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47 ud af 47 tidsskrifter valgt, søgeord (urin) valgt, emner højest 180 dage gamle, sorteret efter nyeste først.
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Journal of the American Medical Association, 8.02.2024
Tilføjet 8.02.2024
In the Original Investigation titled “Prone Positioning During Extracorporeal Membrane Oxygenation in Patients With Severe ARDS: The PRONECMO Randomized Clinical Trial,” published in the December 26, 2023, issue of JAMA, errors in percentages occurred. In the Results of the Abstract and in the Results, Secondary Outcomes, section of the text, the risk difference for 90-day mortality should have been 3.5% with a 95% CI of −12.7% to 19.7%. In Table 1, the numbers of female participants reported were correct but the percentages should have been 27.9% and 42.8% for the prone ECMO and supine ECMO groups, respectively; the number of patients with COVID-19 pneumonia in the supine ECMO group was correct but the percentage should have been 94.0%. This article was corrected online.
Læs mere Tjek på PubMedJournal of the American Medical Association, 8.02.2024
Tilføjet 8.02.2024
This cohort study evaluates the risks of neonatal adverse events after exposure to COVID-19 vaccination during pregnancy.
Læs mere Tjek på PubMedAmerican Journal of Tropical Medicine and Hygiene, 8.02.2024
Tilføjet 8.02.2024
Journal Name: The American Journal of Tropical Medicine and Hygiene Volume: 110 Issue: 2 Pages: 379-386
Læs mere Tjek på PubMedBMC Infectious Diseases, 8.02.2024
Tilføjet 8.02.2024
Abstract Background In Burkina Faso, the prevalence of malaria has decreased over the past two decades, following the scale-up of control interventions. The successful development of malaria parasites depends on several climatic factors. Intervention gains may be reversed by changes in climatic factors. In this study, we investigated the role of malaria control interventions and climatic factors in influencing changes in the risk of malaria parasitaemia. Methods Bayesian logistic geostatistical models were fitted on Malaria Indicator Survey data from Burkina Faso obtained in 2014 and 2017/2018 to estimate the effects of malaria control interventions and climatic factors on the temporal changes of malaria parasite prevalence. Additionally, intervention effects were assessed at regional level, using a spatially varying coefficients model. Results Temperature showed a statistically important negative association with the geographic distribution of parasitaemia prevalence in both surveys; however, the effects of insecticide-treated nets (ITNs) use was negative and statistically important only in 2017/2018. Overall, the estimated number of infected children under the age of 5 years decreased from 704,202 in 2014 to 290,189 in 2017/2018. The use of ITNs was related to the decline at national and regional level, but coverage with artemisinin-based combination therapy only at regional level. Conclusion Interventions contributed more than climatic factors to the observed change of parasitaemia risk in Burkina Faso during the period of 2014 to 2017/2018. Intervention effects varied in space. Longer time series analyses are warranted to determine the differential effect of a changing climate on malaria parasitaemia risk.
Læs mere Tjek på PubMedBMC Infectious Diseases, 8.02.2024
Tilføjet 8.02.2024
Abstract Background Maternal sepsis is the third leading cause of maternal death in the world. Women in resource-limited countries shoulder most of the burdens related to sepsis. Despite the growing risk associated with maternal sepsis, there are limited studies that have tried to assess the impact of maternal sepsis in resource-limited countries. The current study determined the outcomes of maternal sepsis and factors associated with having poor maternal outcomes. Methods A facility-based retrospective cross-sectional study design was employed to assess the clinical presentation, maternal outcomes, and factors associated with maternal sepsis. The study was conducted in Ayder Comprehensive Specialized Hospital, Tigray, Ethiopia, from January 1, 2017, to December 31, 2021. Sociodemographic characteristics, clinical characteristics and outcomes of women with maternal sepsis were analyzed using a descriptive statistic. The association between dependent and independent variables was determined using multivariate logistic regression. Results Among 27,350 live births, 298 mothers developed sepsis, giving a rate of 109 maternal sepsis for every 10,000 live births. There were 22 maternal deaths, giving rise to a case fatality rate of 7.4% and a maternal mortality ratio of 75 per 100,000 live births. Admission to the intensive care unit and use of mechanical ventilator were observed in 23.5% and 14.1% of the study participants, respectively. A fourth (24.2%) of the mothers were complicated with septic shock. Overall, 24.2% of women with maternal sepsis had severe maternal outcomes (SMO). Prolonged hospital stay, having parity of two and above, having the lung as the focus of infection, switchof antibiotics, and developing septic shock were significantly associated with SMO. Conclusions This study revealed that maternal sepsis continues to cause significant morbidity and mortality in resource-limited settings; with a significant number of women experiencing death, intensive care unit admission, and intubation attributable to sepsis. The unavailability of recommended diagnostic modalities and management options has led to the grave outcomes observed in this study. To ward off the effects of infection during pregnancy, labor and postpartum period and to prevent progression to sepsis and septic shock in low-income countries, we recommend that concerted and meticulous efforts should be applied to build the diagnostic capacity of health facilities, to have effective infection prevention and control practice, and to avail recommended diagnostic and management options.
Læs mere Tjek på PubMedBMC Infectious Diseases, 8.02.2024
Tilføjet 8.02.2024
Abstract Background Syndromic surveillance of acute gastroenteritis plays a significant role in the diagnosis and management of gastrointestinal infections that are responsible for a substantial number of deaths globally, especially in developing countries. In Lebanon, there is a lack of national surveillance for acute gastroenteritis, and limited data exists regarding the prevalence of pathogens causing diarrhea. The one-year study aims to investigate the epidemiology of common gastrointestinal pathogens and compare our findings with causative agents of diarrhea reported by our study collaborative centers. Methods A multicenter, cross-sectional study was conducted over a one-year period. A total of 271 samples were obtained from outpatients and inpatients presenting with symptoms of acute gastroenteritis at various healthcare facilities. The samples were then analyzed using Allplex gastrointestinal assay that identifies a panel of enteric pathogens. Results Overall, enteropathogens were detected in 71% of the enrolled cases, 46% of those were identified in patients as single and 54% as mixed infections. Bacteria were observed in 48%, parasites in 12% and viruses in 11%. Bacterial infections were the most prevalent in all age groups. Enteroaggregative E. coli (26.5%), Enterotoxigenic E. coli (23.2%) and Enteropathogenic E. coli (20.3%) were the most frequently identified followed by Blastocystis hominis (15.5%) and Rotavirus (7.7%). Highest hospitalization rate occurred with rotavirus (63%), Enterotoxigenic E. coli (50%), Blastocystis hominis (45%) and Enteropathogenic E. coli (43%). Enteric pathogens were prevalent during summer, fall and winter seasons. Conclusions The adoption of multiplex real-time PCR assays in the diagnosis of gastrointestinal infections has identified gaps and improved the rates of detection for multiple pathogens. Our findings highlight the importance of conducting comprehensive surveillance to monitor enteric infections. The implementation of a syndromic testing panel can therefore provide healthcare professionals with timely and accurate information for more effective treatment and public health interventions.
Læs mere Tjek på PubMedEddy Kinganda-Lusamaki, Shannon Whitmer, Emmanuel Lokilo-Lofiko, Adrienne Amuri-Aziza, Francisca Muyembe-Mawete, Jean Claude Makangara-Cigolo, Gerry Makaya, Francis Mbuyi, Amy Whitesell, Ruth Kallay, Mary Choi, Catherine Pratt, Daniel Mukadi-Bamuleka, Hugo Kavunga-Membo, Meris Matondo-Kuamfumu, Fabrice Mambu-Mbika, Richard Ekila-Ifinji, Trevor Shoemaker, Miles Stewart, Julia Eng, Abraham Rajan, Gnakub N Soke, Peter N Fonjungo, John Otokoye Otshudiema, Gervais Léon Tengomo Folefack, Elisabeth Pukuta-Simbu, Emir Talundzic, Elizabeth Shedroff, Jacques Likofata Bokete, Anaïs Legand, Pierre Formenty, Christopher N Mores, Abigail J Porzucek, Sarah R Tritsch, John Kombe, Gaston Tshapenda, Felix Mulangu, Ahidjo Ayouba, Eric Delaporte, Martine Peeters, Michael R Wiley, Joel M Montgomery, John D Klena, Jean-Jacques Muyembe-Tamfum, Steve Ahuka-Mundeke, Placide Mbala-Kingebeni
The Lancet Microbe, 8.02.2024
Tilføjet 8.02.2024
Integrating genetic and epidemiological data allowed for investigative fact-checking and verified patient-reported sources of possible zoonotic spillover. These results demonstrate that rapid genetic sequencing combined with epidemiological data can inform responders of the mechanisms of viral spread, uncover novel transmission modes, and provide a deeper understanding of the outbreak, which is ultimately needed for infection prevention and control during outbreaks.
Læs mere Tjek på PubMedYang Wang, Mark Livingston, David P. McArthur, Nick Bailey
PLoS One Infectious Diseases, 7.02.2024
Tilføjet 7.02.2024
by Yang Wang, Mark Livingston, David P. McArthur, Nick Bailey The growth of the online short-term rental market, facilitated by platforms such as Airbnb, has added to pressure on cities’ housing supply. Without detailed data on activity levels, it is difficult to design and evaluate appropriate policy interventions. Up until now, the data sources and methods used to derive activity measures have not provided the detail and rigour needed to robustly carry out these tasks. This paper demonstrates an approach based on daily scrapes of the calendars of Airbnb listings. We provide a systematic interpretation of types of calendar activity derived from these scrapes and define a set of indicators of listing activity levels. We exploit a unique period in short-term rental markets during the UK’s first COVID-19 lockdown to demonstrate the value of this approach.
Læs mere Tjek på PubMedLan Li, Ava Sullivan, Anwar Musah, Katerina Stavrianaki, Caroline E. Wood, Philip Baker, Patty Kostkova
PLoS One Infectious Diseases, 7.02.2024
Tilføjet 7.02.2024
by Lan Li, Ava Sullivan, Anwar Musah, Katerina Stavrianaki, Caroline E. Wood, Philip Baker, Patty Kostkova The COVID-19 pandemic has had a profound impact on society; it changed the way we work, learn, socialise, and move throughout the world. In the United Kingdom, policies such as business closures, travel restrictions, and social distance mandates were implemented to slow the spread of COVID-19 and implemented and relaxed intermittently throughout the response period. While negative emotions and feelings such as distress and anxiety during this time of crisis were to be expected, we also see the signs of human resilience, including positive feelings like determination, pride, and strength. A longitudinal study using online survey tools was conducted to assess people’s changing moods during the pandemic in the UK. The Positive and Negative Affect Schedule (PANAS) was used to measure self-reported feelings and emotions throughout six periods (phases) of the study from March 2020 to July 2021. A total of 4,222 respondents participated in the survey, while a sub-group participated in each of the six study phases (n = 167). The results were analysed using a cross-sectional study design for the full group across each study phase, while prospective cohort analysis was used to assess the subset of participants who voluntarily answered the survey in each of the six study phases (n = 167). Gender, age and employment status were found to be most significant to PANAS score, with older people, retirees, and women generally reporting more positive moods, while young people and unemployed people generally reported lower positive scores and higher negative scores, indicating more negative emotions. Additionally, it was found that people generally reported higher positive feelings in the summer of 2021, which may be related to the relaxation of COVID-19-related policies in the UK as well as the introduction of vaccines for the general population. This study is an important investigation into what allows for positivity during a crisis and gives insights into periods or groups that may be vulnerable to increased negative states of emotions and feelings.
Læs mere Tjek på PubMedAli A. Asadi-Pooya, Meshkat Nemati, Mina Shahisavandi, Hamid Nemati, Afrooz Karimi, Anahita Jafari, Sara Nasiri, Seyyed Saeed Mohammadi, Zahra Rahimian, Hossein Bayat, Ali Akbari, Amir Emami, Owrang Eilami
PLoS One Infectious Diseases, 7.02.2024
Tilføjet 7.02.2024
by Ali A. Asadi-Pooya, Meshkat Nemati, Mina Shahisavandi, Hamid Nemati, Afrooz Karimi, Anahita Jafari, Sara Nasiri, Seyyed Saeed Mohammadi, Zahra Rahimian, Hossein Bayat, Ali Akbari, Amir Emami, Owrang Eilami Objective The current study aimed to identify the association between COVID-19 vaccination and prolonged post-COVID symptoms (long-COVID) in adults who reported suffering from this condition. Methods This was a retrospective follow-up study of adults with long-COVID syndrome. The data were collected during a phone call to the participants in January-February 2022. We inquired about their current health status and also their vaccination status if they agreed to participate. Results In total, 1236 people were studied; 543 individuals reported suffering from long long- COVID (43.9%). Chi square test showed that 15 out of 51 people (29.4%) with no vaccination and 528 out of 1185 participants (44.6%) who received at least one dose of any vaccine had long long- COVID symptoms (p = 0.032). Conclusions In people who have already contracted COVID-19 and now suffer from long-COVID, receiving a COVID vaccination has a significant association with prolonged symptoms of long-COVID for more than one year after the initial infection. However, vaccines reduce the risk of severe COVID-19 (including reinfections) and its catastrophic consequences (e.g., death). Therefore, it is strongly recommended that all people, even those with a history of COVID-19, receive vaccines to protect themselves against this fatal viral infection.
Læs mere Tjek på PubMedMegan A. DeJongM. Allison WolfGraham J. BitzerJesse M. HallNicholas A. FitzgeraldGage M. PylesAnnalisa B. HuckabyJonathan E. PettyKatherine LeeMariette BarbierJustin R. BevereRobert K. ErnstF. Heath Damron1Department of Microbiology, Immunology, and Cell Biology, West Virginia University, Morgantown, West Virginia, USA2Vaccine Development Center at West Virginia University Health Sciences Center, Morgantown, West Virginia, USA3Department of Microbial Pathogenesis, University of Maryland School of Dentistry, Baltimore, Maryland, USA, Denise Monack
Infection and Immunity, 7.02.2024
Tilføjet 7.02.2024
Journal of Infectious Diseases, 7.02.2024
Tilføjet 7.02.2024
Abstract Background The 2022-2023 global mpox outbreak disproportionately affected gay, bisexual, and other men who have sex with men (GBM). In Canada, almost all cases occurred among GBM and >70% of them were from the country’s three largest cities: Montréal, Toronto, and Vancouver. We examined how the distributions of sexual partners 1) varied by city and over time (2017-2023) and 2) were associated with mpox transmission.Methods The Engage Cohort Study (2017-2023) recruited GBM via respondent-driven sampling in Montréal, Toronto, and Vancouver (n=2,449). We compared reported numbers of sexual partners in the past 6 months across cities and three time periods: pre-COVID-19 pandemic (2017-2019), pandemic (2020-2021), and post-restrictions (2021-2023). We modeled the distribution of sexual partners using Bayesian negative binomial regressions and post-stratification, adjusting for sampling design and attrition. We estimated mpox’s basic reproduction number (ℛ0) using a risk-stratified compartmental model.Results The pre-COVID-19 pandemic distributions of sexual partner numbers were similar across cities: participants’ mean number of partners over the last 6 months was 10.4 (95%CrI: 9.4-11.5) in Montréal, 13.1 (11.3-15.1) in Toronto, and 10.7 (9.5-12.1) in Vancouver. Partner numbers decreased during the pandemic in all cities. Post-restrictions, sexual activity increased but remained below pre-pandemic levels. Based on reported cases and post-restrictions distributions of sexual partners, the estimated ℛ0 for mpox varied from 2.4-2.7 between cities. The estimated mpox per-partnership transmission probability was 84% (uncertainty ranging from 51-98%). Cumulative incidences (0.7-0.9%) were similar across cities.Conclusion GBM sexual activity after restrictions were lifted remained below pre-pandemic levels. Comparable sexual partner distributions may explain similarities in mpox ℛ0 and cumulative incidence across cities. With potential for further recovery in sexual activity, mpox vaccination and surveillance strategies should be maintained.
Læs mere Tjek på PubMedTweedie-Cullen, R. Y., Leong, K., Wilson, B. C., Derraik, J. G. B., Albert, B. B., Monk, R., Vatanen, T., Creagh, C., Depczynski, M., Edwards, T., Beck, K., Thabrew, H., O'Sullivan, J. M., Cutfield, W. S.
BMJ Open, 7.02.2024
Tilføjet 7.02.2024
IntroductionAutism (formally autism spectrum disorder) encompasses a group of complex neurodevelopmental conditions, characterised by differences in communication and social interactions. Co-occurring chronic gastrointestinal symptoms are common among autistic individuals and can adversely affect their quality of life. This study aims to evaluate the efficacy of oral encapsulated faecal microbiome transfer (FMT) in improving gastrointestinal symptoms and well-being among autistic adolescents and adults. Methods and analysisThis double-blind, randomised, placebo-controlled trial will recruit 100 autistic adolescents and adults aged 16–45 years, who have mild to severe gastrointestinal symptoms (Gastrointestinal Symptoms Rating Scale (GSRS) score ≥2.0). We will also recruit eight healthy donors aged 18–32 years, who will undergo extensive clinical screening. Recipients will be randomised 1:1 to receive FMT or placebo, stratified by biological sex. Capsules will be administered over two consecutive days following an overnight bowel cleanse with follow-up assessments at 6, 12 and 26 weeks post-treatment. The primary outcome is GSRS score at 6 weeks. Other assessments include anthropometry, body composition, hair cortisol concentration, gut microbiome profile, urine/plasma gut-derived metabolites, plasma markers of gut inflammation/permeability and questionnaires on general well-being, sleep quality, physical activity, food diversity and treatment tolerability. Adverse events will be recorded and reviewed by an independent data monitoring committee. Ethics and disseminationEthics approval for the study was granted by the Central Health and Disability Ethics Committee on 24 August 2021 (reference number: 21/CEN/211). Results will be published in peer-reviewed journals and presented to both scientific and consumer group audiences. Trial registration numberACTRN12622000015741.
Læs mere Tjek på PubMedBorgonovo, F., Lovaglio, P. G., Mariani, C., Berta, P., Cossu, M. V., Rizzardini, G., Vittadini, G., Capetti, A. F.
BMJ Open, 7.02.2024
Tilføjet 7.02.2024
ObjectiveTo define macro symptoms of long COVID and to identify predictive factors, with the aim of preventing the development of the long COVID syndrome. DesignA single-centre longitudinal prospective cohort study conducted from May 2020 to October 2022. SettingThe study was conducted at Luigi Sacco University Hospital in Milan (Italy). In May 2020, we activated the ARCOVID (Ambulatorio Rivalutazione COVID) outpatient service for the follow-up of long COVID. ParticipantsHospitalised and non-hospitalised patients previously affected by COVID-19 were either referred by specialists or general practitioners or self-referred. InterventionDuring the first visit, a set of questions investigated the presence and the duration of 11 symptoms (palpitations, amnesia, headache, anxiety/panic, insomnia, loss of smell, loss of taste, dyspnoea, asthenia, myalgia and telogen effluvium). The follow-up has continued until the present time, by sending email questionnaires every 3 months to monitor symptoms and health-related quality of life. Primary and secondary outcome measuresMeasurement of synthetic scores (aggregation of symptoms based on occurrence and duration) that may reveal the presence of long COVID in different clinical macro symptoms. To this end, a mixed supervised and empirical strategy was adopted. Moreover, we aimed to identify predictive factors for post-COVID-19 macro symptoms. ResultsIn the first and second waves of COVID-19, 575 and 793 patients (respectively) were enrolled. Three different post-COVID-19 macro symptoms (neurological, sensorial and physical) were identified. We found significant associations between post-COVID-19 symptoms and (1) the patients’ comorbidities, and (2) the medications used during the COVID-19 acute phase. ACE inhibitors (OR=2.039, 95% CI: 1.095 to 3.892), inhaled steroids (OR=4.08, 95% CI: 1.17 to 19.19) and COVID therapies were associated with increased incidence of the neurological macro symptoms. Age (OR=1.02, 95% CI: 1.01 to 1.04), COVID-19 severity (OR=0.42, 95% CI: 0.21 to 0.82), number of comorbidities (OR=1.22, 95% CI: 1.01 to 1.5), metabolic (OR=2.52, 95% CI: 1.25 to 5.27), pulmonary (OR=1.87, 95% CI: 1.10 to 3.32) and autoimmune diseases (OR=4.57, 95% CI: 1.57 to 19.41) increased the risk of the physical macro symptoms. ConclusionsBeing male was the unique protective factor in both waves. Other factors reflected different medical behaviours and the impact of comorbidities. Evidence of the effect of therapies adds valuable information that may drive future medical choices.
Læs mere Tjek på PubMedReena H Doshi, Patrick K Mukadi, Rebecca M Casey, Gabriel M Kizito, Hongjiang Gao, Beatrice Nguete U, Janeen Laven, Lilliane Sabi, Didine K Kaba, Jean-Jacques Muyembe-Tamfum, Terri B Hyde, Steve Ahuka-Mundeke, J Erin Staples
Lancet Infectious Diseases, 7.02.2024
Tilføjet 7.02.2024
A fractional dose of the 17DD yellow fever vaccine induced an immunologic response with detectable titres at 5 years among the majority of participants in the Democratic Republic of the Congo. These findings support the use of fractional-dose vaccination for outbreak prevention with the potential for sustained immunity.
Læs mere Tjek på PubMedClinical Infectious Diseases, 7.02.2024
Tilføjet 7.02.2024
Abstract Background Carbapenemase-producing, carbapenem-resistant Pseudomonas aeruginosa (CP-CRPA) are extensively drug resistant bacteria. We investigated the source of a multistate CP-CRPA outbreak.Methods Cases were defined as a U.S. patient’s first isolation of P. aeruginosa sequence type 1203 with the carbapenemase gene blaVIM-80 and cephalosporinase gene blaGES-9 from any specimen source collected and reported to CDC between January 1, 2022–May 15, 2023. We conducted a 1:1 matched case-control study at the post-acute care facility with the most cases, assessed exposures associated with case status for all case-patients, and tested products for bacterial contamination.Results We identified 81 case-patients from 18 states, 27 of whom were identified through surveillance cultures. Four (7%) of 54 case-patients with clinical cultures died within 30 days of culture collection, and four (22%) of 18 with eye infections underwent enucleation. In the case-control study, case-patients had increased odds of receiving artificial tears compared to controls (crude matched OR: 5.0, 95% CI: 1.1, 22.8). Overall, artificial tears use was reported by 61 (87%) of 70 case-patients with information; 43 (77%) of 56 case-patients with brand information reported use of Brand A, an imported, preservative-free, over-the-counter (OTC) product. Bacteria isolated from opened and unopened bottles of Brand A were genetically related to patient isolates. FDA inspection of the manufacturing plant identified likely sources of contamination.Conclusions A manufactured medical product serving as the vehicle for carbapenemase-producing organisms is unprecedented in the U.S. The clinical impacts from this outbreak underscore the need for improved requirements for U.S. OTC product importers.
Læs mere Tjek på PubMedAaron E. Cozen, Thomas Carton, Rita Hamad, John Kornak, Madelaine Faulkner Modrow, Noah D. Peyser, Soo Park, Jaime H. Orozco, Matthew Brandner, Emily C. O’Brien, Djeneba Audrey Djibo, Cheryl N. McMahill-Walraven, Carmen R. Isasi, Alexis L. Beatty, Jeffrey E. Olgin, Gregory M. Marcus, Mark J. Pletcher
PLoS One Infectious Diseases, 6.02.2024
Tilføjet 6.02.2024
by Aaron E. Cozen, Thomas Carton, Rita Hamad, John Kornak, Madelaine Faulkner Modrow, Noah D. Peyser, Soo Park, Jaime H. Orozco, Matthew Brandner, Emily C. O’Brien, Djeneba Audrey Djibo, Cheryl N. McMahill-Walraven, Carmen R. Isasi, Alexis L. Beatty, Jeffrey E. Olgin, Gregory M. Marcus, Mark J. Pletcher COVID-19 increased the prevalence of clinically significant anxiety in the United States. To investigate contributing factors we analyzed anxiety, reported online via monthly Generalized Anxiety Disorders-7 (GAD-7) surveys between April 2020 and May 2022, in association with self-reported worry about the health effects of COVID-19, economic difficulty, personal COVID-19 experience, and subjective social status. 333,292 anxiety surveys from 50,172 participants (82% non-Hispanic white; 73% female; median age 55, IQR 42–66) showed high levels of anxiety, especially early in the pandemic. Anxiety scores showed strong independent associations with worry about the health effects of COVID-19 for oneself or family members (GAD-7 score +3.28 for highest vs. lowest category; 95% confidence interval: 3.24, 3.33; p
Læs mere Tjek på PubMedAbeer Omar, Lindsay N. Grenier, Olivia Marquez, Sue Faber, Elizabeth K. Darling
PLoS One Infectious Diseases, 6.02.2024
Tilføjet 6.02.2024
by Abeer Omar, Lindsay N. Grenier, Olivia Marquez, Sue Faber, Elizabeth K. Darling Introduction Lyme disease is one of the most prevalent vector-borne disease in North America, yet its implications during pregnancy are poorly understood. Our knowledge of perinatal transmission of Lyme disease is limited due to the lack of robust epidemiological studies and longitudinal follow-up. Objectives This study aimed to understand the research priorities of people who have experienced Lyme disease in pregnancy and the feasibility of recruiting this population for future studies on perinatal transmission of Lyme disease. We also sought to understand the barriers and enablers to participating in research on perinatal transmission of Lyme disease. Methods We conducted a qualitative study using focus groups and interviews with people who had experienced Lyme disease during pregnancy. English speaking participants were recruited through an online survey. There was no geographic restriction on participation. The focus groups and the interview were recorded and transcribed. Data were analyzed using interpretive content analysis. Results Twenty people participated in four semi-structured focus groups and one semi-structured individual interview. The majority of participants were from North America. Participants’ research priorities fell into five categories: transmission, testing, treatment, disease presentation, and education. All study participants expressed interest in future participation in research on Lyme disease in pregnancy and highlighted barriers and enablers to participation that could be addressed to facilitate future study recruitment. Conclusion The research priorities identified in this research would be well addressed through prospective research. People who experience Lyme disease in pregnancy are invested in continued research into perinatal transmission of Lyme disease.
Læs mere Tjek på PubMedMalaria Journal, 6.02.2024
Tilføjet 6.02.2024
Abstract Background An estimated 50% of suspected malaria cases in sub-Saharan Africa first seek care in the private sector, especially in private medicine retail outlets. Quality of care in these outlets is generally unknown but considered poor with many patients not receiving a confirmatory diagnosis or the recommended first-line artemisinin-based combination therapy (ACT). In 2010, a subsidy pilot scheme, the Affordable Medicines Facility malaria, was introduced to crowd out the use of monotherapies in favour of WHO-pre-qualified artemisinin-based combinations (WHO-PQ-ACTs) in the private health sector. The scheme improved the availability, market share, and cost of WHO-PQ-ACTs in countries like Nigeria and Uganda, but in 2018, the subsidies were halted in Nigeria and significantly reduced in Uganda. This paper presents findings from six retail audit surveys conducted from 2014 to 2021 in Nigeria and Uganda to assess whether the impact of subsidies on the price, availability, and market share of artemisinin-based combinations has been sustained after the subsidies were reduced or discontinued. Methods Six independent retail audits were conducted in private medicine retail outlets, including pharmacies, drug shops, and clinics in Nigeria (2016, 2018, 2021), and Uganda (2014, 2019, 2020) to assess the availability, price, and market share of anti-malarials, including WHO-PQ-ACTs and non-WHO-PQ-ACTs, and malaria rapid diagnostic tests (RDTs). Results Between 2016 and 2021, there was a 57% decrease in WHO-PQ-ACT availability in Nigeria and a 9% decrease in Uganda. During the same period, non-WHO-PQ-ACT availability increased in Nigeria by 41% and by 34% in Uganda. The price of WHO-PQ-ACTs increased by 42% in Nigeria to $0.68 and increased in Uganda by 24% to $0.95. The price of non-WHO-PQ-ACTs decreased in Nigeria by 26% to $1.08 and decreased in Uganda by 64% to $1.23. There was a 76% decrease in the market share of WHO-PQ-ACTs in Nigeria and a 17% decrease in Uganda. Malaria RDT availability remained low throughout. Conclusion With the reduction or termination of subsidies for WHO-PQ-ACTs in Uganda and Nigeria, retail prices have increased, and retail prices of non-WHO-PQ-ACTs decreased, likely contributing to a shift of higher availability and increased use of non-WHO-PQ-ACTs.
Læs mere Tjek på PubMedMalaria Journal, 6.02.2024
Tilføjet 6.02.2024
Abstract Background Artemisinin-based combination therapy (ACT) has been effective in the supervised treatment of uncomplicated malaria in Ghana. Since ACT usage is primarily unsupervised, this study aimed to determine the effectiveness of artemether–lumefantrine (AL) for treating malaria patients in two transmission settings in Ghana. Methods Eighty-four individuals with uncomplicated Plasmodium falciparum malaria were recruited from Lekma Hospital (LH) in Accra (low-transmission area; N = 28), southern Ghana, and King’s Medical Centre (KMC) in Kumbungu (high-transmission area; N = 56), northern Ghana. Participants were followed up for 28 days after unsupervised treatment with AL. The presence of asexual parasites was determined by microscopic examination of Giemsa-stained blood smears. Plasmodium species identification was confirmed using species-specific primers targeting the 18S rRNA gene. Parasite recrudescence or reinfection was determined by genotyping the Pfmsp 1 and Pfmsp 2 genes. Results After AL treatment, 3.6% (2/56) of the patients from KMC were parasitaemic on day 3 compared to none from the LH patients. One patient from KMC with delayed parasite clearance on day 3 remained parasite-positive by microscopy on day 7 but was parasite-free by day 14. While none of the patients from LH experienced parasite recurrence during the 28-day follow-up, three and two patients from KMC had recurrent parasitaemia on days 21 and 28, respectively. Percentage reduction in parasite densities from day 1, 2, and 3 for participants from the KMC was 63.2%, 89.5%, and 84.5%. Parasite densities for participants from the LH reduced from 98.2%, 99.8% on day 1, and 2 to 100% on day 3. The 28-day cumulative incidence rate of treatment failure for KMC was 12.8% (95% confidence interval: 1.9–23.7%), while the per-protocol effectiveness of AL in KMC was 89.47%. All recurrent cases were assigned to recrudescence after parasite genotyping by Pfmsp 1 and Pfmsp 2. Conclusion While AL is efficacious in treating uncomplicated malaria in Ghana, when taken under unsupervised conditions, it showed an 89.4% PCR-corrected cure rate in northern Ghana, which is slightly below the WHO-defined threshold.
Læs mere Tjek på PubMedInfection, 6.02.2024
Tilføjet 6.02.2024
Abstract Background Little is known about the etiology, clinical presentation, management, and outcome of central nervous system (CNS) infections in Indonesia, a country with a high burden of infectious diseases and a rising prevalence of HIV. Methods We included adult patients with suspected CNS infections at two referral hospitals in a prospective cohort between April 2019 and December 2021. Clinical, laboratory, and radiological assessments were standardized. We recorded initial and final diagnoses, treatments, and outcomes during 6 months of follow-up. Results Of 1051 patients screened, 793 were diagnosed with a CNS infection. Patients (median age 33 years, 62% male, 38% HIV-infected) presented a median of 14 days (IQR 7–30) after symptom onset, often with altered consciousness (63%), motor deficits (73%), and seizures (21%). Among HIV-uninfected patients, CNS tuberculosis (TB) was most common (60%), while viral (8%) and bacterial (4%) disease were uncommon. Among HIV-infected patients, cerebral toxoplasmosis (41%) was most common, followed by CNS TB (19%), neurosyphilis (15%), and cryptococcal meningitis (10%). A microbiologically confirmed diagnosis was achieved in 25% of cases, and initial diagnoses were revised in 46% of cases. In-hospital mortality was 30%, and at six months, 45% of patients had died, and 12% suffered from severe disability. Six-month mortality was associated with older age, HIV, and severe clinical, radiological and CSF markers at presentation. Conclusion CNS infections in Indonesia are characterized by late presentation, severe disease, frequent HIV coinfection, low microbiological confirmation and high mortality. These findings highlight the need for earlier disease recognition, faster and more accurate diagnosis, and optimized treatment, coupled with wider efforts to improve the uptake of HIV services.
Læs mere Tjek på PubMedInfection, 6.02.2024
Tilføjet 6.02.2024
Abstract Purpose This study assessed the clinical and immunological outcomes of SARS-CoV-2-infected patients with risk factors for severe disease depending on their immunological status. Methods In this retrospective study with single follow-up visit, clinical outcome and humoral immunity was monitored in SARS-CoV-2 infected patients at risk. The results were compared based on the patients’ initial immunological status: unvaccinated (UV), patients who did not develop neutralizing antibodies after vaccination (vaccine non-responders, VNR), and patients who expressed neutralizing antibodies after vaccination (vaccine responders, VR). Patients who lacked neutralizing antibodies (VNR and UV) were treated with nMABs. Results In total, 113 patients at risk of severe COVID-19 consented to participate in the study. VR and UV were not admitted to the hospital. During the observation period, UVs had the highest rate of SARS-CoV-2 re-infections. Three of 41 VNRs (7.3%) were hospitalized due to severe COVID-19, with two of them having undergone iatrogenic B-cell depletion. The humoral immune response after infection was significantly lower in the VNR group than in the VR group in terms of anti-N, anti-receptor-binding domain (RBD), anti-S antibody titers, and anti-S antibody avidity. In a sub-analysis of VNR, B cell-deficient non-responders had significantly lower levels of anti-N antibodies and anti-S avidity after infection than other VNRs. Conclusion VNR, particularly B-cell-depleted VNR, remained at risk of hospitalization due to COVID-19. In the VR group, however, no clinical complications or severe disease were observed, despite not receiving nMAbs. Tailoring the administration of nMABs according to patient vaccination and immunological status may be advisable.
Læs mere Tjek på PubMedCharu Aggarwal, Hasan Ahmed, Pragati Sharma, Elluri Seetharami Reddy, Kaustuv Nayak, Mohit Singla, Deepti Maheshwari, Yadya M. Chawla, Harekrushna Panda, Ramesh Chandra Rai, Sivaram Gunisetty, Lalita Priyamvada, Siddhartha Kumar Bhaumik, Syed Fazil Ahamed, Rosario Vivek, Priya Bhatnagar, Prabhat Singh, Manpreet Kaur, Kritika Dixit, Sanjeev Kumar, Kamal Gottimukkala, Keshav Saini, Prashant Bajpai, Gopinathan Pillai Sreekanth, Shobha Mammen, Anand Rajan, Valsan Philip Verghese, Asha Mary Abraham, Paresh Shah, Kalichamy Alagarasu, Tianwei Yu, Carl W. Davis, Jens Wrammert, Aftab Ansari, Rustom Antia, Sushil Kumar Kabra, Guruprasad R. Medigeshi, Rafi Ahmed, Rakesh Lodha, Anita Shet, Anmol Chandele, Kaja Murali-Krishna
Nature, 6.02.2024
Tilføjet 6.02.2024
Pollock, B. D., Devkaran, S., Dowdy, S. C.
BMJ Open, 6.02.2024
Tilføjet 6.02.2024
ObjectivesIn the USA and UK, pandemic-era outcome data have been excluded from hospital rankings and pay-for-performance programmes. We assessed the relationship between US hospitals’ pre-pandemic Centers for Medicare and Medicaid Services (CMS) Overall Hospital Star ratings and early pandemic 30-day mortality among both patients with COVID and non-COVID to understand whether pre-existing structures, processes and outcomes related to quality enabled greater pandemic resiliency. Design and data sourceA retrospective, claim-based data study using the 100% Inpatient Standard Analytic File and Medicare Beneficiary Summary File including all US Medicare Fee-for-Service inpatient encounters from 1 April 2020 to 30 November 2020 linked with the CMS Hospital Star Ratings using six-digit CMS provider IDs. Outcome measureThe outcome was risk-adjusted 30-day mortality. We used multivariate logistic regression adjusting for age, sex, Elixhauser mortality index, US Census Region, month, hospital-specific January 2020 CMS Star rating (1–5 stars), COVID diagnosis (U07.1) and COVID diagnosisxCMS Star Rating interaction. ResultsWe included 4 473 390 Medicare encounters from 2533 hospitals, with 92 896 (28.2%) mortalities among COVID-19 encounters and 387 029 (9.3%) mortalities among non-COVID encounters. There was significantly greater odds of mortality as CMS Star Ratings decreased, with 18% (95% CI 15% to 22%; p
Læs mere Tjek på PubMedHartman, T. J., Christie, J., Wilson, A., Ziegler, T. R., Methe, B., Flanders, W. D., Rolls, B. J., Loye Eberhart, B., Li, J. V., Huneault, H., Cousineau, B., Perez, M. R., O'Keefe, S. J. D.
BMJ Open, 6.02.2024
Tilføjet 6.02.2024
IntroductionRecently published studies support the beneficial effects of consuming fibre-rich legumes, such as cooked dry beans, to improve metabolic health and reduce cancer risk. In participants with overweight/obesity and a history of colorectal polyps, the Fibre-rich Foods to Treat Obesity and Prevent Colon Cancer randomised clinical trial will test whether a high-fibre diet featuring legumes will simultaneously facilitate weight reduction and suppress colonic mucosal biomarkers of colorectal cancer (CRC). Methods/designThis study is designed to characterise changes in (1) body weight; (2) biomarkers of insulin resistance and systemic inflammation; (3) compositional and functional profiles of the faecal microbiome and metabolome; (4) mucosal biomarkers of CRC risk and (5) gut transit. Approximately 60 overweight or obese adults with a history of noncancerous adenomatous polyps within the previous 3 years will be recruited and randomised to one of two weight-loss diets. Following a 1-week run-in, participants in the intervention arm will receive preportioned high-fibre legume-rich entrées for two meals/day in months 1–3 and one meal/day in months 4–6. In the control arm, entrées will replace legumes with lean protein sources (eg, chicken). Both groups will receive in-person and written guidance to include nutritionally balanced sides with energy intake to lose 1–2 pounds per week. Ethics and disseminationThe National Institutes of Health fund this ongoing 5-year study through a National Cancer Institute grant (5R01CA245063) awarded to Emory University with a subaward to the University of Pittsburgh. The study protocol was approved by the Emory Institutional Review Board (IRB approval number: 00000563). Trial registration number NCT04780477.
Læs mere Tjek på PubMedInfection, 5.02.2024
Tilføjet 5.02.2024
Abstract Background Little is known about the etiology, clinical presentation, management, and outcome of central nervous system (CNS) infections in Indonesia, a country with a high burden of infectious diseases and a rising prevalence of HIV. Methods We included adult patients with suspected CNS infections at two referral hospitals in a prospective cohort between April 2019 and December 2021. Clinical, laboratory, and radiological assessments were standardized. We recorded initial and final diagnoses, treatments, and outcomes during 6 months of follow-up. Results Of 1051 patients screened, 793 were diagnosed with a CNS infection. Patients (median age 33 years, 62% male, 38% HIV-infected) presented a median of 14 days (IQR 7–30) after symptom onset, often with altered consciousness (63%), motor deficits (73%), and seizures (21%). Among HIV-uninfected patients, CNS tuberculosis (TB) was most common (60%), while viral (8%) and bacterial (4%) disease were uncommon. Among HIV-infected patients, cerebral toxoplasmosis (41%) was most common, followed by CNS TB (19%), neurosyphilis (15%), and cryptococcal meningitis (10%). A microbiologically confirmed diagnosis was achieved in 25% of cases, and initial diagnoses were revised in 46% of cases. In-hospital mortality was 30%, and at six months, 45% of patients had died, and 12% suffered from severe disability. Six-month mortality was associated with older age, HIV, and severe clinical, radiological and CSF markers at presentation. Conclusion CNS infections in Indonesia are characterized by late presentation, severe disease, frequent HIV coinfection, low microbiological confirmation and high mortality. These findings highlight the need for earlier disease recognition, faster and more accurate diagnosis, and optimized treatment, coupled with wider efforts to improve the uptake of HIV services.
Læs mere Tjek på PubMedReine Salomé Anguinze, Angeline Touré, Fatoumata Cissé, Solène Grayo, Cécile Troupin, Noël Tordo, Edwige Kouamou, Pierre Roques
Journal of Medical Virology, 3.02.2024
Tilføjet 3.02.2024
Kristjansen, K. A., Engel Krag, A., Schmidt, H., Hölmich, L. R., Bonnelykke-Behrndtz, M. L.
BMJ Open, 3.02.2024
Tilføjet 3.02.2024
IntroductionInflammation is a hallmark of cancer and is involved in tumour growth and dissemination. However, the hallmarks of cancer are also the hallmarks of wound healing, and modulating the wound inflammatory response and immune contexture in relation to cancer surgery may represent effective targets of therapies. Repurposing anti-inflammatory drugs in a cancer setting has gained increasing interest in recent years. Interestingly, the known and thoroughly tested antifibrinolytic drug tranexamic acid reduces the risk of bleeding, but it is also suggested to play important roles in anti-inflammatory pathways, improving wound healing and affecting anti-carcinogenic mechanisms. As a novel approach, we will conduct a randomised controlled trial using perioperative treatment with tranexamic acid, aiming to prevent early relapses by >10% for patients with melanoma. Methods and analysisDesign: investigator-initiated parallel, two-arm, randomised, blinded, Danish multicentre superiority trial. Patients: ≥T2 b melanoma and eligible for sentinel lymph node biopsy (n=1204). Project drug: tranexamic acid or placebo. Treatment: before surgery (intravenous 15 mg/kg) and daily (peroral 1000 mg x 3) through postoperative day 4. Primary outcome: relapse within 2 years after surgery. Primary analysis: risk difference between the treatment arms (2 test). Secondary outcomes: postoperative complications, adverse events and survival. Inclusion period: summer 2023 to summer 2026. Ethics and disseminationThe trial will be initiated during the summer of 2023 and is approved by the National Committee on Health Research Ethics, the Danish Medicine Agency, and registered under the Data Protection Act. The study will be conducted in accordance with the principles of the Declaration of Helsinki and Good Clinical Practice. Patients included in the study will adhere to normal Danish treatment protocols and standards of care, and we expect only mild and temporary side effects. Positive and negative results will be published in peer-reviewed journals, with authorships adhering to the Vancouver rules. Trial registration numberNCT05899465; ClinicalTrials.gov Identifier.
Læs mere Tjek på PubMedKristjansen, K. A., Engel Krag, A., Schmidt, H., Hölmich, L. R., Bonnelykke-Behrndtz, M. L.
BMJ Open, 3.02.2024
Tilføjet 3.02.2024
IntroductionInflammation is a hallmark of cancer and is involved in tumour growth and dissemination. However, the hallmarks of cancer are also the hallmarks of wound healing, and modulating the wound inflammatory response and immune contexture in relation to cancer surgery may represent effective targets of therapies. Repurposing anti-inflammatory drugs in a cancer setting has gained increasing interest in recent years. Interestingly, the known and thoroughly tested antifibrinolytic drug tranexamic acid reduces the risk of bleeding, but it is also suggested to play important roles in anti-inflammatory pathways, improving wound healing and affecting anti-carcinogenic mechanisms. As a novel approach, we will conduct a randomised controlled trial using perioperative treatment with tranexamic acid, aiming to prevent early relapses by >10% for patients with melanoma. Methods and analysisDesign: investigator-initiated parallel, two-arm, randomised, blinded, Danish multicentre superiority trial. Patients: ≥T2 b melanoma and eligible for sentinel lymph node biopsy (n=1204). Project drug: tranexamic acid or placebo. Treatment: before surgery (intravenous 15 mg/kg) and daily (peroral 1000 mg x 3) through postoperative day 4. Primary outcome: relapse within 2 years after surgery. Primary analysis: risk difference between the treatment arms (2 test). Secondary outcomes: postoperative complications, adverse events and survival. Inclusion period: summer 2023 to summer 2026. Ethics and disseminationThe trial will be initiated during the summer of 2023 and is approved by the National Committee on Health Research Ethics, the Danish Medicine Agency, and registered under the Data Protection Act. The study will be conducted in accordance with the principles of the Declaration of Helsinki and Good Clinical Practice. Patients included in the study will adhere to normal Danish treatment protocols and standards of care, and we expect only mild and temporary side effects. Positive and negative results will be published in peer-reviewed journals, with authorships adhering to the Vancouver rules. Trial registration numberNCT05899465; ClinicalTrials.gov Identifier.
Læs mere Tjek på PubMedBMJ Open, 3.02.2024
Tilføjet 3.02.2024
Silva C, Fonseca C, Ferreira R, et al Depression in older adults during the COVID-19 pandemic: a systematic review protocol BMJ Open 2022;12:e065610. doi: 10.1136/bmjopen-2022-065610. Above mentioned article is revised since it was published as Funding statement is now updated as given below: The present publication was funded by Fundacão Ciência e Tecnologia, IP national support through CHRC (UIDP/04923/2020)\'.
Læs mere Tjek på PubMedBMJ Open, 3.02.2024
Tilføjet 3.02.2024
Silva C, Fonseca C, Ferreira R, et al Depression in older adults during the COVID-19 pandemic: a systematic review protocol BMJ Open 2022;12:e065610. doi: 10.1136/bmjopen-2022-065610. Above mentioned article is revised since it was published as Funding statement is now updated as given below: The present publication was funded by Fundacão Ciência e Tecnologia, IP national support through CHRC (UIDP/04923/2020)\'.
Læs mere Tjek på PubMedPaul Ellis, Gita Parekh, Annelyse Duvoix, Lynne Watson, Alex Sharp, Farah Mobeen, Anita Pye, Robert Stockley, Alice Turner
PLoS One Infectious Diseases, 3.02.2024
Tilføjet 3.02.2024
by Paul Ellis, Gita Parekh, Annelyse Duvoix, Lynne Watson, Alex Sharp, Farah Mobeen, Anita Pye, Robert Stockley, Alice Turner Background Pulmonary exacerbations in alpha-1 antitrypsin deficiency (AATD) related lung disease are a significant contributor to disease burden, as with usual COPD. Separating the early stages of an exacerbation from the day-to-day variation in stable COPD is central to the concerns of both clinicians and patients and has been identified as a research priority by NIHR. Clinical tools that distinguish baseline symptoms from those of an exacerbation could allow early and appropriate treatment of AECOPD to reduce the impact and potentially may slow disease progression thereby improving survival and quality of life. Candidate tools include symptom diaries and biomarkers of infection and acute inflammation. Urinary biomarkers of AECOPD have yet to be explored in AATD related COPD. Methods 55 patients with AATD related lung disease with a history of 2 or more AECOPD in the preceding year were prospectively followed for 18 months. Each patient recorded symptom scores daily via an electronic symptom diary (eDiary) based on Bronkotest. Urinary biomarkers for AAT, NE, CRP, TIMP1 and desmosine were measured weekly using a home urinary lateral flow device. During self-reported AECOPD patients were asked to perform urine analysis on the first 7 consecutive days. Results Type I Anthonisen exacerbations and episodes occurring in autumn/winter lasted longer than Type II/III exacerbations and spring/summer episodes respectively. Median urinary CRP concentration across all study participants increased during Type I AECOPD. eDiary adherence was 68% over a median of 17.8 months (IQR 15.7 to 18.5). Conclusions Use of an eDiary and urinary biomarkers to detect and characterise AECOPD remotely in AATD related lung disease is feasible over a prolonged period and paves the way for precision detection of exacerbations.
Læs mere Tjek på PubMedYuran Cao, Jingjing Wang, Xingyu Tang, Yan Tian, Jicheng Yu, Hong Liang, Jufang Wu, Yuancheng Chen, Guoying Cao, Jing Zhang
PLoS One Infectious Diseases, 3.02.2024
Tilføjet 3.02.2024
by Yuran Cao, Jingjing Wang, Xingyu Tang, Yan Tian, Jicheng Yu, Hong Liang, Jufang Wu, Yuancheng Chen, Guoying Cao, Jing Zhang Mesalazine is a well-established treatment for ulcerative colitis by oral or topical administration. However, the pharmacokinetic (PK) and safety profiles of mesalazine administered by an enema has not been clarified in Chinese population. We conducted an open-label study to assess the PK and safety profiles of mesalazine in 11 healthy Chinese subjects after receiving mesalazine enema (1 g/100 mL) once daily for 7 consecutive days. Blood and urine samples were collected for assay of mesalazine and N-acetyl mesalazine by liquid chromatography-tandem mass spectrometry. The PK and safety data were summarized using descriptive statistics. The mean (standard deviation) maximum plasma concentration (Cmax), area under plasma drug concentration-time curve from time 0 to the last measurable plasma concentration time point (AUC0-t) and elimination half-life (t1/2) of mesalazine were 1007.64 (369.00) ng/mL, 9608.59 (3533.08) h·ng/mL and 3.33 (1.99) h, respectively after the first dose administration. In multiple-dose study, the estimated accumulation factor of mesalazine was 1.09. The cumulative urinary excretion rate of parent and major metabolite of mesalazine was 27.77%. After the last doe administration, 2.21% of the administered dose was excreted as mesalazine and 24.47% as N-acetyl mesalazine in urine within 24 h. Overall, 9 adverse events (AEs) were reported in 4 of the 11 subjects (36.4%), including oral ulcer, toothache, upper respiratory tract infection (1 each) and laboratory abnormalities (6 cases). All AEs were mild and recovered spontaneously without treatment, and were not considered as related to mesalazine. Mesalazine enema (1 g/100 mL) was safe and well tolerated in healthy Chinese subjects. These findings support further clinical trials in Chinese patients.Trial registration: This trial was registered to Chinese Clinical Trial Registry (ChiCTR) at https://www.chictr.org.cn (registration number: ChiCTR2300073148).
Læs mere Tjek på PubMedMalaria Journal, 3.02.2024
Tilføjet 3.02.2024
Abstract Background Seasonal Malaria Chemoprevention (SMC) is a highly effective intervention for preventing malaria, particularly in areas with highly seasonal transmission. Monitoring and evaluating (M&E) SMC programmes are complex due to the scale, time-sensitive delivery of the programme, and influence of external factors. This paper describes the process followed to develop a comprehensive M&E framework tailored specifically for the SMC context. Methods The Framework was developed through a literature and programme review, and stakeholder dialogues across three implementing countries—Burkina Faso, Chad, and Nigeria. Expert consultation further refined the Framework through an iterative approach drawing upon data collected through the three sources. The Framework was designed using the Logical Framework Approach incorporating external factors and intentionally aligned with global malaria M&E standards. Results An overall aim and seven programme objectives were developed measured by 70 indicators. The indicators also capture the causal links between the implementation and results of the programme. The Framework leverages the use of current data sources and existing mechanisms, ensuring efficient data use without requiring a significant increase in resources for overall programme optimization. It also promotes the use of data triangulation, and stratification for a more nuanced understanding of factors affecting programme performance and timely data informed decision-making. Conclusions The SMC M&E Framework presented here provides a standardized approach for programme implementers to enhance decision-making for optimal programme performance. This is an essential tool as the scope of SMC programmes expands to new geographies and target age groups.
Læs mere Tjek på PubMedInfection, 3.02.2024
Tilføjet 3.02.2024
Abstract Purpose This study assessed the clinical and immunological outcomes of SARS-CoV-2-infected patients with risk factors for severe disease depending on their immunological status. Methods In this retrospective study with single follow-up visit, clinical outcome and humoral immunity was monitored in SARS-CoV-2 infected patients at risk. The results were compared based on the patients’ initial immunological status: unvaccinated (UV), patients who did not develop neutralizing antibodies after vaccination (vaccine non-responders, VNR), and patients who expressed neutralizing antibodies after vaccination (vaccine responders, VR). Patients who lacked neutralizing antibodies (VNR and UV) were treated with nMABs. Results In total, 113 patients at risk of severe COVID-19 consented to participate in the study. VR and UV were not admitted to the hospital. During the observation period, UVs had the highest rate of SARS-CoV-2 re-infections. Three of 41 VNRs (7.3%) were hospitalized due to severe COVID-19, with two of them having undergone iatrogenic B-cell depletion. The humoral immune response after infection was significantly lower in the VNR group than in the VR group in terms of anti-N, anti-receptor-binding domain (RBD), anti-S antibody titers, and anti-S antibody avidity. In a sub-analysis of VNR, B cell-deficient non-responders had significantly lower levels of anti-N antibodies and anti-S avidity after infection than other VNRs. Conclusion VNR, particularly B-cell-depleted VNR, remained at risk of hospitalization due to COVID-19. In the VR group, however, no clinical complications or severe disease were observed, despite not receiving nMAbs. Tailoring the administration of nMABs according to patient vaccination and immunological status may be advisable.
Læs mere Tjek på PubMedBMC Infectious Diseases, 3.02.2024
Tilføjet 3.02.2024
Abstract Background Healthcare-associated infections (HCAI) place a significant burden on healthcare systems globally. This systematic review and meta-analysis aimed to investigate the prevalence, risk factors, and aetiologic agents of endemic HCAI in Africa. Methods MEDLINE/PubMed, CINAHL, and Global Health databases (EBSCOhost interface) were searched for studies published in English and French describing HCAI in Africa from 2010 to 2022. We extracted data on prevalence of HCAI, risk factors, aetiologic agents, and associated antimicrobial resistance patterns. We used random-effects models to estimate parameter values with 95% confidence intervals for risk factors associated with HCAI. This study was registered in PROSPERO (CRD42022374559) and followed PRISMA 2020 guidelines. Results Of 2541 records screened, 92 were included, comprising data from 81,968 patients. Prevalence of HCAI varied between 1.6 and 90.2% with a median of 15% across studies. Heterogeneity (I2) varied from 93 to 99%. Contaminated wound (OR: 1.75, 95% CI: 1.31–2.19), long hospital stay (OR: 1.39, 95% CI: 0.92–1.80), urinary catheter (OR: 1.57, 95% CI: 0.35–2.78), intubation and ventilation (OR: 1.53, 95% CI: 0.85–2.22), vascular catheters (OR: 1.49, 95% CI: 0.52–2.45) were among risk factors associated with HCAI. Bacteria reported from included studies comprised 6463 isolates, with E. coli (18.3%, n = 1182), S. aureus (17.3%, n = 1118), Klebsiella spp. (17.2%, n = 1115), Pseudomonas spp. (10.3%, n = 671), and Acinetobacter spp. (6.8%, n = 438) being most common. Resistance to multiple antibiotics was common; 70.3% (IQR: 50–100) of Enterobacterales were 3rd -generation cephalosporin resistant, 70.5% (IQR: 58.8–80.3) of S. aureus were methicillin resistant and 55% (IQR: 27.3–81.3) Pseudomonas spp. were resistant to all agents tested. Conclusions HCAI is a greater problem in Africa than other regions, however, there remains a paucity of data to guide local action. There is a clear need to develop and validate sustainable HCAI definitions in Africa to support the implementation of routine HCAI surveillance and inform implementation of context appropriate infection prevention and control strategies.
Læs mere Tjek på PubMedChangqing Yu, Yuanzhe Bai, Wenbo Tan, Yu Bai, Xuemei Li, Yulong Zhou, Jingbo Zhai, Mengzhou Xue, Yan‐Dong Tang, Chunfu Zheng, Qiang Liu
Journal of Medical Virology, 2.02.2024
Tilføjet 2.02.2024
Lam, R. P. K., Hung, K. K. C., Lui, C. T., Kwok, W. S., Lam, W. W. T., Lau, E. H. Y., Sridhar, S., Ng, P. Y. T., Cheng, C. H., Tsang, T. C., Tsui, M. S. H., Graham, C. A., Rainer, T. H.
BMJ Open, 2.02.2024
Tilføjet 2.02.2024
IntroductionEarly sepsis treatment in the emergency department (ED) is crucial to improve patient survival. Despite international promulgation, the uptake of the Surviving Sepsis Campaign (SSC) Hour-1 Bundle (lactate measurement, blood culture, broad-spectrum antibiotics, 30 mL/kg crystalloid for hypotension/lactate ≥4 mmol/L and vasopressors for hypotension during/after fluid resuscitation within 1 hour of sepsis recognition) is low across healthcare settings. Delays in sepsis recognition and a lack of high-quality evidence hinder its implementation. We propose a novel sepsis care model (National Early Warning Score, NEWS-1 care), in which the SSC Hour-1 Bundle is triggered objectively by a high NEWS-2 (≥5). This study aims to determine the feasibility of a full-scale type 1 hybrid effectiveness-implementation trial on the NEWS-1 care in multiple EDs. Methods and analysisWe will conduct a pilot type 1 hybrid trial and prospectively recruit 200 patients from 4 public EDs in Hong Kong cluster randomised in a stepped wedge design over 10 months. All study sites will start with an initial period of standard care and switch in random order at 2-month intervals to the NEWS-1 care unidirectionally. The implementation evaluation will employ mixed methods guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, which includes qualitative and quantitative data from focus group interviews, staff survey and clinical record reviews. We will analyse the 14 feasibility outcomes as progression criteria to a full-scale trial, including trial acceptability to patients and staff, patient and staff recruitment rates, accuracy of sepsis screening, protocol adherence, accessibility to follow-up data, safety and preliminary clinical impacts of the NEWS1 care, using descriptive statistics. Ethics and disseminationThe institutional review boards of all study sites approved this study. This study will establish the feasibility of a full-scale hybrid trial. We will disseminate the findings through peer-reviewed publications, conference presentations and educational activities. Trial registration numberNCT05731349.
Læs mere Tjek på PubMedBrian McCloskey, Tomoya Saito, Satoshi Shimada, Chiaki Ikenoue, Tina Endericks, Lucia Mullen, Pau Mota, Chirag K Kumar, Ramanan Laxminarayan, Richard Budgett, David Heymann, Alimuddin Zumla
Lancet, 2.02.2024
Tilføjet 2.02.2024
The COVID-19 pandemic profoundly affected all mass gatherings for sporting and religious events, causing cancellation, postponement, or downsizing. On March 24, 2020, the Japanese Government, the Tokyo Organising Committee of the Olympic and Paralympic Games, and the International Olympic Committee decided to postpone the Tokyo 2020 Olympic and Paralympic Games until the summer of 2021. With the emergence of SARS-CoV-2, the potential creation of a superspreading event that would overwhelm the Tokyo health system was perceived as a risk.
Læs mere Tjek på PubMedWurihan WurihanYuxuan WangSydney YeungYi ZouZhao LaiJoseph D. FondellWei Vivian LiGuangming ZhongHuizhou Fan1Department of Pharmacology, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA2Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China3Greehey Children's Cancer Research Institute, University of Texas Health San Antonio, San Antonio, Texas, USA4Department of Molecular Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA5Department of Statistics, University of California Riverside, Riverside, California, USA6Department of Microbiology and Immunology, University of Texas Health San Antonio, San Antonio, Texas, USA, Andreas J. Bäumler
Infection and Immunity, 2.02.2024
Tilføjet 2.02.2024
Nora CéspedesErinn L. DonnellyGretchen HanstenAbigail M. FellowsMegan DobsonHannah L. KaylorTaylor A. ColesJoseph SchauerJudy Van de WaterShirley Luckhart1Department of Entomology, Plant Pathology and Nematology, University of Idaho, Moscow, Idaho, USA2Department of Biological Sciences, University of Idaho, Moscow, Idaho, USA3Division of Rheumatology, Allergy and Clinical Immunology, University of California, Davis, California, USA, De'Broski R. Herbert
Infection and Immunity, 2.02.2024
Tilføjet 2.02.2024
BMC Infectious Diseases, 2.02.2024
Tilføjet 2.02.2024
Abstract Background Nocardiosis is a rare infection that typically results from inhalation of or inoculation with Nocardia organisms. It may cause invasive disease in immunocompromised patients. This case describes nocardiosis with bacteremia and pulmonary involvement in a child with a hematologic malignancy. Case presentation A boy with testicular relapsed acute lymphoblastic leukemia with marrow involvement presented with sudden onset of fever, body aches, headaches, chills, and moderate respiratory distress during continuation 2 chemotherapy. Radiographic imaging demonstrated consolidation and ground glass opacities in bilateral lower lungs. Central line blood cultures grew Nocardia nova complex, prompting removal of the central line and initiation of triple therapy with imipenem-cilastatin, linezolid, and trimethoprim-sulfamethoxazole with rapid improvement of symptoms. Antibiotic susceptibilities showed a multidrug-susceptible isolate. The patient is anticipated to remain on trimethoprim-sulfamethoxazole for at least 12 months. Conclusions In an immunocompromised child, blood cultures, chest imaging, and head imaging can aid in the diagnosis of disseminated nocardiosis. Long-term antibiotic therapy is necessary, guided by the organism and simplified with the results of antimicrobial susceptibility testing.
Læs mere Tjek på PubMedManuel Ribeiro, Leonardo Azevedo, André Peralta Santos, Pedro Pinto Leite, Maria João Pereira
PLoS One Infectious Diseases, 1.02.2024
Tilføjet 1.02.2024
by Manuel Ribeiro, Leonardo Azevedo, André Peralta Santos, Pedro Pinto Leite, Maria João Pereira During the SARS-CoV-2 pandemic, governments and public health authorities collected massive amounts of data on daily confirmed positive cases and incidence rates. These data sets provide relevant information to develop a scientific understanding of the pandemic’s spatiotemporal dynamics. At the same time, there is a lack of comprehensive approaches to describe and classify patterns underlying the dynamics of COVID-19 incidence across regions over time. This seriously constrains the potential benefits for public health authorities to understand spatiotemporal patterns of disease incidence that would allow for better risk communication strategies and improved assessment of mitigation policies efficacy. Within this context, we propose an exploratory statistical tool that combines functional data analysis with unsupervised learning algorithms to extract meaningful information about the main spatiotemporal patterns underlying COVID-19 incidence on mainland Portugal. We focus on the timeframe spanning from August 2020 to March 2022, considering data at the municipality level. First, we describe the temporal evolution of confirmed daily COVID-19 cases by municipality as a function of time, and outline the main temporal patterns of variability using a functional principal component analysis. Then, municipalities are classified according to their spatiotemporal similarities through hierarchical clustering adapted to spatially correlated functional data. Our findings reveal disparities in disease dynamics between northern and coastal municipalities versus those in the southern and hinterland. We also distinguish effects occurring during the 2020–2021 period from those in the 2021–2022 autumn-winter seasons. The results provide proof-of-concept that the proposed approach can be used to detect the main spatiotemporal patterns of disease incidence. The novel approach expands and enhances existing exploratory tools for spatiotemporal analysis of public health data.
Læs mere Tjek på PubMedJournal of Infectious Diseases, 1.02.2024
Tilføjet 1.02.2024
Abstract Background Staphylococcus aureus is the most common cause of life-threatening endovascular infections, including infective endocarditis (IE). These infections, especially when caused by methicillin-resistant strains (MRSA), feature limited therapeutic options and high morbidity and mortality rates.Methods Herein, we investigated the role of the purine biosynthesis repressor, PurR, in virulence factor expression and vancomycin (VAN) treatment outcomes in experimental IE due to MRSA.Results The PurR-mediated repression of purine biosynthesis was confirmed by enhanced purF expression and production of an intermediate purine metabolite in purR mutant strain. In addition, enhanced expression of the transcriptional regulators, sigB and sarA, and their key downstream virulence genes (eg, fnbA, and hla) was demonstrated in the purR mutant in vitro and within infected cardiac vegetations. Furthermore, purR deficiency enhanced fnbA/fnbB transcription, translating to increased fibronectin adhesion versus the wild type and purR-complemented strains. Notably, the purR mutant was refractory to significant reduction in target tissues MRSA burden following VAN treatment in the IE model.Conclusions These findings suggest that the purine biosynthetic pathway intersects the coordination of virulence factor expression and in vivo persistence during VAN treatment, and may represent an avenue for novel antimicrobial development targeting MRSA.
Læs mere Tjek på PubMedQianhang Xia, Yujie Yang, Fengling Wang, Zhongyue Huang, Wuqi Qiu, Ayan Mao
International Journal of Infectious Diseases, 1.02.2024
Tilføjet 1.02.2024
The COVID-19 pandemic has severely strained global healthcare systems, marking the most critical public health emergency since World War II [1]. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) underwent continuous mutations, giving rise to diverse variants [2]. While most mutations have minimal impact, certain ones significantly affect SARS-CoV-2′s clinical and epidemiological characteristics, including increased transmissibility, pathogenicity, and reduced vaccine effectiveness [3].
Læs mere Tjek på PubMedBMC Infectious Diseases, 1.02.2024
Tilføjet 1.02.2024
Abstract Background Northern Italy was the first European country affected by the spread of the SARS-CoV-2, with the epicenter in the province of Bergamo. Aim This study aims to analyze the characteristics of patients who experienced more severe symptoms during the first wave of COVID-19 pandemic. Materials and methods We retrospectively collected epidemiological and clinical data on patients with laboratory-confirmed wild-type SARS-CoV-2 infection who were admitted to the “ASST Bergamo Ovest” hospital between February 21 and May 31, 2020. Results A total of seven hundred twenty-three inpatients met the eligible criteria and were included in the study cohort. Among the inpatients who survived, the average hospital length of stay was more than two weeks, with some lasting up to three months. Among the 281 non-survivors, death occurred in 50% within five days. Survivors were those whose first aid operators recorded higher oxygen saturation levels at home. The request for first aid assistance came more than one week after symptom onset, within three days in 10% of cases. Conclusion In similar future scenarios, based on our data, if we aim to enhance the survival rate, we need to improve the territorial healthcare assistance and admit to hospitals only those patients who are at risk of severe illness requiring specialized and urgent interventions within two, three, or, at most, five days from the onset of symptoms. This implies that the crucial factor is, has been, and will be the ability of a healthcare system to react promptly in its entirety within a few days.
Læs mere Tjek på PubMedBMC Infectious Diseases, 1.02.2024
Tilføjet 1.02.2024
Abstract Background Current diagnoses of urinary tract infection (UTI) by standard urine culture (SUC) has significant limitations in sensitivity, especially for fastidious organisms, and the ability to identify organisms in polymicrobial infections. The significant rate of both SUC “negative” or “mixed flora/contamination” results in UTI cases and the high prevalence of asymptomatic bacteriuria indicate the need for an accurate diagnostic test to help identify true UTI cases. This study aimed to determine if infection-associated urinary biomarkers can differentiate definitive UTI cases from non-UTI controls. Methods Midstream clean-catch voided urine samples were collected from asymptomatic volunteers and symptomatic subjects ≥ 60 years old diagnosed with a UTI in a urology specialty setting. Microbial identification and density were assessed using a multiplex PCR/pooled antibiotic susceptibility test (M-PCR/P-AST) and SUC. Three biomarkers [neutrophil gelatinase-associated lipocalin (NGAL), and Interleukins 8 and 1β (IL-8, and IL-1β)] were also measured via enzyme-linked immunosorbent assay (ELISA). Definitive UTI cases were defined as symptomatic subjects with a UTI diagnosis and positive microorganism detection by SUC and M-PCR, while definitive non-UTI cases were defined as asymptomatic volunteers. Results We observed a strong positive correlation (R2 > 0.90; p
Læs mere Tjek på PubMedBMC Infectious Diseases, 1.02.2024
Tilføjet 1.02.2024
Abstract Background Bacterial infections are considered a leading cause of hospitalization and death globally. There is still a need for a rapid and feasible biomarker for bacterial infections. Heparin-binding protein (HBP) was shown to be related to bacterial infections. The objective of the study is to investigate the diagnostic accuracy of HBP in bacterial infections. Methods Articles were screened in PubMed, SCOPUS, Web of Science, and Cochrane to recognize eligible studies. We included studies investigating the diagnostic accuracy of HBP and reported the necessary data to construct 2 × 2 tables. A univariate analysis was conducted to determine the pooled sensitivity and specificity, and a bivariate diagnostic random-effects model was used to calculate the optimal cut-off point. Results The analysis comprised sixteen studies in total. Plasma HBP showed a sensitivity of 0.90 (95% CI: [0.79, 0.96]) and a specificity of 0.87 (95% CI: [0.66, 0.96]) in diagnosing bacterial infections using blood samples. Pooling data from seven studies revealed that HBP in cerebrospinal fluid (CSF) has sensitivity and specificity of 96% (95% CI: [0.85, 0.99]), and 95% (95% CI: [0.89, 0.97]), respectively, for the diagnosis of bacterial meningitis. In urinary tract infections (UTI), urine-HBP was revealed to have a high diagnostic value in discriminating bacterial from non-bacterial UTI infection at a cut-off value of 32.868 ng/ml with sensitivity and specificity of 87%. Conclusion HBP has shown a high diagnostic accuracy of bacterial infections, including UTI and meningitis. Further studies are needed to determine its prognostic value and whether it could guide antibiotic therapy.
Læs mere Tjek på PubMedvan der Wekken-Pas, Lena; Nassiwa, Sylvia; Malaba, Thokozule; Lamorde, Mohammed; Myer, Landon; Waitt, Catriona; Reynolds, Helen; Khoo, Saye; He, Nengjie; van Leeuwen, Liesbeth; Burger, David; Wang, Duolao; Colbers, Angela
AIDS, 1.02.2024
Tilføjet 1.02.2024
Background: Both dolutegravir and efavirenz are known to be effective in pregnancy and post-partum to prevent vertical transmission of HIV and to maintain maternal health. Both drugs have also been associated with neuropsychiatric symptoms. To what extent these symptoms occur in pregnant and post-partum women, however, is not yet known. Methods: This was a secondary analysis of the DolPHIN2 study, a multicenter randomized trial among women presenting late in pregnancy with untreated HIV- who received either a dolutegravir- or efavirenz- containing regimen. Longitudinal measures of depression, anxiety and sleep quality were analyzed during pregnancy and up to 48 weeks post-partum. Results: Among 268 women median (IQR) Edinburgh Post Natal depression score (EPDS) scores were 8 (3–11) and highest at enrolment. In the dolutegravir -and efavirenz arm, respectively, 23.7% and 25.6% had an EPDS score above 9, indicating possible or probable depression. Abnormal Hospital Anxiety Depression scores (HADS) (above 11) were seen at least once during follow up in 42 of patients (15.7%), although no differences were seen between treatment arms. No association was found between EPDS, suicidality and HADS scores and the assigned regimen (p = 0.93, 0.97 and 0.18 respectively). Median (IQR) Pittsburgh Sleep Quality index (PSQI) scores for dolutegravir- and efavirenz were 6 (5–7) and 5 (5–6.5) respectively, p = 0.70. Conclusions: No statistically significant differences were observed between efavirenz- or dolutegravir containing regimens. Rates of depression were high, but decreased over the course of time and confirm the need for psychological support after initial HIV diagnosis in pregnancy. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedDominguez-Dominguez, Lourdes; Campbell, Lucy; Barbini, Birgit; Fox, Julie; Nikiphorou, Elena; Goff, Louise; Lempp, Heidi; Tariq, Shema; Hamzah, Lisa; Post, Frank A.
AIDS, 1.02.2024
Tilføjet 1.02.2024
Objective: Social Determinants of Health (SDH) are important determinants of long-term conditions and multimorbidity in the general population. The intersecting relationship between SDH and multimorbidity in people with HIV remains poorly studied. Design: Cross-sectional study investigating the relationships between eight socio-economic parameters and prevalent comorbidities of clinical significance and multimorbidity in adults of African ancestry with HIV aged 18–65 years in South London, UK. Methods: Multivariable logistic regression analysis was used to evaluate associations between SDH and comorbidities and multimorbidity. Results: Between September 2020 and January 2022, 398 participants (median age 52 years, 55% female) were enrolled; 85% reported at least one SDH and 72% had at least one comorbidity. There were no associations between SDH and diabetes mellitus or kidney disease, few associations between SDH (job and food insecurity) and cardiovascular or lung disease, and multiple associations between SDH (financial, food, housing and job insecurity, low educational level, social isolation, and discrimination) and poor mental health or chronic pain. Associations between SDH and multimorbidity mirrored those for constituent comorbidities. Conclusions: We demonstrate strong associations between SDH and poor mental health, chronic pain and multimorbidity in people of black ethnicities living with HIV in the UK. These findings highlight the likely impact of enduring socio-economic hardship in these communities and underlines the importance of holistic health and social care for people with HIV to address these adverse psychosocial conditions. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
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