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Journal of Infectious Diseases, 17.05.2024
Tilføjet 17.05.2024
Abstract Background Monoclonal antibodies (mAbs) are utilized broadly to treat cancer and infectious diseases, and mAb exposure (serum concentration over time) is one predictor of overall treatment efficacy. Herein, we present findings from a clinical trial evaluating the pharmacokinetics (PK) of the long-acting mAb sotrovimab targeting SARS-CoV-2 in hematopoietic cell transplant (HCT) recipients.Methods All participants received an intravenous infusion of sotrovimab within one week prior to initiating the pre-transplant preparative regimen. The serum concentration of sotrovimab was measured longitudinally for up to 24 weeks post-transplant.Results Compared to non-HCT participants, we found that mAb clearance was 10% and 26% higher in autologous and allogeneic HCT recipients, respectively. Overall sotrovimab exposure was approximately 15% lower in HCT recipients compared to non-HCT recipients. Exposure was significantly reduced in HCT recipients who developed diarrhea and lower gastrointestinal (GI) graft-versus-host disease (GVHD) post-transplant.Conclusions These data show that sotrovimab exposure may be reduced in HCT recipients, possibly related to increased GI clearance in patients with GVHD. This phenomenon has implications for dose selection and duration of efficacy with sotrovimab and potentially other mAbs in this vulnerable patient population. Thus, mAb dose regimens developed in non-HCT populations may have to be optimized when applied to HCT populations.
Læs mere Tjek på PubMedRahmat Dapari, Muhamad Zazali Fikri Mohd Yusop, Dharsshini Chinnasamy, Nurul Izati Zakaria, Siti Munisah Mohd Shoaib, Mohd Erfan Edros
PLoS One Infectious Diseases, 16.05.2024
Tilføjet 16.05.2024
by Rahmat Dapari, Muhamad Zazali Fikri Mohd Yusop, Dharsshini Chinnasamy, Nurul Izati Zakaria, Siti Munisah Mohd Shoaib, Mohd Erfan Edros Introduction Malaria is a vector-borne disease that initially manifests as fever, headache, and chills. The illness could progress to more severe conditions, including lethargy, impaired consciousness, convulsions, shortness of breath, blood in urine, jaundice, and haemorrhage if left untreated. The risk of contracting malaria is considerably heightened in specific occupational settings, particularly among forest rangers, following frequent exposure to natural habitats. Consequently, advancing the understanding of malaria and emphasising how specific occupational environments (including those of forest rangers) contribute to disease risk and management is imperative. Objective The present study aims to determine the factors associated with malaria infection among forest rangers by systematically reviewing electronic articles from three databases (EBSCOhost, ScienceDirect, and ResearchGate). Methods The current review was prepared based on the updated preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. First, three independent reviewers screened the titles and abstracts of the data collected. The information was then stored in Endnote20 based on the inclusion and exclusion criteria. The articles were critically appraised with the mixed methods appraisal tool (MMAT) to assess their quality. Result A total of 103, 31, and 51 articles from EBSCOhost, ScienceDirect, and ResearchGate, respectively, were selected, resulting in 185 unique hits. Nevertheless, only 63 full-text publications were assessed following a rigorous selection screening, from which only five were included in the final review. The studies revealed that several factors contribute to malaria infection among forest rangers. The parameters were classified into sociodemographic, individual, and living condition-related. Conclusion A better understanding of malaria progresses and identifying its potential risk factors is essential to impact worker well-being. The findings might be utilised to improve malaria infection prevention programme implementations, hence maximising their success. Pre-employment and regular health screenings could also aid in evaluating and identifying potential risks for malaria infection among forest rangers.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.05.2024
Tilføjet 14.05.2024
Abstract Background A Bartholin’s gland abscess is one of the most common infections in women of reproductive age. Although Bartholin’s gland abscesses have been reported in prepubertal children, they are rarer in prepubertal children than in adults. Herein, we report a case of bilateral Bartholin’s gland abscesses in a 4-year-old girl with vitamin A deficiency. Case presentation A 4-year-old girl diagnosed with autism spectrum disorder was admitted to the hospital for close examination and treatment because of persistent fever and malaise. The child was a marked fussy eater and was diagnosed with corneal ulceration and night blindness secondary to vitamin A deficiency. Both of the patient’s labia were swollen, and a diagnosis of a bilateral Bartholin’s gland abscess was made using computed tomography. Incisional drainage was performed under general anesthesia. The patient’s postoperative course was uneventful, and she was discharged from the hospital on day 8 after the surgery. During hospitalization, attempts were made to correct the vitamin deficiency by adding nutritional supplements to the diet. Three months after the surgery, no recurrence of abscesses was noted. Conclusions Decreased immunocompetence and mucosal barrier function due to vitamin A deficiency is thought to be the underlying cause of Bartholin’s gland abscesses. Although prepubertal Bartholin’s gland abscesses have been reported, they are rare. To the best of our knowledge, no reports of bilateral Bartholin’s gland abscesses potentially caused by vitamin A deficiency have been reported. When prepubertal girls present with Bartholin’s gland abscesses, the presence of immunodeficiency due to vitamin or trace element deficiency should also be considered.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.05.2024
Tilføjet 14.05.2024
Abstract Background A Bartholin’s gland abscess is one of the most common infections in women of reproductive age. Although Bartholin’s gland abscesses have been reported in prepubertal children, they are rarer in prepubertal children than in adults. Herein, we report a case of bilateral Bartholin’s gland abscesses in a 4-year-old girl with vitamin A deficiency. Case presentation A 4-year-old girl diagnosed with autism spectrum disorder was admitted to the hospital for close examination and treatment because of persistent fever and malaise. The child was a marked fussy eater and was diagnosed with corneal ulceration and night blindness secondary to vitamin A deficiency. Both of the patient’s labia were swollen, and a diagnosis of a bilateral Bartholin’s gland abscess was made using computed tomography. Incisional drainage was performed under general anesthesia. The patient’s postoperative course was uneventful, and she was discharged from the hospital on day 8 after the surgery. During hospitalization, attempts were made to correct the vitamin deficiency by adding nutritional supplements to the diet. Three months after the surgery, no recurrence of abscesses was noted. Conclusions Decreased immunocompetence and mucosal barrier function due to vitamin A deficiency is thought to be the underlying cause of Bartholin’s gland abscesses. Although prepubertal Bartholin’s gland abscesses have been reported, they are rare. To the best of our knowledge, no reports of bilateral Bartholin’s gland abscesses potentially caused by vitamin A deficiency have been reported. When prepubertal girls present with Bartholin’s gland abscesses, the presence of immunodeficiency due to vitamin or trace element deficiency should also be considered.
Læs mere Tjek på PubMedKeita Fukuyama, Yukiko Mori, Hiroaki Ueshima, Shiho Ito, Masaki Tanabe, Tomohiro Kuroda
PLoS One Infectious Diseases, 13.05.2024
Tilføjet 13.05.2024
by Keita Fukuyama, Yukiko Mori, Hiroaki Ueshima, Shiho Ito, Masaki Tanabe, Tomohiro Kuroda Purpose The coronavirus disease 2019 (COVID-19) pandemic exhibited several different waves threatening global health care. During this pandemic, medical resources were depleted. However, the kind of medical resources provided to each wave was not clarified. This study aimed to examine the characteristics of medical care provision at COVID-19 peaks in preparation for the next pandemic. Methods Using medical insurance claim records in Japan, we examined the presence or absence of COVID-19 infection and the use of medical resources for all patients monthly by age group. Results The wave around August 2021 with the Delta strain had the strongest impact on the working population in terms of hospital admission and respiratory support. For healthcare providers, this peak had the highest frequency of severely ill patients. In the subsequent wave, although the number of patients with COVID-19 remained high, they were predominantly older adults, with relatively fewer patients receiving intensive care. Conclusions In future pandemics, we should refer to the wave around August 2021 as a situation of medical resource shortage resulting from the COVID-19 pandemic.
Læs mere Tjek på PubMedBMC Infectious Diseases, 11.05.2024
Tilføjet 11.05.2024
Abstract Background A Bartholin’s gland abscess is one of the most common infections in women of reproductive age. Although Bartholin’s gland abscesses have been reported in prepubertal children, they are rarer in prepubertal children than in adults. Herein, we report a case of bilateral Bartholin’s gland abscesses in a 4-year-old girl with vitamin A deficiency. Case presentation A 4-year-old girl diagnosed with autism spectrum disorder was admitted to the hospital for close examination and treatment because of persistent fever and malaise. The child was a marked fussy eater and was diagnosed with corneal ulceration and night blindness secondary to vitamin A deficiency. Both of the patient’s labia were swollen, and a diagnosis of a bilateral Bartholin’s gland abscess was made using computed tomography. Incisional drainage was performed under general anesthesia. The patient’s postoperative course was uneventful, and she was discharged from the hospital on day 8 after the surgery. During hospitalization, attempts were made to correct the vitamin deficiency by adding nutritional supplements to the diet. Three months after the surgery, no recurrence of abscesses was noted. Conclusions Decreased immunocompetence and mucosal barrier function due to vitamin A deficiency is thought to be the underlying cause of Bartholin’s gland abscesses. Although prepubertal Bartholin’s gland abscesses have been reported, they are rare. To the best of our knowledge, no reports of bilateral Bartholin’s gland abscesses potentially caused by vitamin A deficiency have been reported. When prepubertal girls present with Bartholin’s gland abscesses, the presence of immunodeficiency due to vitamin or trace element deficiency should also be considered.
Læs mere Tjek på PubMedMalaria Journal, 8.05.2024
Tilføjet 8.05.2024
Abstract Background Studies on haemosporidian diversity, including origin of human malaria parasites, malaria\'s zoonotic dynamic, and regional biodiversity patterns, have used target gene approaches. However, current methods have a trade-off between scalability and data quality. Here, a long-read Next-Generation Sequencing protocol using PacBio HiFi is presented. The data processing is supported by a pipeline that uses machine-learning for analysing the reads. Methods A set of primers was designed to target approximately 6 kb, almost the entire length of the haemosporidian mitochondrial genome. Amplicons from different samples were multiplexed in an SMRTbell® library preparation. A pipeline (HmtG-PacBio Pipeline) to process the reads is also provided; it integrates multiple sequence alignments, a machine-learning algorithm that uses modified variational autoencoders, and a clustering method to identify the mitochondrial haplotypes/species in a sample. Although 192 specimens could be studied simultaneously, a pilot experiment with 15 specimens is presented, including in silico experiments where multiple data combinations were tested. Results The primers amplified various haemosporidian parasite genomes and yielded high-quality mt genome sequences. This new protocol allowed the detection and characterization of mixed infections and co-infections in the samples. The machine-learning approach converged into reproducible haplotypes with a low error rate, averaging 0.2% per read (minimum of 0.03% and maximum of 0.46%). The minimum recommended coverage per haplotype is 30X based on the detected error rates. The pipeline facilitates inspecting the data, including a local blast against a file of provided mitochondrial sequences that the researcher can customize. Conclusions This is not a diagnostic approach but a high-throughput method to study haemosporidian sequence assemblages and perform genotyping by targeting the mitochondrial genome. Accordingly, the methodology allowed for examining specimens with multiple infections and co-infections of different haemosporidian parasites. The pipeline enables data quality assessment and comparison of the haplotypes obtained to those from previous studies. Although a single locus approach, whole mitochondrial data provide high-quality information to characterize species pools of haemosporidian parasites.
Læs mere Tjek på PubMedJaffar A. Al-Tawfiq, Shui-Shan Lee, Ziad A. Memish
International Journal of Infectious Diseases, 8.05.2024
Tilføjet 8.05.2024
Worldwide, meningococcal disease is a leading cause of morbidity and mortality [1]. In countries where there are epidemics, the rate of meningococcal disease can rise to 1,000 cases per 100,000 people. There are 12 serogroups of Neisseria meningitidis (N. meningitidis), only 6 of which — A, B, C, W, Y, and X — are accountable for the majority of invasive infections. The most prevalent form of invasive infection is meningitis and septicemia, which is associated with high case fatality rate (10%) and lifelong, disabling sequelae in 10‒20% of survivors [2,3].
Læs mere Tjek på PubMedClinical Infectious Diseases, 6.05.2024
Tilføjet 6.05.2024
Abstract Significant events impacting healthcare over the last several years have been associated with escalating rates of healthcare-associated infections. This has resulted in increased efforts to reinstitute well-established and evidence-based infection prevention practices, particularly for central line associated bloodstream infections. However, implementation of prevention initiatives beyond central lines has not received the same level of acknowledgement and response as being a considerable risk to patients. This article, authored by infection prevention, infectious disease, and vascular access professionals, provides emerging perspectives and technical aspects associated with the complete lifecycle of a vascular access device. The intent is to provide insight and perspective into enhancing current IP practices in the acute care hospital setting. This will also help prepare hospitals for upcoming broader surveillance and intervention activities aimed at reducing Hospital Onset Bacteremia and Fungemia (HOB) associated with all types of vascular access devices.
Læs mere Tjek på PubMedReina Engle-Stone, K Ryan Wessells, Marjorie J. Haskell, Sika M. Kumordzie, Charles D. Arnold, Jennie N. Davis, Emily R. Becher, Ahmed D. Fuseini, Kania W. Nyaaba, Xiuping Tan, Katherine P. Adams, Georg Lietz, Stephen A. Vosti, Seth Adu-Afarwuah
PLoS One Infectious Diseases, 6.05.2024
Tilføjet 6.05.2024
by Reina Engle-Stone, K Ryan Wessells, Marjorie J. Haskell, Sika M. Kumordzie, Charles D. Arnold, Jennie N. Davis, Emily R. Becher, Ahmed D. Fuseini, Kania W. Nyaaba, Xiuping Tan, Katherine P. Adams, Georg Lietz, Stephen A. Vosti, Seth Adu-Afarwuah Introduction Micronutrient deficiencies are prevalent in West Africa, particularly among women of reproductive age (WRA) and young children. Bouillon is a promising food fortification vehicle due to its widespread consumption. This study aims to evaluate the impact of multiple micronutrient-fortified bouillon cubes, compared to control bouillon cubes (fortified with iodine only), on micronutrient status and hemoglobin concentrations among lactating and non-lactating WRA and young children in northern Ghana. Methods This randomized, controlled doubly-masked trial will be conducted in the Kumbungu and Tolon districts in the Northern Region of Ghana, where prior data indicate multiple micronutrient deficiencies are common. Participants will be: 1) non-pregnant non-lactating WRA (15–49 y), 2) children 2–5 y, and 3) non-pregnant lactating women 4–18 months postpartum. Eligible participants will be randomly assigned to receive household rations of one of two types of bouillon cubes: 1) a multiple micronutrient-fortified bouillon cube containing vitamin A, folic acid, vitamin B12, iron, zinc, and iodine, or 2) a control cube containing iodine only.Each participant’s household will receive a ration of bouillon cubes every 2 weeks, and households will be advised to prepare meals as usual, using the study-provided cubes. The trial duration will be 9 months for non-pregnant non-lactating WRA and children, and 3 months for lactating women. The primary outcomes will be changes in biomarkers of micronutrient status and hemoglobin among WRA and children and milk micronutrient concentrations among lactating women. Secondary outcomes will include change in prevalence of micronutrient deficiency and anemia; dietary intake of bouillon and micronutrients; inflammation, malaria, and morbidity symptoms; and child growth and development. Discussion Evidence from this study will inform discussions about bouillon fortification in Ghana and West Africa. Trial registration The trial was registered on ClinicalTrials.gov (NCT05178407) and the Pan-African Clinical Trial Registry (PACTR202206868437931). This manuscript reflects protocol version 4 (August 29, 2022).
Læs mere Tjek på PubMedKelong HanParul PatelScott McCallisterAlex R. RinehartYash GandhiWilliam SpreenRaphael J. LandovitzSinead Delany-MoretlweMark A. MarzinkeTodd McKeonPiotr BudnikJean van WykSusan L. Ford1GSK, Collegeville, Pennsylvania, USA2ViiV Healthcare, Durham, North Carolina, USA3ViiV Healthcare, Branford, Connecticut, USA4Center for Clinical AIDS Research and Education, David Geffen School of Medicine, University of California, Los Angeles, California, USA5Wits RHI, University of the Witwatersrand, Johannesburg, South Africa6Johns Hopkins University, Baltimore, Maryland, USA7ViiV Healthcare, Brentford, United Kingdom8GSK, Durham, North Carolina, USA, Ryan K. Shields
Antimicrobial Agents And Chemotherapy, 6.05.2024
Tilføjet 6.05.2024
Ayumi Hirao, Yasushi Hojo, Gen Murakami, Rina Ito, Miki Hashizume, Takayuki Murakoshi, Naonori Uozumi
PLoS One Infectious Diseases, 4.05.2024
Tilføjet 4.05.2024
by Ayumi Hirao, Yasushi Hojo, Gen Murakami, Rina Ito, Miki Hashizume, Takayuki Murakoshi, Naonori Uozumi Network oscillation in the anterior cingulate cortex (ACC) plays a key role in attention, novelty detection and anxiety; however, its involvement in cognitive impairment caused by acute systemic inflammation is unclear. To investigate the acute effects of systemic inflammation on ACC network oscillation and cognitive function, we analyzed cytokine level and cognitive performance as well as network oscillation in the mouse ACC Cg1 region, within 4 hours after lipopolysaccharide (LPS, 30 μg/kg) administration. While the interleukin-6 concentration in the serum was evidently higher in LPS-treated mice, the increases in the cerebral cortex interleukin-6 did not reach statistical significance. The power of kainic acid (KA)-induced network oscillation in the ACC Cg1 region slice preparation increased in LPS-treated mice. Notably, histamine, which was added in vitro, increased the oscillation power in the brain slices from LPS-untreated mice; for the LPS-treated mice, however, the effect of histamine was suppressive. In the open field test, frequency of entries into the center area showed a negative correlation with the power of network oscillation (0.3 μM of KA, theta band (3–8 Hz); 3.0 μM of KA, high-gamma band (50–80 Hz)). These results suggest that LPS-induced systemic inflammation results in increased network oscillation and a drastic change in histamine sensitivity in the ACC, accompanied by the robust production of systemic pro-inflammatory cytokines in the periphery, and that these alterations in the network oscillation and animal behavior as an acute phase reaction relate with each other. We suggest that our experimental setting has a distinct advantage in obtaining mechanistic insights into inflammatory cognitive impairment through comprehensive analyses of hormonal molecules and neuronal functions.
Læs mere Tjek på PubMedJournal of Infectious Diseases, 3.05.2024
Tilføjet 3.05.2024
Abstract We evaluated hair tenofovir (TFV) concentrations as an adherence metric for HIV pre-exposure prophylaxis (PrEP) during pregnancy and postpartum and compared hair levels with tenofovir-diphosphate (TFV-DP) levels in dried blood spots (DBS). Overall, 152 hair samples from 102 women and 36 hair-DBS paired samples from 29 women were collected from a subset of women in a cluster randomized trial. Having a partner known to be living with HIV was associated with higher hair TFV levels (p
Læs mere Tjek på PubMedAmerican Journal of Tropical Medicine and Hygiene, 2.05.2024
Tilføjet 2.05.2024
Journal Name: The American Journal of Tropical Medicine and Hygiene Volume: 110 Issue: 5 Pages: 953-960
Læs mere Tjek på PubMedSaraiva, I. E., Hamahata, N., Huang, D. T., Kane-Gill, S. L., Rivosecchi, R. M., Shiva, S., Nolin, T. D., Chen, X., Minturn, J., Chang, C.-C. H., Li, X., Kellum, J., Gomez, H.
BMJ Open, 1.05.2024
Tilføjet 1.05.2024
IntroductionAcute kidney injury (AKI) is a common complication of sepsis associated with increased risk of death. Preclinical data and observational human studies suggest that activation of AMP-activated protein kinase, an ubiquitous master regulator of energy that can limit mitochondrial injury, with metformin may protect against sepsis-associated AKI (SA-AKI) and mortality. The Randomized Clinical Trial of the Safety and FeasibiLity of Metformin as a Treatment for sepsis-associated AKI (LiMiT AKI) aims to evaluate the safety and feasibility of enteral metformin in patients with sepsis at risk of developing SA-AKI. Methods and analysisBlind, randomised, placebo-controlled clinical trial in a single-centre, quaternary teaching hospital in the USA. We will enrol adult patients (18 years of age or older) within 48 hours of meeting Sepsis-3 criteria, admitted to intensive care unit, with oral or enteral access. Patients will be randomised 1:1:1 to low-dose metformin (500 mg two times per day), high-dose metformin (1000 mg two times per day) or placebo for 5 days. Primary safety outcome will be the proportion of metformin-associated serious adverse events. Feasibility assessment will be based on acceptability by patients and clinicians, and by enrolment rate. Ethics and disseminationThis study has been approved by the Institutional Review Board. All patients or surrogates will provide written consent prior to enrolment and any study intervention. Metformin is a widely available, inexpensive medication with a long track record for safety, which if effective would be accessible and easy to deploy. We describe the study methods using the Standard Protocol Items for Randomized Trials framework and discuss key design features and methodological decisions. LiMiT AKI will investigate the feasibility and safety of metformin in critically ill patients with sepsis at risk of SA-AKI, in preparation for a future large-scale efficacy study. Main results will be published as soon as available after final analysis. Trial registration numberNCT05900284.
Læs mere Tjek på PubMedJeffrey V. Lazarus, Trenton M. White, Katarzyna Wyka, Scott C. Ratzan, Kenneth Rabin, Heidi J. Larson, Federico Martinon-Torres, Ernest Kuchar, Salim S. Abdool Karim, Tamara Giles-Vernick, Selina Müller, Carolina Batista, Nellie Myburgh, Beate Kampmann, Ayman El-Mohandes
Nature, 30.04.2024
Tilføjet 30.04.2024
Murphy, Matthew; Rogers, Brooke; Galipeau, Drew; Toma, Emily; Almonte, Alexi; Napoleon, Siena; Schmid, Christopher H.; Ahluwalia, Jasjit S.; Chan, Philip
Journal of Acquired Immune Deficiency Syndromes, 29.04.2024
Tilføjet 29.04.2024
Background: Pre-exposure prophylaxis (PrEP) is an effective approach to preventing HIV acquisition and is recommended for populations overrepresented in carceral systems given the overlap with populations disproportionately impacted by HIV. However, few studies have focused on PrEP initiation outcomes in a carceral setting to maximize public health impact. Setting: This study was conducted in a unified jail/prison system within the state of Rhode Island located in the United States. Methods: A prospective observational cohort of men initiating PrEP within a jail setting were enrolled in this trial. Men were referred by providers, staff, or after self-presenting for HIV preventive care, these individuals were offered enrollment in the study which involved evaluation for clinical PrEP eligibility, PrEP initiation while incarcerated, continuation upon community re-entry and linkage to a community PrEP provider post-release. Results: A total of (N=100) men in the jail facility (e.g. “intake”) were enrolled in the cohort. Of the 100 men enrolled, 83% were determined to be PrEP eligible through standard clinical evaluation, 37% were prescribed PrEP, and 26% initiated PrEP while incarcerated. In total, 5% of enrolled individuals were linked successfully to PrEP care in the community. Conclusion: Our findings suggest preliminary feasibility and acceptability of initiating PrEP within a jail setting. There were significant challenges across the PrEP care continuum that can be used to inform future studies and practice. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedWhite, Douglas AE; Godoy, Ashley; Jewett, Montana; Burns, Molly; Pinto, Cinthya Mujica; Packel, Laura J; Garcia-Chinn, Maria; Anderson, Erik S; McCoy, Sandra I
Journal of Acquired Immune Deficiency Syndromes, 29.04.2024
Tilføjet 29.04.2024
Background: Emergency departments (ED) provide care to patients at increased risk for acquiring HIV and for many of them, the ED serves as their sole point of entry into the healthcare system. We implemented the HIV PreventED Program to increase access to HIV prevention services for ED patients. Setting: Emergency department in Oakland, CA with an annual census of 57,000 visits. Methods: This cross-sectional study evaluated the first 9 months of the HIV PreventED Program. In this program, a navigator surveyed adult HIV negative ED patients to determine their risk for acquiring HIV infection, incorporating HIV prevention counseling into their assessments. Patients at higher risk for acquiring HIV were referred to outpatient prevention services, if interested. The primary outcome measure was the number and proportion of ED patients at higher risk for acquiring HIV that followed up for outpatient prevention services. Results: There were 1,233 HIV negative patients assessed by the navigator and who received ED-based HIV prevention counseling. Of these, 193 (15.7%) were identified at higher risk and offered an outpatient referral for prevention services, of which 104 accepted (53.9%), 23 (11.9%) attended the referral, and 13 (6.7%) were prescribed pre-exposure prophylaxis (PrEP). The median time to linkage was 28 days (interquartile range 15 to 41 days). Conclusion: A navigator focused on providing ED-based HIV prevention counseling and linkage to outpatient services is feasible. Strategies to more efficiently identify ED patients at higher risk for HIV acquisition, such as automated identification of risk data from the electronic health record, and policies to improve follow up and the receipt of PrEP, such as same-day PrEP initiation, should be prospectively evaluated. Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.
Læs mere Tjek på PubMedBMC Infectious Diseases, 27.04.2024
Tilføjet 27.04.2024
Abstract Introduction Carbapenemase-producing Enterobacterales (CPE) are an important public health threat, with costly operational and economic consequences for NHS Integrated Care Systems and NHS Trusts. UK Health Security Agency guidelines recommend that Trusts use locally developed risk assessments to accurately identify high-risk individuals for screening, and implement the most appropriate method of testing, but this presents many challenges. Methods A convenience sample of cross-specialty experts from across England met to discuss the barriers and practical solutions to implementing UK Health Security Agency framework into operational and clinical workflows. The group derived responses to six key questions that are frequently asked about screening for CPE. Key findings Four patient groups were identified for CPE screening: high-risk unplanned admissions, high-risk elective admissions, patients in high-risk units, and known positive contacts. Rapid molecular testing is a preferred screening method for some of these settings, offering faster turnaround times and more accurate results than culture-based testing. It is important to stimulate action now, as several lessons can be learnt from screening during the COVID-19 pandemic, as well as from CPE outbreaks. Conclusion Further decisive and instructive information is needed to establish CPE screening protocols based on local epidemiology and risk factors. Local management should continually evaluate local epidemiology, analysing data and undertaking frequent prevalence studies to understand risks, and prepare resources– such as upscaled screening– to prevent increasing prevalence, clusters or outbreaks. Rapid molecular-based methods will be a crucial part of these considerations, as they can reduce unnecessary isolation and opportunity costs.
Læs mere Tjek på PubMedMpirirwe, R., Segawa, I., Ojiambo, K. O., Kamacooko, O., Nangendo, J., Semitala, F. C., Kyambadde, P., Kalyango, J. N., Kiragga, A., Karamagi, C., Katahoire, A., Kamya, M., Mujugira, A.
BMJ Open, 26.04.2024
Tilføjet 26.04.2024
ObjectiveTo evaluate oral pre-exposure prophylaxis (PrEP) uptake, retention and adherence among female sex workers (FSWs) receiving care through community and facility delivery models in sub-Saharan Africa (SSA). DesignSystematic review and meta-analysis. Data sourcesWe searched online databases (PubMed, MEDLINE, SCOPUS, EMBASE, Google Scholar, Cochrane Database of Systematic Reviews and Web of Science) between January 2012 and 3 April 2022. Eligibility criteria for studiesRandomised controlled trials, cohort studies, cross-sectional studies and quasi-experimental studies with PrEP uptake, adherence and retention outcomes among FSWs in SSA. Data extraction and synthesisSeven coders extracted data. The framework of the Cochrane Consumers and Communication Review Group guided data synthesis. The Risk of Bias In Non-Randomized Studies of Interventions tool was used to evaluate the risk of bias. Meta-analysis was conducted using a random-effects model. A narrative synthesis was performed to analyse the primary outcomes of PrEP uptake, adherence and retention. ResultsOf 8538 records evaluated, 23 studies with 40 669 FSWs were included in this analysis. The pooled proportion of FSWs initiating PrEP was 70% (95% CI: 56% to 85%) in studies that reported on facility-based models and 49% (95% CI: 10% to 87%) in community-based models. At 6 months, the pooled proportion of FSWs retained was 66% (95% CI: 15% to 100%) for facility-based models and 83% (95% CI: 75% to 91%) for community-based models. Factors associated with increased PrEP uptake were visiting a sex worker programme (adjusted OR (aOR) 2.92; 95% CI: 1.91 to 4.46), having ≥10 clients per day (aOR 1.71; 95% CI: 1.06 to 2.76) and lack of access to free healthcare in government-run health clinics (relative risk: 1.16; 95% CI: 1.06 to 1.26). ConclusionsA hybrid approach incorporating both facility-based strategies for increasing uptake and community-based strategies for improving retention and adherence may effectively improve PrEP coverage among FSWs. PROSPERO registration numberCRD42020219363.
Læs mere Tjek på PubMedAmbrosio, L., Faulkner, J., Morris, J. H., Stuart, B., Lambrick, D., Compton, E., Portillo, M. C.
BMJ Open, 26.04.2024
Tilføjet 26.04.2024
ObjectiveTo understand the physical activity and mental health of individuals living with long-term conditions during the COVID-19 pandemic. DesignA sequential explanatory mixed-methods study with two phases: phase 1: quantitative survey and phase 2: qualitative follow-up interviews. SettingFor the quantitative phase, an online survey was launched in March 2021, using Microsoft Forms. For the qualitative phase, in-depth semistructured interviews were conducted via online. Participants368 adults over 18 years old living in the UK with at least one long-term condition completed the survey. Interviews were conducted in a subsample of participants from the previous quantitative phase, with 26 people. Data were analysed using thematic analysis. ResultsResponses from the survey showed that people with one long-term condition were significantly more physically active and spent less time sitting, than those with two or more conditions, presenting with significantly higher well-being (p
Læs mere Tjek på PubMedInfection, 26.04.2024
Tilføjet 26.04.2024
Abstract Background Mycoplasma genitalium (MG) is an emerging sexually transmitted infection, often harboring resistance-associated mutations to azithromycin (AZM). Global surveillance has been mandated to tackle the burden caused by MG, yet no data are available for Austria. Thus, we aimed to investigate the prevalence of MG, disease characteristics, and treatment outcomes at the largest Austrian HIV—and STI clinic. Methods All MG test results at the Medical University of Vienna from 02/2019 to 03/2022 were evaluated. Azithromycin resistance testing was implemented in 03/2021. Results Among 2671 MG tests, 199 distinct and mostly asymptomatic (68%; 135/199) MG infections were identified, affecting 10% (178/1775) of all individuals. This study included 83% (1479/1775) men, 53% (940/1775) men who have sex with men (MSM), 31% (540/1754) HIV+, and 15% (267/1775) who were using HIV pre-exposure prophylaxis (PrEP). In logistic regression analysis, ‘MSM’ (aOR 2.55 (95% CI 1.65–3.92)), ‘use of PrEP’ (aOR 2.29 (95% CI 1.58–3.32)), and ‘history of syphilis’ (aOR 1.57 (95% CI 1.01–2.24) were independent predictors for MG infections. Eighty-nine percent (178/199) received treatment: 11% (21/178) doxycycline (2 weeks), 52% (92/178) AZM (5 days), and 37% ( 65/178) moxifloxacin (7–10 days) and 60% (106/178) had follow-up data available showing negative tests in 63% (5/8), 76% (44/58) and 85% (34/40), respectively. AZM resistance analysis was available for 57% (114/199)) and detected in 68% (78/114). Resistance-guided therapy achieved a cure in 87% (53/61), yet, empiric AZM-treatment (prior to 03/2021) cleared 68% (26/38). Conclusions Mycoplasma genitalium was readily detected in this Austrian observational study, affected predominantly MSM and often presented as asymptomatic disease. We observed a worryingly high prevalence of AZM resistance mutations; however, empiric AZM treatment cleared twice as many MG infections as expected.
Læs mere Tjek på PubMedCole, S. W., Glick, J. L., Campoamor, N. B., Sanchez, T. H., Sarkar, S., Vannappagari, V., Rinehart, A., Rawlings, K., Sullivan, P. S., Bridges, J. F. P.
BMJ Open, 23.04.2024
Tilføjet 23.04.2024
IntroductionCabotegravir long-acting injectable HIV pre-exposure prophylaxis (LA-PrEP) was shown to be safe and effective in multiple clinical trials. Increasing uptake and persistence among populations with elevated risk for HIV acquisition, especially among men who have sex with men (MSM), is critical to HIV prevention. ObjectiveThis analysis aims to understand potential users’ preferences for LA-PrEP, with audience segmentation. DesignWillingness to use and preferences for LA-PrEP were measured in HIV-negative, sexually active MSM in the 2020 American Men’s Internet Survey. Respondents answered a discrete choice experiment with paired profiles of hypothetical LA-PrEP characteristics with an opt-out option (no LA-PrEP). Conditional and mixed logit models were run; the final model was a dummy-coded mixed logit that interacted with the opt-out. SettingUS national online sample. ResultsAmong 2506 MSM respondents, most (75%) indicated a willingness to use LA-PrEP versus daily oral PrEP versus no PrEP. Respondents were averse to side effects and increasing costs and preferred increasing levels of protection. Respondents preferred a 2-hour time to obtain LA-PrEP vs 1 hour, with a strong aversion to 3 hours. Overall, there was an aversion to opting out of LA-PrEP, with variations: those with only one partner, no/other insurance or who were Black, Indigenous or People of Colour were significantly less likely to prefer LA-PrEP, while those who were Hispanic/Latino, college educated and
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