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34 emner vises.
Clinical Infectious Diseases, 24.09.2022
Tilføjet 24.09.2022
AbstractBackgroundThis study was performed to evaluate the efficacy of using a thin bronchoscope for the diagnosis of pulmonary tuberculosis (PTB).MethodsBetween March 2019 and November 2021, we prospectively enrolled participants with suspected PTB whose sputum acid-fast bacilli (AFB) smear and tuberculosis (TB)-polymerase chain reaction (PCR) tests were negative or who could not produce self-expectorated sputum. Participants were randomized to a control group (bronchial washing [BW] using a 5.9-mm conventional bronchoscope guided by chest computed tomography) or an investigational group (BW using a 4.0-mm thin bronchoscope under virtual bronchoscopic navigation guidance). The primary outcome was detection of TB in BW fluid, defined as a positive result in the Xpert MTB/RIF assay. The secondary outcomes included AFB smear- and Mycobacterium tuberculosis culture-positivity, time to treatment initiation, and bronchoscopy-related complications.ResultsIn total, 85 participants were included in the final analysis (43 in the control group and 42 in the investigational group). Twenty-three and 29, respectively, were finally diagnosed with PTB. The TB detection rate in BW fluid was higher in the investigational group (72.4 vs. 43.5%, P = 0.035). M. tuberculosis culture positivity was also higher in the investigational group (79.3 vs. 52.2%, P = 0.038). No participants required premature bronchoscopy termination because of complications. Of the participants with PTB, the time to treatment initiation was shorter in the investigational group (median 2.0 days vs. 4.0 days; P = 0.001).ConclusionBW using a thin bronchoscope increases the TB detection rate in patients with PTB compared to conventional bronchoscopy.
Læs mere Tjek på PubMedClinical Infectious Diseases, 22.09.2022
Tilføjet 24.09.2022
ABSTRACTBackgroundViral rebound during antiretroviral treatment (ART) is most often driven by suboptimal adherence in the absence of drug resistance. We assessed the diagnostic performance of point-of-care (POC) tenofovir (TFV) detection in urine for the prediction of viral rebound and drug resistance during ART.MethodsWe performed a nested case-control study within the ADVANCE randomized clinical trial (NCT03122262) in Johannesburg, South Africa. Adult outpatients living with HIV and newly initiating ART were randomized to receive either dolutegravir or efavirenz, tenofovir disoproxil fumarate or alafenamide, and emtricitabine. All participants with rebound ≥200 copies/mL between 24 and 96 weeks of follow-up were selected as cases and matched to controls with virological suppression <50 copies/mL. Rapid POC urine-TFV detection was performed retrospectively.ResultsWe included 281 samples from 198 participants. Urine-TFV was detectable in 30.7% (70/228) of cases and in 100% (53/53) of controls. Undetectable urine-TFV predicted rebound with a sensitivity of 69% [95%CI 63-75] and specificity of 100% [93-100]. In cases with virological failure and sequencing data (n = 42), NRTI drug resistance was detected in 50% (10/20) of cases with detectable urine-TFV versus in 8.3% (2/24) of cases with undetectable urine-TFV. Detectable urine-TFV predicted NRTI resistance (OR 10.4 [1.8-114.4] p = 0.005) with a sensitivity of 83% [52-98] and specificity of 69% [50-84].ConclusionsPoint-of-care objective adherence testing using a urine-TFV test predicted viral rebound with high specificity. In participants with rebound, urine-TFV testing predicted the selection of drug resistance. Objective adherence testing may be used to rapidly provide insight into adherence, suppression, and drug resistance during ART.
Læs mere Tjek på PubMedInfection, 24.09.2022
Tilføjet 24.09.2022
Abstract
Purpose
Infective endocarditis (IE) is frequently caused by streptococcal species, yet clinical features and mortality are poorly investigated. Our aim was to examine patients with streptococcal IE to describe clinical features and outcomes according to streptococcal species.
Methods
From 2002 to 2012, we investigated patients with IE admitted to two tertiary Danish heart centres. Adult patients with left-sided streptococcal IE were included. Adjusted multivariable logistic regression analyses were performed, to assess the association between streptococcal species and heart valve surgery or 1-year mortality.
Results
Among 915 patients with IE, 284 (31%) patients with streptococcal IE were included [mean age 63.5 years (SD 14.1), 69% men]. The most frequent species were S. mitis/oralis (21%) and S. gallolyticus (17%). Fever (86%) and heart murmur (81%) were common symptoms, while dyspnoea was observed in 46%. Further, 18% of all cases were complicated by a cardiac abscess/pseudoaneurysm and 25% by an embolic event. Heart valve surgery during admission was performed in 55% of all patients, and S. gallolyticus (OR 0.28 [95% CI 0.11–0.69]) was associated with less surgery compared with S. mitis/oralis. In-hospital mortality was 7% and 1-year mortality 15%, without any difference between species.
Conclusion
S. mitis/oralis and S. gallolyticus were the most frequent streptococcal species causing IE. Further, S. gallolyticus IE was associated with less heart valve surgery during admission compared with S. mitis/oralis IE. Being aware of specific symptoms, clinical findings, and complications related to different streptococcal species, may help the clinicians in expecting different outcomes.
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Infection, 24.09.2022
Tilføjet 24.09.2022
Abstract
Purpose
Data on encephalitis in elderly patients are scarce. We aimed to describe the characteristics, aetiologies, management, and outcome of encephalitis in patients older than 65 years.
Methods
We performed an ancillary study of ENCEIF, a prospective cohort that enrolled all cases of encephalitis managed in 46 clinical sites in France during years 2016–2019. Cases were categorized in three age groups: (1) 18–64; (2) 65–79; (3) ≥ 80 years.
Results
Of the 494 adults with encephalitis enrolled, 258 (52%) were ≥ 65 years, including 74 (15%) ≥ 80 years. Patients ≥ 65 years were more likely to present with coma, impaired consciousness, confusion, aphasia, and rash, but less likely to present with fever, and headache (P < 0.05 for each). Median cerebrospinal fluid (CSF) white cells count was 61/mm3[13–220] in 65–79 years, 62 [17–180] in ≥ 80 years, vs. 114 [34–302] in < 65 years (P = 0.01). The proportion of cases due to Listeria monocytogenes and VZV increased after 65 years (P < 0.001), while the proportion of tick-borne encephalitis and Mycobacterium tuberculosis decreased with age (P < 0.05 for each). In-hospital mortality was 6/234 (3%) in < 65 years, 18/183 (10%) in 65–79 years, and 13/73 (18%) in ≥ 80 years (P < 0.001). Age ≥ 80 years, coma on admission, CSF protein ≥ 0.8 g/L and viral encephalitis were independently predictive of 6 month mortality.
Conclusion
Elderly patients represent > 50% of adults with encephalitis in France, with higher proportion of L. monocytogenes and VZV encephalitis, increased risk of death, and sequels. The empirical treatment currently recommended, aciclovir and amoxicillin, is appropriate for this age group.
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Parise Adadi, Emmanuel Ofosu Mensah, Salim Abdul‐Razak
Journal of Medical Virology, 24.09.2022
Tilføjet 24.09.2022
Itta Krishna Chaaithanya, Clara Aranha
Journal of Medical Virology, 24.09.2022
Tilføjet 24.09.2022
Mariko Hanafusa, Nobutoshi Nawa, Yuki Goto, Tomoki Kawahara, Shigeru Miyamae, Yutaka Ueki, Nobuyuki Nosaka, Kenji Wakabayashi, Shuji Tohda, Ukihide Tateishi, Takeo Fujiwara
Journal of Medical Virology, 23.09.2022
Tilføjet 24.09.2022
Wubshet Assefa, Tewodros Eshete, Yoseph Solomon, Bersabeh Mekasha
International Journal of Infectious Diseases, 24.09.2022
Tilføjet 24.09.2022
Tuberculosis is the biggest global health issue, tuberculous lymphadenopathy (TBL) being its commonest extra-pulmonary manifestation. Clinical diagnoses of TBL often pose challenges,thus this study aimed to analyze the clinical, epidemiologic and laboratory aspects of TBL in Debre Markos Specialized Comprehensive Hospital (DMSCH), North-west Ethiopia.
Læs mere Tjek på PubMedAnanda S Bandyopadhyay, Simona Zipursky
Lancet Infectious Diseases, 24.09.2022
Tilføjet 24.09.2022
The recent detection of vaccine-derived poliovirus (VDPV) in London (UK) and a case of paralytic polio in New York (USA) have highlighted how the scourge of poliomyelitis has not been totally overcome and remains an international problem, not confined to Afghanistan and Pakistan (where wild-type 1 poliovirus remains endemic) or as outbreaks of circulating VDPV in countries in Africa. To address the risk of circulating VDPVs, a global collaborative effort over the past decade has enabled the development of novel oral polio vaccine type 2 (nOPV2) that is as immunogenic as the current Sabin strain and so equally effective, while being less likely to revert to neurovirulence than Sabin oral polio vaccines.
Læs mere Tjek på PubMedAmy ML Quek, David Tang, Amanda Chin, Kay WP Ng, Hazel Lin, Raymond CS Seet
International Journal of Infectious Diseases, 23.09.2022
Tilføjet 24.09.2022
Tuberculosis is a devastating cause of meningoencephalitis (Wilkinson, Rohlwink et al. 2017). As early recognition and treatment are central to a favorable outcome, anti-tuberculous medications are often initiated before mycobacterial culture results become available, especially in countries where tuberculosis is endemic (Wilkinson, Rohlwink et al. 2017). We describe the case history of 3 patients with autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy who were initially treated for tuberculous meningoencephalitis.
Læs mere Tjek på PubMedLara Bardtke, Ian A. Cockburn
Trends in Parasitology, 23.09.2022
Tilføjet 24.09.2022
Protective antibodies against Plasmodium falciparum merozoite antigens, including EBA-175, can inhibit erythrocyte invasion. New data from Musasia et al. indicate that these antibodies can also trigger antibody-dependent phagocytosis of ring-infected and uninfected erythrocytes and that this correlates with protection from malaria. This provides a new pathway for vaccine design.
Læs mere Tjek på PubMedEstelle Marion, Laurent Marsollier
Trends in Microbiology, 23.09.2022
Tilføjet 24.09.2022
Mycobacterium ulcerans is the etiological agent of Buruli ulcer, an emerging neglected tropical disease. This necrotizing hypodermatitis affects mostly children in West and Central Africa. Mycolactone, the main virulence factor of M. ulcerans, is a macrolide toxin with pleiotropic effects that allow the establishment of M. ulcerans in its hosts. Although early infection can be treated with antibiotics, late stages also require surgery, skin grafts, and functional rehabilitation to limit irreversible damage.
Læs mere Tjek på PubMedBerghs, M. J., Horne, F., Yates, S., Graham, S., Kemp, R., Webster, A., Howson, C.
BMJ Open, 24.09.2022
Tilføjet 24.09.2022
Objective
To understand the psychological and social impact of shielding on people with sickle cell disorders and their carers in the Midlands region of England. This region was badly affected during the pandemic, with the city of Birmingham having some of the highest rates of COVID-19 deaths.
Design
A mixed-methods project with a quantitative survey on shielding and adapted SF36 V.2 questionnaire, which was supplemented by qualitative semistructured interviews analysed using interpretive phenomenological analysis (IPA).
Participants
Fifty-one participants who were predominantly of Black Caribbean or Black African heritage anonymously took part in the online survey. We supplemented this with eight in-depth semistructured interviews with adults with sickle cell disorders using IPA.
Results
The adapted 36-Item Short Form Survey (SF36) version 2 (V. 2) survey indicated worse quality of life and mental health. The open-ended questions from the adapted survey also identified shielding concerns about hospital care, pain management and knowledge of sickle cell by healthcare professionals. From the interviews, it emerged that the racialised element of the pandemic caused significant psychological distress for a population group that had to regularly access hospitals. It was noted that psychological health needs both during a pandemic and outside of it were poorly understood and became invisible in services. The psychological impact of experiences of hospital care as well as growing up with an invisible chronic condition were important to understand psychologically.
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Zhao, Y., Teh, J. J., Kung, V., Mallappa, S.
BMJ Open, 24.09.2022
Tilføjet 24.09.2022
Introduction
COVID-19 disease was declared as a pandemic by WHO since March 2020 and can have a myriad of clinical presentations affecting various organ systems. Patients with COVID-19 are known to have an increased risk of thromboembolism, including cardiovascular, pulmonary and cerebral ischaemic events. However, an increasing number of case studies have reported that COVID-19 infection is also associated with gastrointestinal ischaemia. This scoping review aims to collate the current evidence of COVID-19-related gastrointestinal ischaemia and raise awareness among healthcare professionals of this lesser known, but serious, non-pulmonary complication of COVID-19 infection.
Methods
The proposed scoping review will be conducted as per the Arksey and O’Malley methodological framework (2005) the Joanna Briggs Institute methodology for scoping reviews. A systematic search will be undertaken on different databases including EMBASE, PubMed and MEDLINE. Two independent reviewers will screen titles, abstracts and full-text articles according to the inclusion criteria and extract relevant data from the included articles. Results will be presented in a tabular form with a narrative discussion.
Ethics and dissemination
Ethical approval will not be required for this scoping review. This scoping review will provide an extensive overview of the association between COVID-19 infection and bowel ischaemia. Further ethical and methodological challenges will also be discussed in our findings to define a new research agenda. Findings will be disseminated through peer-reviewed publications and presentations at both national and international conferences.
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Harimanana, A., Rakotondrasoa, A., Rivoarilala, L. O., Criscuolo, A., Opatowski, L., Rakotomanana, E. F. N., Herindrainy, P., Collard, J.-M., Crucitti, T., Huynh, B.-T., For the NeoLIC study group, Rasoloson, Gamana, Andriamarohasina, Mattern
BMJ Open, 24.09.2022
Tilføjet 24.09.2022
Introduction
Data regarding the acquisition of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) in neonates at the community level are scarce in low-income and middle-income countries (LMICs), where the burden of neonatal sepsis is high.
Our study aims at identifying and quantifying the role of the different routes of ESBL-PE transmission for neonates, which are still undefined in the community in LMICs.
Methods and analysis
In a semirural community in Madagascar, 60 mothers and their neonates will be recruited at delivery, during which a maternal stool sample and meconium of the newborn will be collected. Home visits will be planned the day of the delivery and next at days 3, 7, 14, 21 and 28. Stool samples from the newborn, the mother and every other household member will be collected at each visit, as well as samples from the environment in contact with the newborn (food, surfaces and objects). Sociodemographic data and factors which might drive ESBL-PE acquisition will also be collected.
We will analyse the isolated ESBL-PE using DNA sequencing methods to characterise clones, resistance genes and plasmids of ESBL-PE. To analyse these data globally, we will develop novel analytical approaches combining mathematical modelling and statistics. Finally, mathematical simulations will be performed to test different strategies of control of ESBL-PE transmission to neonates.
In complement, we will conduct an anthropological investigation to understand local environments and practices that would contribute to neonatal ESBL-PE acquisition. In-depth interviews with members of 16 households will be conducted and 4 mother–newborn pairs will be followed by a participants’ observations methodology.
Ethics and dissemination
The study was approved by the ethical committee in Madagascar and by the institutional review board of Institut Pasteur, Paris, France.
Findings will be reported to participating families, collaborators and local government; presented at national and international conferences and disseminated by peer-review publications.
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Kandasamy, S., Ariyarajah, A., Limbachia, J., An, D., Lopez, L., Manoharan, B., Pacht, E., Silver, A., Uddandam, A., Vansjalia, K. M., Williams, N. C., Anand, S. S., for the SAY-VAC team
BMJ Open, 24.09.2022
Tilføjet 24.09.2022
Objectives
There have been substantial amounts of misinformation surrounding the importance, safety and effectiveness of the COVID-19 vaccine. The impacts of this misinformation may be augmented as they circulate among ethnic communities, who may concurrently face other barriers related to vaccine uptake and access. To combat some of the key sources of COVID-19 vaccine misinformation among the South Asian communities of the Greater Toronto and Hamilton Area (GTHA), an interdisciplinary team of researchers and marketing experts established the South Asian Youth as Vaccine Agents of Change (SAY-VAC) programme to support and empower South Asian youth to disseminate COVID-19 vaccine information.
Design
Cross-sectional and one-group pretest–post-test design.
Setting
GTHA.
Participants
South Asian youth (18–29 years).
Intervention
The team partnered with grass-roots South Asian organisations to collaborate on shared objectives, curate key concerns, create video products regarding the COVID-19 vaccine that would resonate with the community, disseminate the products using established social media channels and evaluate the effectiveness of this effort.
Outcomes
We assessed the change in self-reported knowledge about the COVID-19 vaccine and participant confidence to facilitate a conversation around the COVID-19 vaccine using pre-post surveys, after the implementation of the SAY-VAC programme.
Results
In total, 30 South Asian youth (median age=23.2 years) from the GTHA participated in the programme. After completing the SAY-VAC programme, participants reported an increase in their self-reported knowledge regarding the COVID-19 vaccine from 73.3% to 100.0% (p=0.005), and their self-reported confidence to have a conversation about the vaccine with their unvaccinated community members increased from 63.6% to 100.0% (p=0.002). Overall, 51.9% of the participants reported being able to positively affect an unvaccinated/community member’s decision to get vaccinated.
Conclusions
The SAY-VAC programme highlights the importance of community partnerships in developing and disseminating culturally responsive health communication strategies. A constant assessment of the evidence and utilisation of non-traditional avenues to engage the public are essential.
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Paterson, K. L., Bennell, K. L., Metcalf, B. R., Campbell, P. K., McManus, F., Lamb, K. E., Hinman, R. S.
BMJ Open, 24.09.2022
Tilføjet 24.09.2022
Objectives
To determine if motion control walking shoes are superior to neutral walking shoes in reducing knee pain on walking in people with lateral knee osteoarthritis (OA).
Design
Participant-blinded and assessor-blinded, comparative effectiveness, superiority randomised controlled trial.
Setting
Melbourne, Australia.
Participants
People with symptomatic radiographic lateral tibiofemoral OA from the community and our volunteer database.
Intervention
Participants were randomised to receive either motion control or neutral shoes and advised to wear them >6 hours/day over 6 months.
Primary and secondary outcome measures
The primary outcome was change in average knee pain on walking over the previous week (11-point Numeric Rating Scale (NRS), 0–10) at 6 months. The secondary outcomes included other measures of knee pain, physical function, quality of life, participant-perceived change in pain and function, and physical activity.
Results
We planned to recruit 110 participants (55 per arm) but ceased recruitment at 40 (n=18 motion control shoes, n=22 neutral shoes) due to COVID-19-related impacts. All 40 participants completed 6-month outcomes. There was no evidence that motion control shoes were superior to neutral shoes for the primary outcome of pain (mean between-group difference 0.4 NRS units, 95% CI –1.0 to 1.7) nor for any secondary outcome. The number of participants experiencing any adverse events was similar between groups (motion control shoes: n=5, 28%; neutral shoes: n=4, 18.2%) and were minor.
Conclusions
Motion control shoes were not superior to neutral shoes in improving knee pain on walking in symptomatic radiographic lateral tibiofemoral joint OA. Further research is needed to identify effective treatments in this important but under-researched knee OA subgroup.
Trial registration number
ACTRN12618001864213.
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Zhou, Y., Zhong, L., Chen, W., Liang, F., Liao, Y., Zhong, Y.
BMJ Open, 24.09.2022
Tilføjet 24.09.2022
Objective
To explore the association between dynamic changes in red blood cell distribution width to platelet count ratio (RPR) during hospitalisation and short-term mortality in patients with sepsis.
Design
A retrospective cohort study using propensity score matching.
Setting
Intensive care units (ICUs) of Beth Israel Deaconess Medical Center.
Participants
A total of 8731 adult patients with sepsis were included in the study. The patients were identified from the ICU of the Medical Information Mart for Intensive Care database. The observed group included patients who experienced an increase in RPR of more than 30% during the first week of ICU admission, whereas the control group included the rest.
Main outcome and measure
Using propensity score matching, a matched control group was created. The primary outcome was 28-day mortality, and the length of hospital stay and in-hospital mortality were the secondary outcomes.
Results
The difference was evident in 28-day mortality between the two groups (85.8% vs 74.5%, p<0.001, Kaplan-Meier analysis, and HR=1.896, 95% CI=1.659 to 2.168, p<0.001, Cox regression). In the secondary outcomes, there was a significant difference in in-hospital mortality (p<0.001). In addition, the study discovered that the observed groups had a significantly longer hospital stay (p<0.001). Meanwhile, the results of subgroup analyses were consistent with those of the primary analyses.
Conclusions
In patients with sepsis, a significantly increased RPR is positively associated with the short-term death rate. Continuous RPR monitoring could be a valuable measure for predicting short-term mortality in patients with sepsis.
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Sialubanje, C., Kunka, E., Sumbwa, P. I., Mukumbuta, N., Chibowa, M., Syakantu, G., Chikoya, L., Mukonka, V. M.
BMJ Open, 24.09.2022
Tilføjet 24.09.2022
Introduction
Little is known about the clinical course of COVID-19 following mild symptoms, and how the disease affects the survivors over time. Moreover, information on the severity of the long-term health effects as well as the associated risk factors is scant. This study aims to determine the short, intermediate and long-term health effects of COVID-19 on the survivors and the associated risk factors.
Methods and analysis
We propose conducting a 24-month prospective quantitative study in 10 health facilities (2 specialist, 3 regional, 2 mission and 3 subdistrict hospitals) from Lusaka and Southern Province of Zambia. Health facilities will be those which served as COVID-19 treatment centres during the third wave (June–August 2021). Study participants will comprise a randomly selected cohort of 450 COVID-19 survivors who had mild or no symptoms (80%) and severe cases (20%). Using a questionnaire, respondent demographic, clinical and laboratory data will be collected at baseline and at a 3-month interval for 18 months using a questionnaire. Respondents’ medical records will be reviewed and data collected using a checklist. Descriptive statistics will be computed to summarise respondents’ characteristics and clinical outcomes. Bivariate analysis (X2 and t-test) will be conducted to test the association between respondent characteristics and clinical outcomes. Multivariate logistic regression analysis will be run to determine the risk factors for short, intermediate and long-term health effects; adjusted ORs will be computed to test the strength of the association (p<0.05).
Ethics and dissemination
Ethical approval was obtained from the University of Zambia Biomedical Research and the National Health Research Authority. Results will be disseminated to key stakeholders in Zambia, international open-access peer-reviewed journals, websites and international conferences, and likely lead to design of evidence-informed strategies to mitigate health effects of COVID-19 on survivors.
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Moradi-Lakeh, M., Goharinezhad, S., Hoviedamanesh, S., Amirkafi, A., Zahraei, S. M., Eshrati, B.
BMJ Open, 24.09.2022
Tilføjet 24.09.2022
Introduction
WHO declared vaccine hesitancy as a global public health threat in 2019. Since even a slight reduction in vaccine coverage rates can lead to a decrease in herd immunity, it is imperative to explore the underlying factors affecting vaccine hesitancy. This qualitative study protocol aims to explore determinant factors that influence vaccine hesitancy in Iran from the parent’s perspective.
Methods and analysis
Descriptive-Interpretive Qualitative research will be conducted to gain an insight into vaccine hesitancy in the west of Tehran province in Iran. Participants in the study will be recruited from vaccine-hesitant parents of children under 5 years’ old who will be recognised as being hesitant to extract from the national health information system. The semistructured interviews and in-depth questions will be performed both face-to-face in an open space such as a park near their homes and via video call because of the COVID-19 pandemic and social distancing. Interviews will be conducted by a trained qualitative person. Transcribed data will be analysed through thematic analysis.
Ethics and dissemination
Ethics approval was obtained from the research ethics committee at the Iran University of Medical Sciences (Approval ID #IR.IUMS.REC.1399.273). The results of the study are expected to be presented by the end of 2022 year. A variety of dissemination methods will be employed to communicate research findings, including presentations at conferences and peer-reviewed publications.
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Msukwa, M. T., MacLachlan, E. W., Gugsa, S. T., Theu, J., Namakhoma, I., Bangara, F., Blair, C. L., Payne, D., Curran, K. G., Arons, M., Namachapa, K., Wadonda, N., Kabaghe, A. N., Dobbs, T., Shanmugam, V., Kim, E., Auld, A., Babaye, Y., O'Malley, G., Nyirenda, R., Bello, G.
BMJ Open, 24.09.2022
Tilføjet 24.09.2022
Objectives
In Malawi, a recent infection testing algorithm (RITA) is used to characterise infections of persons newly diagnosed with HIV as recent or long term. This paper shares results from recent HIV infection surveillance and describes distribution and predictors.
Setting
Data from 155 health facilities in 11 districts in Malawi were pooled from September 2019 to March 2020.
Participants
Eligible participants were ≥13 years, and newly diagnosed with HIV. Clients had RITA recent infections if the rapid test for recent infection (RTRI) test result was recent and viral load (VL) ≥1000 copies/mL; if VL was <1000 copies/mL the RTRI result was reclassified as long-term. Results were stratified by age, sex, pregnancy/breastfeeding status and district.
Results
13 838 persons consented to RTRI testing and 12 703 had valid RTRI test results and VL results after excluding clients not newly HIV-positive, RTRI negative or missing data (n=1135). A total of 12 365 of the 12 703 were included in the analysis after excluding those whose RTRI results were reclassified as long term (n=338/784 or 43.1%). The remainder, 446/12 703 or 3.5%, met the definition of RITA recent infection. The highest percentage of recent infections was among breastfeeding women (crude OR (COR) 3.2; 95% CI 2.0 to 5.0), young people aged 15–24 years (COR 1.6; 95% CI 1.3 to 1.9) and persons who reported a negative HIV test within the past 12 months (COR 3.3; 95% CI 2.6 to 4.2). Factors associated with recent infection in multivariable analysis included being a non-pregnant female (adjusted OR (AOR) 1.4; 95% CI 1.2 to 1.8), a breastfeeding female (AOR 2.2; 95% CI 1.4 to 3.5), aged 15–24 years (AOR 1.6; 95% CI 1.3 to 1.9) and residents of Machinga (AOR 2.0; 95% CI 1.2 to 3.5) and Mzimba (AOR 2.4; 95% CI 1.3 to 4.5) districts.
Conclusions
Malawi’s recent HIV infection surveillance system demonstrated high uptake and identified sub-populations of new HIV diagnoses with a higher percentage of recent infections.
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Seyyed-Reza Sadat-Ebrahimi, Aysa Rezabakhsh, Naser Aslanabadi, Milad Asadi, Venus Zafari, Dariush Shanebandi, Habib Zarredar, Elgar Enamzadeh, Hamed Taghizadeh, Reza Badalzadeh
PLoS One Infectious Diseases, 23.09.2022
Tilføjet 23.09.2022
by Seyyed-Reza Sadat-Ebrahimi, Aysa Rezabakhsh, Naser Aslanabadi, Milad Asadi, Venus Zafari, Dariush Shanebandi, Habib Zarredar, Elgar Enamzadeh, Hamed Taghizadeh, Reza Badalzadeh
Background A number of circulating micro-ribonucleic acids (miRNAs) have been introduced as convincing predictive determinants in a variety of cardiovascular diseases. This study aimed to evaluate some miRNAs’ diagnostic and prognostic value in patients with acute heart failure (AHF). Method Forty-four AHF patients were randomly selected from a tertiary heart center, and 44 healthy participants were included in the control group. Plasma levels of assessed miRNAs, including miR -1, -21, -23, and -423-5-p were measured in both groups. The patients were followed for one year, and several clinical outcomes, including in-hospital mortality, one-year mortality, and the number of readmissions, were recorded. Results An overall 88 plasma samples were evaluated. There was no significant difference in terms of demographic characteristics between the AHF and healthy groups. Our findings revealed that mean levels of miR-1, -21, -23, and -423-5-p in AHF patients were significantly higher than in the control group. Although all assessed miRNAs demonstrated high diagnostic potential, the highest sensitivity (77.2%) and specificity (97.7%) is related to miR-1 for the values above 1.22 (p = 0.001, AUC = 0.841; 95%CI, 0.751 to 946). Besides, the levels of miR-21 and -23 were significantly lower in patients with ischemia-induced HF. However, the follow-up data demonstrated no significant association between miRNAs and prognostic outcomes including in-hospital mortality, one-year mortality, and the number of readmissions. Conclusion The result of our study demonstrated that miR-1, -21, -23, and -423-5-p can be taken into account as diagnostic aids for AHF. Nevertheless, there was no evidence supporting the efficacy of these miRNAs as prognostic factors in our study.
Læs mere Tjek på PubMedAlexander T. Cohen, Janvi Sah, Amol D. Dhamane, Theodore Lee, Lisa Rosenblatt, Patrick Hlavacek, Birol Emir, Allison Keshishian, Huseyin Yuce, Xuemei Luo
PLoS One Infectious Diseases, 23.09.2022
Tilføjet 23.09.2022
by Alexander T. Cohen, Janvi Sah, Amol D. Dhamane, Theodore Lee, Lisa Rosenblatt, Patrick Hlavacek, Birol Emir, Allison Keshishian, Huseyin Yuce, Xuemei Luo
This study evaluated effectiveness and safety of apixaban versus warfarin among venous thromboembolism patients at high-risk of bleeding (defined as having at least one of the following bleeding risk factors: ≥75 years; used antiplatelet, NSAIDs, or corticosteroids; had prior gastrointestinal bleeding or gastrointestinal-related conditions; late stage chronic kidney disease). Adult venous thromboembolism patients initiating apixaban or warfarin with ≥1 bleeding risk factor were identified from Medicare and four commercial claims databases in the United States. To balance characteristics between apixaban and warfarin patients, stabilized inverse probability treatment weighting was conducted. Cox proportional hazards models were used to estimate the risk of recurrent venous thromboembolism, major bleeding, and clinically relevant non-major bleeding. In total, 88,281 patients were identified. After inverse probability treatment weighting, the baseline patient characteristics were well-balanced between the two cohorts. Among venous thromboembolism patients at high-risk of bleeding, apixaban was associated with significantly lower risk of recurrent venous thromboembolism, major bleeding and clinically relevant non-major bleeding. No significant interactions were observed between treatment and number of risk factors on major bleeding and clinically relevant non-major bleeding or between treatment and type of bleeding risk factors on any of the outcomes. In conclusion, apixaban was associated with significantly lower risk of recurrent venous thromboembolism and bleeding among venous thromboembolism patients at high-risk of bleeding. Effects were generally consistent across subgroups of patients with different number or type of bleeding risk factors.
Læs mere Tjek på PubMedBjørn Sætrevik, Sebastian B. Bjørkheim
PLoS One Infectious Diseases, 23.09.2022
Tilføjet 23.09.2022
by Bjørn Sætrevik, Sebastian B. Bjørkheim
Compliance to infection control measures may be influenced both by the fear of negative consequences of a pandemic, but also by the expectation to be able to handle the pandemic’s challenges. We performed a survey on a representative sample for Norway (N = 4,083) in the first weeks of the COVID-19 lock-down in March 2020. We had preregistered hypotheses to test the effect of optimism and perceived risk on compliance. Perceived risk had small effects on increasing compliance and on leading to more careful information gathering. The expected negative association between optimism and compliance was not supported, and there was instead a small positive association. We found a small effect that optimism was associated with seeing less risk from the pandemic and with a larger optimistic bias. Finally, an exploratory analysis showed that seeing the infection control measures as being effective in protecting others explained a substantial proportion of the variation in compliance. The study indicates that how we think about pandemic risk has complex and non-intuitive relationships with compliance. Our beliefs and motivations toward infection control measures appears to be important for compliance.
Læs mere Tjek på PubMedAzene Tesfaye, Agena Anjulo, Addisu Fekadu, Kassaw Beyene, Abebe Girma, Birhanu Gemeda, Gebremaryam Temesgen, Fistum Wolde, Eyob Mulugeta, Aseer Manilal
PLoS One Infectious Diseases, 23.09.2022
Tilføjet 23.09.2022
by Azene Tesfaye, Agena Anjulo, Addisu Fekadu, Kassaw Beyene, Abebe Girma, Birhanu Gemeda, Gebremaryam Temesgen, Fistum Wolde, Eyob Mulugeta, Aseer Manilal
Introduction Moringa stenopetala Bak. Cuf. is a native plant of Ethiopia with important nutraceutical applications. However, little is known about its nutritional, ethno-pharmaceutical and therapeutic properties. Hence, the present study sought to assess the nutraceutical applications of M. stenopetala among traditional healers in southern Ethiopia. Methods A community-based cross-sectional study was conducted on 50 selected administrative units in Gamo Gofa, Segen areas and south Omo zones of southern Ethiopia from May to June 2020. Data were gathered using a semi-structured interview, field observation, and group discussion. Both quantitative and qualitative data were analysed using Excel 2019 and open code version 4.03, respectively. The results were presented using descriptive statistics, with the fidelity level (FL)% used to distinguish the preferential use of various plant parts. Results A total of 120 individuals participated in the study, and the majority of them, 89 (74.2%), were male and farmers by occupation. Eight four (70%) of them were residents of the Gamo Gofa Zone. The fidelity level revealed that the leaf and root were the most commonly used parts for nutraceutical purposes. Remarkably, M. stenopetala is used to treat human ailments such as leprosy and kidney and liver infections via various modes of utilisation and administration. As a result, the most common methods of utilising plant products are chewing or consuming crushed plant parts, and the oral route is the much-preferred method of application. On the other hand, the larvae of Moringa moth Nurda blitealis, are a defoliating insect during the rainy season and have been identified as a limiting factor for its production. Conclusions The nutraceutical aspects of M. stenopetala are extremely important to the rural community in southern Ethiopia. However, the defoliating moth larvae threaten its growth and biomass production, necessitating the need to manage and improve the plant’s productivity and sustainable use. Additionally, conducting experimental studies to validate the plant’s pharmacological potential correspond to a milestone in drug discovery.
Læs mere Tjek på PubMedRitwik Nigam, Gaurav Tripathi, Tannu Priya, Alvarinho J. Luis, Eric Vaz, Shashikant Kumar, Achala Shakya, Bruno Damásio, Mahender Kotha
PLoS One Infectious Diseases, 23.09.2022
Tilføjet 23.09.2022
by Ritwik Nigam, Gaurav Tripathi, Tannu Priya, Alvarinho J. Luis, Eric Vaz, Shashikant Kumar, Achala Shakya, Bruno Damásio, Mahender Kotha
This work quantifies the impact of pre-, during- and post-lockdown periods of 2020 and 2019 imposed due to COVID-19, with regards to a set of satellite-based environmental parameters (greenness using Normalized Difference Vegetation and water indices, land surface temperature, night-time light, and energy consumption) in five alpha cities (Kuala Lumpur, Mexico, greater Mumbai, Sao Paulo, Toronto). We have inferenced our results with an extensive questionnaire-based survey of expert opinions about the environment-related UN Sustainable Development Goals (SDGs). Results showed considerable variation due to the lockdown on environment-related SDGs. The growth in the urban environmental variables during lockdown phase 2020 relative to a similar period in 2019 varied from 13.92% for Toronto to 13.76% for greater Mumbai to 21.55% for Kuala Lumpur; it dropped to −10.56% for Mexico and −1.23% for Sao Paulo city. The total lockdown was more effective in revitalizing the urban environment than partial lockdown. Our results also indicated that Greater Mumbai and Toronto, which were under a total lockdown, had observed positive influence on cumulative urban environment. While in other cities (Mexico City, Sao Paulo) where partial lockdown was implemented, cumulative lockdown effects were found to be in deficit for a similar period in 2019, mainly due to partial restrictions on transportation and shopping activities. The only exception was Kuala Lumpur which observed surplus growth while having partial lockdown because the restrictions were only partial during the festival of Ramadan. Cumulatively, COVID-19 lockdown has contributed significantly towards actions to reduce degradation of natural habitat (fulfilling SDG-15, target 15.5), increment in available water content in Sao Paulo urban area(SDG-6, target 6.6), reduction in NTL resulting in reducied per capita energy consumption (SDG–13, target 13.3).
Læs mere Tjek på PubMedJui-Lin Chen, Chelsea N. Fries, Stella J. Berendam, Nicole S. Rodgers, Emily F. Roe, Yaoying Wu, Shuk Hang Li, Rishabh Jain, Brian Watts, Joshua Eudailey, Richard Barfield, Cliburn Chan, M. Anthony Moody, Kevin O. Saunders, Justin Pollara, Sallie R. Permar, Joel H. Collier, Genevieve G. Fouda
Science Advances, 23.09.2022
Tilføjet 23.09.2022
Qi Yang, Anju Kelkar, Anirudh Sriram, Ryoma Hombu, Thomas A. Hughes, Sriram Neelamegham
Science Advances, 23.09.2022
Tilføjet 23.09.2022
Infection, 22.09.2022
Tilføjet 23.09.2022
Abstract
Background
Coagulopathy is still a serious pattern of coronavirus-19 disease. We aimed to evaluate COVID-19-associated coagulopathy and multiple hemostatic markers in Egyptian patients. In addition, to assess coagulation acute phase reactants and its effect on the outcome.
Methods
The study included 106 COVID-19 patients, and 51 controls. All patients were positive for COVID-19 infection by nasopharyngeal swab for detection of viral RNA by real-time PCR. In addition to baseline data and radiological findings, the coagulation profile was done with special attention to Fibrinogen, d-dimer, Factor VIII, von Willebrand factor (VWF), Protein C, Protein S, Antithrombin III (ATIII) and Lupus anticoagulant (LA)-1 and 2.
Results
The results showed significantly higher VWF, d-dimer, and LA1 (screening) and LA2 (confirmation) in patients than a control group. Significantly higher d-dimer FVIII, VWF and LA1-2 were detected in the severe group. ATIII had high diagnostic accuracy in severity prediction. We found a significantly higher international randomized ratio (INR) and VWF among patients with thrombotic events. For prediction of thrombosis; VWF at cutoff > 257.7 has 83.3% sensitivity and 83.3% specificity.
Conclusion
Patients with COVID-19 infection are vulnerable to different forms of coagulopathy. This could be associated with poor outcomes. d-Dimer is a chief tool in diagnosis, severity evaluation but not thrombosis prediction. Early screening for this complication and its proper management would improve the outcome.
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BMC Infectious Diseases, 23.09.2022
Tilføjet 23.09.2022
Abstract
Background
In persons living with HIV (PLWH), the burden of non-communicable chronic diseases increased over time, because of aging associated with chronic inflammation, systemic immune activation, and long-term exposure to the combination antiretroviral therapy (ART).
Methods
To explore the association of chronological age, age at first ART, and exposure to ART with non-communicable chronic diseases, we performed a cross-sectional analysis to evaluate the prevalence of comorbidities in patients enrolled in the SCOLTA Project, stratified by groups of chronological age (50–59 and 60–69 years) and by years of antiretroviral treatment (ART, ≤ 3 or > 3 years).
Results
In 1394 subjects (23.8% women), mean age at enrollment was 57.4 (SD 6.5) years, and at first ART 45.3 (SD 10.7). Men were older than women both at enrollment (57.6 vs 56.8, p = 0.06) and at first ART (45.8 vs 43.6, p = 0.0009). ART duration was longer in women (13.1 vs 11.7 years, p = 0.01). The age- and sex-adjusted rate ratios (aRRs, and 95% confidence interval, CI) showed that longer ART exposure was associated with dyslipidemia (aRR 1.35, 95% CI 1.20–1.52), hypertension (aRR 1.52, 95% CI 1.22–1.89), liver disease (aRR 1.78, 95% CI 1.32–2.41), osteopenia/osteoporosis (aRR 2.88, 95% CI 1.65–5.03) and multimorbidity (aRR 1.36, 95% CI 1.21–1.54). These findings were confirmed in strata of age, adjusting for sex.
Conclusions
Our data suggest that longer ART exposure was associated with increased risk of dyslipidemia, hypertension, and osteopenia/osteoporosis, hence the presence of multimorbidity, possibly due to the exposition to more toxic antiretrovirals. We observed different comorbidities, according to ART exposure and age.
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Rikke Thoft Nielsen, Güldas Köse, Louise Sloth, Christian Østergaard Andersen, Jørgen Holm Petersen, Marie Norredam
Tropical Medicine & International Health, 23.09.2022
Tilføjet 23.09.2022
Serena Messali, Antonella Bugatti, Federica Filippini, Arnaldo Caruso, Francesca Caccuri
Journal of Medical Virology, 23.09.2022
Tilføjet 23.09.2022
Maria Francilene Souza Silva, Ana Carolina Matias Dinelly Pinto, Fátima de Cássia Evangelista de Oliveira, Ludmilla Freire Caetano, Fernanda Montenegro de Carvalho Araújo, Marcela Helena Gambim Fonseca
Journal of Medical Virology, 23.09.2022
Tilføjet 23.09.2022
Julien Lupo, Mansour Tsougaev, Stéphane Blachier, Guillaume Chovelon, Aurélie Truffot, Corentin Leroy, Joris Giai, Olivier Epaulard, Raphaële Germi, Patrice Morand
Journal of Medical Virology, 23.09.2022
Tilføjet 23.09.2022