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Journal of Infectious Diseases, 1.04.2024
Tilføjet 1.04.2024
Abstract Background H56:IC31 is a candidate vaccine against tuberculosis (TB) with the potential to reduce TB recurrence rate. It is thus important for future clinical trials to demonstrate safety and immunogenicity of H56:IC31 in individuals treated for TB.Methods 22 adults confirmed to be Mtb negative (by 2 GeneXpert tests or 2 sputum cultures) after four-five months of TB treatment, and not more than 28 days after completion of TB treatment, were randomized to receive two doses of H56:IC31 (5 mg H56:500 nmol IC31; N=16) or placebo (N=6) 56 days apart. Participants were followed for 420 days for safety and immunogenicity.Results H56:IC31 vaccination was associated with an acceptable safety profile, consisting mostly of mild self-limited injection site reactions. No serious adverse events, and no vaccine-related severe adverse events, were reported. H56:IC31 induced a CD4+ T-cell response for Ag85B and ESAT-6, with ESAT-6 being immunodominant, which persisted through six months after the last vaccination. There was some evidence of CD8+ T-cell responses for both Ag85B and ESAT-6, but to a lesser extent than CD4+ responses.Conclusions H56:IC31 was associated with an acceptable safety profile, and induced a predominant CD4+ T-cell response, in adults recently treated for drug-susceptible, uncomplicated pulmonary TB.Trial registration ClinicalTrials.gov, NCT02375698
Læs mere Tjek på PubMedJournal of Infectious Diseases, 1.04.2024
Tilføjet 1.04.2024
Abstract Vγ9Vδ2 T-cells play a key role in the innate immune response to viral infections through butyrophilin (BTN)-3A. Here, we reported that blood Vγ9Vδ2 T-cells decreased in clinically mild COVID-19 compared to healthy volunteers (HV), and was maintained up to 28-days and in the recovery period. Terminally differentiated Vγ9Vδ2 T-cells tend to be enriched on the day of diagnosis, 28-days after and during the recovery period. These cells showed cytotoxic and inflammatory activities following anti-BTN3A activation. BTN3A upregulation and Vγ9Vδ2 T-cell infiltration were observed in a lung biopsy from a fatal SARS-CoV-2 infection. In vitro, SARS-CoV-2 infection increased BTN3A expression in macrophages and lung cells that enhanced the anti-SARS-CoV-2 Vγ9Vδ2 T-cells cytotoxicity and IFNγ and TNFα. Increasing concentrations of anti-BTN3A lead to viral replication inhibition. Altogether, we report that Vγ9Vδ2 T-cells are important in the immune response against SARS-CoV-2 infection and that activation by an anti-BTN3A antibody may enhance their response.
Læs mere Tjek på PubMedJournal of Infectious Diseases, 1.04.2024
Tilføjet 1.04.2024
Abstract Enterovirus D68 (EV-D68) infections are associated with severe respiratory disease and acute flaccid myelitis (AFM). The European Non-Polio Enterovirus Network (ENPEN) aimed to investigate the epidemiological and genetic characteristics of EV-D68 and its clinical impact during the fall-winter season of 2021/22.From 19 European countries, 58 institutes reported 10,481 (6.8%) EV-positive samples of which 1,004 (9.6%) were identified as EV-D68 (852 respiratory samples). Clinical data was reported for 969 cases. 78.9% of infections were reported in children (0-5 years); 37.9% of cases were hospitalised. Acute respiratory distress was commonly noted (93.1%) followed by fever (49.4%). Neurological problems were observed in 6.4% of cases with six reported with AFM. Phylodynamic/Nextstrain and phylogenetic analyses based on 694 sequences showed the emergence of two novel B3-derived lineages, with no regional clustering.In conclusion, we describe a large-scale EV-D68 European upsurge with severe clinical impact and the emergence of B3-derived lineages.
Læs mere Tjek på PubMedGianni Bergamin, Joshua Hudson, Bart J Currie, Kate E Mounsey
International Journal of Infectious Diseases, 1.04.2024
Tilføjet 1.04.2024
Crusted scabies (CS, historically referred to as Norwegian scabies), caused by a proliferation of Sarcoptes scabiei mites, is a highly contagious and severe dermatological infection characterised by hyperkeratotic skin scaling that can progress from loose and flaky skin to thick adherent crusts. While hands and feet are most commonly affected, the most severe cases have near total body surface involvement [1]. Without adequate treatment, secondary infections can develop leading to bacterial sepsis with historically high fatality [2].
Læs mere Tjek på PubMedMalaria Journal, 1.04.2024
Tilføjet 1.04.2024
Abstract Background As part of implementation quality standards, community distributors are expected to ensure that only age-eligible children (aged 3–59 months) receive seasonal malaria chemoprevention (SMC) medicines during monthly campaigns. There is uncertainty about the extent to which SMC medicines are administered to ineligible children. This study aimed to assess the magnitude of this occurrence, while exploring the factors associated with it across nine states where SMC was delivered in Nigeria during the 2022 round. Methods This analysis was based on data from representative end-of-round SMC household surveys conducted in nine SMC-implementing states in Nigeria. Data of 3299 age-ineligible children aged > 5 years and their caregivers were extracted from the survey dataset. Prevalence of receipt of SMC medicines by ineligible children was described by child-, caregiver- and SMC-related factors. Mixed-effects multivariable logistic regression models were fitted to explore the factors associated with ineligible receipt of SMC medicines. Results 30.30% (95% CI 27.80–32.90) of ineligible children sampled received at least one dose of SMC medicines in 2022, the majority (60.60%) of whom were aged 5–6 years while the rest were aged 7–10 years. There were lower odds of an age-ineligible child receiving SMC among caregivers who had knowledge of SMC age eligibility (OR: 0.53, 95% CI 0.37–0.77, p
Læs mere Tjek på PubMedBMC Infectious Diseases, 31.03.2024
Tilføjet 31.03.2024
Abstract Background In recent years, Raoultella ornithinolytica (R. ornithinolytica) have attracted clinical attention as a new type of pathogen. A wide range of infections with these germs is reported, and commonly found in urinary tract infections, respiratory infections, and bacteremia. Case presentation We report the case of an elderly woman with liver abscess, choledocholithiasis and cholangitis, who developed gastric fistula and abdominal abscess after underwent choledocholithotomy, and R. ornithinolytica were isolated from the abdominal drainage fluid. The patient was treated with meropenem and levofloxacin and had a good outcome. Conclusions To the best of our knowledge, case of isolating R. ornithinolytica from a patient with non-viscerally abdominal abscess was extremely rare. We share a case of a woman with non-viscerally abdominal abscess secondary to postoperative gastric fistula, R. ornithinolytica was isolated from the patient’s pus, and the pathogenic bacteria may originate from the gastrointestinal tract. Based on this case, We should be cautious that invasive treatment may greatly increase the probability of infection with this pathogenic bacterium.
Læs mere Tjek på PubMedBMC Infectious Diseases, 31.03.2024
Tilføjet 31.03.2024
Abstract This comprehensive retrospective data-linkage study aimed at evaluating the impact of Direct-Acting Antivirals (DAAs) on Hepatitis C Virus (HCV) testing, treatment trends, and access to care in Tuscany over six years following their introduction. Utilizing administrative healthcare records, our work reveals a substantial increase in HCV tests in 2017, attributed to the decision to provide universal access to treatment. However, despite efforts to eradicate chronic HCV through a government-led plan, the target of treating 6,221 patients annually was not met, and services contracted after 2018, exacerbated by the COVID-19 pandemic. Key findings indicate a higher prevalence of HCV screening among females in the 33–53 age group, influenced by pregnancy-related recommendations, while diagnostic tests and treatment uptake were more common among males. Problematic substance users constituted a significant proportion of those tested and treated, emphasizing their priority in HCV screening. Our paper underscores the need for decentralized HCV models and alternative testing strategies, such as point-of-care assays, especially in populations accessing harm reduction services, communities, and prisons. The study acknowledges limitations in relying solely on administrative records, advocating for improved data access and timely linkages to accurately monitor HCV care cascades and inform regional plans. Despite challenges, the paper demonstrates the value of administrative record linkages in understanding the access to care pathway for hard-to-reach populations. The findings emphasize the importance of the national HCV elimination strategy and the need for enhanced data collection to assess progress accurately, providing insights for future regional and national interventions.
Læs mere Tjek på PubMedGianella, Sara; Anderson, Christy; Chaillon, Antoine; Wells, Alan; Porrachia, Magali; Caballero, Gemma; Vargas, Milenka; Lonergan, Joseph; Woodworth, Brendon; Gaitan, Noah; Rawlings, Stephen A.; Muttera, Leticia; Harkness, Liliana; Little, Susan J.; May, Susanne; Smith, Davey
AIDS, 30.03.2024
Tilføjet 30.03.2024
Objective: :We sought to determine if standard influenza and pneumococcal vaccines can be used to stimulate HIV reservoirs during antiretroviral therapy (ART). Design: :Prospective, randomized, double-blinded, placebo-controlled, crossover trial of two clinically recommended vaccines (influenza and pneumococcal). Methods: :Persons with HIV on ART (N = 54) were enrolled in the clinical trial. Blood was collected at baseline and days 2,4,7,14 and 30 postimmunizations. Levels of cellular HIV RNA and HIV DNA were measured by ddPCR. Expression of immunological markers on T cell subsets were measured by flow cytometry. Changes in unspliced cellular HIV RNA from baseline to day 7 postinjection between each vaccine and placebo was the primary outcome. Results: :Forty-seven participants completed at least one cycle and there were no serious adverse events related to the intervention. We observed no significant differences in the change in cellular HIV RNA after either vaccine compared to placebo at any timepoint. In secondary analyses we observed a transient increase in total HIV DNA levels after influenza vaccine, as well as increased T cell activation and exhaustion on CD4+ T cells after pneumococcal vaccine. Conclusions: :Clinically recommended vaccines were safe but did not appear to stimulate the immune system strongly enough to elicit significantly noticeable HIV RNA transcription during ART. Clinicaltrials.gov identifier: NCT02707692. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedWijstma, Eline S.; Jongen, Vita W.; Boyd, Anders; van den Elshout, Mark; de Vries, Henry J.C.; Davidovich, Udi; Anderson, Peter L.; Prins, Maria; Hoornenborg, Elske; Schim van der Loeff, Maarten F.
AIDS, 30.03.2024
Tilføjet 30.03.2024
Objective: We assessed the association and concordance between self-reported oral preexposure prophylaxis (PrEP) intake in a diary app and intraerythrocytic drug metabolite concentrations. Design: AMPrEP was a prospective demonstration study providing daily and event-driven PrEP to MSM in Amsterdam, the Netherlands (2015–2020). Methods: Participants could record their PrEP intake in a diary app. Dried blood spots (DBS) were taken at 6, 12, 24, and 48 months and analysed for tenofovir diphosphate (TFV-DP) and emtricitabine triphosphate (FTC-TP) concentrations. We included TFV-DP measurements preceded by diary completion on at least 90% of days in the 6 weeks prior. We examined the association between self-reported PrEP intake (i.e. number of pills) and TFV-DP concentrations using tobit regression with a random intercept per participant. We also calculated concordance between categorized PrEP intake (i.e.
Læs mere Tjek på PubMedMigisha, Richard; Chen, Geoffrey; Muyindike, Winnie R.; Aung, Taing Nandi; Nanfuka, Victoria; Komukama, Nimusiima; Chandiwana, Nomathemba; Shazi, Gugulethu; Tien, Dessie; Moosa, Mahomed-Yunus S.; Gupta, Ravindra K.; Pillay, Deenan; Marconi, Vincent C.; Hedt-Gauthier, Bethany; Venter, Willem D.F.; Siedner, Mark J.; McCluskey, Suzanne M.; Manne-Goehler, Jennifer
AIDS, 30.03.2024
Tilføjet 30.03.2024
Background: People with HIV (PWH) on integrase inhibitor-based regimens may be at risk of excess weight gain, but it is unclear if this risk is consistent across settings. We assessed weight change over 48 weeks among PWH who were transitioned to tenofovir disoproxil fumarate/lamivudine/dolutegravir (TLD). Design: We conducted a prospective cohort study at public-sector HIV clinics in Uganda and South Africa. Methods: Eligible participants were adults who were transitioned to TLD. Weight was measured at enrollment, 24-, and 48-weeks post TLD transition. Our outcomes were (1) weight change, (2) change in waist circumference, and (3) clinically significant weight gain, defined as ≥10% increase in weight from baseline, over 48 weeks. We used linear mixed-effects regression models, adjusted for demographic factors, to estimate weight gain and identify risk factors. Results: Weight data were available for 428 participants in Uganda and 367 in South Africa. The mean weight change was 0.6 kg [95%CI: 0.1–1.0] in Uganda and 2.9 kg [2.3–3.4] in South Africa (p
Læs mere Tjek på PubMedKemp, Christopher G.; Pence, Brian W.; Velloza, Jennifer; Concepcion, Tessa; Moitra, Modhurima; Iroezindu, Michael; Bahemana, Emmanuel; Kibuuka, Hannah; Semwogerere, Michael; Owuoth, John; Maswai, Jonah; Langat, Rither; Esber, Allahna L.; Dear, Nicole F.; Parikh, Ajay; Crowell, Trevor A.; Ake, Julie A.; Polyak, Christina S.; Collins, Pamela Y.; the AFRICOS Study Group
AIDS, 30.03.2024
Tilføjet 30.03.2024
Objective: :We estimated the effects of cumulative exposure to depressive symptoms on risk of all-cause mortality among people living with HIV in four African countries. Design: :Analysis of prospective cohort data. Methods: :The African Cohort Study (AFRICOS) is a prospective cohort of people receiving care at twelve clinics in Kenya, Nigeria, Tanzania, and Uganda. Every six months from January 2013 to May 2020, participants underwent laboratory monitoring, structured surveys, and assessment of depressive symptom severity using the Center for Epidemiologic Studies Depression Scale (CES-D). All-cause mortality was the outcome of interest. The predictor of interest was a time-updated measure of the percentage of days lived with depression (PDD). Marginal structural Cox proportional hazards regression models were used, adjusting for potential confounders including time-varying alcohol use, drug use, and viral load. Results: :Among 2520 enrolled participants, 1479 (59%) were women and the median age was 38 (interquartile range [IQR]: 32–46). At enrollment, 1438 (57%) were virally suppressed (
Læs mere Tjek på PubMedCholli, Preetam A.; Buchacz, Kate M.; Harris, Norma S.; Crim, Stacy M.; Yuan, Xin; Tie, Yunfeng; Koenig, Linda J.; Beer, Linda
AIDS, 30.03.2024
Tilføjet 30.03.2024
Objective(s): To evaluate associations between self-rated health (SRH) and care outcomes among United States adults with diagnosed HIV infection. Design: We analyzed interview and medical record data collected during June 2020–May 2021 from the Medical Monitoring Project, a complex, nationally representative sample of 3,692 people with HIV (PWH). Respondents reported SRH on a 5-point Likert type scale (poor to excellent), which we dichotomized into “good or better” and “poor or fair”. We computed weighted percentages with 95% confidence intervals (CIs) and age-adjusted prevalence ratios (aPRs) to investigate associations between SRH and HIV outcomes and demographic, psychosocial, and behavioral characteristics. Results: Nationally, 72% of PWH reported “good or better” SRH. PWH with the following characteristics had a lower prevalence of “good or better” SRH, compared with those without: any missed HIV care appointment in the last 12 months (aPR 0.86, 95% CI:0.81–0.91), symptoms of moderate or severe depression (aPR 0.51, 95% CI:0.43–0.59) and anxiety (aPR 0.60, 95% CI:0.54–0.68), unstable housing or homelessness (aPR 0.77, 95% CI:0.71–0.82), and hunger or food insecurity (aPR 0.74, 95% CI:0.69–0.80), as well as having a mean CD4 count 500 cells/mm3 (aPR 0.70, 95% CI:0.57–0.86). Conclusions: Though SRH is a holistic measure reflective of HIV outcomes, integrated approaches addressing needs beyond physical health are necessary to improve SRH among PWH in the U.S. Modifiable factors like mental health, unstable housing or homelessness, and food insecurity warrant further study as potential high-yield targets for clinical and policy interventions to improve SRH among PWH. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedHaw, Nel Jason L.; Lesko, Catherine R.; Ng, Derek K.; Lam, Jennifer; Lang, Raynell; Kitahata, Mari M.; Crane, Heidi; Eron, Joseph Jr.; Gill, M. John; Horberg, Michael A.; Karris, Maile; Loutfy, Mona; Mcginnis, Kathleen A.; Moore, Richard D.; Althoff, Keri; Agwu, Allison; North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD)∗
AIDS, 30.03.2024
Tilføjet 30.03.2024
Objective: To describe the incidence of diabetes mellitus type 2 (T2DM), hypercholesterolemia, hypertriglyceridemia, hypertension, and chronic kidney disease (CKD) from 2000 to 2019 among North American adults with perinatally-acquired HIV (PHIV) aged 18 to 30 Design: Description of outcomes based on electronic health records for a cohort of 375 young adults with PHIV enrolled in routine HIV care at clinics contributing data to the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) Methods: We estimated overall, sex-, and race-stratified cumulative incidences using Turnbull estimation, and incidence rates using quasi-Poisson regression. T2DM was defined as glycosylated hemoglobin >6.5% or based on clinical diagnosis and medication use. Hypercholesterolemia was based on medication use or total cholesterol ≥200 mg/dL. Hypertriglyceridemia was based on medication use or fasting triglyceride ≥150 mg/dL or non-fasting ≥200 mg/dL. Hypertension was based on clinical diagnosis. CKD was defined as estimated glomerular filtration rates
Læs mere Tjek på PubMedHu, Fei-Hong; Tang, Xiao-Lei; Ge, Meng-Wei; Jia, Yi-Jie; Zhang, Wan-Qing; Tang, Wen; Shen, Lu-Ting; Du, Wei; Xia, Xiao-Peng; Chen, Hong-Lin
AIDS, 30.03.2024
Tilføjet 30.03.2024
Objective: Children and adolescents with HIV infection are well-known to face a heightened risk of tuberculosis. However, the exact mortality rates and temporal trends of those with HIV-TB co-infection remain unclear. We aimed to identify the overall mortality and temporal trends within this population. Methods: PubMed, Web of Science, and Embase were employed to search for publications reporting on the mortality rates of children and adolescents with HIV-TB co-infection from inception to March 2, 2024. The outcome is the mortality rate for children and adolescents with HIV-TB co-infection during the follow-up period. In addition, we evaluate the temporal trends of mortality. Results: During the follow-up period, the pooled mortality was 16% (95% CI 13–20). Single infection of either HIV or TB exhibit lower mortality rates (6% and 4%, respectively). We observed elevated mortality risks among individuals aged less than 12 months, those with EPTB, poor adherence to ART, and severe immunosuppression. In addition, we observed a decreasing trend in mortality before 2008 and an increasing trend after 2008, although the trends were not statistically significant (P = 0.08 and 0.2 respectively). Conclusions: Children and adolescents with HIV-TB co-infection bear a significant burden of mortality. Timely screening, effective treatment, and a comprehensive follow-up system contribute to reducing the mortality burden in this population. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedQingni LiYunfeng ChenWenjing ZhangChunyang LiDing TangWanlu HuaFan HouZhuo ChenYuanlang LiuYi TianKaili SunXiuli XuYan ZengFei XiaJia LuZejun Wanga Biosafety Level 3 Laboratory, Wuhan Institute of Biological Products Co., Ltd., Wuhan, People’s Republic of Chinab National Engineering Technology Research Center for Combined Vaccines, Wuhan, People’s Republic of Chinac National Key Laboratory for Novel Vaccines Research and Development of Emerging Infectious Diseases, Wuhan, People’s Republic of Chinad Hubei Provincial Vaccine Technology Innovation Center, Wuhan, People’s Republic of China
Emerg Microbes Infect, 30.03.2024
Tilføjet 30.03.2024
Infectious Disease Modelling, 30.03.2024
Tilføjet 30.03.2024
Publication date: Available online 30 March 2024 Source: Infectious Disease Modelling Author(s): Kaijing Chen, Fengying Wei, Xinyan Zhang, Hao Jin, Zuwen Wang, Yue Zuo, Kai Fan
Læs mere Tjek på PubMedUshanandini Mohanraj, Liisa Väkevä, Annamari Ranki, Maria Söderlund‐Venermo
Journal of Medical Virology, 30.03.2024
Tilføjet 30.03.2024
Bei Jiang, Leijie Wang, Huan Liu, Lin Wang, Rui Su, Liang Xu, Guochao Wei, Jia Li, Fengmin Lu, Xiangmei Chen
Journal of Medical Virology, 30.03.2024
Tilføjet 30.03.2024
Getnet Amsalu, Christine Tedijanto Wen, Olga Perovic, Addisalem Gebru, Bezawit M. Hunegnaw, Fisseha Tadesse, Marshagne Smith, Addisalem Fikre, Delayehu Bekele, Lisanu Taddesse, Grace Chan
International Journal of Infectious Diseases, 30.03.2024
Tilføjet 30.03.2024
Neonatal infections, particularly sepsis, meningitis, and pneumonia, are among the most common causes of mortality in the first 28 days of life, accounting for approximately 23% of 2.4 million neonatal deaths worldwide [1,2]. Treatment of infections is increasingly challenging in the context of antimicrobial resistance [3], with over 40% of neonatal sepsis cases estimated to have resistance or reduced susceptibility to both the first- (ampicillin/penicillin and gentamicin) and second-line (third-generation cephalosporins) treatments recommended by the World Health Organization (WHO) [4].
Læs mere Tjek på PubMedIván Sanz-Muñoz, Javier Sánchez-Martínez, Carla Rodríguez-Crespo, Irene Arroyo-Hernantes, Marta Domínguez-Gil, Silvia Rojo-Rello, Marta Hernández, José M Eiros
International Journal of Infectious Diseases, 30.03.2024
Tilføjet 30.03.2024
Since the precise significance of viral load (VL) test for the management and treatment of patients with respiratory viruses remains unknown, it is not a commonly used tool. However, since the COVID-19 pandemic, VL evaluation has gained popularity in the scientific community and healthcare providers due to the possible application in daily clinical practice and research [1–3]. During the worst part of the pandemic, when hospitalization was overcrowded and a huge need for resources was the most important issue, the Ct value (Cycle threshold), a subrogate of the VL, was used as a criterion for discharging patients.
Læs mere Tjek på PubMedAndré Teixeira Antunes, Pierre Monney, Georgios Tzimas, Piergiorgio Tozzi, Matthias Kirsch, Benoit Guery, Matthaios Papadimitriou-Olivgeris
International Journal of Infectious Diseases, 30.03.2024
Tilføjet 30.03.2024
Blood cultures are the cornerstone for diagnosing infective endocarditis (IE), identifying the microbial cause in over 90% of cases [1]. The significance of blood cultures in diagnosing IE is underscored by their incorporation into all versions of the Duke criteria as a major criterion, alongside the presence of typical intracardiac lesions [1]. In inconclusive initial assessments, persistently positive follow-up blood cultures heighten the suspicion of IE [1]. Follow-up blood cultures are integral for managing intravascular infections like IE, S.
Læs mere Tjek på PubMedNicolas Salvadori, Gonzague Jourdain, Rungroj Krittayaphong, Taweegrit Siripongboonsitti, Subsai Kongsaengdao, Kriangsak Atipornwanich, Parichart Sakulkonkij, Nasikarn Angkasekwinai, Rujipas Sirijatuphat, Sarunyou Chusri, Tanavit Mekavuthikul, Anucha Apisarnthanarak, Sirawat Srichatrapimuk, Somnuek Sungkanuparph, Suppachok Kirdlarp, Thanyakamol Phongnarudech, Suraphan Sangsawang, Panuwat Napinkul, Jullapong Achalapong, Suwimon Khusuwan, Piyanut Pratipanawat, Pornboonya Nookeu, Namphol Danpipat, Pornvimol Leethong, Piya Hanvoravongchai, Pra-ornsuda Sukrakanchana, Prasert Auewarakul
International Journal of Infectious Diseases, 30.03.2024
Tilføjet 30.03.2024
Evaluate and compare the efficacy and safety of molnupiravir and favipiravir in outpatients with mild to moderate COVID-19 and at risk of severe COVID-19.
Læs mere Tjek på PubMedNeupane, Maniraj; De Jonge, Nathaniel; Angelo, Sahil; Sarzynski, Sadia; Sun, Junfeng; Rochwerg, Bram; Hick, John; Mitchell, Steven H.; Warner, Sarah; Mancera, Alex; Cooper, Diane; Kadri, Sameer S.
Critical Care Medicine, 30.03.2024
Tilføjet 30.03.2024
Objectives: COVID-19 pandemic surges strained hospitals globally. We performed a systematic review to examine measures of pandemic caseload surge and its impact on mortality of hospitalized patients. Data Sources: PubMed, Embase, and Web of Science. Study Selection: English-language studies published between December 1, 2019, and November 22, 2023, which reported the association between pandemic “surge”-related measures and mortality in hospitalized patients. Data Extraction: Three authors independently screened studies, extracted data, and assessed individual study risk of bias. We assessed measures of surge qualitatively across included studies. Given multidomain heterogeneity, we semiquantitatively aggregated surge–mortality associations. Data Synthesis: Of 17,831 citations, we included 39 studies, 17 of which specifically described surge effects in ICU settings. The majority of studies were from high-income countries (n = 35 studies) and included patients with COVID-19 (n = 31). There were 37 different surge metrics which were mapped into four broad themes, incorporating caseloads either directly as unadjusted counts (n = 11), nested in occupancy (n = 14), including additional factors (e.g., resource needs, speed of occupancy; n = 10), or using indirect proxies (e.g., altered staffing ratios, alternative care settings; n = 4). Notwithstanding metric heterogeneity, 32 of 39 studies (82%) reported detrimental adjusted odds/hazard ratio for caseload surge–mortality outcomes, reporting point estimates of up to four-fold increased risk of mortality. This signal persisted among study subgroups categorized by publication year, patient types, clinical settings, and country income status. Conclusions: Pandemic caseload surge was associated with lower survival across most studies regardless of jurisdiction, timing, and population. Markedly variable surge strain measures precluded meta-analysis and findings have uncertain generalizability to lower-middle-income countries (LMICs). These findings underscore the need for establishing a consensus surge metric that is sensitive to capturing harms in everyday fluctuations and future pandemics and is scalable to LMICs.
Læs mere Tjek på PubMedClinical & Experimental Immunology, 30.03.2024
Tilføjet 30.03.2024
Abstract The intestine hosts the largest immune cell compartment in the body as a result of its continuous exposure to exogenous antigens. The intestinal barrier is formed by a single layer of epithelial cells which separate immune cells from the gut lumen. Bidirectional interactions between the epithelium and the immune compartment are critical for maintaining intestinal homeostasis by limiting infection, preventing excessive immune activation, and promoting tissue repair processes. However, our understanding of epithelial–immune interactions incomplete as the complexity of in vivo models can hinder mechanistic studies, cell culture models lack the cellular heterogeneity of the intestine and when established from primary cell can be difficult to maintain. In the last decade, organoids have emerged as a reliable model of the intestine, recapitulating key cellular and architectural features of native tissues. Herein, we provide an overview of how intestinal organoids are being co-cultured with immune cells leading to substantial advances in our understanding of immune–epithelial interactions in the gut. This has enabled new discoveries of the immune contribution to epithelial maintenance and regeneration both in homeostasis and in disease such as chronic inflammation, infection and cancer. Organoids can additionally be used to generate immune cells with a tissue-specific phenotype and to investigate the impact of disease associated risk genes on the intestinal immune environment. Accordingly, this review demonstrates the multitude of applications for intestinal organoids in immunological research and their potential for translational approaches.
Læs mere Tjek på PubMedKeene, C. M., Dickinson, S., Naidoo, R., Andersen-Waine, B., Ferguson-Lewis, A., Polner, A., Amswych, M., White, L., Molyneux, S., Wanat, M., EY-Oxford Health Analytics Consortium, Moldokmatova, Polner, Ferguson-Lewis, Andersen-Waine, Gao, Franco, Keene, Rowe, Norman, Stepniewska, Bimpong, Cantrell, White, Tsui, Amswych, Wanat, Mills, Voysey, Kasim, Dahal, Hounsell, Naidoo, Lewis, Shretta, Anye, Aguas, Creswell, Dittrich, Molyneux, Chen, Silal, Saralamba, Dickinson, Bajaj, Pokharel, Evans, Mahmood, Pan-ngum, Lambert
BMJ Open, 30.03.2024
Tilføjet 30.03.2024
ObjectiveTesting for COVID-19 was a key component of the UK’s response to the COVID-19 pandemic. This strategy relied on positive individuals self-isolating to reduce transmission, making isolation the lynchpin in the public health approach. Therefore, we scoped evidence to systematically identify and categorise barriers and facilitators to compliance with self-isolation guidance during the COVID-19 pandemic in the UK, to inform public health strategies in future pandemics. DesignA rapid scoping review was conducted. Search strategyKey terms were used to search literature databases (PubMed, Scopus and the WHO COVID-19 Research Database, on 7 November 2022), Google Scholar and stakeholder-identified manuscripts, ultimately including evidence published in English from UK-based studies conducted between 2020 and 2022. Data extraction and synthesisData were extracted and synthesised into themes, organised broadly into capability, opportunity and motivation, and reviewed with key stakeholders from the UK Health Security Agency (UKHSA). ResultsWe included 105 sources, with 63 identified from UKHSA and used to inform their decision-making during the pandemic. Influences on the decision to comply with isolation guidance were categorised into six themes: perceived ability to isolate; information and guidance; logistics; social influences, including trust; perceived value; and perceived consequences. Individuals continuously assessed these factors in deciding whether or not to comply with guidance and self-isolate. ConclusionsDecisions to self-isolate after a positive test were influenced by multiple factors, including individuals’ beliefs, concerns, priorities and personal circumstances. Future testing strategies must facilitate meaningful financial, practical and mental health support to allow individuals to overcome the perceived and actual negative consequences of isolating. Clear, consistent communication of the purpose and procedures of isolating will also be critical to support compliance with self-isolation guidance, and should leverage people’s perceived value in protecting others. Building public trust is also essential, but requires investment before the next pandemic starts.
Læs mere Tjek på PubMedSaillard, C., Cuvelier, S., Villaron-Goetgheluck, C., Boher, J.-M., Almeida-Lopez, L., Le Corroller, A.-G., Denis, P., Rivieccio, C., Calvin, S., Vey, N., Bannier-Braticevic, C.
BMJ Open, 30.03.2024
Tilføjet 30.03.2024
ObjectivesAcute myeloid leukaemia (AML) and high-risk myelodysplastic syndromes (MDS) are often treated with intensive chemotherapy followed by allogeneic haematopoietic stem cell transplantation (allo-HSCT). The pretransplant treatment results in a general deterioration of the patient’s health and quality of life. Furthermore, allo-HSCT can be responsible for significant toxicity with risks of graft-versus-host disease (GvHD). Developing strategies to prevent physical deconditioning, undernutrition and psychological distress could help maintain a satisfactory general state of health before transplantation and thus limit these deleterious effects. This protocol evaluates the feasibility and adherence to a personalised prehabilitation programme, which can be modulated and assisted by connected objects, provided from the diagnosis to the allo-HSCT. Methods and analysisThis multicentre interventional study will include 50 patients treated for AML or high-risk MDS with intensive chemotherapy and eligible for allo-HSCT. The intervention consists of a coached, supervised or self-directed physical activity programme, organised during the hospitalisation phases and periods at home. At the same time, patients will receive a weekly dietary follow-up. The whole intervention is controlled and modulated through the use of a dedicated application and connected objects allowing adaptation and individualisation. The rate of participation in the prescribed physical activity sessions will assess the feasibility of this study. In addition, the evolution of physical capacities (Short Physical Performance Battery, grip and quadriceps strengths), psychosocial parameters (Functional Assessment of Cancer Therapy - Leukaemia, Functional Assessment of Cancer Therapy - Fatigue, subjective well-being, Hospital Anxiety and Depression Scale, self-efficacy, Coach-Athlete Relationship Questionnaire, interviews) and clinical status (weight, lean body mass, survival rate, number of infections, days of hospitalisation, GvHD) will be evaluated. Ethics and disseminationThe study procedures have been approved by the National Ethics Committee (21.00223.000003). Consent is given in person by each participant. The information collected on the participants contains only a non-identifiable study identifier. The results of this protocol will be published in a scientific paper and communicated to the medical staff of the medical centre. Trial registration numberNCT03595787.
Læs mere Tjek på PubMedPeter, D., Li, S.-X., Wang, Y., Zhang, J., Grady, J., McDowell, K., Norton, E., Lin, Z., Bernheim, S., Venkatesh, A. K., Fleisher, L. A., Schreiber, M., Suter, L. G., Triche, E. W.
BMJ Open, 30.03.2024
Tilføjet 30.03.2024
ObjectivesThe extent to which care quality influenced outcomes for patients hospitalised with COVID-19 is unknown. Our objective was to determine if prepandemic hospital quality is associated with mortality among Medicare patients hospitalised with COVID-19. DesignThis is a retrospective observational study. We calculated hospital-level risk-standardised in-hospital and 30-day mortality rates (risk-standardised mortality rates, RSMRs) for patients hospitalised with COVID-19, and correlation coefficients between RSMRs and pre-COVID-19 hospital quality, overall and stratified by hospital characteristics. SettingShort-term acute care hospitals and critical access hospitals in the USA. ParticipantsHospitalised Medicare beneficiaries (Fee-For-Service and Medicare Advantage) age 65 and older hospitalised with COVID-19, discharged between 1 April 2020 and 30 September 2021. Intervention/exposurePre-COVID-19 hospital quality. OutcomesRisk-standardised COVID-19 in-hospital and 30-day mortality rates (RSMRs). ResultsIn-hospital (n=4256) RSMRs for Medicare patients hospitalised with COVID-19 (April 2020–September 2021) ranged from 4.5% to 59.9% (median 18.2%; IQR 14.7%–23.7%); 30-day RSMRs ranged from 12.9% to 56.2% (IQR 24.6%–30.6%). COVID-19 RSMRs were negatively correlated with star rating summary scores (in-hospital correlation coefficient –0.41, p
Læs mere Tjek på PubMedLin, D., Hu, B., Xiu, Y., Ji, R., Zeng, H., Chen, H., Wu, Y.
BMJ Open, 30.03.2024
Tilføjet 30.03.2024
ObjectiveTo identify risk factors for premature rupture of membranes (PROM) in pregnant women. DesignSystematic review and meta-analysis. Data sourcesWeb of Science, PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, Chinese Scientific Journal Database (VIP) and China Biology Medicine Disc were searched from inception to October 2022. Eligibility criteriaCross-sectional, case–control and cohort studies published in English or Chinese that reported the risk factors for PROM were eligible for inclusion. Data extraction and synthesisTwo reviewers independently extracted the data and evaluated the risk of bias using the Newcastle–Ottawa Scale and American Agency for Healthcare Research and Quality tools. Analyses were performed using RevMan 5.4 software, and heterogeneity was assessed using 2 tests and I2 statistics. The sensitivity analyses included a methodological transition between fixed-effect and random-effect models and the systematic stepwise exclusion of studies. ResultsA total of 21 studies involving 18 174 participants with 18 risk factors were included. The significant risk factors were low Body Mass Index (BMI) (OR 2.18, 95% CI 1.32 to 3.61), interpregnancy interval (IPI)
Læs mere Tjek på PubMedMollons, M., Levasseur-Puhach, S., Kaur, J., Doyle, J., Giesbrecht, G., Lebel, C. A., Woods, L., Tomfohr-Madsen, L., Roos, L.
BMJ Open, 30.03.2024
Tilføjet 30.03.2024
ObjectivesThis study aimed to explore how the unprecedented stressors associated with the COVID-19 pandemic may have contributed to heightened levels of depression and anxiety among pregnant Indigenous persons, and identify protective individual-level factors. DesignThe current study used a mixed-methods design including standardised questionnaires and open-ended response questions. Using hierarchical regression models, we examined the extent to which COVID-19-related factors of service disruption (ie, changes to prenatal care, changes to birth plans and social support) were associated with mental well-being. Further, through qualitative analyses of open-ended questions, we examined the coping strategies used by pregnant Indigenous persons in response to the pandemic. SettingParticipants responded to an online questionnaire consisting of standardised measures from 2020 to 2021. ParticipantsThe study included 336 self-identifying Indigenous pregnant persons in Canada. ResultsDescriptive results revealed elevated rates of clinically relevant depression (52.7%) and anxiety (62.5%) symptoms among this population. 76.8% of participants reported prenatal care service disruptions, including appointment cancellations. Thematic analyses identified coping themes of staying informed, social and/or cultural connections and activities, and internal mental well-being strategies. Disruptions to services and decreased quality of prenatal care negatively impacted mental well-being of Indigenous pregnant persons during the COVID-19 pandemic. ConclusionsGiven the potential for mental well-being challenges to persist and long-term effects of perinatal distress, it is important to examine the quality of care that pregnant individuals receive. Service providers should advance policies and practices that promote relationship quality and health system engagement as key factors linked to well-being during the perinatal period for Indigenous persons.
Læs mere Tjek på PubMedGupta, R., Sharma, K., Khedar, R. S., Sharma, S. K., Makkar, J. S., Natani, V., Bana, A., Sharma, S.
BMJ Open, 30.03.2024
Tilføjet 30.03.2024
ObjectiveThe study examined the influence of the COVID-19 pandemic in India on variation in clinical features, management and in-hospital outcomes in patients undergoing percutaneous coronary intervention (PCI). DesignProspective registry-based observational study. SettingA tertiary care hospital in India participant in the American College of Cardiology CathPCI Registry. Participants7089 successive patients who underwent PCI from April 2018 to March 2023 were enrolled (men 5627, women 1462). Details of risk factors, clinical presentation, coronary angiography, coronary interventions, clinical management and in-hospital outcomes were recorded. Annual data were classified into specific COVID-19 periods according to Government of India guidelines as pre-COVID-19 (April 2018 to March 2019, n=1563; April 2019 to March 2020, n=1594), COVID-19 (April 2020 to March 2020, n=1206; April 2021 to March 2022, n=1223) and post-COVID-19 (April 2022 to March 2023, n=1503). ResultsCompared with the patients in pre-COVID-19 and post-COVID-19 periods, during the first COVID-19 year, patients had more hypertension, non-ST elevation myocardial infarction (NSTEMI), lower left ventricular ejection fraction (LVEF) and multivessel coronary artery disease (CAD). In the second COVID-19 year, patients had more STEMI, lower LVEF, multivessel CAD, primary PCI, multiple stents and more vasopressor and mechanical support. There were 99 (1.4%) in-hospital deaths which in the successive years were 1.2%, 1.4%, 0.8%, 2.4% and 1.3%, respectively (p=0.019). Compared with the baseline year, deaths were slightly lower in the first COVID-19-year (age-sex adjusted OR 0.68, 95% CI 0.31 to 1.47) but significantly more in the second COVID-19-year (OR 1.97, 95% CI 1.10 to 3.54). This variation attenuated following adjustment for clinical presentation, extent of CAD, in-hospital treatment and duration of hospitalisation. ConclusionsIn-hospital mortality among patients with CAD undergoing PCI was significantly higher in the second year of the COVID-19 pandemic in India and could be one of the reasons for excess deaths in the country. These patients had more severe CAD, lower LVEF, and more vasopressor and mechanical support and duration of hospitalisation.
Læs mere Tjek på PubMedKurotschka, P. K., Borgulya, G., Bucher, E., Endrich, I., Figueiras, A., Gensichen, J., Hay, A. D., Hapfelmeier, A., Kretzschmann, C., Kurzai, O., Lam, T.-T., Massidda, O., Sanftenberg, L., Schmiemann, G., Schneider, A., Simmenroth, A., Stark, S., Warkentin, L., Ebell, M. H., Gagyor, I., on behalf of the Bavarian Practice-Based Research Network (BayFoNet), Baumgärtel, Bössenecker, Dreischulte, Eck, Hueber, Klanke, Kühlein, Lasher, Linde, Lorenz-Dant, Roos, Uebel, Walter
BMJ Open, 30.03.2024
Tilføjet 30.03.2024
IntroductionUncomplicated urinary tract infections (uUTIs) in women are common infections encountered in primary care. Evidence suggests that rapid point-of-care tests (POCTs) to detect bacteria and erythrocytes in urine at presentation may help primary care clinicians to identify women with uUTIs in whom antibiotics can be withheld without influencing clinical outcomes. This pilot study aims to provide preliminary evidence on whether a POCT informed management of uUTI in women can safely reduce antibiotic use. Methods and analysisThis is an open-label two-arm parallel cluster-randomised controlled pilot trial. 20 general practices affiliated with the Bavarian Practice-Based Research Network (BayFoNet) in Germany were randomly assigned to deliver patient management based on POCTs or to provide usual care. POCTs consist of phase-contrast microscopy to detect bacteria and urinary dipsticks to detect erythrocytes in urine samples. In both arms, urine samples will be obtained at presentation for POCTs (intervention arm only) and microbiological analysis. Women will be followed-up for 28 days from enrolment using self-reported symptom diaries, telephone follow-up and a review of the electronic medical record. Primary outcomes are feasibility of patient enrolment and retention rates per site, which will be summarised by means and SDs, with corresponding confidence and prediction intervals. Secondary outcomes include antibiotic use for UTI at day 28, time to symptom resolution, symptom burden, number of recurrent and upper UTIs and re-consultations and diagnostic accuracy of POCTs versus urine culture as the reference standard. These outcomes will be explored at cluster-levels and individual-levels using descriptive statistics, two-sample hypothesis tests and mixed effects models or generalised estimation equations. Ethics and disseminationThe University of Würzburg institutional review board approved MicUTI on 16 December 2022 (protocol n. 109/22-sc). Study findings will be disseminated through peer-reviewed publications, conferences, reports addressed to clinicians and the local citizen’s forums. Trial registration numberClinicalTrials.gov NCT05667207.
Læs mere Tjek på PubMedZhong, L., Zhong, Y., Chen, W., Liang, F., Liao, Y., Zhou, Y.
BMJ Open, 30.03.2024
Tilføjet 30.03.2024
ObjectiveThe association between haemoglobin-to-red blood cell distribution width ratio (HRR) and all-cause mortality remains poorly understood. This study aimed to examine the influence of HRR at the time of admission mortality over 1 year and 30 days in patients with sepsis. DesignThis was a secondary analysis. SettingThis study was conducted in intensive care units (ICUs). ParticipantsAdult patients with sepsis were identified and included from an intensive care database based on eligibility criteria. Primary outcome and measureThe primary outcome was the rate of death within 1 year. The secondary outcome was the death rate within 30 days. ResultsA total of 4233 patients with sepsis who met the inclusion criteria were analysed, excluding those ineligible. These participants were divided into quartiles based on their HRR at admission. The overall mortality rates at 1 year and 30 days were 42.9% and 25.5%, respectively. A significant inverse association was observed between HRR quartiles and all-cause mortality (p
Læs mere Tjek på PubMedGolden, B. N., Elrefaay, S., McLemore, M. R., Alspaugh, A., Baltzell, K., Franck, L. S.
BMJ Open, 30.03.2024
Tilføjet 30.03.2024
IntroductionIncreasing the midwifery workforce has been identified as an evidence-based approach to decrease maternal mortality and reproductive health disparities worldwide. Concurrently, the profession of midwifery, as with all healthcare professions, has undergone a significant shift in practice with acceleration of telehealth use to expand access. We conducted a systematic literature review to identify and synthesize the existing evidence regarding how midwives experience, perceive and accept providing sexual and reproductive healthcare services at a distance with telehealth. MethodsFive databases were searched, PubMed, CINHAL, PsychInfo, Embase and the Web of Science, using search terms related to ‘midwives’, ‘telehealth’ and ‘experience’. Peer-reviewed studies with quantitative, qualitative or mixed methods designs published in English were retrieved and screened. Studies meeting the inclusion criteria were subjected to full-text data extraction and appraisal of quality. Using a convergent approach, the findings were synthesized into major themes and subthemes. ResultsAfter applying the inclusion/exclusion criteria, 10 articles on midwives’ experience of telehealth were reviewed. The major themes that emerged were summarized as integrating telehealth into clinical practice; balancing increased connectivity; challenges with building relationships via telehealth; centring some patients while distancing others; and experiences of telehealth by age and professional experience. ConclusionsMost current studies suggest that midwives’ experience of telehealth is deeply intertwined with midwives’ experience of the response to COVID-19 pandemic in general. More research is needed to understand how sustained use of telehealth or newer hybrid models of telehealth and in-person care are perceived by midwives.
Læs mere Tjek på PubMedSharma, Y., Sumanadasa, S., Shahi, R., Thompson, C.
BMJ Open, 30.03.2024
Tilføjet 30.03.2024
IntroductionCommunity-acquired pneumonia (CAP) is a leading cause of hospitalisation and is associated with a high mortality. Vitamin C is a powerful antioxidant and has been used in treatment of infections; however, its role as an adjunctive treatment in CAP is unclear. This review aims to assess the efficacy and safety of vitamin C in adults who require hospitalisation for CAP. Methods and analysesSearches will be conducted from inception to November 2023 on Ovid MEDLINE Daily and MEDLINE, Embase CINAHL, the Cochrane Central Register of Controlled Trials, Scopus, Web of Science and ClinicalTrials.gov databases with the aid of a medical librarian. We will include data from randomised controlled trials reporting vitamin C supplementation in patients with CAP requiring hospitalisation. Two independent reviewers will select studies, extract data and will assess the risk of bias by use of the Risk of Bias tool. The overall certainty of evidence will be assessed by use of the Grading of Recommendations Assessment, Development and Evaluation framework. Random-effects meta-analyses will be conducted, and effect measures will be reported as relative risks with 95% CIs. Ethics and disseminationNo previous ethical approval is required for this review. The findings of this review will be submitted to a scientific journal and presented at an international medical conference. PROSPERO registration number483860.
Læs mere Tjek på PubMedBMC Infectious Diseases, 30.03.2024
Tilføjet 30.03.2024
Abstract Background Since the early 1970s, cholera outbreaks have been a major public health burden in the Democratic Republic of Congo (DRC). Cholera cases have been reported in a quasi-continuous manner in certain lakeside areas in the Great Lakes Region. As these cholera-endemic health zones constitute a starting point for outbreaks and diffusion towards other at-risk areas, they play a major role in cholera dynamics in the country. Monitoring the spatiotemporal dynamics of cholera hotspots and adjusting interventions accordingly thus reduces the disease burden in an efficient and cost-effective manner. Methods A literature review was conducted to describe the spatiotemporal dynamics of cholera in the DRC at the province level from 1973 to 1999. We then identified and classified cholera hotspots at the provincial and health zone levels from 2003 to 2022 and described the spatiotemporal evolution of hotspots. We also applied and compared three different classification methods to ensure that cholera hotspots are identified and classified according to the DRC context. Results According to all three methods, high-priority hotspots were concentrated in the eastern Great Lakes Region. Overall, hotspots largely remained unchanged over the course of the study period, although slight improvements were observed in some eastern hotspots, while other non-endemic areas in the west experienced an increase in cholera outbreaks. The Global Task Force on Cholera Control (GTFCC) and the Department of Ecology and Infectious Disease Control (DEIDC) methods largely yielded similar results for the high-risk hotspots. However, the medium-priority hotspots identified by the GTFCC method were further sub-classified by the DEIDC method, thereby providing a more detailed ranking for priority targeting. Conclusions Overall, the findings of this comprehensive study shed light on the dynamics of cholera hotspots in the DRC from 1973 to 2022. These results may serve as an evidence-based foundation for public health officials and policymakers to improve the implementation of the Multisectoral Cholera Elimination Plan, guiding targeted interventions and resource allocation to mitigate the impact of cholera in vulnerable communities.
Læs mere Tjek på PubMedBMC Infectious Diseases, 30.03.2024
Tilføjet 30.03.2024
Abstract Background There are abundant studies on COVID-19 but few on its impact on hepatitis E. We aimed to assess the effect of the COVID-19 countermeasures on the pattern of hepatitis E incidence and explore the application of time series models in analyzing this pattern. Methods Our pivotal idea was to fit a pre-COVID-19 model with data from before the COVID-19 outbreak and use the deviation between forecast values and actual values to reflect the effect of COVID-19 countermeasures. We analyzed the pattern of hepatitis E incidence in China from 2013 to 2018. We evaluated the fitting and forecasting capability of 3 methods before the COVID-19 outbreak. Furthermore, we employed these methods to construct pre-COVID-19 incidence models and compare post-COVID-19 forecasts with reality. Results Before the COVID-19 outbreak, the Chinese hepatitis E incidence pattern was overall stationary and seasonal, with a peak in March, a trough in October, and higher levels in winter and spring than in summer and autumn, annually. Nevertheless, post-COVID-19 forecasts from pre-COVID-19 models were extremely different from reality in sectional periods but congruous in others. Conclusions Since the COVID-19 pandemic, the Chinese hepatitis E incidence pattern has altered substantially, and the incidence has greatly decreased. The effect of the COVID-19 countermeasures on the pattern of hepatitis E incidence was temporary. The incidence of hepatitis E was anticipated to gradually revert to its pre-COVID-19 pattern.
Læs mere Tjek på PubMedBMC Infectious Diseases, 30.03.2024
Tilføjet 30.03.2024
Abstract Background The burden of cervical cancer in Ghana is high due to a lack of a national screening and vaccination program. Geographical variations in high-risk Human Papilloma Virus incidence and type should be considered for vaccine improvement and screening in LMICs. Methods A descriptive, multi-center cross-sectional study with purposive sampling of cases with cervical cancer diagnosed from January 2012 through to December 2018 was employed relying on archived Formalin Fixed Paraffin Embedded (FFPE) tissues from four (4) Teaching Hospitals. Cervical cancers were assessed for histopathological features following WHO guidelines. In addition, the novel Tumour Budding and Nest Size Grade (TBNS) for SCC, SILVA pattern of invasion for EAC and Tumour Infiltrating Lymphocytes (TILs) were assessed. High Risk HPV testing was performed using an isothermal, multiplex nucleic acid amplification method from ATILA biosystem (Mountain View California, USA). The FFPE blocks were tested for 15 hrHPV genotypes. Results were analyzed using SPSS v.26.0, with descriptive statistics and cross-tabulation and chi-square tests done with significance established at p
Læs mere Tjek på PubMedBMC Infectious Diseases, 30.03.2024
Tilføjet 30.03.2024
Abstract Background This real-world study assessed the epidemiology and clinical complications of Clostridioides difficile infections (CDIs) and recurrences (rCDIs) in hospital and community settings in Germany from 2015 − 2019. Methods An observational retrospective cohort study was conducted among adult patients diagnosed with CDI in hospital and community settings using statutory health insurance claims data from the BKK database. A cross-sectional approach was used to estimate the annual incidence rate of CDI and rCDI episodes per 100,000 insurants. Patients’ demographic and clinical characteristics were described at the time of first CDI episode. Kaplan-Meier method was used to estimate the time to rCDIs and time to complications (colonic perforation, colectomy, loop ileostomy, toxic megacolon, ulcerative colitis, peritonitis, and sepsis). A Cox model was used to assess the risk of developing complications, with the number of rCDIs as a time-dependent covariate. Results A total of 15,402 CDI episodes were recorded among 11,884 patients. The overall incidence of CDI episodes declined by 38% from 2015 to 2019. Most patients (77%) were aged ≥ 65 years. Around 19% of CDI patients experienced at least one rCDI. The median time between index CDI episode to a rCDI was 20 days. The most frequent complication within 12-months of follow-up after the index CDI episode was sepsis (7.57%), followed by colectomy (3.20%). The rate of complications increased with the number of rCDIs. The risk of any complication increased by 31% with each subsequent rCDI (adjusted hazard ratio [HR]: 1.31, 95% confidence interval: 1.17;1.46). Conclusions CDI remains a public health concern in Germany despite a decline in the incidence over recent years. A substantial proportion of CDI patients experience rCDIs, which increase the risk of severe clinical complications. The results highlight an increasing need of improved therapeutic management of CDI, particularly efforts to prevent rCDI.
Læs mere Tjek på PubMedBMC Infectious Diseases, 30.03.2024
Tilføjet 30.03.2024
Abstract Background The prevalence and distinction between first Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and reinfection with the Omicron variant among healthcare workers (HCWs) remain unclear. Methods A cross-sectional study was conducted at a hospital in Southern China. The study included 262 HCWs who were infected with SARS-CoV-2 between April and June 2023, with 101 cases of first infection and 161 ones of reinfection. Student’s t-test, Analysis of Variance (ANOVA), and Mann-Whitney U tests were used based on the distribution of quantitative variables. Pearson’s chi-square and Fisher’s exact tests were used based on the expected frequencies of categorical variables. Results The reinfection rate among HCWs was 11.5% (161/1406). The majority of the infected HCWs were female (212/262, 80.9%, first infection vs. reinfection: 76.2% vs. 83.9%). The nursing staff, had the highest percentage of SARS-CoV-2 infection (42.0%), especially of its reinfection (47.8%). Out of the 262 infected individuals, 257 had received SARS-CoV-2 vaccination, primarily inactivated vaccines (243/257, 91.1%). The first infection group, which received four doses (24, 23.8%), was significantly higher than that in the reinfection group (6, 3.7%) (P
Læs mere Tjek på PubMedBMC Infectious Diseases, 30.03.2024
Tilføjet 30.03.2024
Abstract Purpose This study aims to evaluate the effectiveness of mitigation strategies and analyze the impact of human behavior on the transmission of Mpox. The results can provide guidance to public health authorities on comprehensive prevention and control for the new Mpox virus strain in the Democratic Republic of Congo as of December 2023. Methods We develop a two-layer Watts-Strogatz network model. The basic reproduction number is calculated using the next-generation matrix approach. Markov chain Monte Carlo (MCMC) optimization algorithm is used to fit Mpox cases in Canada into the network model. Numerical simulations are used to assess the impact of mitigation strategies and human behavior on the final epidemic size. Results Our results show that the contact transmission rate of low-risk groups and susceptible humans increases when the contact transmission rate of high-risk groups and susceptible humans is controlled as the Mpox epidemic spreads. The contact transmission rate of high-risk groups after May 18, 2022, is approximately 20% lower than that before May 18, 2022. Our findings indicate a positive correlation between the basic reproduction number and the level of heterogeneity in human contacts, with the basic reproduction number estimated at 2.3475 (95% CI: 0.0749–6.9084). Reducing the average number of sexual contacts to two per week effectively reduces the reproduction number to below one. Conclusion We need to pay attention to the re-emergence of the epidemics caused by low-risk groups when an outbreak dominated by high-risk groups is under control. Numerical simulations show that reducing the average number of sexual contacts to two per week is effective in slowing down the rapid spread of the epidemic. Our findings offer guidance for the public health authorities of the Democratic Republic of Congo in developing effective mitigation strategies.
Læs mere Tjek på PubMedBMC Infectious Diseases, 30.03.2024
Tilføjet 30.03.2024
Abstract Introduction Skin diseases such as impetigo pose a significant public health challenge in low resource settings. Despite this, there is a dearth of epidemiological data on the prevalence of this condition in Ghana. Methods We conducted a cross sectional study in three settings in Ghana: community members in East Mamprusi district in the North East region, a secondary school in Sekyere East district, and inmates of the Kumasi central prisons both in the Ashanti region. Following a period of training, we performed a standardised skin examination on each participant to assess for scabies and impetigo. We calculated the prevalence of each skin condition and investigated determinants of impetigo. Results/ findings Of the 1327 participants [males 64.1% and median age 22 (16–29) years], 746 (56.2%) had scabies and 186 (14%) had impetigo which was usually very mild or mild in severity. Most participants with impetigo also had scabies (161/186, 86.6%). Having an itch [RR 6.05 (95% CI 2.53–14.47)], presence of scabies burrows [RR 1.99 (95% CI 1.54–2.59)], clinical scabies [RR 3.15 (2.11–4.72)] or being in preschool [RR 4.56 (1.78–11.67)] increased the risk for impetigo. A combination of the presence of clinical scabies, age, sex and itch most accurately predicted the odds of having impetigo. Conclusions There is substantial burden of impetigo and scabies in Ghana. There is a need to institute measures to improve detection and control of these common dermatoses as part of Universal Health Coverage package to reduce the scourge of the diseases in this setting.
Læs mere Tjek på PubMedBMC Infectious Diseases, 30.03.2024
Tilføjet 30.03.2024
Abstract Introduction Leprosy is a chronic granulomatous infectious disease, mainly affecting the skin and peripheral nerves, caused by the obligate intracellular bacteria Mycobacterium leprae. The disease has been discussed in several review articles in recent research, but as far as we know, only a few have addressed the effects of leprosy on nails, especially those who examine the dermoscopic features of nails in leprosy patients. Purposes We aimed to document nail changes in leprosy patients and identify any particular findings through dermoscopic examination. Method This was an observational study conducted in the Dermatology and Venereology Clinic of Hasan Sadikin Hospital, West Java, Indonesia, from March 2023 through May 2023. All patients have established cases of leprosy, and the diagnosis is based on clinical and bacteriological examinations. Recruitment was done through total sampling. Dermoscopic examination of all fingernails and toenails was performed at 10x magnification using a handheld dermatoscope (Heine DELTA 20 T Dermatoscope) in polarized mode without the linkage fluid to document the dermoscopic features. Result Of a total of 19 patients, 15 had nail changes due to leprosy. Out of 15 patients, 13 patients were male. Patients below 25 years old had more nail changes. Most of the patients had a duration of disease greater than two years. Both fingers and toes were involved in nine patients. In this study, the most common dermoscopic feature found was the longitudinal ridge. Other dermoscopic features found in this study were transverse lines, onycholysis, longitudinal melanonychia, leukonychia, subungual hemorrhage, subungual hyperkeratosis, anonychia, and onychorrexis. Conclusion Nail changes are found in leprosy patients and have a wide variety of clinical appearances. A dermoscopy should be performed to assess nail changes in leprosy.
Læs mere Tjek på PubMedBMC Infectious Diseases, 30.03.2024
Tilføjet 30.03.2024
Abstract Background Timely and accurate identification of pathogens is crucial for appropriate treatment and prognosis of infectious diseases. As an increasingly popular pathogen detection method, the performance of metagenomic next-generation sequencing (mNGS) in detecting pathogens in febrile patients with suspected infection requires further exploration. Methods This study included 368 febrile patients with suspected infections who were admitted to the Infectious Disease Department of Qilu Hospital, Shandong University between January 5, 2021 and April 14, 2023. Both mNGS testing and conventional culture were performed in all patients. Clinical data of enrolled patients were collected, and the diagnostic performances of mNGS and culture were compared. Results Of the 368 enrolled patients, 231 were finally diagnosed with infection and 137 were with diseases other than infection. The sensitivity (58.01% vs. 21.65%, p
Læs mere Tjek på PubMedBMC Infectious Diseases, 30.03.2024
Tilføjet 30.03.2024
Abstract Background Pakistan witnessed five waves of COVID-19 infections during the pandemic. Punjab, the largest province of Pakistan, remained the epicentre due to a high infection rate. Administrative data for five waves of the pandemic was analyzed to determine the rate of infections and the significance of pharmacological and non-pharmacological interventions on the severity and duration of infection. Methodology COVID-19 data from March 2020 to May 2023 was obtained from the Provincial Public Health Reference Laboratory (PPHRL), Punjab AIDS Control Program, Lahore. The data included samples from index cases, contacts, and recovered patients. A total of 36,252,48 cases were screened for COVID-19, and 90,923 (2.50%) were detected positive by RT-PCR, accounting for 5.69% of the cases reported positive throughout the country. Results Among the positive cases, 50.86% (n = 46,244) cases were new cases (registered for the first time), 40.41% (n = 36751) were the contact cases traced from the newly identified cases and 8.62% (n = 7842) repeated cases. The positivity rates among index cases were reported to be 2.37%, 2.34%, 4.61%, 2.09%, and 1.19%, respectively, for the five respective COVID-19 pandemic waves. Distribution by gender indicated that 64% of males and 35% of females were infected during the pandemic. The age factor demonstrated the most susceptibility to infection in women aged 19-29 years, whereas most males between the ages of 29-39 had an infection. Susceptibility to COVID-19 infection was observed to be equally likely between males and females; however, clinical outcomes indicated that infections in males were more severe and often resulted in fatalities as compared to those in females. This trend was also reflected in the viral titer as measured by the Ct values, where 40% of males had Ct values < 25 (an indicator of high viral titers) compared to 30% of females with Ct values < 25. Conclusion Overall, our data indicated that infection rates remained stable throughout the pandemic except for 3rd wave, which showed a higher incidence of infection rate of 4%. Additionally, data showed a positive impact of masking, social distancing, and immunization, as indicated by the shorter window of high infection rates.
Læs mere Tjek på PubMedBMC Infectious Diseases, 30.03.2024
Tilføjet 30.03.2024
Abstract Background Men who have sex with men (MSM) are a key population group disproportionately affected by HIV and other sexually transmitted infections (STIs) worldwide. In Rwanda, the HIV epidemic remains a significant public health concern, and understanding the burden of HIV and hepatitis B and C coinfections among MSM is crucial for designing effective prevention and control strategies. This study aims to determine the prevalence of HIV, hepatitis B, and hepatitis C infections among MSM in Rwanda and identify correlates associated with HIV infection within this population. Methods We used respondent-driven sampling (RDS) to recruit participants between November and December 2021. A face-to-face, structured questionnaire was administered. Testing for HIV infection followed the national algorithm using two rapid tests: Alere Combo and STAT PAK as the first and second screening tests, respectively. Hepatitis B surface antigen (HBsAg) and anti-HCV tests were performed. All statistics were adjusted for RDS design, and a multivariable logistic regression model was constructed to identify factors associated with HIV infection. Results The prevalence of HIV among MSM was 6·9% (95% CI: 5·5–8·6), and among HIV-positive MSM, 12·9% (95% CI: 5·5–27·3) were recently infected. The prevalence of hepatitis B and C was 4·2% (95% CI: 3·0–5·7) and 0·7% (95% CI: 0·4–1·2), respectively. HIV and hepatitis B virus coinfection was 0·5% (95% CI: 0·2–1·1), whereas HIV and hepatitis C coinfection was 0·1% (95% CI: 0·0–0·5), and no coinfection for all three viruses was observed. MSM groups with an increased risk of HIV infection included those who ever suffered violence or abuse because of having sex with other men (AOR: 3·42; 95% CI: 1·87–6·25), those who refused to answer the question asking about ‘ever been paid money, goods, or services for sex’ (AOR: 10·4; 95% CI: 3·30–32·84), and those not consistently using condoms (AOR: 3·15; 95% CI: 1·31–7·60). Conclusion The findings suggest more targeted prevention and treatment approaches and underscore the importance of addressing structural and behavioral factors contributing to HIV vulnerability, setting interventions to reduce violence and abuse against MSM, promoting safe and consensual sexual practices, and expanding access to HIV prevention tools such as condoms and preexposure prophylaxis (PrEP).
Læs mere Tjek på PubMedBMC Infectious Diseases, 30.03.2024
Tilføjet 30.03.2024
Abstract Background This study explores regional variations in COVID-19 hospitalization rates, in-hospital mortality, and acute kidney injury (AKI) in England. We investigated the influence of population demographic characteristics, viral strain changes, and therapeutic advances on clinical outcomes. Methods Using hospital episode statistics, we conducted a retrospective cohort study with 749,844 admissions in 337,029 adult patients with laboratory-confirmed COVID-19 infection (March 1, 2020, to March 31, 2021). Multivariable logistic regression identified factors predicting AKI and mortality in COVID-19 hospitalized patients. Results London had the highest number of COVID-19 admissions (131,338, 18%), followed by the North-west region (122,683, 16%). The North-west had the highest population incidence of COVID-19 hospital admissions (21,167 per million population, pmp), while the South-west had the lowest (9,292 admissions pmp). Patients in London were relatively younger (67.0 ± 17.7 years) than those in the East of England (72.2 ± 16.8 years). The shortest length of stay was in the North-east (12.2 ± 14.9 days), while the longest was in the North-west (15.2 ± 17.9 days). All eight regions had higher odds of death compared to London, ranging from OR 1.04 (95% CI 1.00, 1.07) in the South-west to OR 1.24 (95% CI 1.21, 1.28) in the North-west. Older age, Asian ethnicity, emergency admission, transfers from other hospitals, AKI presence, ITU admission, social deprivation, and comorbidity were associated with higher odds of death. AKI incidence was 30.3%, and all regions had lower odds of developing AKI compared to London. Increasing age, mixed and black ethnicity, emergency admission, transfers from other providers, ITU care, and different levels of comorbidity were associated with higher odds of developing AKI. Conclusions London exhibited higher hospital admission numbers and AKI incidence, but lower odds of death compared to other regions in England. Trial registration Registered on National Library of Medicine website (www.clinicaltrials.gov) with registration number NCT04579562 on 8/10/2020.
Læs mere Tjek på PubMedBMC Infectious Diseases, 30.03.2024
Tilføjet 30.03.2024
Abstract Introduction To answer to patients’ medical wandering, often due to “unexplained symptoms” of “unexplained diseases” and to misinformation, multidisciplinary care centers for suspected Lyme borreliosis (LB), such as the 5 Tick-Borne Diseases (TBDs) Reference Centers (TBD-RC), were created a few years ago in France, the Netherlands and Denmark. Our study consisted of a comprehensive analysis of the satisfaction of the patients managed at a TBD-RC for suspected LB in the context of scientific and social controversy. Methods We included all adults who were admitted to one of the TBD-RC from 2017 to 2020. A telephone satisfaction survey was conducted 12 months after their first consultation. It consisted of 5 domains, including 2 free-text items: “What points did you enjoy?” and “What would you like us to change or to improve?”. In the current study, the 2 free-items were analyzed with a qualitative method called reflexive thematic analysis within a semantic and latent approach. Results The answer rate was 61.3% (349/569) and 97 distinctive codes from the 2-free-text items were identified and classified into five themes: (1) multidisciplinarity makes it possible to set up quality time dedicated to patients; (2) multidisciplinarity enables seamless carepaths despite the public hospital crisis compounded by the COVID-19 pandemic; (3) multidisciplinarity is defined as trust in the team’s competences; (4) an ambivalent opinion and uncertainty are barriers to acceptance of the diagnosis, reflecting the strong influence of the controversy around LB; and (5) a lack of adapted communication about TBDs, their management, and ongoing research is present. Conclusion The multidisciplinary management for suspected LB seemed an answer to medical wandering for the majority of patients and helped avoid misinformation, enabling better patient-centered shared information and satisfaction, despite the context of controversy.
Læs mere Tjek på PubMedBMC Infectious Diseases, 30.03.2024
Tilføjet 30.03.2024
Abstract Background Aspergillus spp liver abscess is a relatively rare entity and thus far no systematic review has been performed examining patients’ demographics, clinical manifestations, diagnosis, management, and outcome. Methods We performed a systematic review of the literature using MEDLINE and LILACS databases. We searched for articles published in the period from January 1990 to December 24, 2022, to identify patients who developed liver abscesses due to Aspergillus spp. Results Our search yielded 21 patients all of whom had invasive aspergillosis confirmed on liver biopsy. Of these patients 81% were adults, and 60% were males. The majority (86%) of patients were immunocompromised and 95% had symptomatic disease at the time of diagnosis. The most common symptoms were fever (79%), abdominal pain (47%), and constitutional symptoms (weight loss, chills, night sweats, fatigue) (38%). Liver enzymes were elevated in 50%, serum galactomannan was positive in 57%, and fungal blood cultures were positive in only 11%. Co-infection with other pathogens preceded development of apsergillosis in one-third of patients, and the majority of the abscesses (43%) were cryptogenic. In the remaining patients with known source, 28% of patients developed liver abscess through dissemination from the lungs, 19% through the portal vein system, and in 10% liver abscess developed through contiguous spread. The most common imaging modality was abdominal computerized tomography done in 86% of patients. Solitary abscess was present in 52% of patients while 48% had multiple abscesses. Inadequate initial empiric therapy was prescribed in 60% of patients and in 44% of patients definite treatment included combination therapy with two or more antifungal agents. Percutaneous drainage of the abscesses was done in 40% of patients, while 20% required liver resection for the treatment of the abscess. Overall mortality was very high at 38%. Conclusion Further studies are urgently needed for a better understanding of pathophysiology of liver aspergillosis and for developement of newer blood markers in order to expedite diagnosis and decrease mortality.
Læs mere Tjek på PubMedBMC Infectious Diseases, 30.03.2024
Tilføjet 30.03.2024
Abstract Background Vagococcal infections are extremely rare in humans. There are limited studies on the optimal methods for identification, antimicrobial susceptibility testing, and clinical manifestations of vagococcal infections. Herein, we report a patient with a urinary tract infection who had Vagococcus fluvialis in the urine. Case presentation An 84-year-old man presented to our urology department with a fever that had persisted for several days. He previously worked as a zoo clerk. The patient underwent a left nephroureterectomy for ureteral cancer 5 years ago, and total cystectomy and right cutaneous ureterostomy for muscle-invasive bladder cancer 1 year prior. He was empirically treated with 500 mg of levofloxacin intravenously every 24 h for the urinary tract infection. V. fluvialis was detected in his urine samples and Pseudomonas aeruginosa was detected in his urine and blood samples. Two bacterial species were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. He was administered intravenous levofloxacin for approximately 1 week, followed by oral levofloxacin for another week, after which the infections were eradicated. Conclusions To the best of our knowledge, this is the first report of V. fluvialis detected in human urine in Japan. Vagococcus spp. is commonly isolated from fish or animals, and based on the patient’s work history, it is possible that the patient was a carrier because of transmission from animals.
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