Jessica Price, Carolyn Bain, John Tanko Bawa, Nikki Gurley, Amresh Kumar, Guwani Liyanage, Rouden Esau Mkisi, Chris Odero, Karim Seck, Evan Simpson, William P. Hausdorff
PLoS One Infectious Diseases, 23.06.2022
Tilføjet 23.06.2022
by Jessica Mooney, Jessica Price, Carolyn Bain, John Tanko Bawa, Nikki Gurley, Amresh Kumar, Guwani Liyanage, Rouden Esau Mkisi, Chris Odero, Karim Seck, Evan Simpson, William P. Hausdorff
Background Live oral rotavirus vaccines (LORVs) have significantly reduced rotavirus hospitalizations and deaths worldwide. However, LORVs are less effective in low- and middle-income countries (LMICs). Next-generation rotavirus vaccines (NGRVs) may be more effective but require administration by injection or a neonatal oral dose, adding operational complexity. Healthcare providers (HPs) were interviewed to assess rotavirus vaccine preferences and identify delivery issues as part of an NGRV value proposition. Objective Determine HP vaccine preferences about delivering LORVs compared to injectable (iNGRV) and neonatal oral (oNGRV) NGRVs. Methods 64 HPs from Ghana, Kenya, Malawi, Peru, and Senegal were interviewed following a mixed-method guide centered on three vaccine comparisons: LORV vs. iNGRV; LORV vs. oNGRV; oNGRV vs. iNGRV. HPs reviewed attributes for each vaccine in the comparisons, then indicated and explained their preference. Additional questions elicited views about co-administering iNGRV+LORV for greater public health impact, a possible iNGRV-DTP-containing combination vaccine, and delivering neonatal doses. Results Almost all HPs preferred oral vaccine options over iNGRV, with many emphasizing an aversion to additional injections. Despite this strong preference, HPs described challenges delivering oral doses. Preferences for LORV vs. oNGRV were split, marked by disparate views on rotavirus disease epidemiology and the safety, need, and feasibility of delivering neonatal vaccines. Although overwhelmingly enthusiastic about an iNGRV-DTP-containing combination option, several HPs had concerns. HP views were divided on the feasibility of co-administering iNGRV+LORV, citing challenges around logistics and caregiver sensitization. Conclusion Our findings provide valuable insights on delivering NGRVs in routine immunization. Despite opposition to injectables, openness to co-administering LORV+iNGRV to improve efficacy suggests future HP support of iNGRV if adequately informed of its advantages. Rationales for LORV vs. oNGRV underscore needs for training on rotavirus epidemiology and stronger service integration. Expressed challenges delivering existing LORVs merit further examination and indicate need for improved delivery.
Læs mere Tjek på PubMedPhimon Atsawasuwan, Dhammacari Martin Del Campo, Laura Martin Del Campo, Grace Viana, Sriram Ravindran, Veerasathpurush Allareddy, Shrihari Kadkol
PLoS One Infectious Diseases, 23.06.2022
Tilføjet 23.06.2022
by Phimon Atsawasuwan, Dhammacari Martin Del Campo, Laura Martin Del Campo, Grace Viana, Sriram Ravindran, Veerasathpurush Allareddy, Shrihari Kadkol
COVID-19 has impacted and increased risks for healthcare providers, including orthodontists. There is no information regarding the potential transmission risks in the orthodontic community. This study aims to compare the positivity rate of SARS-CoV-2 infection in orthodontic patients at the University of Illinois Chicago (UIC) orthodontic clinic to the positivity rate of the local population in Chicago. All orthodontic patients who sought treatment at the UIC orthodontic clinic from June 16 to October 31, 2021, were invited to participate in the study. Three milliliters of saliva from the participants were collected in the sample collection tubes and subjected to a polymerase chain reaction (PCR) based assay to detect SAR-CoV-2. All participants’ age, sex, history of COVID-19 infection, and vaccination status were recorded. The COVID-19 positivity rates of Chicago, Cook County of Illinois, and the orthodontic clinic at UIC were compared. One thousand four hundred and thirty-seven orthodontic patients aged 6 to 70 years old (41.8% males and 58.2% females) participated in the study. Among all participants, nine participants tested positive for SARS-CoV-2 (5 males and 4 females). During the study, the average COVID-19 positivity rate at the UIC orthodontic clinic was 0.626%. All of the positive participants were asymptomatic, and two of the participants had a history of COVID-19 infection. Among all positive participants, three participants had received complete COVID-19 vaccination. An increased frequency of positive cases at the orthodontic clinic was observed during the time of high positivity rate in Chicago and Cook County. A potential risk of COVID-19 transmission from patients to orthodontic providers remains, even with asymptomatic and vaccinated patients.
Læs mere Tjek på PubMedJun Seung Lee, Kyung Hoon Sun, Yongjin Park
PLoS One Infectious Diseases, 23.06.2022
Tilføjet 23.06.2022
by Jun Seung Lee, Kyung Hoon Sun, Yongjin Park
Background In this study, a hydrogel comprising poly (vinyl alcohol)/pectin (PVA/PET) was prepared by the addition of Melia azedarach extract for epithelial restoration. M. azedarach extract (MAE) contains volatile organic plant-derived compounds with antimicrobial properties. MAE has a variety of physiological properties, including antimicrobial, insecticidal, and anti-inflammatory activity. This study aimed to investigate whether MAE-loaded PVA/PET hydrogels have protective effects against burn wound healing. Methods and findings To mix M. azedarach with the gel, nanoparticles containing M. azedarach were prepared using chitosan/maltodextrin as the wall material. A PVA/PET hydrogel containing M. azedarach was developed and its applicability as a wound dressing was evaluated. In the in vitro scratch assay, MAE treatment showed a scratch recovery-promoting effect comparable to that of the positive control TGF-β1. The MAE-PVA/PET hydrogel was found to be non-toxic, and the antibacterial activity of the hydrogel was excellent against both gram-positive and gram-negative bacteria. Furthermore, as the formulated hydrogel demonstrated strong antimicrobial activity, its wound-healing efficacy was investigated in vivo using a rat model. Conclusion MAE was found to be effective against burn wounds and to have antimicrobial activity in vitro and in vivo.
Læs mere Tjek på PubMedJohn Bosco Isunju, Solomon Tsebeni Wafula, Rawlance Ndejjo, Rebecca Nuwematsiko, Pamela Bakkabulindi, Aisha Nalugya, James Muleme, Winnie Kansiime Kimara, Simon P. S. Kibira, Joana Nakiggala, Richard K. Mugambe, Esther Buregyeya, Tonny Ssekamatte, Rhoda K. Wanyenze
PLoS One Infectious Diseases, 23.06.2022
Tilføjet 23.06.2022
by John Bosco Isunju, Solomon Tsebeni Wafula, Rawlance Ndejjo, Rebecca Nuwematsiko, Pamela Bakkabulindi, Aisha Nalugya, James Muleme, Winnie Kansiime Kimara, Simon P. S. Kibira, Joana Nakiggala, Richard K. Mugambe, Esther Buregyeya, Tonny Ssekamatte, Rhoda K. Wanyenze
Background Healthcare providers (HCPs) are at an elevated occupational health risk of hepatitis B virus infections. Post-exposure prophylaxis (PEP) is one of the measures recommended to avert this risk. However, there is limited evidence of HCPs’ awareness of hepatitis B PEP. Therefore, this study aimed to establish awareness of hepatitis B PEP among HCPs in Wakiso, a peri-urban district that surrounds Uganda’s capital, Kampala. Methods A total of 306 HCPs, selected from 55 healthcare facilities (HCFs) were interviewed using a validated structured questionnaire. The data were collected and entered using the Kobo Collect mobile application. Multivariable binary logistic regression was used to establish the factors associated with awareness of hepatitis B PEP. Results Of the 306 HCPs, 93 (30.4%) had ever heard about hepatitis B PEP and 16 (5.2%) had ever attended training where they were taught about hepatitis B PEP. Only 10.8% were aware of any hepatitis B PEP options, with 19 (6.2%) and 14 (4.6%) mentioning hepatitis B immunoglobulin (HBIG) and hepatitis B vaccine, respectively as PEP options. Individuals working in the maternity department were less likely to be aware of hepatitis B PEP (AOR = 0.10, 95% CI = 0.02–0.53). There was a positive association between working in a healthcare facility in an urban setting and awareness of hepatitis B PEP (AOR = 5.48, 95% CI = 1.42–21.20). Hepatitis B screening and vaccination were not associated with awareness of PEP. Conclusions Only one-tenth of the HCPs were aware of any hepatitis B PEP option. Awareness of hepatitis B PEP is associated with the main department of work and working in a healthcare facility in an urban setting. This study suggests a need to sensitise HCPs, especially those in rural HCFs and maternity wards on hepatitis B PEP. The use of innovative strategies such as e-communication channels, including mobile text messaging might be paramount in bridging the awareness gap.
Læs mere Tjek på PubMedDenise Ann Dayao, Justyna Jaskiewcz, Sangun Lee, Bruno Cesar Oliveira, Abhineet Sheoran, Giovanni Widmer, Saul Tzipori aDepartment of Infectious Disease and Global Health; Cummings School of Veterinary Medicine, Tufts Universitygrid.429997.8, North Grafton, Massachusetts, USA bCenter for Engineering in Medicine, Department of Surgery, Massachusetts General Hospitalgrid.32224.35, Harvard Medical School, and Shriners Hospitals for Children, Boston, Massachusetts, USA cUnião das Faculdades dos Grandes Lagos, São José do Rio Preto, Brazil, Liise-anne Pirofski
Infection and Immunity, 23.06.2022
Tilføjet 23.06.2022
James A. Watson, Stephen M. Kissler, Nicholas P. J. Day, Yonatan H. Grad, Nicholas J. White aMahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol Universitygrid.10223.32, Bangkok, Thailand bCentre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom cDepartment of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
Antimicrobial Agents And Chemotherapy, 23.06.2022
Tilføjet 23.06.2022
Jakub M. Kwiecinski, Diamond A. Jelani, Ernesto J. Fuentes, Alexander R. Horswill aDepartment of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA bDepartment of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland cDepartment of Biochemistry and Molecular Biology, University of Iowagrid.214572.7, Iowa City, Iowa, USA dDepartment of Veterans Affairs, Eastern Colorado Health Care System, Aurora, Colorado, USA
Antimicrobial Agents And Chemotherapy, 23.06.2022
Tilføjet 23.06.2022
Garam Choi, Sang Ho Choi
Trends in Microbiology, 23.06.2022
Tilføjet 23.06.2022
The fulminating zoonotic pathogen Vibrio vulnificus is the causative agent of fatal septicemia in humans and fish, raising tremendous economic burdens in healthcare and the aquaculture industry. V. vulnificus exploits various virulence factors, including biofilm-related factors and exotoxins, for its persistence in nature and pathogenesis during infection. Substantial studies have found that the expression of virulence factors is coordinately regulated by numerous transcription factors that recognize the changing environments.
Læs mere Tjek på PubMedNtuku, H., Smith-Gueye, C., Scott, V., Njau, J., Whittemore, B., Zelman, B., Tambo, M., Prach, L. M., Wu, L., Schrubbe, L., Kang Dufour, M.-S., Mwilima, A., Uusiku, P., Sturrock, H., Bennett, A., Smith, J., Kleinschmidt, I., Mumbengegwi, D., Gosling, R., Hsiang, M.
BMJ Open, 23.06.2022
Tilføjet 23.06.2022
Objectives
To estimate the cost and cost effectiveness of reactive case detection (RACD), reactive focal mass drug administration (rfMDA) and reactive focal vector control (RAVC) to reduce malaria in a low endemic setting.
Setting
The study was part of a 2x2 factorial design cluster randomised controlled trial within the catchment area of 11 primary health facilities in Zambezi, Namibia.
Participants
Cost and outcome data were collected from the trial, which included 8948 community members that received interventions due to their residence within 500 m of malaria index cases.
Outcome measures
The primary outcome was incremental cost effectiveness ratio (ICER) per in incident case averted. ICER per prevalent case and per disability-adjusted life years (DALY) averted were secondary outcomes, as were per unit interventions costs and personnel time. Outcomes were compared as: (1) rfMDA versus RACD, (2) RAVC versus no RAVC and (3) rfMDA+RAVC versus RACD only.
Results
rfMDA cost 1.1x more than RACD, and RAVC cost 1.7x more than no RAVC. Relative to RACD only, the cost of rfMDA+RAVC was double ($3082 vs $1553 per event). The ICERs for rfMDA versus RACD, RAVC versus no RAVC and rfMDA+RAVC versus RACD only were $114, $1472 and $842, per incident case averted, respectively. Using prevalent infections and DALYs as outcomes, trends were similar. The median personnel time to implement rfMDA was 20% lower than for RACD (30 vs 38 min per person). The median personnel time for RAVC was 34 min per structure sprayed.
Conclusion
Implemented alone or in combination, rfMDA and RAVC were cost effective in reducing malaria incidence and prevalence despite higher implementation costs in the intervention compared with control arms. Compared with RACD, rfMDA was time saving. Cost and time requirements for the combined intervention could be decreased by implementing rfMDA and RAVC simultaneously by a single team.
Trial registration number
NCT02610400; Post-results.
Læs mere Tjek på PubMed
Wang, H., Zhou, X., Song, C., Yin, P., Shi, R., Zhang, H., Dan, Y., Wu, H., Ye, J.
BMJ Open, 23.06.2022
Tilføjet 23.06.2022
Objectives
This study aimed to examine the influence and conditioning process of hindrance stressors on the emotional exhaustion of the front-line healthcare workers during recuperation, examine the potential mediating process of rumination, and explore the moderating role of organisational and family factors.
Setting
This cross-sectional study was conducted during 12–20 July 2020. Total 418 questionnaires were collected from front-line healthcare workers by random cluster sampling. Hierarchical regression was performed to analyse the mediating effect of affective rumination using SPSS25.0, while PROCESS was used to further investigate the moderating role of servant leadership and family support.
Participants
418 healthcare workers were investigated randomly from front-line medical teams. Inclusion criteria included worked as front-line health workers and participated in the fight against COVID-19 in Hubei; age ≥18 years; normal cognitive and comprehension abilities under physical and mental health; volunteer to participate in this study. Exclusion criteria included recently affected by major events other than COVID-19 or those with a history of neurasthenia and trauma.
Results
Using descriptive analysis of average value and SD measured by a five-item scale (MBI-GS), we found that front-line healthcare workers’ emotional exhaustion score (2.45±0.88) was at the medium level. Hindrance stressors, mediated by affective rumination, had a significant positive predictive effect on emotional exhaustion. Servant leadership negatively moderated the direct effect of hindrance stressors on emotional exhaustion (β=–0.106, p<0.01). Family support positively moderated the impact of hindrance stressors on emotional exhaustion (β=0.082, p<0.05).
Conclusions
During the recuperation period, after successfully controlling COVID-19 at the front line, the first-line healthcare workers should be screened through affective rumination evaluation to gain insight for targeted interventions. We find that servant leadership is beneficial in alleviating emotional exhaustion while family support worsens emotional exhaustion. We suggest that servant leadership should be further promoted in medical organisations, and family support should be applied correctly and cautiously.
Læs mere Tjek på PubMed
Hong, C., Zhang, H. G., L'Yi, S., Weber, G., Avillach, P., Tan, B. W. Q., Gutierrez-Sacristan, A., Bonzel, C.-L., Palmer, N. P., Malovini, A., Tibollo, V., Luo, Y., Hutch, M. R., Liu, M., Bourgeois, F., Bellazzi, R., Chiovato, L., Sanz Vidorreta, F. J., Le, T. T., Wang, X., Yuan, W., Neuraz, A., Benoit, V., Moal, B., Morris, M., Hanauer, D. A., Maidlow, S., Wagholikar, K., Murphy, S., Estiri, H., Makoudjou, A., Tippmann, P., Klann, J., Follett, R. W., Gehlenborg, N., Omenn, G. S., Xia, Z., Dagliati, A., Visweswaran, S., Patel, L. P., Mowery, D. L., Schriver, E. R., Samayamuthu, M. J., Kavuluru, R., Lozano-Zahonero, S., Zöller, D., Tan, A. L. M., Tan, B. W. L., Ngiam, K. Y., Holmes, J. H., Schubert, P., Cho, K., Ho, Y.-L., Beaulieu-Jones, B. K., Pedrera-Jimenez, M., Garcia-Barrio, N., Serrano-Balazote, P., Kohane, I., The Consortium for Clinical Characterization of COVID-19 by EHR (4CE), South, A., Brat, G. A., Cai, T.
BMJ Open, 23.06.2022
Tilføjet 23.06.2022
Objective
To assess changes in international mortality rates and laboratory recovery rates during hospitalisation for patients hospitalised with SARS-CoV-2 between the first wave (1 March to 30 June 2020) and the second wave (1 July 2020 to 31 January 2021) of the COVID-19 pandemic.
Design, setting and participants
This is a retrospective cohort study of 83 178 hospitalised patients admitted between 7 days before or 14 days after PCR-confirmed SARS-CoV-2 infection within the Consortium for Clinical Characterization of COVID-19 by Electronic Health Record, an international multihealthcare system collaborative of 288 hospitals in the USA and Europe. The laboratory recovery rates and mortality rates over time were compared between the two waves of the pandemic.
Primary and secondary outcome measures
The primary outcome was all-cause mortality rate within 28 days after hospitalisation stratified by predicted low, medium and high mortality risk at baseline. The secondary outcome was the average rate of change in laboratory values during the first week of hospitalisation.
Results
Baseline Charlson Comorbidity Index and laboratory values at admission were not significantly different between the first and second waves. The improvement in laboratory values over time was faster in the second wave compared with the first. The average C reactive protein rate of change was –4.72 mg/dL vs –4.14 mg/dL per day (p=0.05). The mortality rates within each risk category significantly decreased over time, with the most substantial decrease in the high-risk group (42.3% in March–April 2020 vs 30.8% in November 2020 to January 2021, p<0.001) and a moderate decrease in the intermediate-risk group (21.5% in March–April 2020 vs 14.3% in November 2020 to January 2021, p<0.001).
Conclusions
Admission profiles of patients hospitalised with SARS-CoV-2 infection did not differ greatly between the first and second waves of the pandemic, but there were notable differences in laboratory improvement rates during hospitalisation. Mortality risks among patients with similar risk profiles decreased over the course of the pandemic. The improvement in laboratory values and mortality risk was consistent across multiple countries.
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Krauss, S. R., Barbateskovic, M., Klingenberg, S. L., Djurisic, S., Petersen, S. B., Kenfelt, M., Kong, D. Z., Jakobsen, J. C., Gluud, C.
BMJ Open, 23.06.2022
Tilføjet 23.06.2022
Objectives
To assess the benefits and harms of aluminium adjuvants versus placebo or no intervention in randomised clinical trials in relation to human vaccine development.
Design
Systematic review with meta-analysis and trial sequential analysis assessing the certainty of evidence with Grading of Recommendations Assessment, Development and Evaluation (GRADE).
Data sources
We searched CENTRAL, MEDLINE, Embase, LILACS, BIOSIS, Science Citation Index Expanded and Conference Proceedings Citation Index-Science until 29 June 2021, and Chinese databases until September 2021.
Eligibility criteria
Randomised clinical trials irrespective of type, status and language of publication, with trial participants of any sex, age, ethnicity, diagnosis, comorbidity and country of residence.
Data extraction and synthesis
Two independent reviewers extracted data and assessed risk of bias with Cochrane’s RoB tool 1. Dichotomous data were analysed as risk ratios (RRs) and continuous data as mean differences. We explored both fixed-effect and random-effects models, with 95% CI. Heterogeneity was quantified with I2 statistic. We GRADE assessed the certainty of the evidence.
Results
We included 102 randomised clinical trials (26 457 participants). Aluminium adjuvants versus placebo or no intervention may have no effect on serious adverse events (RR 1.18, 95% CI 0.97 to 1.43; very low certainty) and on all-cause mortality (RR 1.02, 95% CI 0.74 to 1.41; very low certainty). No trial reported on quality of life. Aluminium adjuvants versus placebo or no intervention may increase adverse events (RR 1.13, 95% CI 1.07 to 1.20; very low certainty). We found no or little evidence of a difference between aluminium adjuvants versus placebo or no intervention when assessing serology with geometric mean titres or concentrations or participants’ seroprotection.
Conclusions
Based on evidence at very low certainty, we were unable to identify benefits of aluminium adjuvants, which may be associated with adverse events considered non-serious.
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Aukland, E. A., Klepstad, P., Aukland, S. M., Ghavidel, F. Z., Buanes, E. A.
BMJ Open, 23.06.2022
Tilføjet 23.06.2022
Objectives
Acute kidney injury (AKI) is a frequent complication among critical ill patients with COVID-19, but the actual incidence is unknown as AKI-incidence varies from 25% to 89% in intensive care unit (ICU) populations. We aimed to describe the prevalence and risk factors of AKI in patients with COVID-19 admitted to ICU in Norway.
Design
Nation-wide observational study with data sampled from the Norwegian Intensive Care and Pandemic Registry (NIPaR) for the period between 10 March until 31 December 2020.
Setting
ICU patients with COVID-19 in Norway. NIPaR collects data on intensive care stays covering more than 90% of Norwegian ICU and 98% of ICU stays.
Participants
Adult patients with COVID-19 admitted to Norwegian ICU were included in the study. Patients with chronic kidney disease (CKD) were excluded in order to avoid bias from CKD on the incidence of AKI.
Primary and secondary outcome measures
Primary outcome was AKI at ICU admission as defined by renal Simplified Acute Physiology Score in NIPaR. Secondary outcome measures included survival at 30 and 90 days after admission to hospital.
Results
A total number of 361 patients with COVID-19 were included in the analysis. AKI was present in 32.0% of the patients at ICU admission. The risk for AKI at ICU admission was related to acute circulatory failure at admission to hospital. Survival for the study population at 30 and 90 days was 82.5% and 77.6%, respectively. Cancer was a predictor of 30-day mortality. Age, acute circulatory failure at hospital admission and AKI at ICU admission were predictors of both 30-day and 90-day mortality.
Conclusions
A high number of patients with COVID-19 had AKI at ICU admission. The study indicates that AKI at ICU admission was related to acute circulatory failure at hospital admission. Age, acute circulatory failure at hospital admission and AKI at ICU admission were associated with mortality.
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Griffin, L., Riley, R.
BMJ Open, 23.06.2022
Tilføjet 23.06.2022
Objectives
To identify the psychological impact of working during the COVID-19 pandemic on medical and nursing students’ psychological well-being. To inform recommendations for the provision of future student well-being support.
Design
An interpretative qualitative, semistructured interview study employing maximum variation sampling, snowball sampling and a thematic analysis.
Setting
A large West Midlands (UK) university with medical and nursing undergraduate and postgraduate programmes. Study undertaken between January and May 2020.
Participants
A purposive sample of eight medical (six women and two men) and seven nursing (all women) students who worked >2 weeks in a healthcare setting during the COVID-19 pandemic (from 1 March 2020 onwards).
Results
Four core themes with corresponding subthemes were identified: (1) COVID-19 sources of distress—working conditions, exposure to suffering, death and dying, relationships and teams, individual inexperience and student identity, (2) negative impact on mental health and well-being—psychological and emotional distress, delayed distress, exhaustion, mental ill health, (3) protective factors from distress—access to support, environment, preparation and induction, recognition and reward, time for breaks and rest and (4) positive experiences and meaningful outcomes.
Conclusions
Student pandemic deployment has had a significant negative impact on students’ psychological well-being, as a result of demanding working conditions, unprecedented exposure to death and suffering and lack of preparation for new job roles. Universities and healthcare organisations must formally acknowledge this impact and provide well-being support for distressed students working in such challenging contexts. They must also establish more supportive and inclusive healthcare environments for medical and nursing students in future pandemic and postpandemic circumstances, through the implementation of support systems and adequate preparation.
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Infection, 22.06.2022
Tilføjet 23.06.2022
Abstract
Purpose
In infections of the Central Nervous System (iCNS), rapid identification of causing pathogens is crucial for survival and to avoid long-term sequelae. Targeted therapy may reduce side effects and development of antibiotic resistance. New molecular-based syndromic tests such as the “meningitis/encephalitis panel” (MEP) allow accelerated pathogen identification from cerebrospinal fluid. We conducted a clinical study to evaluate the MEP’s efficacy in paediatric patients.
Methods
Cohort study in a unique clinical setting by comparing the outcome data of two neighbouring Children’s Hospitals in Germany which are comparable in size, catchment area and equipment but differ regarding availability of the MEP: study centre 1 (SC1): yes; SC2: no. The study population included 213 paediatric patients with a suspected iCNS (SC1: 106; SC2: 107), with comparable age, CRP at admission and frequency of intensive care. The primary outcome was total use of antibiotics.
Results
Total antibiotic use per patient was numerically lower in SC1 than in SC2 (SC1: median 2.83 days; SC2 3.67 days; p = 0.671). Multiple linear regression analysis did not show a relevant association between MEP-availability and total antibiotic use (ß = 0.1, 95% confidence interval [−1.46; +1.67], p = 0.897). In the subcohort with suspected meningoencephalitis (SC1: 18, SC2: 17), duration of acyclovir treatment was shorter in SC1 than in SC2 (median 1.3 days vs. 2.7 days, descriptive p = 0.0397).
Conclusions
The add-on use of the MEP in paediatric patients with suspected iCNS was associated with a non-significant reduction in total antibiotic use, and with a reduced exposure to acyclovir in treated patients.
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Beate Schmoele-Thoma, Agnieszka M. Zareba, Qin Jiang, Mohan S. Maddur, Rana Danaf, Alex Mann, Kingsley Eze, Juin Fok-Seang, Golam Kabir, Andrew Catchpole, Daniel A. Scott, Alejandra C. Gurtman, Kathrin U. Jansen, William C. Gruber, Philip R. Dormitzer, Kena A. Swanson
New England Journal of Medicine, 22.06.2022
Tilføjet 23.06.2022
New England Journal of Medicine, Volume 386, Issue 25, Page 2377-2386, June 2022.
Læs mere Tjek på PubMedEric J. Rubin, Lindsey R. Baden, Stephen Morrissey
New England Journal of Medicine, 22.06.2022
Tilføjet 23.06.2022
New England Journal of Medicine, 22.06.2022
Tilføjet 23.06.2022
New England Journal of Medicine, Volume 386, Issue 25, Page 2438-2440, June 2022.
Læs mere Tjek på PubMedMalini DeSilva, Jacob Haapala, Gabriela Vazquez-Benitez, Kimberly K. Vesco, Matthew F. Daley, Darios Getahun, Ousseny Zerbo, Allison Naleway, Jennifer C. Nelson, Joshua T.B. Williams, Simon J. Hambidge, Thomas G. Boyce, Candace C. Fuller, Heather S. Lipkind, Eric Weintraub, Michael M. McNeil, Elyse O. Kharbanda
New England Journal of Medicine, 22.06.2022
Tilføjet 23.06.2022
Nicole P. Hachmann, Jessica Miller, Ai-ris Y. Collier, John D. Ventura, Jingyou Yu, Marjorie Rowe, Esther A. Bondzie, Olivia Powers, Nehalee Surve, Kevin Hall, Dan H. Barouch
New England Journal of Medicine, 22.06.2022
Tilføjet 23.06.2022
Sonja A. Rasmussen, Denise J. Jamieson
New England Journal of Medicine, 22.06.2022
Tilføjet 23.06.2022
Natasha B. Halasa, Samantha M. Olson, Mary A. Staat, Margaret M. Newhams, Ashley M. Price, Pia S. Pannaraj, Julie A. Boom, Leila C. Sahni, Kathleen Chiotos, Melissa A. Cameron, Katherine E. Bline, Charlotte V. Hobbs, Aline B. Maddux, Bria M. Coates, Kelly N. Michelson, Sabrina M. Heidemann, Katherine Irby, Ryan A. Nofziger, Elizabeth H. Mack, Laura Smallcomb, Stephanie P. Schwartz, Tracie C. Walker, Shira J. Gertz, Jennifer E. Schuster, Satoshi Kamidani, Keiko M. Tarquinio, Samina S. Bhumbra, Mia Maamari, Janet R. Hume, Hillary Crandall, Emily R. Levy, Matt S. Zinter, Tamara T. Bradford, Heidi R. Flori, Melissa L. Cullimore, Michele Kong, Natalie Z. Cvijanovich, Suzanne M. Gilboa, Kara N. Polen, Angela P. Campbell, Adrienne G. Randolph, Manish M. Patel
New England Journal of Medicine, 22.06.2022
Tilføjet 23.06.2022