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BMC Infectious Diseases, 14.07.2022
Tilføjet 14.07.2022
Abstract
Background
Campylobacter rectus is a gram-negative rod, and Parvimonas micra is a gram-positive coccus, both of which are oral anaerobes that cause chronic periodontitis. Chronic periodontitis can cause bacteremia and systemic diseases, including osteomyelitis. Hematogenous osteomyelitis caused by anaerobic bacteria is uncommon, and to date, there have been no reports of mixed bacteremia with C. rectus and P. micra. Here, we report the first case of osteomyelitis of the femur caused by anaerobic bacteria with mixed bacteremia of C. rectus and P. micra caused by chronic periodontitis.
Case presentation
A 75-year-old man with chronic periodontitis, hyperuricemia, and benign prostatic hyperplasia was admitted to the hospital with a fracture of the left femur. The patient had left thigh pain for 4 weeks prior to admission. Left femoral intramedullary nail fixation was performed, and a large amount of abscess and necrotic tissue was found intraoperatively. The cultures of abscess specimens were identified as P. micra, Fusobacterium nucleatum, and C. rectus. C. rectus and P. micra were also isolated from blood cultures. C. rectus was identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and 16 S ribosomal RNA sequencing. Sulbactam-ampicillin was administered for approximately 1 month, after which it was replaced by oral clavulanic acid-amoxicillin for long-term suppressive treatment.
Conclusions
Only five cases of bloodstream infection with C. rectus have been reported, and this is the first report of mixed bacteremia with P. micra. Clinicians should consider that chronic periodontitis caused by rare oral anaerobic bacteria can cause systemic infections, such as osteomyelitis.
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BMC Infectious Diseases, 14.07.2022
Tilføjet 14.07.2022
Abstract
Background
A high baseline hepatitis B virus (HBV) load has always been listed as an exclusion criterion for programmed cell death-1 (PD-1) inhibitor-associated therapy in clinical trials, as the interaction between HBV load and anti-PD-1/PD-L1 therapy with anti HBV therapy remains controversial.
Methods
We retrospectively enrolled 70 unresectable HCC patients who were seropositive for HBsAg and accepted tenofovir alafenamide fumarate (TAF) therapy before anti-PD-1 in combination with an antiangiogenic treatment. Patients were divided into a low HBV DNA group (≤ 2000 IU/ml) and a high HBV DNA group (> 2000 IU/ml) according to the baseline HBV DNA levels. Tumour response and progression-free survival (PFS) were compared, and univariate and multivariate Cox analyses were performed to identify potential risk factors for PFS. The incidences of HBV reactivation and HBV-associated hepatitis were also recorded.
Results
48 patients were assigned to the low group and the remaining 22 patients were assigned to the high group. The objective response rates (ORRs), disease control rates (DCRs), and PFS between the two groups showed no significant difference (P = 0.761, 0.552, and 0.784, respectively). The results of Cox analyses revealed that there was no relationship between baseline HBV load and PFS. Additionally, HBV reactivation occurred in only 2 patients (2.9%), and no patient experienced HBV-related hepatic impairment when given a continuous TAF treatment.
Conclusions
Baseline HBV loads do not affect the prognosis of HCC patients receiving anti-PD-1 in combination with an antiangiogenic therapy, while PD-1 inhibitors do not aggravate HBV reactivation and hepatic impairment in patients simultaneously subjected to TAF prophylaxis.
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BMC Infectious Diseases, 13.07.2022
Tilføjet 14.07.2022
Abstract
Background
Growing prevalence of multidrug-resistant/Rifampicin-resistant tuberculosis (MDR/RR-TB; resistance to Isoniazid and Rifampicin/Isolated resistance to Rifampicin) is putting in jeopardy the WHO End TB strategy. This study aimed to identify factors contributing to the high prevalence of MDR/RR-TB in Khabarovsk krai region of Russia.
Methods
A cross-sectional retrospective study was conducted, analyzing clinical, demographic, and drug susceptibility testing data on 1440 patients. As a source of raw data, the national electronic TB surveillance system was used. Anonymous data was collected on every patient diagnosed with TB in all healthcare facilities of the region from January 2018 to December 2019. Only patients with proven excretion of m. tuberculosis were included in the study. Factors associated with MDR/RR-TB were identified through logistic regression analysis, in conjunction with in-depth interviews with eight patients, five healthcare managers and five doctors.
Findings
2661 patients were identified with TB, 1440 were incorporated in the study based on inclusion criteria. Of these, 618 (42.9%) were identified with MDR/RR-TB. Patients with a history of imprisonment were 16.53 times (95% CI 5.37 to 50.88,) more likely to have MDR/RR-TB, whereas re-treatment patients were 2.82 times (95% CI 2.16 to 3.66) more likely to have MDR/RR-TB. Other influencing factors included presence of disability (AOR is 2.32, 95% CI 1.38 to 3.89), cavitary disease (AOR is 1.76, 95% CI 1.37 to 2.25), and retirement status (AOR 0.65, 95% CI 0.43 to 0.98, p = 0.042). Poor patient knowledge and understanding of the disease, progressive weariness of prolonged TB treatment, and inability hospitalize infectious patients without their consent were perceived by the interviewees as major influencing factors.
Conclusions
Incarceration and treatment history, regardless of outcome, were identified as major factors influencing MDR/RR-TB prevalence. It is essential for the TB care system to eliminate legal loopholes, which deprive doctors of means to enforce quarantine procedures and epidemiological surveillance on infected patients, former and current inmates. Increasing people’s awareness of TB, early detection and appropriate treatment of patients with TB are needed for successfully combating MDR/RR-TB.
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Mary C. Ottolini, Randheer Shailam, Amita Sharma, Ivy A. Rosales
New England Journal of Medicine, 13.07.2022
Tilføjet 14.07.2022
New England Journal of Medicine, Volume 387, Issue 2, Page 168-176, July 2022.
Læs mere Tjek på PubMedEric J. Rubin, Lindsey R. Baden, Peter Marks, Stephen Morrissey
New England Journal of Medicine, 13.07.2022
Tilføjet 14.07.2022
Saul J. Karpen
New England Journal of Medicine, 13.07.2022
Tilføjet 14.07.2022
L. Helena Gutierrez Sanchez, Henry Shiau, Julia M. Baker, Stephanie Saaybi, Markus Buchfellner, William Britt, Veronica Sanchez, Jennifer L. Potter, L. Amanda Ingram, David Kelly, Xiaoyan Lu, Stephanie Ayers-Millsap, Wesley G. Willeford, Negar Rassaei, Julu Bhatnagar, Hannah Bullock, Sarah Reagan-Steiner, Ali Martin, Michael E. Rogers, Anna M. Banc-Husu, Sanjiv Harpavat, Daniel H. Leung, Elizabeth A. Moulton, Daryl M. Lamson, Kirsten St. George, Aron J. Hall, Umesh Parashar, Adam MacNeil, Jacqueline E. Tate, Hannah L. Kirking
New England Journal of Medicine, 13.07.2022
Tilføjet 14.07.2022
Chayarani Kelgeri, Michael Couper, Girish L. Gupte, Alexandra Brant, Mitul Patel, Lauren Johansen, Joseph Valamparampil, Evelyn Ong, Hermien Hartog, M.T.P.R. Perera, Darius Mirza, Indra van Mourik, Khalid Sharif, Jane Hartley
New England Journal of Medicine, 13.07.2022
Tilføjet 14.07.2022
Daniel Pan, Caroline M. Williams, Jonathan Decker, Eve Fletcher, Shirley Sze, Sara Assadi, Richard Haigh, Baber Saleem, Joshua Nazareth, Natalie J. Garton, Manish Pareek, Michael R. Barer
Clinical Microbiology and Infection, 14.07.2022
Tilføjet 14.07.2022
No studies have examined longitudinal patterns of naturally exhaled SARS-CoV-2 RNA viral load (VL) during acute infection. We report this using facemask sampling (FMS) and assessed the relationship between emitted RNA VL and household transmission.
Læs mere Tjek på PubMedEllis, J., Harvey, D., Defres, S., Chandna, A., MacLachlan, E., Solomon, T., Heyderman, R. S., McGill, F., on behalf of the National Audit of Meningitis Management (NAMM) group, Chue, Moran, Gokani, Thompson, Ajdukiewicz, Ward, Barrett, Edwards, Usher, McLeod, Singh, Htwe, Rogers, Duane, Wiselka, Wong, Vink, Poyner, Crane, Lloyd, Chisholm, Kustos, McEwen, Sutton, Jones, Tilley, Estee Torok, Ramsay, Ivan, York, Ansett, Varadarajan, Eshiwe, Fife, Harris, Jayesinghe, Sekhon, Cruise, Larkin, Kanabar, Mutengesa, Ling, Green, Williams, Stevens, Griffith, Bulteel, Milne, Sarma, Wilson, Shone, Urquhart, Eldirdiri, Muir, White, Aberdein, Simpson, Mar, Bowen, Tan, Zin thein, Aziz, Cadwgan, Davies, White, Weston, Zeb, Houston, Fordham, Evans, Wootton, Turner, Willingham, Johnson, Wickramasinghe, Horsley, Trainor, Gaillemin, Rosser, Norton, Crossingham, Cheung, Duxbury, Deshpande, Bellhouse, Khalsa, Brezovjakova, McLean, Tanmay, Davies, Dawidziuk, Allen, Saman, Kelly, Adler, Ejere, Shah, Soo, Beadles, Sturgeon, Cameron, Ben Tomlinson, McGoldrick, McDowell, Miller, Graham, Molosiwa, Hunter, Owen, Kennedy, Robinson, Cross, Perry, Inpadhas, Khan, Selvam, Bateman, Wong, Wu, Pasztor, Patel, Karunakaran, Soliman, Paraiso, McLeod, Htwe, Smith, Blanshard, Reddy, Shahi, Chesterfield, Schroeder, Woodhouse, Coebergh, Levee, Muldoon, Oregan, Teoh, Subbarao, Tiberi, Bell, Lambourne, McGuire, Serafino, Goodman, Bhide, Sagoo, Melzer, Krutikov, Balakrishnan, Hopkins, Jones, Patel, Faris, Calver, Singh, Sanghvi, Eltayeb, Haris
BMJ Open, 14.07.2022
Tilføjet 14.07.2022
Objectives
To assess practice in the care of adults with suspected community-acquired bacterial meningitis in the UK and Ireland.
Design
Retrospective cohort study.
Setting
64 UK and Irish hospitals.
Participants
1471 adults with community-acquired meningitis of any aetiology in 2017.
Results
None of the audit standards, from the 2016 UK Joint Specialists Societies guideline on diagnosis and management of meningitis, were met in all cases. With respect to 20 of 30 assessed standards, clinical management provided for patients was in line with recommendations in less than 50% of cases. 45% of patients had blood cultures taken within an hour of admission, 0.5% had a lumbar puncture within 1 hour, 26% within 8 hours. 28% had bacterial molecular diagnostic tests on cerebrospinal fluid. Median time to first dose of antibiotics was 3.2 hours (IQR 1.3–9.2). 80% received empirical parenteral cephalosporins. 55% ≥60 years and 31% of immunocompromised patients received anti-Listeria antibiotics. 21% received steroids. Of the 1471 patients, 20% had confirmed bacterial meningitis. Among those with bacterial meningitis, pneumococcal aetiology, admission to intensive care and initial Glasgow Coma Scale Score less than 14 were associated with in-hospital mortality (adjusted OR (aOR) 2.08, 95% CI 0.96 to 4.48; aOR 4.28, 95% CI 1.81 to 10.1; aOR 2.90, 95% CI 1.26 to 6.71, respectively). Dexamethasone therapy was weakly associated with a reduction in mortality in both those with proven bacterial meningitis (aOR 0.57, 95% CI 0.28 to 1.17) and with pneumococcal meningitis (aOR 0.47, 95% CI 0.20 to 1.10).
Conclusion
This study demonstrates that clinical care for patients with meningitis in the UK is not in line with current evidence-based national guidelines. Diagnostics and therapeutics should be targeted for quality improvement strategies. Work should be done to improve the impact of guidelines, understand why they are not followed and, once published, ensure they translate into changed practice.
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Maddalena Peghin, Maria De Martino, Alvisa Palese, Elena Graziano, Miriam Isola, Carlo Tascini
Clinical Microbiology and Infection, 13.07.2022
Tilføjet 14.07.2022
We thank Drs Pathum Sookaromdee and Viroj Wiwanitkit for their thoughtful remarks on our study on the role of vaccination and humoral response in post-COVID-19 syndrome after one year. Their letter raises important issues, and we appreciate the opportunity to address these. Based on our data, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination should be recommended for patients with a history of previous COVID-19 infection, regardless of age and severity of acute disease, because hybrid immunity may not worsen sequalae and may reduce their risk of reinfection to avoid a vicious immune circle.
Læs mere Tjek på PubMedHassan Salame, Rashad Nawfal, Jad Kassem, Remy Mckey, Ali Kassem, Nayef AlKhalil, Mohamad Saleh, Ali H. Abdel Sater, Ali Ibrahim, Linda Abou-Abbas, Oussaima Eldbouni, Hoda Khatoun, Bassam Matar
PLoS One Infectious Diseases, 13.07.2022
Tilføjet 13.07.2022
by Hassan Salame, Rashad Nawfal, Jad Kassem, Remy Mckey, Ali Kassem, Nayef AlKhalil, Mohamad Saleh, Ali H. Abdel Sater, Ali Ibrahim, Linda Abou-Abbas, Oussaima Eldbouni, Hoda Khatoun, Bassam Matar
Background COVID-19 pandemic has led to a catastrophic shortage of ICU beds. This has resulted in the need to identify patients that can be discharged early before full clinical recovery. We designed this study to determine if in changes routine tests like CBCD and CRP can be a useful complement to clinical status when deciding to discharge patients from ICU. Methods This retrospective study was conducted in Rafic Hariri University Hospital. Levels of biomarkers measured at admission (T1) and within 3 days of outcome (T2) were collected and ratios (T2/T1) were calculated. The Odds Ratios of association between the changes in these biomarkers and outcome were estimated. Multivariate analysis and AUC for the performance of these biomarkers were also conducted. Results We found on multivariate analysis that reduction in counts of lymphocyte and platelets and elevation in counts of neutrophils and level of CRP (T2/T1 ratio > 1) are strongly associated with mortality with respective ORs estimated at 6.74, 3.26, 5.65 and 4.34 [p-values < 0.001]. AUCs were found to lie in a range of 0.68 to 0.81 indicating fair to good performance. Other factors found to impact survival were AKI, AF and ACS [p-values < 0.01]. In contrast to other studies, risk factors didn’t show an association with survival when adjusted for effects of complications and changes in biomarker levels. Conclusions Our results confirm that inexpensive tests like lymphocyte count and CRP can be reliably used to follow COVID-19 patients in ICU and to support the decision to discharge patients.
Læs mere Tjek på PubMedHayato Taniguchi, Aimi Ohya, Hidehiro Yamagata, Masayuki Iwashita, Takeru Abe, Ichiro Takeuchi
PLoS One Infectious Diseases, 13.07.2022
Tilføjet 13.07.2022
by Hayato Taniguchi, Aimi Ohya, Hidehiro Yamagata, Masayuki Iwashita, Takeru Abe, Ichiro Takeuchi
Lung ultrasound (LUS), a rapid, bedside, goal-oriented diagnostic test, can be quantitatively assessed, and the scores can be used to evaluate disease progression. However, little data exists on predicting prolonged mechanical ventilation (PMV) and successful extubation using serial LUS scores. We examined the relationship of PMV with successful extubation in patients with severe coronavirus disease (COVID-19) by using two types of serial LUS scores. One LUS score evaluated both the pleura and lung fields, while the other assessed each separately (modified-LUS score). Both LUS scores were determined for 20 consecutive patients with severe COVID-19 at three timepoints: admission (day-1), after 48 h (day-3), and on the seventh follow-up day (day-7). We compared LUS scores with the radiographic assessment of the lung oedema (RALE) scores and laboratory test results, at the three timepoints. The PMV and successful extubation groups showed no significant differences in mortality, but significant differences occurred on day-3 and day-7 both LUS scores, day-7 RALE score, and day-7 PaO2/FiO2 ratio, in the PMV group (p<0.05); and day-3 and day-7 modified-LUS scores, day-7 C-reactive protein levels, and day-7 PaO2/FiO2 ratio, in the successful extubation group (p<0.05). The area under the curves (AUC) of LUS scores on day-3 and day-7, modified-LUS scores on day-3 and day-7,RALE score on day-7, and PaO2/FiO2 ratio on day-7 in the PMV group were 0.98, 0.85, 0.88, 0.98, 0.77, and 0.80, respectively. The AUC of modified-LUS scores on day-3 and day-7, C-reactive protein levels on day-7, and PaO2/FiO2 ratio on day-7 in the successful extubation group were 0.79, 0.90, 0.82, and 0.79, respectively. The modified-LUS score on day 7 was significantly higher than that on day 1 in PMV group (p<0.05). While the LUS score did not exhibit significant differences. The serial modified-LUS score of patients with severe COVID-19 could predict PMV.
Læs mere Tjek på PubMedMulugeta W/mariam Beyen, Gizachew Abdissa Bulto, Eshetu Ejeta Chaka, Bikila Tefera Debelo, Ephrem Yohannes Roga, Negash Wakgari, Kababa Temesgen Danusa, Daniel Belema Fekene
PLoS One Infectious Diseases, 13.07.2022
Tilføjet 13.07.2022
by Mulugeta W/mariam Beyen, Gizachew Abdissa Bulto, Eshetu Ejeta Chaka, Bikila Tefera Debelo, Ephrem Yohannes Roga, Negash Wakgari, Kababa Temesgen Danusa, Daniel Belema Fekene
Background The Human Papillomavirus (HPV) vaccine has offered a great promise to reduce the cervical cancer burden; its utilization (uptake) however has been lagging. However, the levels and factors associated with the uptake of the vaccine have not been well investigated, especially in the local context. Objective To assess the uptake of human papillomavirus vaccination and its associated factors among adolescent school girls in ambo town, Oromia, Ethiopia, 2020. Methods An institution-based cross-sectional quantitative study design supplemented with the qualitative inquiry was employed to assess Human Papillomavirus vaccination uptake and its associated factors among 422 adolescent school girls in Ambo town, central Ethiopia from December 1–30, 2020. The collected data were coded, entered, and cleaned by using Epi info 7.2.3 and exported to SPSS version 25 for analysis. Descriptive statistics were used to compute summary statistics and proportions. Both bivariate and multivariable logistic regression was employed to identify factors associated with HPV vaccine uptake. Adjusted odds ratio and 95% confidence interval were used for the strength and directions of association. A P-value of < 0.05 was used to declare statistical significance. Qualitative findings have been analyzed with manual thematic analysis. Result The proportion of HPV vaccination uptake among school girls in this study was 44.4%. Hearing about HPV vaccine [AOR = 2.50, 95%CI: (1.045–5.959)], availability of awareness creation [AOR = 2.53, 95%CI: (1.507–4.258)], and favorable attitude [AOR = 2.049, 95%CI: (1.153–3.64)] were the key identified factors associated with vaccination uptake. In addition, poor perception, fear of side effects, and misunderstanding were among the major factors identified by qualitative findings. Conclusion There was low uptake of HPV vaccination among the school Adolescents in the study area. Availability of awareness creation programs, favorable attitude towards HPV vaccine, and hearing about HPV vaccine was significantly associated with the uptake of the HPV vaccination. Therefore, awareness creation and behavior change education are mandatory to scale up the vaccination.
Læs mere Tjek på PubMedDenghui Wang, Yaxin Zhang, Meiling Xu, Xiaoling Sun, Xiulin Cui, Xiuran Wang, Dongbo Liu
PLoS One Infectious Diseases, 13.07.2022
Tilføjet 13.07.2022
by Denghui Wang, Yaxin Zhang, Meiling Xu, Xiaoling Sun, Xiulin Cui, Xiuran Wang, Dongbo Liu
Background The diabetes mellitus prevalence is rapidly increasing in most parts of the world and has become a vital health problem. Probiotic and herbal foods are valuable in the treatment of diabetes. Methods and performance In this study, Bacillus licheniformis (BL) and Astragalus membranaceus extract (AE) were given with food to InR[E19]/TM2 Drosophila melanogaster, and the blood glucose, antioxidation activity and intestinal microbiota were investigated. The obtained results showed that BA (BL and AE combination) supplementation markedly decreased the blood glucose concentration compared with the standard diet control group, accompanied by significantly increased enzymatic activities of catalase (CAT), decreased MDA levels and prolonged lifespan of InR[E19]/TM2 D. melanogaster. The treatments with BL, AE and BA also ameliorated intestinal microbiota equilibrium by increasing the population of Lactobacillus and significantly decreasing the abundance of Wolbachia. In addition, clearly different evolutionary clusters were found among the control, BL, AE and BA-supplemented diets, and the beneficial microbiota, Lactobacillaceae and Acetobacter, were found to be significantly increased in male flies that were fed BA. These results indicated that dietary supplementation with AE combined with BL not only decreased blood glucose but also extended the lifespan, with CAT increasing, MDA decreasing, and intestinal microbiota improving in InR[E19]/TM2 D. melanogaster. Conclusion The obtained results showed that dietary supplementation with BL and AE, under the synergistic effect of BL and AE, not only prolonged the lifespan of InR[E19]/TM2 D. melanogaster, increased body weight, and improved the body’s antiaging enzyme activity but also effectively improved the types and quantities of beneficial bacteria in the intestinal flora of InR[E19]/TM2 D. melanogaster to improve the characteristics of diabetes symptoms. This study provides scientific evidence for a safe and effective dietary therapeutic method for diabetes mellitus.
Læs mere Tjek på PubMedKohei Koiwa, Koubun Wakashima, Michiko Ikuta, Keigo Asai, Gen Takagi
PLoS One Infectious Diseases, 13.07.2022
Tilføjet 13.07.2022
by Kohei Koiwa, Koubun Wakashima, Michiko Ikuta, Keigo Asai, Gen Takagi
The fear of COVID-19 has become a social problem during the pandemic. The present study compares the fear of COVID-19 among members of the general public, college students, pregnant women, and hospital nurses. It also examines various factors associated with the fear of COVID-19. In this study, we conducted a survey of the general public on fear of infection and related factors and compared from previous studies of college students, pregnant women, and hospital nurses. A crowdsourced survey was administered to 450 members of the general public, who were asked about their fear of COVID-19 infection. Data from college students, nurses, and pregnant women were recruited from a May-June 2020 survey on fear of COVID-19. An analysis of variance was used to compare the fear of infection among different attribution. The results showed that more pregnant women and fewer college students feared infection, as did equal numbers of hospital nurses and members of the general public. The multiple regression analysis revealed that college students and pregnant women associated the fear of infection with their key source of information, while hospital nurses associated the fear of infection with living with an older person. These results suggest that pregnant women have a significant fear of infection, which is further defined by the risk of serious illness in cases of infection. Although the fear of infection is relatively low among hospital nurses, they fear becoming a source of infection. These results reveal the groups in Japan that fear infection and the reasons for their concern. The present study may help to provide psychological support to counteract the fear of infection in vulnerable groups.
Læs mere Tjek på PubMedTomokazu Ohishi, Takayuki Hishiki, Mirza S. Baig, Sajjan Rajpoot, Uzma Saqib, Tomohiko Takasaki, Yukihiko Hara
PLoS One Infectious Diseases, 13.07.2022
Tilføjet 13.07.2022
by Tomokazu Ohishi, Takayuki Hishiki, Mirza S. Baig, Sajjan Rajpoot, Uzma Saqib, Tomohiko Takasaki, Yukihiko Hara
The outbreak of the coronavirus disease 2019 caused by the severe acute respiratory syndrome coronavirus 2 triggered a global pandemic where control is needed through therapeutic and preventive interventions. This study aims to identify natural compounds that could affect the fusion between the viral membrane (receptor-binding domain of the severe acute respiratory syndrome coronavirus 2 spike protein) and the human cell receptor angiotensin-converting enzyme 2. Accordingly, we performed the enzyme-linked immunosorbent assay-based screening of 10 phytochemicals that already showed numerous positive effects on human health in several epidemiological studies and clinical trials. Among these phytochemicals, epigallocatechin gallate, a polyphenol and a major component of green tea, could effectively inhibit the interaction between the receptor-binding domain of the severe acute respiratory syndrome coronavirus 2 spike protein and the human cell receptor angiotensin-converting enzyme 2. Alternately, in silico molecular docking studies of epigallocatechin gallate and angiotensin-converting enzyme 2 indicated a binding score of −7.8 kcal/mol and identified a hydrogen bond between R393 and angiotensin-converting enzyme 2, which is considered as a key interacting residue involved in binding with the severe acute respiratory syndrome coronavirus 2 spike protein receptor-binding domain, suggesting the possible blocking of interaction between receptor-binding domain and angiotensin-converting enzyme 2. Furthermore, epigallocatechin gallate could attenuate severe acute respiratory syndrome coronavirus 2 infection and replication in Caco-2 cells. These results shed insight into identification and validation of severe acute respiratory syndrome coronavirus 2 entry inhibitors.
Læs mere Tjek på PubMedChirag K. Kumar, Ruchita Balasubramanian, Stefano Ongarello, Sergio Carmona, Ramanan Laxminarayan
PLoS One Infectious Diseases, 13.07.2022
Tilføjet 13.07.2022
by Chirag K. Kumar, Ruchita Balasubramanian, Stefano Ongarello, Sergio Carmona, Ramanan Laxminarayan
Although COVID-19 vaccines are globally available, waning immunity and emerging vaccine-evasive variants of concern have hindered the international response and transition to a post-pandemic era. Testing to identify and isolate infectious individuals remains the most proactive strategy for containing an ongoing COVID-19 outbreak. We developed a stochastic, compartmentalized model to simulate the impact of using Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) assays, rapid antigen tests, and vaccinations on SARS-CoV-2 spread. We compare testing strategies across an example high-income country (the United States) and low- and middle-income country (India). We detail the optimal testing frequency and coverage in the US and India to mitigate an emerging outbreak even in a vaccinated population: overall, maximizing testing frequency is most important, but having high testing coverage remains necessary when there is sustained transmission. A resource-limited vaccination strategy still requires high-frequency testing to minimize subsequent outbreaks and is 16.50% more effective in reducing cases in India than the United States. Tailoring testing strategies to transmission settings can help effectively reduce disease burden more than if a uniform approach were employed without regard to epidemiological variability across locations.
Læs mere Tjek på PubMedFederico Migliorelli, Ludovica Ferrero, Catherine McCarey, Sara Marcenaro, Véronique Othenin-Girard, Antonina Chilin, Begoña Martinez de Tejada
PLoS One Infectious Diseases, 13.07.2022
Tilføjet 13.07.2022
by Federico Migliorelli, Ludovica Ferrero, Catherine McCarey, Sara Marcenaro, Véronique Othenin-Girard, Antonina Chilin, Begoña Martinez de Tejada
Background Recent studies have shown that elective induction of labor versus expectant management after 39 weeks of pregnancy result in lower incidence of perinatal complications, while the proportion of cesarean deliveries remains stable, or even decreases. Still, evidence regarding collateral consequences of the potential increase of induction of labor procedures is still lacking. Also, the results of these studies must be carefully interpreted and thoroughly counter-balanced with women’s thoughts and opinions regarding the active management of the last weeks of pregnancy. Therefore, it may be useful to develop a tool that aids in the decision-making process by differentiating women who will spontaneously go into labor from those who will require induction. Objective To develop a predictive model to calculate the probability of spontaneous onset of labor at term. Methods We designed a prospective national multicentric observational study including women enrolled at 39 weeks of gestation, carrying singleton pregnancies. After signing an informed consent form, several clinical, ultrasonographic, biophysical and biochemical variables will be collected by trained staff. If delivery has not occurred at 40 weeks of pregnancy, a second visit and evaluation will be performed. Prenatal care will be continued according to current hospital guidelines. Once recruitment is completed, the information gathered will be used to develop a logistic regression-based predictive model of spontaneous onset of labor between 39 and 41 weeks of gestation. A secondary exploration of the data collected at 40 weeks, as well as a survival analysis regarding time-to-delivery outcomes will also be performed. A total sample of 429 participants is needed for the expected number of events. Conclusion This study aims to develop a model which may help in the decision-making process during follow-up of the last weeks of pregnancy. Trial registration NCT05109247 (clinicaltrials.gov).
Læs mere Tjek på PubMedYaozong Chen, Lulu Sun, Irfan Ullah, Guillaume Beaudoin-Bussières, Sai Priya Anand, Andrew P. Hederman, William D. Tolbert, Rebekah Sherburn, Dung N. Nguyen, Lorie Marchitto, Shilei Ding, Di Wu, Yuhong Luo, Suneetha Gottumukkala, Sean Moran, Priti Kumar, Grzegorz Piszczek, Walther Mothes, Margaret E. Ackerman, Andrés Finzi, Pradeep D. Uchil, Frank J. Gonzalez, Marzena Pazgier
Science Advances, 13.07.2022
Tilføjet 13.07.2022
Lu Meng, Fengmin Yang, Yan Pang, Zhenping Cao, Feng Wu, Deyue Yan, Jinyao Liu
Science Advances, 13.07.2022
Tilføjet 13.07.2022
Wang, T., Li, C., Li, H., Li, Z.
BMJ Open, 13.07.2022
Tilføjet 13.07.2022
Objective
By using health code blockchain, cities can maximise the use of personal information while maximising the protection of personal privacy in the monitoring and evaluation of the effectiveness of listed vaccines.
Design
This study constructs an urban COVID-19 listed vaccine effectiveness (VE) monitoring, evaluation and application system based on the health code blockchain. This study uses this system and statistical simulation to analyse three urban application scenarios, namely evaluating the vaccination rate (VR) and determining the optimal vaccination strategy, evaluating herd immunity and monitoring the VE on variant.
Main outcome measures
The primary outcomes first establish an urban COVID-19 listed VE monitoring, evaluation and application system by using the health code blockchain, combined with the dynamic monitoring model of VE, the evaluation index system of VE and the monitoring and evaluation system of personal privacy information use, and then three measures are analysed in urban simulation: one is to take the index reflecting urban population mobility as the weight to calculate the comprehensive VR, the second is to calculate the comprehensive basic reproduction number (R) in the presence of asymptomatic persons, the third is to compare the difference between the observed effectiveness and the true effectiveness of listed vaccines under virus variation.
Results
Combining this system and simulation, this study finds: (1) The comprehensive VR, which is weighted to reflect urban population mobility, is more accurate than the simple VR which does not take into account urban population mobility. Based on population mobility, the algorithm principle of urban optimal vaccination strategy is given. In the simulation of urban listed vaccination involving six regions, programmes 1 and 5 have the best protective effect among the eight vaccination programmes, and the optimal vaccination order is 3-5-2-4-6-1. (2) In the presence of asymptomatic conditions, the basic reproduction number, namely R0*(1-VR*VE), does not accurately reflect the effect of herd immunity, but the comprehensive basic reproduction number (R) should be used. The R is directly proportional to the proportion of asymptomatic people (aw) and the duration of the incubation period (ip), and inversely proportional to the VR, the VE and the number of days transmitted in the ip (k). In the simulation analysis, when symptomatic R0=3, even with aw=0.2, the R decreases to nearly 1 until the VR reaches 95%. When aw=0.8, even when the entire population is vaccinated, namely VR=1, the R is 1.688, and still significantly greater than 1. If the R is to be reduced to 1, the VE needs to be increased to 0.87. (3) This system can more comprehensively and accurately grasp the impact of the variant virus on urban VE. The traditional epidemiological investigation can lose the contacts of infected persons, which leads to the deviation between the observed effectiveness and the true effectiveness. Virus variation aggravates the loss, and then increases the deviation. Simulation case 1 assumes the unvaccinated rate of 0.8, the ongoing VR of 0.1, the completed VR of 0.1 and an average infection rate of 2% for the variant virus. If a vaccine is more than 90% effectiveness against the premutant virus, but only 80% effectiveness against the mutant virus, and because 80% of the unvaccinated people who are not infected are not observed, the observed effectiveness of the vaccine is 91.76%, it will lead to the wrong judgement that the VE against the variant virus is not decreased. Simulation case 2 assumes the unvaccinated rate of 0.8, the ongoing VR of 0.1, the completed VR of 0.1 and an average infection rate of 5% for the variant virus. Simulation finds that the higher the proportion of unvaccinated infected people who are not observed, the lower the estimate of observed effectiveness; and the lower the true effectiveness, the larger the gap between observed effectiveness and true effectiveness. Simulation case 3 assumes the unvaccinated rate of 0.2, the ongoing VR of 0.2, the completed VR of 0.6 and an average infection rate of 2% for the variant virus. Simulation finds that the higher the proportion of unobserved completed vaccination patients who are not infected, the lower the estimate of observed effectiveness; and the lower the true effectiveness, the larger the gap between observed effectiveness and true effectiveness. Simulation case 4 assumes the unvaccinated rate of 0.2, the ongoing VR of 0.2, the completed VR of 0.6 and an average infection rate of 5% for the variant virus. If a vaccine is more than 90% effectiveness against the premutant virus, but only 80% effectiveness against the mutant virus, and because 80% of the infected people with complete vaccination are not observed, the observed effectiveness of the vaccine is 91.95%, similar to case 1, it will lead to the wrong judgement that the VE against the variant virus is not decreased.
Conclusion
Compared with traditional epidemiological investigation, this system can meet the challenges of accelerating virus variation and a large number of asymptomatic people, dynamically monitor and accurately evaluate the effectiveness of listed vaccines and maximise personal privacy without locking down the relevant area or city. This system established in this study could serve as a universal template for monitoring and evaluating the effectiveness of COVID-19 listed vaccines in cities around the world. If this system can be promoted globally, it will promote countries to strengthen unity and cooperation and enhance the global ability to respond to COVID-19.
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Enriquez, K., Raouf, S., Shakpeh, J., Niescierenko, M., Mayah-Toto, F.
BMJ Open, 13.07.2022
Tilføjet 13.07.2022
Background
Surgical antibiotic prophylaxis (SAP) is one of the most effective measures to prevent surgical site infections (SSIs). According to WHO SAP guidelines, SAP requires appropriate indication for administration and delivery of the antimicrobial agent to the operative site through intravenous administration within 60–120 min before the initial surgical incision is made. In Liberia, it is unknown how surgeons practice and there has been anecdotal observation of antibiotic overuse.
Objective
To elucidate baseline SAP compliance, particularly appropriate SAP use based on wound class and time of antibiotic administration.
Methods
An observational, cross-sectional study was conducted from November to December 2017. One-day training was provided on SAP/SSI to 24 health workers by the Ministry of Health and WHO. Following this training, surgical cases (general surgery and obstetrics and gynaecology (OB/GYN) underwent chart review with focus on time of SAP administration and appropriate SAP based on Centers for Disease Control and Prevention (CDC) wound classification.
Results
A total of 143 charts were reviewed. Twenty-nine (20.3%) cases showed appropriate prophylaxis through administrations of antibiotics 120 min before surgical incision, resulting in SAP compliance. One hundred and fourteen cases (79.7%) showed SAP noncompliance with timing of antibiotic administration. Of the OB/Gyn cases, 109 wounds were classified as Class I (clean) and one wound was classified as Class III (contaminated). For General Surgical cases, 32 wounds were classified as Class I and one as Class III. Of the 109 Class I OB/Gyn surgeries, 24 (22%) were appropriately given antibiotics based on the CDC wound guidelines while 78% were non-compliant with recommendations. Of the 32 Class I General surgery cases, 4 (12.5%) were compliant with antibiotics guidelines while 28 (87.5%) were not.
Conclusion
Compliance with SAP is low. More studies need to be done to explore the contributing factors to this. Implementing mechanisms to achieve proper use of SAP is needed.
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Daw, P., Wood, G. E. R., Harrison, A., Doherty, P. J., Veldhuijzen van Zanten, J. J. C. S., Dalal, H. M., Taylor, R. S., van Beurden, S. B., McDonagh, S. T. J., Greaves, C. J.
BMJ Open, 13.07.2022
Tilføjet 13.07.2022
Objectives
This study aimed to identify barriers to, and facilitators of, implementation of the Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) programme within existing cardiac rehabilitation services, and develop and refine the REACH-HF Service Delivery Guide (an implementation guide cocreated with healthcare professionals). REACH-HF is an effective and cost-effective 12-week home-based cardiac rehabilitation programme for patients with heart failure.
Setting/participants
In 2019, four early adopter ‘Beacon Sites’ were set up to deliver REACH-HF to 200 patients. In 2020, 5 online REACH-HF training events were attended by 85 healthcare professionals from 45 National Health Service (NHS) teams across the UK and Ireland.
Design
Our mixed-methods study used in-depth semi-structured interviews and an online survey. Interviews were conducted with staff trained specifically for the Beacon Site project, identified by opportunity and snowball sampling. The online survey was later offered to subsequent NHS staff who took part in the online REACH-HF training. Normalisation Process Theory was used as a theoretical framework to guide data collection/analysis.
Results
Seventeen healthcare professionals working at the Beacon Sites were interviewed and 17 survey responses were received (20% response rate). The identified barriers and enablers included, among many, a lack of resources/commissioning, having interest in heart failure and working closely with the clinical heart failure team. Different implementation contexts (urban/rural), timing (during the COVID-19 pandemic) and factors outside the healthcare team/system (quality of the REACH-HF training) were observed to negatively or positively impact the implementation process.
Conclusions
The findings are highly relevant to healthcare professionals involved in planning, delivering and commissioning of cardiac rehabilitation for patients with heart failure. The study’s main output, a refined version of the REACH-HF Service Delivery Guide, can guide the implementation process (eg, designing new care pathways) and provide practical solutions to overcoming common implementation barriers (eg, through early identification of implementation champions).
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Liu, Q., Han, G., Li, R., Fan, D., Du, G., Zhang, M., Tao, L., Li, H., Liu, D., Song, C.
BMJ Open, 13.07.2022
Tilføjet 13.07.2022
Introduction
Zoledronic acid (ZA) has been used as a first-line treatment in patients with osteoporosis (OP) who receive an annual injection of 5 mg. However, side effects of bone pain and fever, known as the acute phase response (APR), have often been observed after clinical usage. A meta-analysis reported that the incidence of APR was 49.4% among patients with OP who received ZA for the first time and that 30% of patients with these adverse effects refused treatment in the following year. As a clinically used hypolipidaemic drug, statins can inhibit 3-hydroxy-3-methylglutaryl coenzyme A reductase to block the pathway upstream of farnesyl pyrophosphate synthase. This process can decrease the accumulation of isopentenyl pyrophosphate to prevent T-cell activation and inflammatory factor production, blocking APR occurrence. The aim of this study is to determine the reduction effect of oral pravastatin on APR and investigate the possible mechanisms underlying the effect in vivo.
Methods and analysis
This will be a single-centre, placebo-controlled trial. Female participants will be allocated at a 1:1 ratio to receive either oral pravastatin or a placebo at 1-hour predose and 24 and 48 hours post-administration of ZA. The primary outcome will be the incidence of APR within 72 hours after ZA infusion. The secondary outcomes will include the occurrence time and severity of APR and the frequency and amount of acetaminophen usage within 72 hours after ZA infusion. This study will determine the preventive effect of oral pravastatin on APR in Chinese patients with OP, supporting the clinical application of ZA to alleviate concerns regarding safety and increase patient compliance.
Ethics and dissemination
This study protocol has been registered with ClinicalTrials.gov. This study protocol was reviewed and approved by the Peking University Third Hospital Medical Science Research Ethics Committee. The results will be published in scientific peer-reviewed journals.
Trial registration number
NCT04719481.
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BMC Infectious Diseases, 13.07.2022
Tilføjet 13.07.2022
Abstract
Background
Recent studies demonstrated that failure of achieving pharmacodynamic targets of commonly used antibiotics is common in critically ill patients. Therapeutic drug monitoring (TDM) can contribute to optimize the exposure of beta-lactams and ciprofloxacin. While evidence for TDM of these antibiotics is growing, translation into clinical implementation remains limited. Therefore, perceived barriers and facilitators are important for implementing TDM in this population. The primary aim of this study was to identify healthcare professionals’ barriers and facilitators for the implementation of TDM of beta-lactams and ciprofloxacin in Dutch intensive care units (ICU).
Methods
We conducted a nationwide cross-sectional online survey among healthcare professionals (HCPs) involved in antibiotic treatment of ICU patients. An adapted version of the Measurement Instrument for Determinants of Innovations was sent out. Items were considered barriers when ≥ 20% of participants responded with a negative answer. If ≥ 80% of the participants responded with a positive answer, the item was considered a facilitator.
Results
Sixty-four HCPs completed the survey, of which 14 were from academic hospitals, 25 from general hospitals, and 25 from teaching hospitals. Most participants were hospital pharmacists (59%) or medical specialists (23%). Eleven barriers and four facilitators for implementation of TDM of beta-lactams were identified; 17 barriers for TDM of ciprofloxacin and no facilitators. The most important barriers were a lack of conclusive evidence, organizational support, and low availability of assays. Additional barriers were a lack of consensus on which specific patients to apply TDM and which pharmacodynamic targets to use. Identified facilitators for beta-lactam TDM implementation are low complexity and high task perception, combined with the perception that TDM is important to prevent side effects and to adequately treat infections. Twenty-eight percent of participants reported that flucloxacillin could be analyzed in their hospital. Assay availability of other beta-lactams and ciprofloxacin was lower (3–17%).
Conclusion
Several barriers were identified that could obstruct the implementation of TDM of beta-lactams and ciprofloxacin in the ICU. In particular, education, clear guidelines, and organizational support should be considered when creating tailored implementation strategies. Finally, evidence of beneficial clinical outcomes on TDM of beta-lactams and ciprofloxacin can enhance further implementation.
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BMC Infectious Diseases, 13.07.2022
Tilføjet 13.07.2022
Abstract
Background
Assessing immune responses after vaccination is part of the evaluation package of vaccine effectiveness in the real world. Regarding SARS-CoV-2, neutralizing antibody levels has been shown to be a good indicator of antibody immune response boosting. So far, limited data have been reported from Africa including in Central Africa. The objective of this study was to provide data on anti-S1 spike total IgG and neutralizing antibodies in vaccinated and non-vaccinated including naturally infected Congolese population during B.1.214.1 and B.1.617.2 variant waves.
Methods
Recruited patients were divided into 4 groups: (1) Naturally infected by the B.1.214.1 variant on January 2021 and followed up until September 2021. These patients have been vaccinated at month 07 and then followed up for 2 months post vaccination; (2) Naturally infected by the B.1.617.2 variant from June 2021; (3) unvaccinated SARS-CoV-2 individuals with no history of prior SARS-CoV-2 infection; (4) fully vaccinated individuals with sinopharm/BBIP-CorV or Janssen/Ad26.COV2.S. SARS-CoV-2 was detected by qRT-PCR and sequenced using Next-Generation Sequencing. ELISA method was used for detecting IgG, and neutralizing Antibody against SARS-CoV-2 antigens using commercial neutralizing assay.
Results
Individuals infected by the B.1214.1 variant elicited consistently high IgG titers at 02, 03 and 06 months. Two months post vaccination with BBIP-CorV, participants showed a significant increase by × 2.5 fold (p < 0.0001) of total IgG and X1.5 fold for neutralizing antibody capacity. This study showed that natural infection with B1.617.2 (delta) variant was more immunogenic compared to those being infected with B1.214.2 variant.
We found a significantly higher concentration in anti-SARS-CoV-2 IgG (p < 0.0002) and antibodies neutralization capacity (P < 0.0001) in fully vaccinated compared to unvaccinated participants. Two months post vaccination, individuals who received Janssen/Ad26.COV2.S presented higher (p = 0.01) total IgG to spike protein compared to BBIP-CorV.
Conclusion
Both natural infection and vaccination with BBIP-CorV and Janssen/Ad26.COV2.S induced antibody response in Congolese population. In addition, Janssen/Ad26.COV2.S was more immunogenic than Sinopharm/BBIP-CorV. There is a need to investigate the duration of these antibodies both in previously infected and naive vaccinated Congolese to allow public heath stakeholders to make evidence-based decision on vaccine schedule for the Congolese population.
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Malaria Journal, 12.07.2022
Tilføjet 13.07.2022
Abstract
Background
Interleukin (IL)-4 had been linked to malaria severity, but the findings are controversial, and the evidence is inconsistent and imprecise. In the current investigation, data on IL-4 levels in patients with severe and uncomplicated malaria were compiled.
Methods
The systematic review was registered at PROSPERO (CRD42022323387). Searches for relevant articles on IL-4 levels in patients with severe malaria and studies that examined IL-4 levels in both uncomplicated malaria and healthy controls were performed in PubMed, Embase, and Scopus using the search strategy without limitation to publication years or language. The quality of all included studies was evaluated using The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: standards for reporting observational studies. Qualitative and quantitative data syntheses were performed. The random-effects model, which weights each study according to its between- and within-study variance, was used to pool the mean difference (MD) of individual studies. The degree of heterogeneity was determined using Cochran's Q and I2 statistics. Additionally, meta-regression and subgroup analyses were perfomed to investigate possible sources of heterogeneity. The outliers were identified using the leave-one-out method and assessed publication bias using funnel plots, Egger’s test, and a contour-enhanced funnel plot.
Results
A total of 2300 studies were identified through database searches, and 36 were included for analyses. The meta-analysis results showed lower mean IL-4 levels in severe malaria (434 cases) than in uncomplicated malaria (611 cases) (P = 0.01, pooled MD: −3.36 pg/mL, 95% confidence intervals CI −5.55 to −1.16 pg/mL, I2: 98.15%, 11 studies). The meta-analysis results showed no difference in mean IL-4 levels between cerebral malaria (96 cases) and noncerebral severe malaria (108 cases) (P = 0.71, pooled MD: 0.86 pg/mL, 95% CI −3.60 to 5.32 pg/mL, I2 92.13%, four studies). Finally, no difference was found in mean IL-4 levels between uncomplicated malaria (635 cases) and healthy controls (674 cases) (P = 0.57, pooled MD: 0.79 pg/mL, 95% CI −1.92 to 3.50 pg/mL, I2: 99.89%, 11 studies).
Conclusion
The meta-analysis revealed lower IL-4 levels in patients with severe malaria than in those with uncomplicated malaria, though a trend toward comparable IL-4 levels between both groups was more likely because several sources of heterogeneities were observed. Based on the limited number of studies included in the meta-analysis, until additional investigations have been conducted, IL-4 consideration as an alternative prognostic factor for malaria severity is not warranted.
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Tural Yarahmadov, Junhua Wang, Daniel Sanchez-Taltavull, Cristian A. Alvarez Rojas, Tess Brodie, Isabel Büchi, Adrian Keogh, Bruno Gottstein, Deborah Stroka, Guido Beldi aDepartment of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland bInstitute for Infectious Diseases, University of Bern, Bern, Switzerland cInstitute of Parasitology, University of Zurich, Zurich, Switzerland, De'Broski R. Herbert
Infection and Immunity, 13.07.2022
Tilføjet 13.07.2022
Jung Hun Kim, Jeong Han Kim, Won Hyeok Choe, So Young Kwon, Byung-chul Yoo, Eileen L. Yoon, Seong Hee Kang aDepartment of Internal Medicine, Konkuk University School of Medicine, Seoul, South Korea bResearch Institute of Medical Science, Konkuk University School of Medicine, Seoul, South Korea cDepartment of Internal Medicine, Inje University Sanggye Paik Hospitalgrid.411627.7, Seoul, South Korea dDepartment of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
Antimicrobial Agents And Chemotherapy, 13.07.2022
Tilføjet 13.07.2022
Infection, 12.07.2022
Tilføjet 13.07.2022
American Journal of Tropical Medicine and Hygiene, 13.07.2022
Tilføjet 13.07.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 107Issue: 1Pages: 216-216
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American Journal of Tropical Medicine and Hygiene, 13.07.2022
Tilføjet 13.07.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 107Issue: 1Pages: 217-217
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American Journal of Tropical Medicine and Hygiene, 13.07.2022
Tilføjet 13.07.2022
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 107Issue: 1Pages: 218-218
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