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47 ud af 47 tidsskrifter valgt, søgeord (guidelines) valgt, emner højest 180 dage gamle, sorteret efter nyeste først.
178 emner vises.
BMC Infectious Diseases, 19.01.2024
Tilføjet 19.01.2024
Introduction Ventilator-associated pneumonia (VAP) is a prominent cause of morbidity and mortality in intensive care unit (ICU) patients. Due to the increase in Methicillin resistant Staphylococcus aureus infection, it is important to consider other more effective and safer alternatives compared to vancomycin. This motivates evaluating whether the use of an apparently more expensive drug such as linezolid can be cost-effective in Colombia. Methods A decision tree was used to simulate the results in terms of the cost and proportion of cured patients. In the simulation, patients can receive antibiotic treatment with linezolid (LZD 600 mg IV/12 h) or vancomycin (VCM 15 mg/kg iv/12 h) for 7 days, patients they can experience events adverse (renal failure and thrombocytopenia). The model was analyzed probabilistically, and a value of information analysis was conducted to inform the value of conducting further research to reduce current uncertainties in the evidence base. Cost-effectiveness was evaluated at a willingness-to-pay (WTP) value of US$5180. Results The mean incremental cost of LZD versus VCM is US$-517. This suggests that LZD is less costly. The proportion of patients cured when treated with LZD compared with VCM is 53 vs. 43%, respectively. The mean incremental benefit of LZD versus VCM is 10 This position of absolute dominance (LZD has lower costs and higher proportion of clinical cure than no supplementation) is unnecessary to estimate the incremental cost-effectiveness ratio. There is uncertainty with a 0.999 probability that LZD is more cost-effective than VCM. Our base‐case results were robust to variations in all assumptions and parameters. Conclusion LNZ is a cost-effective strategy for patients, ≥ 18 years of age, with VAP in Colombia- Our study provides evidence that can be used by decision-makers to improve clinical practice guidelines.
Læs mere Tjek på PubMedClinical Infectious Diseases, 18.01.2024
Tilføjet 18.01.2024
Abstract Background Most international treatment guidelines recommend rapid initiation of antiretroviral therapy (ART) for people newly diagnosed with HIV-1 infection, but experiences with rapid ART initiation remain limited in China. We aimed to evaluate the efficacy and safety of efavirenz (400-mg) plus lamivudine and tenofovir disoproxil fumarate (EFV + 3TC + TDF) versus coformulated bictegravir, emtricitabine, tenofovir alafenamide (BIC/FTC/TAF) in rapid ART initiation among HIV-positive men who have sex with men (MSM).Methods This multicenter, open-label, randomized clinical trial enrolled MSM aged ≥18 years to start ART within 14 days of confirmed HIV diagnosis. The participants were randomly assigned in a 1:1 ratio to receive EFV(400-mg) + 3TC + TDF or BIC/FTC/TAF. The primary end point was viral suppression (
Læs mere Tjek på PubMedBMC Infectious Diseases, 16.01.2024
Tilføjet 16.01.2024
Abstract Background Recent pandemics have had far-reaching effects on the world’s largest economies and amplified the need to estimate the full extent and range of socioeconomic impacts of infectious diseases outbreaks on multi-sectoral industries. This systematic review aims to evaluate the socioeconomic impacts of airborne and droplet-borne infectious diseases outbreaks on industries. Methods A structured, systematic review was performed according to the PRISMA guidelines. Databases of PubMed, Scopus, Web of Science, IDEAS/REPEC, OSHLINE, HSELINE, and NIOSHTIC-2 were reviewed. Study quality appraisal was performed using the Table of Evidence Levels from Cincinnati Children’s Hospital Medical Center, Joanna Briggs Institute tools, Mixed Methods Appraisal Tool, and Center of Evidence Based Management case study critical appraisal checklist. Quantitative analysis was not attempted due to the heterogeneity of included studies. A qualitative synthesis of primary studies examining socioeconomic impact of airborne and droplet-borne infectious diseases outbreaks in any industry was performed and a framework based on empirical findings was conceptualized. Results A total of 55 studies conducted from 1984 to 2021 were included, reporting on 46,813,038 participants working in multiple industries across the globe. The quality of articles were good. On the whole, direct socioeconomic impacts of Coronavirus Disease 2019, influenza, influenza A (H1N1), Severe Acute Respiratory Syndrome, tuberculosis and norovirus outbreaks include increased morbidity, mortality, and health costs. This had then led to indirect impacts including social impacts such as employment crises and reduced workforce size as well as economic impacts such as demand shock, supply chain disruptions, increased supply and production cost, service and business disruptions, and financial and Gross Domestic Product loss, attributable to productivity losses from illnesses as well as national policy responses to contain the diseases. Conclusions Evidence suggests that airborne and droplet-borne infectious diseases have inflicted severe socioeconomic costs on regional and global industries. Further research is needed to better understand their long-term socioeconomic impacts to support improved industry preparedness and response capacity for outbreaks. Public and private stakeholders at local, national, and international levels must join forces to ensure informed systems and sector-specific cost-sharing strategies for optimal global health and economic security.
Læs mere Tjek på PubMedBMC Infectious Diseases, 16.01.2024
Tilføjet 16.01.2024
Abstract Background Recent pandemics have had far-reaching effects on the world’s largest economies and amplified the need to estimate the full extent and range of socioeconomic impacts of infectious diseases outbreaks on multi-sectoral industries. This systematic review aims to evaluate the socioeconomic impacts of airborne and droplet-borne infectious diseases outbreaks on industries. Methods A structured, systematic review was performed according to the PRISMA guidelines. Databases of PubMed, Scopus, Web of Science, IDEAS/REPEC, OSHLINE, HSELINE, and NIOSHTIC-2 were reviewed. Study quality appraisal was performed using the Table of Evidence Levels from Cincinnati Children’s Hospital Medical Center, Joanna Briggs Institute tools, Mixed Methods Appraisal Tool, and Center of Evidence Based Management case study critical appraisal checklist. Quantitative analysis was not attempted due to the heterogeneity of included studies. A qualitative synthesis of primary studies examining socioeconomic impact of airborne and droplet-borne infectious diseases outbreaks in any industry was performed and a framework based on empirical findings was conceptualized. Results A total of 55 studies conducted from 1984 to 2021 were included, reporting on 46,813,038 participants working in multiple industries across the globe. The quality of articles were good. On the whole, direct socioeconomic impacts of Coronavirus Disease 2019, influenza, influenza A (H1N1), Severe Acute Respiratory Syndrome, tuberculosis and norovirus outbreaks include increased morbidity, mortality, and health costs. This had then led to indirect impacts including social impacts such as employment crises and reduced workforce size as well as economic impacts such as demand shock, supply chain disruptions, increased supply and production cost, service and business disruptions, and financial and Gross Domestic Product loss, attributable to productivity losses from illnesses as well as national policy responses to contain the diseases. Conclusions Evidence suggests that airborne and droplet-borne infectious diseases have inflicted severe socioeconomic costs on regional and global industries. Further research is needed to better understand their long-term socioeconomic impacts to support improved industry preparedness and response capacity for outbreaks. Public and private stakeholders at local, national, and international levels must join forces to ensure informed systems and sector-specific cost-sharing strategies for optimal global health and economic security.
Læs mere Tjek på PubMedDavid W Denning
Lancet Infectious Diseases, 13.01.2024
Tilføjet 13.01.2024
Current estimates of fungal disease incidence and mortality are imprecise. Population at risk denominators were used to estimate annual incidence for 2019–21. Extensive literature searches from 2010 to 2023 were combined with over 85 papers on individual country and global disease burden. Crude and attributable mortality were estimated using a combination of untreated mortality, the proportion of patients who are treated, and percentage survival in treated patients. Awareness, guidelines, and accessibility of diagnostics and therapies informed the ratio of treated to untreated cases.
Læs mere Tjek på PubMedClinical Infectious Diseases, 12.01.2024
Tilføjet 12.01.2024
Abstract Purpose Tuberculosis (TB) is a public health threat with >80% of active TB in the U.S. occurring due to reactivation of latent tuberculosis infection (LTBI). We may be under-screening those with high risk for LTBI and over-testing those at lower risk. A better understanding of gaps in current LTBI testing practices in relation to LTBI test positivity is needed.Methods This study, conducted between 01/01/2008 and 12/31/2019 at Kaiser Permanente Southern California, included individuals ≥18 years of age without a history of active TB. We examined factors associated with LTBI testing and LTBI positivity.Results Among 3,816,884 adults (52% female, 37% White, 37% Hispanic, mean age 43.5 years [S.D. 16.1]), 706,367 (19%) were tested for LTBI, among whom 60,393 (9%) had ≥1 positive result. Among 1,211,971 individuals meeting ≥1 screening criteria for LTBI, 210,025 (17%) were tested for LTBI. Factors associated with higher adjusted odds (aOR) of testing positive included male sex [aOR: 1.32, 95% CI:1.30-1.35], Asian/Pacific Islander [2.78, 2.68-2.88], current smoking [1.24, 1.20-1.28], diabetes [1.13, 1.09-1.16], hepatitis B [1.45, 1.34-1.57], hepatitis C [1.54, 1.44-1.66], and birth in a country with an elevated TB rate [3.40, 3.31-3.49]). Despite being risk factors for testing positive for LTBI, none of these factors were associated with higher odds of LTBI testing.Conclusions Current LTBI testing practices may be missing individuals at high risk of LTBI. Additional work is needed to refine and implement screening guidelines that appropriately target testing for those at highest risk for LTBI.
Læs mere Tjek på PubMedLee, J. S., Rose, L., Borgundvaag, B., McLeod, S. L., Melady, D., Mohindra, R., Sinha, S. K., Wesson, V., Wiesenfeld, L., Kolker, S., Kiss, A., Lowthian, J.
BMJ Open, 10.01.2024
Tilføjet 10.01.2024
IntroductionThe COVID-19 pandemic has forced the implementation of physical distancing and self-isolation strategies worldwide. However, these measures have significant potential to increase social isolation and loneliness. Among older people, loneliness has increased from 40% to 70% during COVID-19. Previous research indicates loneliness is strongly associated with increased mortality. Thus, strategies to mitigate the unintended consequences of social isolation and loneliness are urgently needed. Following the Obesity-Related Behavioural Intervention Trials model for complex behavioural interventions, we describe a protocol for a three-arm randomised clinical trial to reduce social isolation and loneliness. Methods and analysisA multicentre, outcome assessor blinded, three-arm randomised controlled trial comparing 12 weeks of: (1) the HOspitals WoRking in Unity (‘HOW R U?’) weekly volunteer-peer support telephone intervention; (2) ‘HOW R U?’ deliver using a video-conferencing solution and (3) a standard care group. The study will follow Consolidated Standard of Reporting Trials guidelines. We will recruit 24–26 volunteers who will receive a previously tested half day lay-training session that emphasises a strength-based approach and safety procedures. We will recruit 141 participants ≥70 years of age discharged from two participating emergency departments or referred from hospital family medicine, geriatric or geriatric psychiatry clinics. Eligible participants will have probable baseline loneliness (score ≥2 on the de Jong six-item loneliness scale). We will measure change in loneliness, social isolation (Lubben social network scale), mood (Geriatric Depression Score) and quality of life (EQ-5D-5L) at 12–14 weeks postintervention initiation and again at 24–26 weeks. Ethics and disseminationApproval has been granted by the participating research ethics boards. Participants randomised to standard care will be offered their choice of telephone or video-conferencing interventions after 12 weeks. Results will be disseminated through journal publications, conference presentations, social media and through the International Federation of Emergency Medicine. Trial registration numberNCT05228782.
Læs mere Tjek på PubMedAkalu, T. Y., Clements, A. C. A., Gebreyohannes, E. A., Wolde, H. F., Shiferaw, F. W., Alene, K. A.
BMJ Open, 9.01.2024
Tilføjet 9.01.2024
IntroductionPeople having close contact with drug-resistant tuberculosis (DR-TB) patients are at increased risk of contracting and developing the disease. However, no comprehensive review has been undertaken to estimate the burden of DR-TB among contacts of DR-TB patients. Therefore, the current systematic review will quantify the prevalence and incidence of DR-TB among contacts of DR-TB patients. Method and analysisSystematic searches will be conducted in Medline, Embase, Web of Science, Scopus, Cochrane Central Register of Controlled trials (CENTRAL) and Cumulative Index to Nursing and Allied Health Literature (CINHAL) databases. The search will be conducted without restrictions on time, language and geography. A random-effects meta-analysis will be conducted for effect estimates. The pooled prevalence and incidence of DR-TB will be compared between people with and without contact with DR-TB patients. The presence of heterogeneity between studies will be assessed by Higgins I2 statistics. Subgroup analysis will be conducted to determine the source of heterogeneity. The risk of bias will be assessed using a visual inspection of the funnel plot and Egger’s regression test statistics. Trim and fill analysis will be done in the presence of publication bias. A sensitivity analysis will be conducted by trimming low-quality studies. The systematic review will be reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol guidelines. Ethics and disseminationEthical approval will not be required for this study as it will be a systematic review and meta-analysis based on previously published evidence. The findings of the systematic review will be presented at scientific conferences and published in scientific journals. Protocol registrationThe protocol is published in PROSPERO with registration number CRD42023390339.
Læs mere Tjek på PubMedJonathan Zhen Liang, Donovan Kai Wei Ng, Vijayprasanth Raveendran, Mac Yu Kai Teo, Elaine Li Ying Quah, Keith Zi Yuan Chua, Jun Kiat Lua, Jasmine Lerk Juan Owyong, Andrew Vimal Vijayan, Nur Amira Binte Abdul Hamid, Ting Ting Yeoh, Eng Koon Ong, Gillian Li Gek Phua, Stephen Mason, Warren Fong, Crystal Lim, Natalie Woong, Simon Yew Kuang Ong, Lalit Kumar Radha Krishna
PLoS One Infectious Diseases, 5.01.2024
Tilføjet 5.01.2024
by Jonathan Zhen Liang, Donovan Kai Wei Ng, Vijayprasanth Raveendran, Mac Yu Kai Teo, Elaine Li Ying Quah, Keith Zi Yuan Chua, Jun Kiat Lua, Jasmine Lerk Juan Owyong, Andrew Vimal Vijayan, Nur Amira Binte Abdul Hamid, Ting Ting Yeoh, Eng Koon Ong, Gillian Li Gek Phua, Stephen Mason, Warren Fong, Crystal Lim, Natalie Woong, Simon Yew Kuang Ong, Lalit Kumar Radha Krishna Evolving individual, contextual, organizational, interactional and sociocultural factors have complicated efforts to shape the professional identity formation (PIF) of medical students or how they feel, act and think as professionals. However, an almost exclusive reliance on online learning during the COVID-19 pandemic offers a unique opportunity to study the elemental structures that shape PIF and the environmental factors nurturing it. We propose two independent Systematic Evidence-Based Approach guided systematic scoping reviews (SSR in SEBA)s to map accounts of online learning environment and netiquette that structure online programs. The data accrued was analysed using the clinically evidenced Krishna-Pisupati Model of Professional Identity Formation (KPM) to study the evolving concepts of professional identity. The results of each SSR in SEBA were evaluated separately with the themes and categories identified in the Split Approach combined to create richer and deeper ‘themes/categories’ using the Jigsaw Perspective. The ‘themes/categories’ from each review were combined using the Funnelling Process to create domains that guide the discussion. The ‘themes/categories’ identified from the 141 included full-text articles in the SSR in SEBA of online programs were the content and effects of online programs. The themes/categories identified from the 26 included articles in the SSR in SEBA of netiquette were guidelines, contributing factors, and implications. The Funnelling Process identified online programs (encapsulating the content, approach, structures and the support mechanisms); their effects; and PIF development that framed the domains guiding the discussion. This SSR in SEBA identifies the fundamental elements behind developing PIF including a structured program within a nurturing environment confined with netiquette-guided boundaries akin to a Community of Practice and the elemental aspect of a socialisation process within online programs. These findings ought to be applicable beyond online training and guide the design, support and assessment of efforts to nurture PIF.
Læs mere Tjek på PubMedClinical Infectious Diseases, 5.01.2024
Tilføjet 5.01.2024
Abstract Background We evaluated associations between antepartum weight change and adverse pregnancy outcomes and between antiretroviral therapy (ART) regimens and week-50 postpartum body mass index in IMPAACT 2010.Methods Women with HIV-1 in 9 countries were randomized 1:1:1 at 14-28 weeks gestational age (GA) to start dolutegravir(DTG)+emtricitabine(FTC)/tenofovir alafenamide fumarate(TAF) versus DTG+FTC/tenofovir disoproxil fumarate(TDF) versus efavirenz (EFV)/FTC/TDF. Insufficient antepartum weight gain was defined using IOM guidelines. Cox-proportional hazards regression models were used to evaluate the association between antepartum weight change and adverse pregnancy outcomes: stillbirth (≥20 weeks GA), preterm delivery (
Læs mere Tjek på PubMedSuleman, S., Calleja, S., Parmar, P. K., Cohen, E.
BMJ Open, 4.01.2024
Tilføjet 4.01.2024
IntroductionChildren and youth who are uninsured or underinsured in Canada and the USA have limited options where they can receive healthcare. In both countries, community health centres (CHCs) have been established as a solution to provide quality care to children without adequate insurance, including those who are newcomers or refugees. However, little is known about how well these models deliver paediatric care. Cross-country analysis provides an important viewpoint to identify areas of success and growth. The purpose of this scoping review is to compare quality of care for uninsured and underinsured children through CHCs in the USA and Canada. MethodsThis scoping review follows the methodological guidelines from the Joanna Briggs Institute Evidence synthesis. The protocol has been registered with the Open Science Framework Registries and can be accessed online. A search will be conducted in electronic databases of peer-reviewed literature (Ovid MEDLINE ALL, CINAHL Complete via EbscoHost, Scopus; Health Business Elite via EbscoHost and Sociological Abstracts via ProQuest) as well as the grey literature. Two reviewers will review all titles and abstracts for inclusion in full-text review. Studies that meet inclusion criteria will be included in full-text review. Data will be extracted into Covidence, using the Donabedian model as a conceptual framework. Findings will be synthesised in a narrative format. Ethics and disseminationAs this study only uses publicly available data, ethics approval is not required. Findings will be shared at national and international conferences and published in a peer-reviewed journal. In addition, findings will be prepared into a policy brief or white paper to be shared with relevant policy stakeholders to advocate for a better model of care for marginalised children and youth.
Læs mere Tjek på PubMedAtchchuthan Kanagasabai, Callum Evans, Hayley E. Jones, Alastair D. Hay, Sarah Dawson, Jelena Savović, Martha M.C. Elwenspoek
Clinical Microbiology and Infection, 3.01.2024
Tilføjet 3.01.2024
Centor and McIsaac scores are clinical prediction rules for diagnosing group A Streptococcus (GAS) infection in patients with pharyngitis. Their recommended thresholds vary between guidelines.
Læs mere Tjek på PubMedBrennan, L., Stres, D. P., Egboko, F., Patel, P., Broad, E., Brewster, L., Lunn, J., Isba, R.
BMJ Open, 3.01.2024
Tilføjet 3.01.2024
ObjectivesHealth inequalities are systematic differences in health between people, which are avoidable and unfair. Globally, more political strategies are required to address health inequalities, which have increased since the global SARS-CoV-2/COVID-19 pandemic, with a disproportionate impact on children. This scoping review aimed to identify and collate information on how hospitals around the world that deliver care to children have addressed health inequalities. DesignScoping review focused solely on grey literature. Eligibility criteria for selecting studiesFollowing Joanna Briggs Institute guidelines, a four-step approach to identifying literature was adopted. Data sourcesOverton, OpenGrey, OpenMD, Trip Database, DuckDuckGo, Google, targeted websites and children’s hospital websites were searched on March 2023 for items published since 2010. Data extraction and synthesisRetrieved items were screened against clear inclusion and exclusion criteria before data were extracted by two independent reviewers using a data extraction tool. Studies were tabulated by a hospital. A meta-analysis was not conducted due to the varied nature of studies and approaches. ResultsOur study identified 26 approaches to reduction of health inequalities, from 17 children’s hospitals. Approaches were categorised based on their size and scope. Seven approaches were defined as macro, including hospital-wide inequality strategies. Ten approaches were classed as meso, including the establishment of new departments and research centres. Micro approaches (n=9) included one-off projects or interventions offered to specific groups/services. Almost half of the reported approaches did not discuss the evaluation of impact. ConclusionsChildren’s hospitals provide a suitable location to conduct public health interventions. This scoping review provides examples of approaches on three scales delivered at hospitals across high-income countries. Hospitals with the most comprehensive and extensive range of approaches employ dedicated staff within the hospital and community. This review indicates the value of recruitment of both public health-trained staff and culturally similar staff to deliver community-based interventions.
Læs mere Tjek på PubMedBMC Infectious Diseases, 2.01.2024
Tilføjet 2.01.2024
Abstract Background Personalized clinical management of spondylodiscitis (SD) and isolated spinal epidural empyema (ISEE) is challenging due to limited evidence of microbiologic findings and their clinical impact during the clinical course of the disease. We aimed to characterize clinico-microbiological and imaging phenotypes of SD and ISEE to provide useful insights that could improve outcomes and potentially modify guidelines. Methods We performed chart review and collected data on the following parameters: bacterial antibiogram-resistogram, type of primary spinal infection, location of spinal infection, source of infection, method of detection, clinical complications (sepsis, septic embolism, and endocarditis), length of hospital and intensive care unit (ICU) stay, relapse rate, and disease-related mortality in patients with proven pyogenic SD and ISEE treated surgically in a university hospital in Germany between 2002 and 2022. Results We included data from 187 patients (125 SD, 66.8% and 62 ISEE, 33.2%). Gram-positive bacteria (GPB) were overall more frequently detected than gram-negative bacteria (GNB) (GPB: 162, 86.6% vs. GNB: 25, 13.4%, p
Læs mere Tjek på PubMedDaba, C., Atamo, A., Gebretsadik Weldehanna, D., Oli, A., Debela, S. A., Luke, A. O., Gebrehiwot, M.
BMJ Open, 30.12.2023
Tilføjet 30.12.2023
ObjectiveNon-compliance with COVID-19 infection prevention and control (IPC) is one of the global public health problems particularly among those frontline healthcare workers. However, there are no detailed investigations on COVID-19 IPC compliance among healthcare workers in conflict-affected settings. The objective of this research was to assess compliance with COVID-19 IPC measures and determine the factors associated with it among healthcare providers in Ethiopian governmental hospitals affected by conflict. DesignA cross-sectional study was carried out within institutional settings. Study setting and periodThe study was conducted in three public hospitals located in northeastern Ethiopia during the period of March to April 2022. ParticipantsSimple random sampling technique was used to select 325 healthcare workers after proportional allocation was made to each public hospital. Primary outcome measuresThe primary outcome was non-compliance with COVID-19 IPC. A multivariable logistic regression analysis was employed to identify factors associated with the lack of adherence to the COVID-19 IPC protocol. ResultsNearly half (150, 46.2%) of the healthcare workers had non-compliance with COVID-19 IPC protocol. Absence of hand washing soap (adjusted OR (AOR)=2.99; 95% CI 2.46 to 5.76), workload (AOR=2.25; 95% CI 1.33 to 3.84), disruption in the supply of piped water (AOR=1.82; 95% CI 1.11 to 2.99), did not undergo training in COVID-19 IPC (AOR=2.85; 95% CI 1.85 to 4.84), absence of COVID-19 IPC guidelines (AOR=2.14; 95% CI 1.11 to 4.13) and chewing khat (AOR=2.3; 95% CI 1.32 to 3.72) were determinant factors for non-compliance. ConclusionsThe magnitude of non-compliance with COVID-19 IPC was high. Hospital managers and federal ministry of health should provide regular training on COVID-19 IPC, continuous piped water and personal protective facilities for healthcare workers. Ultimately, improving the security situation in the area would help improve COVID-19 IPC compliance among healthcare workers in these and other similar conflict-affected settings.
Læs mere Tjek på PubMedZhen Zhao, Owen Lou, Yiyang Wang, Raymond Yin, Carrie Gong, Florence Deng, Ethan C. Wu, Jing Yi Xie, Jerry Wu, Avery Ma, Yongzhi Guo, Wei Ting Xiong
PLoS One Infectious Diseases, 30.12.2023
Tilføjet 30.12.2023
by Zhen Zhao, Owen Lou, Yiyang Wang, Raymond Yin, Carrie Gong, Florence Deng, Ethan C. Wu, Jing Yi Xie, Jerry Wu, Avery Ma, Yongzhi Guo, Wei Ting Xiong While systemic corticosteroids quicken patient recovery during acute exacerbations of COPD, they also have many adverse effects. The optimal duration of corticosteroid administration remains uncertain. We performed a systematic review and meta-analysis to compare patient outcomes between short- (≤7 days) and long- (>7 days) corticosteroid regimens in adults with acute exacerbations of COPD. MEDLINE, EMBASE, CENTRAL, and hand searches were used to identify eligible studies. Risk of bias was assessed using the Cochrane RoB 2.0 tool and ROBINS-I. Data were summarized as ORs (odds ratios) or MDs (mean differences) whenever possible and qualitatively described otherwise. A total of 11532 participants from eight RCTs and three retrospective cohort studies were included, with 1296 from seven RCTs and two cohort studies eligible for meta-analyses. Heterogeneity was present in the methodology and settings of the studies. The OR (using short duration as the treatment arm) for mortality was 0.76 (95% CI = 0.40–1.44, n = 1055). The MD for hospital length-of-stay was -0.91 days (95% CI = -1.81–-0.02 days, n = 421). The OR for re-exacerbations was 1.31 (95% CI = 0.90–1.90, n = 552). The OR for hyperglycemia was 0.90 (95% CI = 0.60–1.33, n = 423). The OR for infection incidence was 0.96 (95% CI = 0.59–1.156, n = 389). The MD for one-second forced expiratory volume change was -18.40 mL (95% CI = -111.80–75.01 mL, n = 161). The RCTs generally had low or unclear risks of bias, while the cohort studies had serious or moderate risks of bias. Our meta-analyses were affected by imprecision due to insufficient data. Some heterogeneity was present in the results, suggesting population, setting, and treatment details are potential prognostic factors. Our evidence suggests that short-duration treatments are not worse than long-duration treatments in moderate/severe exacerbations and may lead to considerably better outcomes in milder exacerbations. This supports the current GOLD guidelines.Trial registration: Our protocol is registered in PROSPERO: CRD42023374410.
Læs mere Tjek på PubMedLuke Bracegirdle, Matthew Stubbs, Rezaur Rahman, Alexander I. R. Jackson, Helmi C. Burton-Papp, Robert Chambers, Sanjay Gupta, Michael P. W. Grocott, Ahilanandan Dushianthan
PLoS One Infectious Diseases, 29.12.2023
Tilføjet 29.12.2023
by Luke Bracegirdle, Matthew Stubbs, Rezaur Rahman, Alexander I. R. Jackson, Helmi C. Burton-Papp, Robert Chambers, Sanjay Gupta, Michael P. W. Grocott, Ahilanandan Dushianthan Background COVID-19 placed immense strain on healthcare systems, necessitating innovative responses to the surge of critically ill patients, particularly those requiring mechanical ventilation. In this report, we detail the establishment of a dedicated critical care prone positioning team at University Hospital Southampton in response to escalating demand for prone positioning during the initial wave of the pandemic. Methods The formation of a prone positioning team involved meticulous planning and collaboration across disciplines to ensure safe and efficient manoeuvrers. A comprehensive training strategy, aligned with national guidelines, was implemented for approximately 550 staff members from a diverse background. We surveyed team members to gain insight to the lived experience. Results A total of 78 full-time team members were recruited and successfully executed over 1200 manoeuvres over an eight-week period. Our survey suggests the majority felt valued and expressed pride and willingness to participate again should the need arise. Conclusion The rapid establishment and deployment of a dedicated prone positioning team may have contributed to both patient care and staff well-being. We provide insight and lessons that may be of value for future respiratory pandemics. Future work should explore objective clinical outcomes and long-term sustainability of such services.
Læs mere Tjek på PubMedFajardo, E., Lastrucci, C., Bah, N., Mingiedi, C. M., Ba, N. S., Mosha, F., Lule, F. J., Paul, M. A. S., Hughes, L., Barr-DiChiara, M., Jamil, M. S., Sands, A., Baggaley, R., Johnson, C.
BMJ Open, 28.12.2023
Tilføjet 28.12.2023
ObjectivesIn 2019, the WHO released guidelines on HIV testing service (HTS). We aim to assess the adoption of six of these recommendations on HIV testing strategies among African countries. DesignPolicy review. Setting47 countries within the WHO African region. ParticipantsNational HTS policies from the WHO African region as of December 2021. Primary and secondary outcome measures: Uptake of WHO recommendations across national HTS policies including the standard three-test strategy; discontinuation of a tiebreaker test to rule in HIV infection; discontinuation of western blotting (WB) for HIV diagnosis; retesting prior to antiretroviral treatment (ART) initiation and the use of dual HIV/syphilis rapid diagnostic tests (RDTs) in antenatal care. Country policy adoption was assessed on a continuum, based on varying levels of complete adoption. ResultsNational policies were reviewed for 96% (n=45/47) of countries in the WHO African region, 38% (n=18) were published before 2019 and 60% (n=28) adopted WHO guidance. Among countries that had not fully adopted WHO guidance, not yet adopting a three-test strategy was the most common reason for misalignment (45%, 21/47); of which 31% and 22% were in low-prevalence (
Læs mere Tjek på PubMedYirga Legesse Niriayo, Melisew Ayalneh, Gebre Teklemariam Demoz, Nigusse Tesfay, Kidu Gidey
PLoS One Infectious Diseases, 23.12.2023
Tilføjet 23.12.2023
by Yirga Legesse Niriayo, Melisew Ayalneh, Gebre Teklemariam Demoz, Nigusse Tesfay, Kidu Gidey Background Antibiotic use related problems lead to the emergence of resistance, failure of therapy, morbidity, mortality, and unnecessary healthcare expenditure. However, little is known about antimicrobial use related problems in our setting particularly in hospitalized surgical patients. Objective The purpose of this study was to investigate antibiotic use related problems and their determinants among hospitalized surgical patients. Methodology A prospective observational study was conducted from December 2018 to April 2019 at the surgical ward of the Ayder comprehensive specialized hospital, located in Northern Ethiopia. We included patients admitted to the surgical ward who were on antibiotic therapy or were candidates for antibiotic therapy/prophylaxis. The patients were recruited during admission and were followed daily until discharge. Data were collected through patient interviews and expert reviews of medical and medication records. The appropriateness of antibiotic use was evaluated according to the Infectious Disease Society of America, American Society of Health System Pharmacists, and World Health Organization guidelines. Subsequently, antibiotic use related problems were identified and classified based on Cipolle’s method followed by consensus review with experts. Binary logistic regression was performed to identify the determinants of antibiotic use related problems. Statistical significance was set at p
Læs mere Tjek på PubMedNene Kaah Keneh, Sebastien Kenmoe, Arnol Bowo-Ngandji, Jane-Francis Tatah Kihla Akoachere, Hortense Gonsu Kamga, Roland Ndip Ndip, Jean Thierry Ebogo-Belobo, Cyprien Kengne-Ndé, Donatien Serge Mbaga, Nicholas Tendongfor, Lucy Mande Ndip, Seraphine Nkie Esemu
PLoS One Infectious Diseases, 23.12.2023
Tilføjet 23.12.2023
by Nene Kaah Keneh, Sebastien Kenmoe, Arnol Bowo-Ngandji, Jane-Francis Tatah Kihla Akoachere, Hortense Gonsu Kamga, Roland Ndip Ndip, Jean Thierry Ebogo-Belobo, Cyprien Kengne-Ndé, Donatien Serge Mbaga, Nicholas Tendongfor, Lucy Mande Ndip, Seraphine Nkie Esemu Background The emergence of methicillin-resistant Staphylococcus aureus (MRSA) has increased and poses a significant threat to human and animal health in Cameroon and the world at large. MRSA strains have infiltrated various settings, including hospitals, communities, and livestock, contributing to increased morbidity, treatment costs, and mortality. This evidence synthesis aims to understand MRSA prevalence, resistance patterns, and genetic characterization in Cameroon. Methods The methodology was consistent with the PRISMA 2020 guidelines. Studies of any design containing scientific data on MRSA prevalence, genetic diversity, and antimicrobial resistance patterns in Cameroon were eligible for inclusion, with no restrictions on language or publication date. The search involved a comprehensive search strategy in several databases including Medline, Embase, Global Health, Web of Science, African Index Medicus, and African Journal Online. The risk of bias in the included studies was assessed using the Hoy et al tool, and the results were synthesized and presented in narrative synthesis and/or tables and graphs. Results The systematic review analyzed 24 studies, mostly conducted after 2010, in various settings in Cameroon. The studies, characterized by moderate to low bias, revealed a wide prevalence of MRSA ranging from 1.9% to 46.8%, with considerable variation based on demographic and environmental factors. Animal (0.2%), food (3.2% to 15.4%), and environmental samples (0.0% to 34.6%) also showed a varied prevalence of MRSA. The genetic diversity of MRSA was heterogeneous, with different virulence gene profiles and clonal lineages identified in various populations and sample types. Antimicrobial resistance rates showed great variability in the different regions of Cameroon, with notable antibiotic resistance recorded for the beta-lactam, fluoroquinolone, glycopeptide, lincosamide, and macrolide families. Conclusion This study highlights the significant variability in MRSA prevalence, genetic diversity, and antimicrobial resistance patterns in Cameroon, and emphasizes the pressing need for comprehensive antimicrobial stewardship strategies in the country.
Læs mere Tjek på PubMedMohamed Abdulla Ghuloom Abdulla Bucheeri, Marion Elligsen, Philip W. Lam, Nick Daneman, Derek MacFadden
PLoS One Infectious Diseases, 21.12.2023
Tilføjet 21.12.2023
by Mohamed Abdulla Ghuloom Abdulla Bucheeri, Marion Elligsen, Philip W. Lam, Nick Daneman, Derek MacFadden Background Empiric antibiotic treatment selection should provide adequate coverage for potential pathogens while minimizing unnecessary broad-spectrum antibiotic use. We sought to pilot a sepsis treatment algorithm to individualize antibiotic recommendations, and thereby improve early antibiotic de-escalation while maintaining adequacy of coverage (Early-IDEAS). Methods In this observational study, the Early-IDEAS decision support algorithm was derived from previous Gram- negative and Gram-positive prediction rules and models along with local guidelines, and then applied to prospectively identified consecutive adults within 24 hours of suspected sepsis. The primary outcome was the proportion of patients for whom de-escalation of the primary antibiotic regimen was recommended by the algorithm. Secondary outcomes included: (1) proportion of patients for whom escalation was recommended; (2) number of recommended de-escalation steps along a pre-specified antibiotic cascade; and (3) adequacy of therapy in patients with culture-confirmed infection. Results We screened 578 patients, of whom 107 eligible patients were included. The Early-IDEAS treatment recommendation was informed by Gram-negative models in 76 (71%) patients, Gram-positive rules in 64 (59.8%), and local guidelines in 27 (25.2%). Antibiotic de-escalation was recommended in almost half of all patients (n = 52, 48.6%), with a median of 2 steps down the a priori antibiotic treatment cascade. No treatment change was recommended in 45 patients (42.1%), and escalation was recommended in 10 (9.3%). Among the 17 patients with positive blood cultures, both the clinician prescribed regimen and the algorithm recommendation provided adequate coverage for the isolated pathogen in 12 patients (70.6%), (p = 1). Among the 25 patients with positive relevant, non-blood cultures, both the clinician prescribed regimen and the algorithm recommendation provided adequate coverage in 20 (80%), (p = 1). Conclusion An individualized decision support algorithm in early sepsis could lead to substantial antibiotic de-escalation without compromising adequate antibiotic coverage.
Læs mere Tjek på PubMedRobina Aerts, Varun Mehra, Andreas H Groll, Rodrigo Martino, Katrien Lagrou, Christine Robin, Katia Perruccio, Nicole Blijlevens, Marcio Nucci, Monica Slavin, Stéphane Bretagne, Catherine Cordonnier, European Conference on Infections in Leukaemia group
Lancet Infectious Diseases, 20.12.2023
Tilføjet 20.12.2023
Patients with haematological malignancies might develop life-threatening toxoplasmosis, especially after allogeneic haematopoietic stem-cell transplantation (HSCT). Reactivation of latent cysts is the primary mechanism of toxoplasmosis following HSCT; hence, patients at high risk are those who were seropositive before transplantation. The lack of trimethoprim–sulfamethoxazole prophylaxis and various immune status parameters of the patient are other associated risk factors. The mortality of toxoplasma disease—eg, with organ involvement—can be particularly high in this setting.
Læs mere Tjek på PubMedWang, J., Tong, S., Niu, Y., Lu, B.
BMJ Open, 20.12.2023
Tilføjet 20.12.2023
ObjectivesTo explore the attitudes towards exercise, factors influencing exercise and exercise-related needs of patients with moderately to severely active inflammatory bowel disease. DesignA qualitative phenomenological research. SettingThe study was conducted at a comprehensive tertiary hospital in Suzhou, China, which is a secondary care facility. ParticipantsThe study included 17 participants who met specific inclusion criteria: aged between 16 and 70 years, diagnosed with inflammatory bowel disease and in a state of moderate to severe disease activity. Participants were required to be capable of clear self-expression and provide voluntary consent. Exclusion criteria included the presence of cancer or severe physical illness, cognitive impairment or mental illness. InterventionsSemistructured interviews were used to collect data. ResultsThe exercise experiences of participants with moderate to severe inflammatory bowel disease yielded three themes: attitudes towards exercise, factors influencing exercise and exercise-related needs. ConclusionThe majority of participants had negative attitudes towards exercise during periods of moderate to severe activity, largely influenced by disease activity, symptom management, inadequate knowledge of exercise and uncertainty about the value of exercise. Of particular note, professional guidance was generally recognised as stimulating a willingness to exercise positively, and participants demonstrated a strong need for professional guidance. Therefore, it is recommended that clear exercise guidelines for inflammatory bowel disease be constructed to ensure that patients receive safe and effective guidance to develop a healthy lifestyle in order to maximise the benefits of exercise.
Læs mere Tjek på PubMedMaan, Irfaan; Kohli, Manik; Gilson, Richard
Current Opinion in Infectious Diseases, 19.12.2023
Tilføjet 19.12.2023
Purpose of review The 2022 global outbreak of mpox disproportionally affected people with HIV (PWH). We review the data on the presentation, treatment, and prevention of mpox in PWH. Recent findings Most PWH with mpox had a mild and self-limiting illness, no different to people without HIV. A higher rate of rectal symptoms has been reported among PWH and those with advanced HIV disease were at higher risk of severe disease, hospitalization, and death. Treatment with antivirals was widely used in hospitalized patients without any randomized control trial data to support its use and without any data specifically in PWH. Use of smallpox vaccines to prevent mpox is safe in PWH regardless of CD4+ cell count. There is limited data on efficacy in those with lower CD4+ cell count and on long-term protective efficacy. Summary PWH should be offered vaccination against mpox in line with national guidelines. PWH should be individually risk-assessed for severe mpox, based on their CD4+ cell count and co-morbidities and ideally recruited into treatment trials to build an evidence base on efficacy. HIV and other sexually transmitted infection testing should be offered to all people diagnosed with mpox.
Læs mere Tjek på PubMedBamford, Alasdair; Foster, Caroline; Lyall, Hermione
Current Opinion in Infectious Diseases, 19.12.2023
Tilføjet 19.12.2023
Purpose of review HIV screening in pregnancy, universal suppressive antiretroviral therapy (ART) and breastfeeding avoidance can almost completely prevent vertical transmission of HIV. Breastfeeding is associated with an additional risk of transmission, although this risk is extremely low with suppressive maternal ART. This minimal risk must be balanced with the benefits of breastfeeding for women living with HIV (WLHIV) and their infants. Guidance in high-income countries has evolved, moving towards supported breast feeding for women on suppressive ART. Recent findings Breastmilk transmission accounts for an increasing proportion of new infant infections globally. The majority of transmission data comes from studies including women not on suppressive ART. Breastmilk transmissions in the context of undetectable viral load have rarely occurred, although risk factors remain unclear. Outcome data on supported breastfeeding are accumulating, providing evidence for guidelines and informing infant feeding decisions. Long-acting ART for maternal preexposure prophylaxis or treatment, and infant postnatal prophylaxis are promising future options. Summary Breastfeeding on suppressive ART has a very low risk of vertical transmission and can have multiple benefits for WLHIV and their infants. However, caution is advised with relaxation of breastfeeding guidance so as not to jeopardise the global goal of elimination of vertical transmission by 2030.
Læs mere Tjek på PubMedChow, Eric P.F.; Fairley, Christopher K.; Kong, Fabian Y.S.
Current Opinion in Infectious Diseases, 19.12.2023
Tilføjet 19.12.2023
Purpose of review The rise in antimicrobial resistance in several STI pathogens such as Neisseria gonorrhoeae has become a public health threat as only one first-line treatment remains. Reducing screening interval for gonorrhoea and chlamydia in high-prevalence populations has been proposed to address antimicrobial stewardship, but this remains controversial. This review aimed to revisit the epidemiology of infections at the oropharynx and review the current screening recommendations and treatment guidelines in different populations. Recent findings Emerging evidence suggests that the oropharynx is the primary anatomical site for gonorrhoea transmission but maybe not for chlamydia transmission. Most international guidelines recommend 3-monthly oropharyngeal gonorrhoea and chlamydia screening for high-prevalence populations (e.g. men who have sex with men) but not low-prevalence populations (e.g. heterosexuals) given the clinical and public health benefits of screening in low-prevalence populations are still unclear. Doxycycline remains the first-line treatment for oropharyngeal chlamydia in most guidelines. However, some countries have moved from dual therapy (ceftriaxone and azithromycin) to monotherapy (ceftriaxone) for oropharyngeal gonorrhoea treatment to address antimicrobial stewardship. Summary The transmission of gonorrhoea and chlamydia is still not fully understood. Further work will be required to evaluate the benefits and harms of reducing screening in high-prevalence populations.
Læs mere Tjek på PubMedLi, Chunyan; Zhao, Peipei; Tan, Rayner K.J.; Wu, Dan
Current Opinion in Infectious Diseases, 19.12.2023
Tilføjet 19.12.2023
Purpose of review Community engagement is key to the success of sustainable public health interventions. This review highlights recent published studies that describe the use of community-engaged methods in sexually transmitted infection (STI) prevention research. Recent findings We organized the findings using a socio-ecological model. At the individual level, communities were engaged through participation in formative research, short-term consultations and community advisory board participation, as well as co-creation activities. At the interpersonal level, studies reviewed described peer-led interventions that leverage the influence and guidance of peers, patient-led interventions in the form of patient navigation and notification, as well as those that mobilize social networks and the power of social relationships to promote health. At the organizational and community level, multisectoral, multifacility collaborations between community, government, and academic stakeholders were highlighted. At the policy and population level, communities were engaged through community dialogues to disseminate research findings, as well as in developing strategic frameworks and clinical guidelines. Digital tools have also been leveraged for effective community engagement. Summary Communities have an effective role to play in STI prevention and can be engaged at multiple levels. Future efforts may consider the use of community engagement tools highlighted in this review, including digital technologies that have the potential to reach more diverse end-users.
Læs mere Tjek på PubMedJournal of the American Medical Association, 19.12.2023
Tilføjet 19.12.2023
Imagine if a new multicenter, randomized trial of a pharmaceutical drug found that for every 3 patients treated on presentation to the hospital with a common severe illness, one intubation and an intensive care unit (ICU) admission were prevented. This would be an instant blockbuster drug. Insurers would scramble to reimburse it, and guidelines and quality metrics would be established to facilitate implementation. In the setting of worsening hospital and ICU strain globally, health systems would work rapidly to implement pathways for using this new therapy. For reference, the RECOVERY trial testing the use of dexamethasone in hospitalized patients with COVID-19, cited more than 2500 times since publication 3 years ago, reduced the need for intubation for 1 in every 50 patients.
Læs mere Tjek på PubMedClinical Infectious Diseases, 19.12.2023
Tilføjet 19.12.2023
Abstract Accurate molecular diagnostic tests are necessary for confirming a diagnosis of coronavirus disease 2019 (COVID-19) and for identifying asymptomatic carriage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The number of available SARS-CoV-2 nucleic acid detection tests continues to increase as does the COVID-19 diagnostic literature. Thus, the Infectious Diseases Society of America (IDSA) developed an evidence-based diagnostic guideline to assist clinicians, clinical laboratorians, patients, and policymakers in decisions related to the optimal use of SARS-CoV-2 nucleic acid amplification tests. In addition, we provide a conceptual framework for understanding molecular diagnostic test performance, discuss nuances of test result interpretation in a variety of practice settings, and highlight important unmet research needs related to COVID-19 diagnostic testing. IDSA convened a multidisciplinary panel of infectious diseases clinicians, clinical microbiologists, and experts in systematic literature review to identify and prioritize clinical questions and outcomes related to the use of SARS-CoV-2 molecular diagnostics. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make testing recommendations. The panel agreed on 12 diagnostic recommendations. Access to accurate SARS-CoV-2 nucleic acid testing is critical for patient care, hospital infection prevention, and the public health response to COVID-19 infection. Information on the clinical performance of available tests continues to grow, but the quality of evidence of the current literature to support this updated molecular diagnostic guideline remains moderate to very low. Recognizing these limitations, the IDSA panel weighed available diagnostic evidence and recommends nucleic acid testing for all symptomatic individuals suspected of having COVID-19. In addition, testing is suggested for asymptomatic individuals with known or suspected contact with a COVID-19 case when the results will impact isolation/quarantine/personal protective equipment (PPE) usage decisions. Evidence in support of rapid testing and testing of upper respiratory specimens other than nasopharyngeal swabs, which offer logistical advantages, is sufficient to warrant conditional recommendations in favor of these approaches.
Læs mere Tjek på PubMedManlapaz, D., Vergara, J. A., Alpuerto, K. M. B., De Los Santos, I. K. S., Enriquez, M. U., Manicio, Z. Z., Mendres, J. E. F., Tolosa, C. G. S., Vilela, Z. G. D., Zabat, Z. E. G. A.
BMJ Open, 15.12.2023
Tilføjet 15.12.2023
BackgroundThe COVID-19 pandemic has taken a toll on both physical activity and fitness as several pursuits and activities have been restricted. Coupled with this, increased food intake and sedentary lifestyles have produced poor physical health outcomes. Online physical education classes have been more difficult to conduct given the limitations of the setup. As such, exergaming has been identified as a possible educational tool that could improve students’ motivation, participation and fitness levels and reduce negative behaviours in class while contributing to the current curriculum. ObjectivesThe study explores the perspectives of both the physical education academic staff and senior high school students from the University of Santo Tomas on the implementation of exergaming to determine the feasibility of exergaming as an educational tool in the Philippines’ physical education curriculum. MethodologyA descriptive qualitative design will be used and participants will be selected through criterion sampling. The authors will conduct a process of question development and pilot FGDs beforehand to ensure smooth proceedings. Once done, they will undergo FGDs conducted through Google Meet. Data will be coded and analysed via thematic analysis using manual coding and NVivo V.12 software to summarise central themes and perceptions. Ethics and disseminationThis study will abide by the Nuremberg Code, Declaration of Helsinki, Belmont Report, Data Privacy Act of 2012 and National Ethical Guidelines (for health-related research) of 2017. The study has received approval from the University of Santo Tomas (UST)-College of Rehabilitation Sciences (CRS) Ethics Review Committee. All participant data will be labelled according to random two-digit computer generated codes to preserve anonymity and stored in password-protected laptops and Google Drive folders to preserve confidentiality. Results will be made available to individual UST physical education academic staff and senior high school students prior to publication in peer-reviewed journal.
Læs mere Tjek på PubMedInfection, 15.12.2023
Tilføjet 15.12.2023
Abstract In a 21-year-old female, AIDS following infection with HIV-2 was diagnosed alongside an HIV-associated high-grade B cell lymphoma. Treatment of HIV-2 with dolutegravir, emtricitabine, and tenofovir resulted in viral suppression and slow recovery of CD4 cell counts. Treatment of lymphoma caused significant adverse effects but led to complete remission. The patient denied sexual activity and intravenous drug abuse. The patient had been born to an HIV-2-positive mother but appropriate perinatal testing based on national guidelines had remained negative. This case recapitulates the natural course of HIV-2 infection.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.12.2023
Tilføjet 14.12.2023
Abstract Background The Viral hepatitis elimination by 2030 is uncertain in resource-limited settings (RLS), due to high burdens and poor diagnostic coverage. This sounds more challenging for hepatitis C virus (HCV) given that antibody (HCVAb) sero-positivity still lacks wide access to HCV RNA molecular testing. This warrants context-specific strategies for appropriate management of liver impairment in RLS. We herein determine the association between anti-HCV positivity and liver impairment in an African RLS. Methods A facility-based observational study was conducted from July-August 2021 among individuals attending the “St Monique” Health Center at Ottou, a rural community of Yaounde,Cameroon. Following a consecutive sampling, consenting individuals were tested for anti-HCV antibodies, hepatitis B surface antigen (HBsAg) and HIV antibodies (HIVAb) as per the national guidelines. After excluding positive cases for HBsAg and/or HIVAb, liver function tests (ALT/AST) were performed on eligible participants (HBsAg and HIVAb negative) and outcomes were compared according to HCVAb status; with p 50 years compared to younger ones [38.46%(15/39) versus 12.36% (33/267) respectively, OR(95%CI) = 4.43(2.11-9.29), p 50 versus younger ones [69.23% (27/39) versus 24.72%(66/267) respectively, p
Læs mere Tjek på PubMedYek, Christina; Wang, Jing; Fintzi, Jonathan; Mancera, Alex G.; Keller, Michael B.; Warner, Sarah; Kadri, Sameer S.
Critical Care Explorations, 14.12.2023
Tilføjet 14.12.2023
IMPORTANCE: Many U.S. State crisis standards of care (CSC) guidelines incorporated Sequential Organ Failure Assessment (SOFA), a sepsis-related severity score, in pandemic triage algorithms. However, SOFA performed poorly in COVID-19. Although disease-specific scores may perform better, their prognostic utility over time and in overcrowded care settings remains unclear. OBJECTIVES: We evaluated prognostication by the modified 4C (m4C) score, a COVID-19–specific prognosticator that demonstrated good predictive capacity early in the pandemic, as a potential tool to standardize triage across time and hospital-surge environments. DESIGN: Retrospective observational cohort study. SETTING: Two hundred eighty-one U.S. hospitals in an administrative healthcare dataset. PARTICIPANTS: A total of 298,379 hospitalized adults with COVID-19 were identified from March 1, 2020, to January 31, 2022. m4C scores were calculated from admission diagnosis codes, vital signs, and laboratory values. MAIN OUTCOMES AND MEASURES: Hospital-surge index, a severity-weighted measure of COVID-19 caseload, was calculated for each hospital-month. Discrimination of in-hospital mortality by m4C and surge index-adjusted models was measured by area under the receiver operating characteristic curves (AUC). Calibration was assessed by training models on early pandemic waves and measuring fit (deviation from bisector) in subsequent waves. RESULTS: From March 2020 to January 2022, 298,379 adults with COVID-19 were admitted across 281 U.S. hospitals. m4C adequately discriminated mortality in wave 1 (AUC 0.779 [95% CI, 0.769–0.789]); discrimination was lower in subsequent waves (wave 2: 0.772 [95% CI, 0.765–0.779]; wave 3: 0.746 [95% CI, 0.743–0.750]; delta: 0.707 [95% CI, 0.702–0.712]; omicron: 0.729 [95% CI, 0.721–0.738]). m4C demonstrated reduced calibration in contemporaneous waves that persisted despite periodic recalibration. Performance characteristics were similar with and without adjustment for surge. CONCLUSIONS AND RELEVANCE: Mortality prediction by the m4C score remained robust to surge strain, making it attractive for when triage is most needed. However, score performance has deteriorated in recent waves. CSC guidelines relying on defined prognosticators, especially for dynamic disease processes like COVID-19, warrant frequent reappraisal to ensure appropriate resource allocation.
Læs mere Tjek på PubMedAmber Sacre, Clare Bambra, Josephine M. Wildman, Katie Thomson, Natalie Bennett, Sarah Sowden, Adam Todd
PLoS One Infectious Diseases, 14.12.2023
Tilføjet 14.12.2023
by Amber Sacre, Clare Bambra, Josephine M. Wildman, Katie Thomson, Natalie Bennett, Sarah Sowden, Adam Todd This global umbrella review aimed to synthesise evidence of socioeconomic inequalities in the uptake of routine vaccinations and identify the mechanisms that may contribute to the association. To our knowledge, no attempt has been made to synthesise the global body of systematic reviews across a variety of vaccines, geographical locations, and measures of SES. The inclusion criteria were as follows: studies assessing vaccination uptake according to education, income, occupation/employment, and/or area-level deprivation; any country or universally recommended routine vaccination (according to the WHO); qualitative or quantitative reviews, published 2011-present. The searches were performed in eight databases. The screening process followed PRISMA-E guidelines, each stage was performed by one reviewer, and a 10% sample checked by a second for consistency. Included reviews underwent data extraction, quality appraisal (AMSTAR-2), and narrative synthesis according to country-context. After deduplication, 9,163 reports underwent title and abstract screening, leaving 119 full texts to be assessed for eligibility. Overall, 26 studies were included in the umbrella review. Evidence for lower uptake amongst disadvantaged SES individuals was found in all 26 reviews. However, 17 reviews showed mixed results, as inverse associations were also identified (lower uptake for advantaged SES, and/or higher uptake for disadvantaged SES). Those that explored high-income countries had a greater prevalence of mixed findings than those focusing on low/middle-income countries. The two most frequently cited mechanisms were vaccination knowledge, and confidence in vaccination or vaccination providers. These mechanisms were often understood by review authors as varying by level of education. We find socioeconomic differences in routine vaccination uptake, but the association did not always follow a gradient. Whilst education may be associated with uptake globally, our study indicates that its role varies by country-context. A limitation is the overlap of some primary studies across the included systematic reviews.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.12.2023
Tilføjet 14.12.2023
Abstract Background The Viral hepatitis elimination by 2030 is uncertain in resource-limited settings (RLS), due to high burdens and poor diagnostic coverage. This sounds more challenging for hepatitis C virus (HCV) given that antibody (HCVAb) sero-positivity still lacks wide access to HCV RNA molecular testing. This warrants context-specific strategies for appropriate management of liver impairment in RLS. We herein determine the association between anti-HCV positivity and liver impairment in an African RLS. Methods A facility-based observational study was conducted from July-August 2021 among individuals attending the “St Monique” Health Center at Ottou, a rural community of Yaounde,Cameroon. Following a consecutive sampling, consenting individuals were tested for anti-HCV antibodies, hepatitis B surface antigen (HBsAg) and HIV antibodies (HIVAb) as per the national guidelines. After excluding positive cases for HBsAg and/or HIVAb, liver function tests (ALT/AST) were performed on eligible participants (HBsAg and HIVAb negative) and outcomes were compared according to HCVAb status; with p 50 years compared to younger ones [38.46%(15/39) versus 12.36% (33/267) respectively, OR(95%CI) = 4.43(2.11-9.29), p 50 versus younger ones [69.23% (27/39) versus 24.72%(66/267) respectively, p
Læs mere Tjek på PubMedInfection, 13.12.2023
Tilføjet 13.12.2023
Abstract In a 21-year-old female, AIDS following infection with HIV-2 was diagnosed alongside an HIV-associated high-grade B cell lymphoma. Treatment of HIV-2 with dolutegravir, emtricitabine, and tenofovir resulted in viral suppression and slow recovery of CD4 cell counts. Treatment of lymphoma caused significant adverse effects but led to complete remission. The patient denied sexual activity and intravenous drug abuse. The patient had been born to an HIV-2-positive mother but appropriate perinatal testing based on national guidelines had remained negative. This case recapitulates the natural course of HIV-2 infection.
Læs mere Tjek på PubMedOrmiston, C. K., Chiangong, J., Livinski, A., Tompkins, D., Williams, F.
BMJ Open, 13.12.2023
Tilføjet 13.12.2023
IntroductionThe COVID-19 pandemic has had drastic effects on worldwide mental health and laid bare health disparities and inequities among marginalised groups and racial/ethnic minoritised communities in the USA. This is especially the case among Hispanic/Latino/a immigrants who face numerous structural and socioeconomic barriers to well-being. The increased mental health burden on Hispanic/Latino/a immigrants may have far reaching effects if left unaddressed. Thus, by understanding further Hispanic/Latino/a immigrant mental health during the pandemic, communities and health providers may be able to better address this growing issue. This scoping review aims to assess and outline the current literature on the pandemic’s effects on Hispanic/Latino/a immigrant mental health in the USA, identify research gaps and areas of urgent concern, and inform future research and public health interventions and guidelines. Methods and analysisA scoping review following the Joanna Briggs Institute methodology will be conducted. The PsycINFO, PubMed, Scopus and Web of Science: Core Collection databases and five grey literature sources will be searched for articles published in English from 1 January 2020 to 31 December 2022. Two independent reviewers will screen the search results at title and abstract and then full text using Covidence with conflicts resolved by a third reviewer. Data collection will also be performed in duplicate using Microsoft Excel with discrepancies resolved by a third reviewer and consensus discussion. Ethics and disseminationEthics approval is not required for this scoping review. Results will be published in a peer-reviewed journal as well as presented at local and national conferences and meetings relevant to our field. Furthermore, to make our findings accessible to non-scientific audiences, we will use various mediums, such as graphical abstracts, policy briefs and fact sheets to share the results in both English and Spanish on different platforms.
Læs mere Tjek på PubMedXiong, S., Klesges, L., Doering, M., Pratt, R. J.
BMJ Open, 12.12.2023
Tilføjet 12.12.2023
BackgroundImplementation science (IS) frameworks, models and theories (FMTs) have gained popularity in guiding the implementation and evaluation of evidence-based interventions (EBIs) for cancer screening. However, there are significant research gaps in understanding their applications in cancer health disparities contexts. This paper outlines a scoping review protocol designed to explore the utilisation of IS FMTs in cancer screening EBIs to inform intervention designs and adaptations. Methods and analysisThis scoping review protocol adheres to Arksey and O’Malley’s five-step methodological framework for conducting scoping studies. Search strategies were conducted in five bibliographic databases: Ovid MEDLINE, PubMed, Scopus, Web of Science and EMBASE. The search was run on 22 June 2023 with an English language filter and a date limit of 2001-current. Two reviewers will independently screen studies for inclusion and exclusion criteria. A third reviewer will be consulted, where appropriate at any of the review stages, to achieve consensus or resolve conflicts. Data will be collected, managed and analysed using Covidence. A narrative synthesis, based on Popay et al’s methodology, will guide reporting and summarisation of results. The review will adhere to the PRISMA Extension for Scoping Reviews guidelines. Ethics and disseminationThis scoping review is a novel approach for examining a growing corpus of research literature on IS FMT applications used in cancer screening EBIs. As a secondary analysis, this scoping review does not require approval from an institutional review board. We anticipate the review will produce insightful information (eg, challenges, key areas for future directions) on the applications of IS TMFs in designing, deploying and testing EBIs for populations experiencing cancer screening disparities. We will disseminate the results through journals and conferences targeting IS and cancer prevention researchers and practitioners.
Læs mere Tjek på PubMedBushra Jamil, Divya Nair, Pruthu Thekkur, Neelofar Laeeq, Anum Adil, Mohammed Khogali, Rony Zachariah, Selma Dar Berger, Srinath Satyanarayana, Ajay M. V. Kumar, Aaron Bochner, Amanda McClelland, Razia Fatima, Anthony D. Harries
PLoS One Infectious Diseases, 11.12.2023
Tilføjet 11.12.2023
by Bushra Jamil, Divya Nair, Pruthu Thekkur, Neelofar Laeeq, Anum Adil, Mohammed Khogali, Rony Zachariah, Selma Dar Berger, Srinath Satyanarayana, Ajay M. V. Kumar, Aaron Bochner, Amanda McClelland, Razia Fatima, Anthony D. Harries Introduction Screening household contacts of TB patients and providing TB preventive therapy (TPT) is a key intervention to end the TB epidemic. Global and timely implementation of TPT in household contacts, however, is dismal. We adapted the 7-1-7 timeliness metric designed to evaluate and respond to infectious disease outbreaks or pandemics, and assessed the feasibility, enablers and challenges of implementing this metric for screening and management of household contacts of index patients with bacteriologically-confirmed pulmonary TB in Karachi city, Pakistan. Methods We conducted an explanatory mixed methods study with a quantitative component (cohort design) followed by a qualitative component (descriptive design with focus group discussions). Results From January-June 2023, 92% of 450 index patients had their household contacts line-listed within seven days of initiating anti-TB treatment (“first 7”). In 84% of 1342 household contacts, screening outcomes were ascertained within one day of line-listing (“next 1”). In 35% of 256 household contacts eligible for further evaluation by a medical officer (aged ≤5 years or with chest symptoms), anti-tuberculosis treatment, TPT or a decision for no drugs was made within seven days of symptom screening (“second 7”). The principal reason for not starting anti-tuberculosis treatment or TPT was failure to consult a medical officer: only 129(50%) of 256 contacts consulted a medical officer. Reasons for poor performance in the “second 7” component included travel costs to see a medical officer, loss of daily earnings and fear of a TB diagnosis. Field staff reported that timeliness metrics motivated them to take prompt action in household contact screening and TPT provision and they suggested these be included in national guidelines. Conclusions Field staff found “7-1-7” timeliness metrics to be feasible and useful. Integration of these metrics into national guidelines could improve timeliness of diagnosis, treatment and prevention of TB within households of index patients.
Læs mere Tjek på PubMedMantina, N. M., Nakayima Miiro, F., Smith, J., McClelland, D. J., Magrath, P. A., Madhivanan, P.
BMJ Open, 10.12.2023
Tilføjet 10.12.2023
IntroductionHuman papillomavirus (HPV) is the causative agent of nearly all cervical cancers. Despite the proven safety and efficacy of HPV vaccines in preventing HPV-related cancers, the global vaccine coverage rate is estimated to only be 15%. HPV vaccine coverage rates are more actively tracked and reported for adolescents 17 years and younger but there is still a critical window of opportunity to intervene and promote HPV vaccination among young adults aged 18–26 years who are still eligible to be vaccinated. This protocol for a qualitative evidence synthesis aims to review perspectives of HPV vaccination among young adults (18–26 years) and identify facilitators and barriers that influence HPV vaccination uptake and decision-making. Methods and analysisSeven databases will be searched from 1 January 2006 to the date of final search. For inclusion, studies must report HPV vaccination perspectives of young adults aged 18–26 years and use qualitative study methods or analysis techniques. Studies will be screened in a two-stage process guided by the eligibility criteria. Final included studies will be evaluated for methodological strengths and limitations using the Critical Appraisal Skills Programme quality assessment tool for qualitative studies. After data extraction, framework analysis will be used to analyse the data applying the socioecological model. Finally, the Grading of Recommendations Assessment, Development and Evaluation - Confidence in the Evidence from Reviews of Qualitative research will be applied to evaluate the confidence in synthesised qualitative findings. The methodology of this review follows the Cochrane Handbook guidelines on qualitative evidence syntheses. Ethics and disseminationFormal ethical approval is not required for this study. Findings will be disseminated through peer-reviewed publications, conference presentations and professional networks. PROSPERO registration numberCRD42023417052.
Læs mere Tjek på PubMedFischer, H.-T., Müller, K., Wenham, C., Hanefeld, J.
BMJ Open, 10.12.2023
Tilføjet 10.12.2023
IntroductionFour years after the devastating Ebola outbreak, governments in West Africa were quick to implement non-pharmaceutical interventions (NPIs) in response to the rapid spread of SARS-CoV-2. The NPIs implemented included physical distancing, closure of schools and businesses, restrictions on public gatherings and mandating the use of face masks among others. In the absence of widely available vaccinations, NPIs were the only known means to try to slow the spread of COVID-19. While numerous studies have assessed the effectiveness of these NPIs in high-income countries, less is known about the processes that lead to the adoption of policies and the factors that influence their implementation and adherence in low-income and middle-income countries. The objective of this scoping review is to understand the extent and type of evidence in relation to the policy formulation, decision-making and implementation stages of NPIs in West Africa. Methods and analysisA scoping review will be undertaken following the guidance developed by Arskey and O’Malley, the Joanna Briggs Institute (JBI) methodology for scoping reviews and the PRISMA guidelines for Scoping Reviews. Both peer-reviewed and grey literature will be searched using Web of Science, Embase, Scopus, APA PsycInfo, WHO Institutional Repository for Information Sharing, JSTOR and Google Advanced Search, and by searching the websites of the WHO, and the West African Health Organisation. Screening will be conducted by two reviewers based on inclusion and exclusion criteria, and data will be extracted, coded and narratively synthesised. Ethics and disseminationWe started this scoping review in May 2023, and anticipate finishing by April 2024. Ethics approval is not required since we are not collecting primary data. This protocol was registered at Open Science Framework (https://osf.io/gvek2/). We plan to disseminate this research through publications, conference presentations and upcoming West African policy dialogues on pandemic preparedness and response.
Læs mere Tjek på PubMedAku, F. Y., Amuasi, J. H., Debrah, L. B., Opoku, D., Gmanyami, J. M., Hoerauf, A., Debrah, A. Y., Quentin, W.
BMJ Open, 9.12.2023
Tilføjet 9.12.2023
IntroductionCountries in the WHO’s African region have found community-based surveillance useful in ensuring the effectiveness of the Integrated Disease Surveillance and Response strategy. This approach encourages community participation in the surveillance system, in addition to early detection of outbreaks and other health threats. Thus, advancements in mobile health have the potential to improve community-based surveillance in Africa. The purpose of this review is to map evidence on available mhealth tools for community-based infectious disease surveillance in Africa. Methods and analysisThe scoping review will follow a mixed-methods approach in line with the framework of Arksey and O’Malley amended by Levac and colleagues and the Joanna Briggs Institute. To retrieve published literature, PubMed, Scopus, Web of Science, Google Scholar and Google databases will be explored. Websites of organisations involved in surveillance activities across the African region will also be explored. Authors will be interested in published literature between 2000 and 2022 in any language. The primary investigator and a second author will independently review the retrieved titles according to the inclusion criteria, while a third reviewer will resolve conflicts that may arise. The review will map evidence according to the key concepts (mhealth, community-based surveillance and Africa) to inform stakeholders and mhealth designers on best practices to adopt involving mhealth approaches at the community level and mhealth tool designs, respectively. Results following the review will be presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: Extension for Scoping Review Guidelines. Ethics and disseminationEthical approval is not required for scoping reviews as it does not involve the use of human subjects. This review is the first phase in an overall project on digital health. The findings of the review will be published in a peer-reviewed journal and disseminated at suitable forums and conferences.
Læs mere Tjek på PubMedZayadi, A., Edge, R., Parker, C. E., Macdonald, J. K., Neustifter, B., Chang, J., Zhong, G., Singh, S., Feagan, B. G., Ma, C., Jairath, V.
BMJ Open, 9.12.2023
Tilføjet 9.12.2023
ObjectivesExternal control arms (ECAs) provide useful comparisons in clinical trials when randomised control arms are limited or not feasible. We conducted a systematic review to summarise applications of ECAs in trials of immune-mediated inflammatory diseases (IMIDs). DesignSystematic review with an appraisal of ECA source quality rated across five domains (data collection, study populations, outcome definitions, reliability and comprehensiveness of the dataset, and other potential limitations) as high, low or unclear quality. Data sourcesEmbase, Medline and Cochrane Central Register of Controlled Trial were searched through to 12 September 2023. Eligibility criteriaEligible studies were single-arm or randomised controlled trials (RCTs) of inflammatory bowel disease, pouchitis, rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, psoriatic arthritis, psoriasis and atopic dermatitis in which an ECA was used as the comparator. Data extraction and synthesisTwo authors independently screened the search results in duplicate. The characteristics of included studies, external data source(s), outcomes and statistical methods were recorded, and the quality of the ECA data source was assessed by two independent authors. ResultsForty-three studies met the inclusion criteria (inflammatory bowel disease: 16, pouchitis: 1, rheumatoid arthritis: 12, juvenile idiopathic arthritis: 1, ankylosing spondylitis: 5, psoriasis: 3, multiple indications: 4). The majority of these trials were single-arm (33/43) and enrolled adult patients (34/43). All included studies used a historical control rather than a contemporaneous ECA. In RCTs, ECAs were most often derived from the placebo arm of another RCT (6/10). In single-arm trials, historical case series were the most common ECA source (19/33). Most studies (31/43) did not employ a statistical approach to generate the ECA from historical data. ConclusionsStandardised ECA methodology and reporting conventions are lacking for IMIDs trials. The establishment of ECA reporting guidelines may enhance the rigour and transparency of future research.
Læs mere Tjek på PubMedDyer, A. H., Dolphin, H., OConnor, A., Morrison, L., Sedgwick, G., McFeely, A., Killeen, E., Gallagher, C., Davey, N., Connolly, E., Lyons, S., Young, C., Gaffney, C., Ennis, R., McHale, C., Joseph, J., Knight, G., Kelly, E., OFarrelly, C., Bourke, N. M., Fallon, A., ODowd, S., Kennelly, S. P.
BMJ Open, 9.12.2023
Tilføjet 9.12.2023
IntroductionAlzheimer’s disease and other dementias affect >50 million individuals globally and are characterised by broad clinical and biological heterogeneity. Cohort and biobank studies have played a critical role in advancing the understanding of disease pathophysiology and in identifying novel diagnostic and treatment approaches. However, further discovery and validation cohorts are required to clarify the real-world utility of new biomarkers, facilitate research into the development of novel therapies and advance our understanding of the clinical heterogeneity and pathobiology of neurodegenerative diseases. Methods and analysisThe Tallaght University Hospital Institute for Memory and Cognition Biobank for Research in Ageing and Neurodegeneration (TIMC-BRAiN) will recruit 1000 individuals over 5 years. Participants, who are undergoing diagnostic workup in the TIMC Memory Assessment and Support Service (TIMC-MASS), will opt to donate clinical data and biological samples to a biobank. All participants will complete a detailed clinical, neuropsychological and dementia severity assessment (including Addenbrooke’s Cognitive Assessment, Repeatable Battery for Assessment of Neuropsychological Status, Clinical Dementia Rating Scale). Participants undergoing venepuncture/lumbar puncture as part of the clinical workup will be offered the opportunity to donate additional blood (serum/plasma/whole blood) and cerebrospinal fluid samples for longitudinal storage in the TIMC-BRAiN biobank. Participants are followed at 18-month intervals for repeat clinical and cognitive assessments. Anonymised clinical data and biological samples will be stored securely in a central repository and used to facilitate future studies concerned with advancing the diagnosis and treatment of neurodegenerative diseases. Ethics and disseminationEthical approval has been granted by the St. James’s Hospital/Tallaght University Hospital Joint Research Ethics Committee (Project ID: 2159), which operates in compliance with the European Communities (Clinical Trials on Medicinal Products for Human Use) Regulations 2004 and ICH Good Clinical Practice Guidelines. Findings using TIMC-BRAiN will be published in a timely and open-access fashion.
Læs mere Tjek på PubMedFilip, Iulia
AIDS, 9.12.2023
Tilføjet 9.12.2023
Yu, J.-S., Kim, E.-S., Park, K. S., Lee, Y. J., Park, Y. C., Nam, D., Kim, E.-J., Ha, I.-H.
BMJ Open, 7.12.2023
Tilføjet 7.12.2023
ObjectivesFibromyalgia treatment trends vary globally; however, the trend in South Korea has not been investigated yet. This study aimed to analyse the fibromyalgia treatment trends in South Korea. DesignRetrospective, observational study using serial cross-sectional data. SettingThe National Patient Samples of the Korean Health Insurance Review & Assessment Service from 2011 to 2018 were used. ParticipantsA total of 31 059 patients with fibromyalgia were included in this study. The basic characteristics of the patients were stratified by sex, age and comorbidity. A patient was considered to have a condition if it was recorded as a principal diagnosis at least once in a year. Primary and secondary outcome measuresTrends in the types of medical visits and prescribed treatments were investigated and the values are presented as rates per 100 patients. The types of pharmacological treatment were presented according to the existing clinical guidelines. Additionally, combination prescription trends and associated characteristics were investigated. ResultsOf the patients, 66.2% were female. Visits to internal medicine departments showed the most significant increase (2011: 11.34; 2018: 21.99; p
Læs mere Tjek på PubMedCarolina A.D. Santos, Artemis P. Paula, Gentil G. Fonseca Filho, Manoella M. Alves, Andréia F. Nery, Monise G.A. Pontes, Erianna Y.L. Macedo, Ruy M. Oliveira Jr, Sabrinna M. Freitas, Sarah Lima, Fernanda V.C. Varela, Andrezza L.S. Viana, Aline L.P. Silva, Érika G.C. Silva, Lília D'Souza-Li
International Journal of Infectious Diseases, 5.12.2023
Tilføjet 5.12.2023
SARS-CoV-2 has infected over 620 million people and killed more than 6 million worldwide. [1] Since the beginning of the pandemic, Brazil has reported a disproportionately large number of infections and deaths of pregnant women attributed to COVID-19, [2] arguably caused by the disastrous response to the pandemic in its early months, with national policies contrary to scientific recommendations and against international infectious disease societies guidelines. [3]
Læs mere Tjek på PubMedBMC Infectious Diseases, 3.12.2023
Tilføjet 3.12.2023
Abstract We present a rare case of pathology-proven CMV pneumonitis in a patient with HIV infection after presenting with cough and fever. This presentation was complicated by recurrence of symptoms after treatment in the setting of continued uncontrolled HIV infection. This case raised the importance of further discussion regarding best treatment guidelines for CMV pneumonitis for patients with HIV.
Læs mere Tjek på PubMedBMC Infectious Diseases, 30.11.2023
Tilføjet 30.11.2023
Abstract We present a rare case of pathology-proven CMV pneumonitis in a patient with HIV infection after presenting with cough and fever. This presentation was complicated by recurrence of symptoms after treatment in the setting of continued uncontrolled HIV infection. This case raised the importance of further discussion regarding best treatment guidelines for CMV pneumonitis for patients with HIV.
Læs mere Tjek på PubMedJournal of the American Medical Association, 29.11.2023
Tilføjet 29.11.2023
In Reply Dr Bergman highlights a number of important potential barriers to COVID-19 antiviral treatment use in nursing homes, including rapidly evolving guidelines concerning the use of monoclonal antibodies, insufficient supply of recommended monoclonal antibodies, and high staffing needs to administer monoclonal antibodies intravenously. These factors likely contributed to the low antiviral treatment rates observed in our study, when monoclonal antibodies were the only treatment available.
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