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King, W., Homer, T., Harding, C., Mossop, H., Chadwick, T., Abouhajar, A., Vale, L.
BMJ Open, 30.04.2024
Tilføjet 30.04.2024
ObjectivesTo estimate the cost-effectiveness of methenamine hippurate compared with antibiotic prophylaxis in the management of recurrent urinary tract infections. DesignMulticentre, open-label, randomised, non-inferiority trial. SettingEight centres in the UK, recruiting from June 2016 to June 2018. ParticipantsWomen aged ≥18 years with recurrent urinary tract infections, requiring prophylactic treatment. InterventionsWomen were randomised to receive once-daily antibiotic prophylaxis or twice-daily methenamine hippurate for 12 months. Treatment allocation was not masked and crossover between arms was allowed. Primary and secondary outcome measuresThe primary economic outcome was the incremental cost per quality-adjusted life year (QALY) gained at 18 months. All costs were collected from a UK National Health Service perspective. QALYs were estimated based on responses to the EQ-5D-5L administered at baseline, 3, 6, 9, 12 and 18 months. Incremental costs and QALYs were estimated using an adjusted analysis which controlled for observed and unobserved characteristics. Stochastic sensitivity analysis was used to illustrate uncertainty on a cost-effectiveness plane and a cost-effectiveness acceptability curve. A sensitivity analysis, not specified in the protocol, considered the costs associated with antibiotic resistance. ResultsData on 205 participants were included in the economic analysis. On average, methenamine hippurate was less costly (–£40; 95% CI: –684 to 603) and more effective (0.014 QALYs; 95% CI: –0.05 to 0.07) than antibiotic prophylaxis. Over the range of values considered for an additional QALY, the probability of methenamine hippurate being considered cost-effective ranged from 51% to 67%. ConclusionsOn average, methenamine hippurate was less costly and more effective than antibiotic prophylaxis but these results are subject to uncertainty. Methenamine hippurate is more likely to be considered cost-effective when the benefits of reduced antibiotic use were included in the analysis. Trial registration number ISRCTN70219762.
Læs mere Tjek på PubMedWildeman, P., Rolfson, O., Wretenberg, P., Natman, J., Gordon, M., Söderquist, B., Lindgren, V.
BMJ Open, 30.04.2024
Tilføjet 30.04.2024
ObjectivesProsthetic joint infection (PJI) is a serious complication following total hip arthroplasty (THA) entailing increased mortality, decreased quality of life and high healthcare costs. The primary aim was to investigate whether the national project: Prosthesis Related Infections Shall be Stopped (PRISS) reduced PJI incidence after primary THA; the secondary aim was to evaluate other possible benefits of PRISS, such as shorter time to diagnosis. DesignCohort study. SettingIn 2009, a nationwide, multidisciplinary infection control programme was launched in Sweden, PRISS, which aimed to reduce the PJI burden by 50%. ParticipantsWe obtained data on patients undergoing primary THA from the Swedish Arthroplasty Registry 2012–2014, (n=45 723 patients, 49 946 THAs). Using personal identity numbers, this cohort was matched with the Swedish Prescribed Drug Registry. Medical records of patients with ≥4 weeks’ antibiotic consumption were reviewed to verify PJI diagnosis (n=2240, 2569 THAs). ResultsThe cumulative incidence of PJI following the PRISS Project was 1.2% (95% CI 1.1% to 1.3%) as compared with 0.9% (95% CI 0.8% to 1.0%) before. Cox regression models for the PJI incidence post-PRISS indicates there was no statistical significance difference versus pre-PRISS (HR 1.1 (95% CI 0.9 to 1.3)). There was similar time to PJI diagnosis after the PRISS Project 24 vs 23 days (p=0.5). ConclusionsDespite the comprehensive nationwide PRISS Project, Swedish PJI incidence was higher after the project and time to diagnosis remained unchanged. Factors contributing to PJI, such as increasing obesity, higher American Society of Anesthesiology class and more fractures as indications, explain the PJI increase among primary THA patients.
Læs mere Tjek på PubMedPadhani, Z. A., Rahman, A. R., Lakhani, S., Yasin, R., Khan, M. H., Mirani, M., Jamali, M., Ali Khan, Z., Khatoon, S., Partab, R., ul Haq, A., Kampalath, V., Hosseinalipour, S.-M., Blanchet, K., Das, J. K.
BMJ Open, 30.04.2024
Tilføjet 30.04.2024
ObjectiveMigrants and refugees are at a disadvantage in accessing basic necessities. The objective of this study is to assess the inequity in access, needs and determinants of COVID-19 vaccination among refugees and migrant populations in Pakistan. DesignWe conducted a mixed-method study comprising a cross-sectional survey and a qualitative study. In this paper, we will only report the findings from the cross-sectional survey. SettingThis survey was conducted in different cities of Pakistan including Quetta, Karachi and Hyderabad. ParticipantsA total of 570 participants were surveyed including refugees and migrants, both in regular and irregular situations. Primary and secondary outcome measuresThe primary outcome of the study was to estimate the proportion of refugees and migrants, both in regular and irregular situations vaccinated against COVID-19 and assess the inequity. The 2 test and Fisher’s exact test were used to determine the significant differences in proportions between refugees and migrants and between regions. ResultsThe survey showed that only 26.9% of the refugee and migrant population were tested for COVID-19, 4.56% contracted coronavirus, and 3.85% were hospitalised due to COVID-19. About 66% of the refugees and migrants were fully vaccinated including those who received the single-dose vaccine or received all two doses, and 17.6% were partially vaccinated. Despite vaccination campaigns by the government, 14.4% of the refugee and migrant population remained unvaccinated mostly because of vaccines not being offered, distant vaccination sites, limited access, unavailability of COVID-19 vaccine or due to a difficult registration process. Vaccination rates varied across provinces, genders and migrant populations due to misconceptions, and several social, cultural and geographical barriers. ConclusionThis study highlights the COVID-19 vaccine coverage, access and inequity faced by refugees and migrants during the pandemic. It suggests early prioritisation of policies inclusive of all refugees and migrants and the provision of identification documents to ease access to basic necessities.
Læs mere Tjek på PubMedLuo, W., Xiao, Z., Yang, X., Wu, R., Li, J., Yu, Z., Guo, S., Nie, B., Liu, D.
BMJ Open, 30.04.2024
Tilføjet 30.04.2024
IntroductionType 2 diabetes and non-alcoholic fatty liver disease (NAFLD) often coexist and increase risk for developing liver fibrosis and diabetes complications if no effective measures are taken. Dietary intervention is known to be able to achieve diabetes remission, while evidence regarding the long-term effect on liver fat is limited for comorbidity management of type 2 diabetes and NAFLD. This study aims to investigate the long-term effect of a Chinese Medical Nutrition Therapy (CMNT) diet accompanied by intermittent energy restriction on reducing liver fat and glycated haemoglobin (HbA1c) in patients with type 2 diabetes and NAFLD. Methods and analysisThis is a multicentre two-armed parallel randomised controlled trial study. 120 participants with type 2 diabetes and NAFLD will be recruited from the physical examination centres of multiple hospitals in China. Participants will be randomly allocated 1:1 to either the CMNT group or the usual care group. The CMNT group will be instructed to consume the provided specific meal replacement Chinese medicinal foods consisting of 6 cycles of 5 consecutive days followed by 10 days of regular food intake. The usual care group will be given standard dietary advice. Primary outcomes are changes in the controlled attenuation parameter value by transient elastography and HbA1c level. Secondary outcomes include differences in anthropometrics, clinical blood markers, questionnaires, gut microbiota and metabolomics. Further follow-up will be performed at 6 months, 1 year and 2 years. Ethics and disseminationThe study protocol was approved by the Biomedical Research Ethics Committee of Hunan Agricultural University (BRECHAU20200235). The results will be disseminated via relevant peer-reviewed publications and conference presentations. Trial registration number NCT05439226.
Læs mere Tjek på PubMedArmengol, M., Hayward, G., Abbott, M. G., Bird, C., Bergmann, J. H. M., Glogowska, M.
BMJ Open, 30.04.2024
Tilføjet 30.04.2024
ObjectiveTo explore the experiences of healthcare professionals (HCPs) and parents of urine collection methods, to identify barriers to successful sampling and what could improve the process. DesignQualitative research, using individual semistructured interviews with HCPs and parents. The interviews were audiorecorded, transcribed and thematically analysed. SettingUK-based HCPs from primary and secondary care settings and parents with experience with urine collection in primary and/or secondary care settings. ParticipantsHCPs who were involved in aiding, supervising or ordering urine samples. Parents who had experience with urine collection in at least one precontinent child. Results13 HCPs and 16 parents were interviewed. 2 participating HCPs were general practitioners (GPs), 11 worked in paediatric secondary care settings (8 were nurses and 3 were doctors). Two parents had children with underlying conditions where frequent urine collection was required to rule out infections. HCPs and parents reported that there were no straightforward methods of urine collection for precontinent children. Each method—‘clean catch’, urine bag and urine pad—had limitations and problems with usage. ‘Clean catch’, regarded as the gold standard by HCPs with a lower risk of contamination, often proved difficult for parents to achieve. Other methods had elevated risk of contamination but were more acceptable to parents because they were less challenging. Many of the parents expressed the need for more information about urine collection. ConclusionsCurrent methods of urine collection are challenging to use and may be prone to contamination. A new device is required to assist with urine collection in precontinent children, to simplify and reduce the stress of the situation for those involved. Parents are key partners in the process of urine collection with young children. Meeting their expressed need for more information could be an important way to achieve better-quality samples while awaiting a new device.
Læs mere Tjek på PubMedGamble, A. R., McKay, M. J., Anderson, D. B., Pappas, E., Alvarez Cooper, I., Macpherson, S., Harris, I. A., Filbay, S. R., McCaffery, K., Thompson, R., Hoffmann, T. C., Maher, C. G., Zadro, J. R.
BMJ Open, 30.04.2024
Tilføjet 30.04.2024
AimTo develop and user test an evidence-based patient decision aid for children and adolescents who are considering anterior cruciate ligament (ACL) reconstruction. DesignMixed-methods study describing the development of a patient decision aid. SettingA draft decision aid was developed by a multidisciplinary steering group (including various types of health professionals and researchers, and consumers) informed by the best available evidence and existing patient decision aids. ParticipantsPeople who ruptured their ACL when they were under 18 years old (ie, adolescents), their parents, and health professionals who manage these patients. Participants were recruited through social media and the network outreach of the steering group. Primary and secondary outcomesSemistructured interviews and questionnaires were used to gather feedback on the decision aid. The feedback was used to refine the decision aid and assess acceptability. An iterative cycle of interviews, refining the aid according to feedback and further interviews, was used. Interviews were analysed using reflexive thematic analysis. ResultsWe conducted 32 interviews; 16 health professionals (12 physiotherapists, 4 orthopaedic surgeons) and 16 people who ruptured their ACL when they were under 18 years old (7 were adolescents and 9 were adults at the time of the interview). Parents participated in 8 interviews. Most health professionals, patients and parents rated the aid’s acceptability as good-to-excellent. Health professionals and patients agreed on most aspects of the decision aid, but some health professionals had differing views on non-surgical management, risk of harms, treatment protocols and evidence on benefits and harms. ConclusionOur patient decision aid is an acceptable tool to help children and adolescents choose an appropriate management option following ACL rupture with their parents and health professionals. A clinical trial evaluating the potential benefit of this tool for children and adolescents considering ACL reconstruction is warranted.
Læs mere Tjek på PubMedLi, W., Chung, S. L., Lei, M., Yang, X., Jin, Z.
BMJ Open, 30.04.2024
Tilføjet 30.04.2024
BackgroundSevere pneumonia (SP) stands as one of the most prevalent critical illnesses encountered in clinical practice, characterised by its rapid onset and progression, numerous complications and elevated mortality rates. While modern medical interventions primarily focus on symptomatic management such as anti-infective therapy and mechanical ventilation, challenges including high drug resistance and suboptimal therapeutic outcomes for certain patients persist. Dry cupping as an ancient practice with over a millennium of clinical use in China is renowned for its convenience and perceived clinical efficacy in various illnesses. Nevertheless, the lack of well-designed studies assessing its effects remains a notable gap in the literature. This protocol describes a placebo-controlled, randomised, single-blind study to evaluate the efficacy and safety of dry cupping as an adjuvant treatment for SP. Methods and analysis66 patients diagnosed with SP, aged 18–80 years, will be randomly divided into two groups: intervention group, receiving 10 times of dry cupping treatment; control group, receiving placebo dry cupping therapy. Both applications are used in bilateral Fei Shu (BL13), Pi Shu (BL21) and Shen Shu (BL22) cupping. The application will be conducted once a day for 10 days. Participants will be assessed before treatment (D0), after the first intervention (D1), after the fifth intervention (D5) and after treatment ended (D10). The assessments include blood oxygen saturation, respiratory rate, traditional Chinese medicine symptom score, inflammatory response, mechanical ventilation time and oxygen condition. Ethics and disseminationThis protocol has been approved by the Ethics Committee of Shanghai Seventh People’s Hospital (2023-7th-HIBR-070). The results of the study will be disseminated to participants through social networks and will be submitted to a peer-reviewed journal and scientific meetings. Trial registration numberChiCTR2300076958.
Læs mere Tjek på PubMedTrocheris-Fumery, O., Scetbon, C., Flet, T., Meynier, J., Sellier, M., Rumbach, M., Badaoui, R., Villeret, L., Tarpin, P., Abou-Arab, O., Bar, S., Dupont, H.
BMJ Open, 30.04.2024
Tilføjet 30.04.2024
BackgroundPost-induction anaesthesia often promotes intraoperative hypotension (IOH) that can worsen postoperative outcomes. This study aims to assess the benefit of norepinephrine versus ephedrine at the induction of anaesthesia to prevent postoperative complications following major abdominal surgery by preventing IOH. Methods and analysisThe EPON STUDY is a prospective single-centre randomised controlled trial with the planned inclusion of 500 patients scheduled for major abdominal surgery at the Amiens University Hospital. The inclusion criteria are patients aged over 50 years weighing more than 50 kg with an American Society of Anesthesiologists physical status score of ≥2 undergoing major abdominal surgery under general anaesthesia. Patients are allocated either to the intervention group (n=250) or the standard group (n=250). In the intervention group, the prevention of post-induction IOH is performed with norepinephrine (dilution to 0.016 mg/mL) using an electric syringe pump at a rate of 0.48 mg/h (30 mL/h) from the start of anaesthesia and then titrated to achieve the haemodynamic target. In the control group, the prevention of post-induction IOH is performed with manual titration of ephedrine, with a maximal dose of 30 mg, followed by perfusion with norepinephrine. In both groups, the haemodynamic target to maintain is a mean arterial pressure (MAP) of 65 mm Hg or 70 mm Hg for patients with a medical history of hypertension. An intention-to-treat analysis will be performed. The primary outcome is the Clavien–Dindo score assessed up to 30 days postoperatively. The secondary endpoints are the length of hospital stay and length of stay in an intensive care unit/postoperative care unit; postoperative renal function; postoperative cardiovascular, respiratory, neurological, haematological and infectious complications at 1 month; and volume of intraoperative vascular filling and mortality at 1 month. Ethics and disseminationEthical approval was obtained from the committee of protection of the persons of Ile de France in May 2021 (number 21 05 41). The authors will be involved in disseminating the research findings (through attending conferences and co-authoring papers). The results of the study will be disseminated via peer-reviewed publications and presentations at national and international conferences. Trial registration number NCT05276596.
Læs mere Tjek på PubMedBMC Infectious Diseases, 30.04.2024
Tilføjet 30.04.2024
BMC Infectious Diseases, 30.04.2024
Tilføjet 30.04.2024
Abstract Background Hepatitis C virus (HCV) infection poses a major public health challenge globally, especially among injecting drug users. China has the world’s largest burden of HCV infections. However, little is known about the characteristics of transmission networks among drug user populations. This study aims to investigate the molecular epidemiology and transmission characteristics of HCV infections among drug users in Zhuhai, a bustling port city connecting Mainland China and its Special Administrative Regions. Methods Participants enrolled in this study were drug users incarcerated at Zhuhai’s drug rehabilitation center in 2015. Their sociodemographic and behavioral information, including gender, promiscuity, drug use method, and so forth, was collected using a standardized questionnaire. Plasmas separated from venous blood were analyzed for HCV infection through ELISA and RT-PCR methods to detect anti-HCV antibodies and HCV RNA. The 5’UTR fragment of the HCV genome was amplified and further sequenced for subtype identifications and phylogenetic analysis. The phylogenetic tree was inferred using the Maximum Likelihood method based on the Tamura-Nei model, and the transmission cluster network was constructed using Cytoscape3.8.0 software with a threshold of 0.015. Binary logistic regression models were employed to assess the factors associated with HCV infection. Results The overall prevalence of HCV infection among drug users was 44.37%, with approximately 19.69% appearing to clear the HCV virus successfully. Binary logistic regression analysis revealed that those aged over 40, engaging in injecting drug use, and being native residents were at heightened risk for HCV infection among drug user cohorts. The predominant HCV subtypes circulating among those drug users were 6a (60.26%), followed by 3b (16.7%), 3a (12.8%), 1b (6.41%) and 1a (3.85%), respectively. Molecular transmission network analysis unveiled the presence of six transmission clusters, with the largest propagation cluster consisting of 41 individuals infected with HCV subtype 6a. Furthermore, distinct transmission clusters involved eight individuals infected with subtype 3b and seven with subtype 3a were also observed. Conclusion The genetic transmission networks revealed a complex transmission pattern among drug users in Zhuhai, emphasizing the imperative for a targeted and effective intervention strategy to mitigate HCV dissemination. These insights are pivotal for shaping future national policies on HCV screening, treatment, and prevention in port cities.
Læs mere Tjek på PubMedBMC Infectious Diseases, 30.04.2024
Tilføjet 30.04.2024
Abstract Quantifying the potential spatial spread of an infectious pathogen is key to defining effective containment and control strategies. The aim of this study is to estimate the risk of SARS-CoV-2 transmission at different distances in Italy before the first regional lockdown was imposed, identifying important sources of national spreading. To do this, we leverage on a probabilistic model applied to daily symptomatic cases retrospectively ascertained in each Italian municipality with symptom onset between January 28 and March 7, 2020. Results are validated using a multi-patch dynamic transmission model reproducing the spatiotemporal distribution of identified cases. Our results show that the contribution of short-distance ( (le 10 km)) transmission increased from less than 40% in the last week of January to more than 80% in the first week of March 2020. On March 7, 2020, that is the day before the first regional lockdown was imposed, more than 200 local transmission foci were contributing to the spread of SARS-CoV-2 in Italy. At the time, isolation measures imposed only on municipalities with at least ten ascertained cases would have left uncontrolled more than 75% of spillover transmission from the already affected municipalities. In early March, national-wide restrictions were required to curb short-distance transmission of SARS-CoV-2 in Italy.
Læs mere Tjek på PubMedBMC Infectious Diseases, 30.04.2024
Tilføjet 30.04.2024
Abstract Background Clinically, most patients with Kaposi\'s sarcoma (KS) are male, and several direct and indirect mechanisms may underlie this increased susceptibility in men, Kaposi\'s sarcoma-associated herpesvirus (KSHV), also known as human herpesvirus 8 (HHV-8), is considered to be the primary etiological agent responsible for KS. Thus, we propose the hypothesis that men are more susceptible to HHV-8 infection, leading to a higher incidence of Kaposi\'s sarcoma among males. A meta-analysis was conducted to evaluate the association between gender and HHV-8 seropositivity in the general population. Methods A comprehensive literature search was performed using 6 online databases: PubMed, EMBASE, Cochrane library, Web of Science, CNKI, and Wanfang. Studies published before March 15, 2023, were included. Results In all, 33 articles including 41 studies were included in the meta-analysis. In the included adult population. men had a higher risk of HHV-8 infection than did women in adult populations from all over the world (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 1.01–1.15), but no differences were found in child population from all over the world (OR: 0.90, 95% CI: 0.79–1.01). There was a significant difference in HHV-8 seroprevalence between men and women in sub-Saharan Africa (SSA) adult population (OR: 1.15, 95% CI: 1.05–1.26). However, no significant differences were observed in sub-Saharan Africa (SSA) child population (OR: 0.90, 95%CI 0.78–1.03). As for other continents, the results showed no significant difference, such as the Asian population (OR: 1.03, 95%CI: 0.92–1.16). or the European and American populations (OR 1.01, 95%CI 0.87–1.17). Conclusion There was a slight gender disparity for HHV-8 infection in the adult population. Among the adult populations from SSA and globally, men were more likely to be infected with HHV-8 than were women. However, no statistical significance was observed in the child populations from SSA and globally. In the future, the inclusion of more standardized studies may strengthen the results of this study.
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
Feba Ann John, Valeria Criollo, Carissa Gaghan, Abigail Armwood, Jennifer Holmes, Anil J. Thachil, Rocio Crespo, Raveendra R. Kulkarni
PLoS One Infectious Diseases, 29.04.2024
Tilføjet 29.04.2024
by Feba Ann John, Valeria Criollo, Carissa Gaghan, Abigail Armwood, Jennifer Holmes, Anil J. Thachil, Rocio Crespo, Raveendra R. Kulkarni Clostridial dermatitis (CD), caused by Clostridium septicum, is an emerging disease of increasing economic importance in turkeys. Currently, there are no effective vaccines for CD control. Here, two non-toxic domains of C. septicum alpha toxin, namely ntATX-D1 and ntATX-D2, were identified, cloned, and expressed in Escherichia coli as recombinant subunit proteins to investigate their use as potential vaccine candidates. Experimental groups consisted of a Negative control (NCx) that did not receive C. septicum challenge, while the adjuvant-only Positive control (PCx), ntATX-D1 immunization (D1) and ntATX-D2 immunization (D2) groups received C. septicum challenge. Turkeys were immunized subcutaneously with 100 μg of protein at 7, 8 and 9 weeks of age along with an oil-in-water nano-emulsion adjuvant, followed by C. septicum challenge at 11 weeks of age. Results showed that while 46.2% of birds in the PCx group died post-challenge, the rate of mortality in D1- or D2-immunization groups was 13.3%. The gross and histopathological lesions in the skin, muscle and spleen showed that the disease severity was highest in PCx group, while the D2-immunized birds had significantly lower lesion scores when compared to PCx. Gene expression analysis revealed that PCx birds had significantly higher expression of pro-inflammatory cytokine genes in the skin, muscle and spleen than the NCx group, while the D2 group had significantly lower expression of these genes compared to PCx. Peripheral blood cellular analysis showed increased frequencies of activated CD4+ and/or CD8+ cells in the D1 and D2-immunized groups. Additionally, the immunized turkeys developed antigen-specific serum IgY antibodies. Collectively, these findings indicate that ntATX proteins, specifically the ntATX-D2 can be a promising vaccine candidate for protecting turkeys against CD and that the protection mechanisms may include downregulation of C. septicum-induced inflammation and increased CD4+ and CD8+ cellular activation.
Læs mere Tjek på PubMedPfariso Maumela, Sinomncedi Magida, Mahloro Hope Serepa-Dlamini
PLoS One Infectious Diseases, 29.04.2024
Tilføjet 29.04.2024
by Pfariso Maumela, Sinomncedi Magida, Mahloro Hope Serepa-Dlamini The Pb bioremediation mechanism of a multi-metal resistant endophytic bacteria Bacillus sp. strain MHSD_36, isolated from Solanum nigrum, was characterised. The strain tested positive for the presence of plant growth promoters such as indoleacetic acid, 1-aminocyclopropane-1-carboxylate deaminase, siderophores, and phosphate solubilization. The experimental data illustrated that exopolysaccharides and cell hydrophobicity played a role in Pb uptake. The data further showed that the cell wall biosorbed a significant amount (71%) of the total Pb (equivalent to 4 mg/L) removed from contaminated water, compared to the cell membrane (11%). As much as 11% of the Pb was recovered from the cytoplasmic fraction, demonstrating the ability of the strain to control the influx of toxic heavy metals into the cell and minimize their negative impacts. Pb biosorption was significantly influenced by the pH and the initial concentration of the toxic ions. Furthermore, the presence of siderophores and biosurfactants, when the strain was growing under Pb stress, was detected through liquid chromatography mass spectrometry. The strain demonstrated a multi-component based Pb biosorption mechanism and thus, has a great potential for application in heavy metal bioremediation.
Læs mere Tjek på PubMedMuhammad Asim Khan, Kiran Afshan, Sabika Firasat, Muhammad Abbas, Neil D. Sargison, Martha Betson, Umer Chaudhry
PLoS One Infectious Diseases, 29.04.2024
Tilføjet 29.04.2024
by Muhammad Asim Khan, Kiran Afshan, Sabika Firasat, Muhammad Abbas, Neil D. Sargison, Martha Betson, Umer Chaudhry Dicrocoelium lancet flukes cause significant production loss in ruminant livestock. Although co-infection with multiple Dicrocoelium species within a host is common, techniques for studying the composition of these complex parasite communities are lacking. The pathogenicity, epidemiology, and therapeutic susceptibility of different helminth species vary, and little is known about the interactions that take place between co-infecting species and their hosts. Here, we describe the first applicationof metabarcoding deep amplicon sequencing method to studythe Dicrocoelium species in sheep and goats. First, rDNA ITS-2 sequences of four Dicrocoelium species (Dicrocoelium dendriticum, Dicrocoelium hospes, Dicrocoelium orientalis, and Dicrocoelium chinensis) were extracted from the NCBI public database. Phylogenetic analysis revealed separate clades of Dicrocoelium species; hence, molecular differentiation between each species is possible in co-infections. Second, 202 flukes belonging to seventeen host populations (morphologically verified as belonging to the Dicrocoelium genus) were evaluated to determine the deep amplicon sequencing read threshold of an individual fluke for each of the four species. The accuracy of the method in proportional quantification of samples collected from single hosts was further assessed. Overall, 198 (98.01%) flukes were confirmed as D. dendriticum and 1.98% produced no reads. The comparison of genetic distances between rDNA ITS-2 revealed 86% to 98% identity between the Dicrocoelium species. Phylogenetic analysis demonstrated a distinct clustering of species, apart from D. orientalis and D. chinensis, which sit very close to each other in a single large clade whereas D. hospes and D. dendriticum are separated into their own clade. In conclusion each sample was identified as D. dendriticum based on the proportion of MiSeq reads and validated the presence of this group of parasites in the Gilgit Baltistan and Khyber Pakhtunkhwa provinces of Pakistan. The metabarcoding deep amplicon sequencing technology and bioinformatics pathway have several potential applications, including species interactions during co-infections, identifying the host and geographical distribution of Dicrocoelium in livestock, drug therapy response evaluation and understanding of the emergence and spread of drug resistance.
Læs mere Tjek på PubMedApolinar M. Hernández, Luis D. Alcaraz, Cristóbal Hernández-Álvarez, Miguel F. Romero, Angélica Jara-Servín, Hugo Barajas, Carlos M. . Ramírez, Mariana Peimbert
PLoS One Infectious Diseases, 29.04.2024
Tilføjet 29.04.2024
by Apolinar M. Hernández, Luis D. Alcaraz, Cristóbal Hernández-Álvarez, Miguel F. Romero, Angélica Jara-Servín, Hugo Barajas, Carlos M. . Ramírez, Mariana Peimbert The mosquito Aedes spp. holds important relevance for human and animal health, as it serves as a vector for transmitting multiple diseases, including dengue and Zika virus. The microbiome’s impact on its host’s health and fitness is well known. However, most studies on mosquito microbiomes have been conducted in laboratory settings. We explored the mixed microbial communities within Aedes spp., utilizing the 16S rRNA gene for diversity analysis and shotgun metagenomics for functional genomics. Our samples, which included Ae. aegypti and Ae. albopictus, spanned various developmental stages—eggs, larvae, and adults—gathered from five semiurban areas in Mexico. Our findings revealed a substantial diversity of 8,346 operational taxonomic units (OTUs), representing 967 bacterial genera and 126,366 annotated proteins. The host developmental stage was identified as the primary factor associated with variations in the microbiome composition. Subsequently, we searched for genes and species involved in mosquito biocontrol. Wolbachia accounted for 9.6% of the 16S gene sequences. We observed a high diversity (203 OTUs) of Wolbachia strains commonly associated with mosquitoes, such as wAlb, with a noticeable increase in abundance during the adult stages. Notably, we detected the presence of the cifA and cifB genes, which are associated with Wolbachia’s cytoplasmic incompatibility, a biocontrol mechanism. Additionally, we identified 221 OTUs related to Bacillus, including strains linked to B. thuringiensis. Furthermore, we discovered multiple genes encoding insecticidal toxins, such as Cry, Mcf, Vip, and Vpp. Overall, our study contributes to the understanding of mosquito microbiome biodiversity and metabolic capabilities, which are essential for developing effective biocontrol strategies against this disease vector.
Læs mere Tjek på PubMedZerin Jannat, Hemel Das, Md. Wazed Ali, Tasnuva Wahed, Md. Nurul Alam, Md. Jasim Uddin
PLoS One Infectious Diseases, 29.04.2024
Tilføjet 29.04.2024
by Zerin Jannat, Hemel Das, Md. Wazed Ali, Tasnuva Wahed, Md. Nurul Alam, Md. Jasim Uddin Background Vaccination has been an indispensable step in controlling the coronavirus disease pandemic. In early 2021, Bangladesh launched a mass vaccination campaign to boost the COVID-19 vaccination rate when doses were available and immunized millions in the country. Although deemed a success, disparities became conspicuous in vaccination coverage across population of different socioeconomic background. Methods The purpose of this cross-sectional study was to assess the vaccination coverage for three doses and detect disparities in uptake of the COVID-19 vaccine among rural population of hard-to-reach areas and urban individuals belonging to the high-risk group -defined in our study as individuals from elusive population such as floating population/street dwellers, transgender, addicts and disabled population. We conducted household survey (n = 12,298) and survey with high risk group of people (2,520). The collected primary data were analysed using descriptive statistical analysis. Results Our findings show that coverage for the first dose of COVID-19 vaccination was high among respondents from both rural Hard-to-reach (HTR) (92.9%) and non-HTR (94.6%) areas. However, the coverage for subsequent doses was observed to reduce significantly, especially for third dose (52.2% and 56.4% for HTR and non-HTR, respectively). Conclusion Vaccination coverage among urbanites of high-risk group was found to be critically low. Vaccine hesitancy was also found to be high among individuals of this group. It is essential that the individuals of urban high-risk group be prioritized. Individuals from this group could be provided incentives (transport for disabled, monetary incentive to transgenders; food and medicine for drug user and floating people) and vaccination centers could be established with flexible schedule (morning/afternoon/evening sessions) so that they receive vaccine at their convenient time. Community engagement can be used for both high-risk group and rural population to enhance the COVID-19 vaccination coverage and lower disparities in uptake of the vaccine doses nationwide.
Læs mere Tjek på PubMedPavla Vrabcová, Petr Scholz, Ivica Linderová, Hana Kotoučková
PLoS One Infectious Diseases, 29.04.2024
Tilføjet 29.04.2024
by Pavla Vrabcová, Petr Scholz, Ivica Linderová, Hana Kotoučková The economic recovery of the tourism industry after the Covid-19 pandemic to find modern and efficient trends to increase profitability is accompanied by the adoption of comprehensive accommodation approaches towards resilience and environmental sustainability. The research aims at the application of environmental management elements and measures in all types of accommodation facilities in the Czech Republic (n1 = 1,016). A qualitative focus group method complemented the quantitative research using correspondence analysis, Levene’s, Kruskal-Wallis, and Tukey’s HSD tests (n2 = 9 + moderator). The results indicate that the differences in the number of environmental measures implemented were minimal for the monitored hotels and guesthouses. On the other hand, the star rating of accommodation facilities is not a key parameter in the environmental impact assessment. The most used environmental measures were devices reducing electricity consumption (hotels 94%, guesthouses 94%), separating waste (hotels 88%, guesthouses 89%), and water consumption reduction (hotels 85%, guesthouses 86%). At the same time, the most minor used were measures reducing chemical consumption (hotels 23%, guesthouses 22%) communication and environmental education of employees and guests (hotels 32%, guesthouses 18%).
Læs mere Tjek på PubMedYing Kong, Liang Hong, Xiao-cheng Xu, Yun-feng Chen, Jia Xu
PLoS One Infectious Diseases, 29.04.2024
Tilføjet 29.04.2024
by Ying Kong, Liang Hong, Xiao-cheng Xu, Yun-feng Chen, Jia Xu Objective Immune checkpoint inhibitor pneumonitis (CIP) is a prevalent form of immunotherapy-induced pulmonary toxicity, ranking among the leading causes of mortality associated with immune checkpoint inhibitors (ICIs). Despite its significance, the risk stratification of CIP in advanced non-small cell lung cancer (NSCLC) remains uncertain. In this study, we conducted a comprehensive analysis, comparing various factors such as histological types, treatment regimens, PD-L1 expression levels, and EGFR/ALK negativity in advanced NSCLC. Our investigation extends to evaluating the relative risk of developing CIP based on previous treatment history. This analysis aims to provide valuable insights for the identification of specific patient subgroups at higher risk, facilitating more effective risk management and precision therapy approaches. Methods PubMed, Embase, and Cochrane databases were systematically searched up to February 16, 2023. We conducted a screening of randomized controlled trials (RCTs) that compared ICI monotherapy or its combination with chemotherapy in advanced NSCLC. The trials were categorized based on histological type, treatment regimen, PD-L1 expression level, EGFR/ALK-negative status, and prior treatment history. Subsequently, the data were stratified into five subgroups, and the occurrences of all-grades (1–5) and high-grades (3–5) pneumonia events were extracted. Odds ratios (OR) and corresponding 95% confidence intervals (CI) were then calculated for further analysis. Results Twenty-two RCTs, encompassing 13,725 patients with advanced NSCLC, were included in this analysis. Regardless of histology (OR = 2.47, 95% CI 1.41–4.33, P = 0.002; OR = 1.84, 95% CI 1.10–3.09, P = 0.02), treatment regimen (OR = 3.27, 95% CI 2.00–5.35, P < 0.00001; OR = 2.91, 95% CI 1.98–4.27, P < 0.00001), PD-L1 expression level (OR = 5.11, 95% CI 2.58–10.12, P < 0.00001; OR = 5.15, 95% CI 2.48–10.70, P < 0.0001), negative EGFR/ALK expression (OR = 4.32, 95% CI 2.22–8.41, P < 0.0001; OR = 3.6, 95% CI 1.56–8.28, P = 0.003), whether there is a history of treatment (OR = 3.27, 95% CI 2.00–5.35, P < 0.00001; OR = 2.74, 95% CI 1.75–4.29, P < 0.0001), ICI use was associated with a higher risk of all-grade (1–5) and high-grade (3–5) pneumonia compared to chemotherapy. Subgroup analysis revealed that the squamous group, the ICI vs. combination chemotherapy (CT) group, the PD-L1 > 50% group, and the previously untreated group had a higher risk of developing all-grade and grade 3–5 CIP (P < 0.05). Conclusions In advanced NSCLC, ICI treatment was linked to an elevated risk of pneumonitis across all grades (1–5) as well as high-grade occurrences (3–5) compared to chemotherapy. Notably, individuals with squamous histology and high PD-L1 expression, along with those lacking a history of prior treatment, demonstrated a heightened susceptibility to developing immune-related pneumonitis of all grades (1–5) and high grades (3–5). These observations provide valuable insights for clinicians seeking to enhance the management of pulmonary toxicity associated with immunotherapy.
Læs mere Tjek på PubMedFrancisco Guillén-Chable, Johnny Omar Valdez Iuit, Luis Alejandro Avila Castro, Carlos Rosas, Enrique Merino, Zuemy Rodríguez-Escamilla, Mario Alberto Martínez-Núñez
PLoS One Infectious Diseases, 29.04.2024
Tilføjet 29.04.2024
by Francisco Guillén-Chable, Johnny Omar Valdez Iuit, Luis Alejandro Avila Castro, Carlos Rosas, Enrique Merino, Zuemy Rodríguez-Escamilla, Mario Alberto Martínez-Núñez Horizontal gene transfer (HGT) is a well-documented strategy used by bacteria to enhance their adaptability to challenging environmental conditions. Through HGT, a group of conserved genetic elements known as mobile genetic elements (MGEs) is disseminated within bacterial communities. MGEs offer numerous advantages to the host, increasing its fitness by acquiring new functions that help bacteria contend with adverse conditions, including exposure to heavy metal and antibiotics. This study explores MGEs within microbial communities along the Yucatan coast using a metatranscriptomics approach. Prior to this research, nothing was known about the coastal Yucatan’s microbial environmental mobilome and HGT processes between these bacterial communities. This study reveals a positive correlation between MGEs and antibiotic resistance genes (ARGs) along the Yucatan coast, with higher MGEs abundance in more contaminated sites. The Proteobacteria and Firmicutes groups exhibited the highest number of MGEs. It’s important to highlight that the most abundant classes of MGEs might not be the ones most strongly linked to ARGs, as observed for the recombination/repair class. This work presents the first geographical distribution of the environmental mobilome in Yucatan Peninsula mangroves.
Læs mere Tjek på PubMedMalaria Journal, 29.04.2024
Tilføjet 29.04.2024
Abstract Background Despite efforts made to reduce morbidity and mortality associated with malaria, especially in sub-Saharan Africa, malaria continues to be a public health concern that requires innovative efforts to reach the WHO-set zero malaria agenda. Among the innovations is the use of artemisinin-based combination therapy (ACT) that is effective against Plasmodium falciparum. Generic artemether–lumefantrine (AL) is used to treat uncomplicated malaria after appropriate diagnosis. AL is metabolized by the cytochrome P450 family of enzymes, such as CYP2B6, CYP3A4 and CYP3A5, which can be under pharmacogenetic influence. Pharmacogenetics affecting AL metabolism, significantly influence the overall anti-malarial activity leading to variable therapeutic efficacy. This study focused on generic AL drugs used in malarial treatment as prescribed at health facilities and evaluated pharmacogenomic influences on their efficacy. Methods Patients who have been diagnosed with malaria and confirmed through RDT and microscopy were recruited in this study. Blood samples were taken on days 1, 2, 3 and 7 for parasite count and blood levels of lumefantrine, artemisinin, desbutyl-lumefantrine (DBL), and dihydroartemisinin (DHA), the active metabolites of lumefantrine and artemether, respectively, were analysed using established methods. Pharmacogene variation analysis was undertaken using iPLEX microarray and PCR–RFLP. Results A total of 52 patients completed the study. Median parasite density from day 1 to 7 ranged from 0–2666/μL of blood, with days 3 and 7 recording 0 parasite density. Highest median plasma concentration for lumefantrine and desbutyl lumefantrine, which are the long-acting components of artemisinin-based combinations, was 4123.75 ng/mL and 35.87 ng/mL, respectively. Day 7 plasma lumefantrine concentration across all generic ACT brands was ≥ 200 ng/mL which potentially accounted for the parasitaemia profile observed. Monomorphism was observed for CYP3A4 variants, while there were observed variations in CYP2B6 and CYP3A5 alleles. Among the CYP3A5 genotypes, significant differences in genotypes and plasma concentration for DBL were seen on day 3 between 1/*1 versus *1/*6 (p = 0.002), *1/*3 versus *1/*6 (p = 0.006) and *1/*7 versus *1/*6 (p = 0.008). Day 7 plasma DBL concentrations showed a significant difference between *1/*6 and *1/*3 (p = 0.026) expressors. Conclusions The study findings show that CYP2B6 and CYP3A5 pharmacogenetic variations may lead to higher plasma exposure of AL metabolites.
Læs mere Tjek på PubMedInfection, 29.04.2024
Tilføjet 29.04.2024
Infection, 29.04.2024
Tilføjet 29.04.2024
Abstract Purpose Bloodstream infections (BSI) and sepsis are important causes of hospitalization, loss of health, and death globally. Targetable risk factors need to be identified to improve prevention and treatment. In this study, we aimed to evaluate the association of chronic kidney disease (CKD) and risk of and mortality from BSI and sepsis in the general population during a 22-year period. Methods We conducted a prospective cohort study among participants in the population-based Norwegian HUNT Study, where 68,438 participated. The median follow-up time was 17.4 years. The exposures were estimated glomerular filtration rate (eGFR) and albumin–creatinine ratio (ACR) in urine. The outcomes were hazard ratios (HR) of hospital admission or death due to BSI or sepsis. The associations were adjusted for age, sex, diabetes, obesity, systolic blood pressure, smoking status, and cardiovascular disease. Results Participants with eGFR 30 mg/mmol) had HR 3.60 for BSI (95% CI 2.30–5.6) and 3.14 for sepsis (95% CI 1.94–5.1) compared to normal albumin excretion (ACR
Læs mere Tjek på PubMedJournal of the American Medical Association, 29.04.2024
Tilføjet 29.04.2024
Observational studies have suggested that rapid viral testing for respiratory viruses is tied to lower use of antibiotics. Now, a meta-analysis published in JAMA Internal Medicine suggests that may not be the case, based on results from 11 randomized clinical trials involving about 6100 participants.
Læs mere Tjek på PubMedJournal of the American Medical Association, 29.04.2024
Tilføjet 29.04.2024
Currently, the World Health Organization (WHO) recommends using dolutegravir, an integrase strand transfer inhibitor approved by the US Food and Drug Administration in 2013, as a first- and second-line drug for treating people with HIV. But resistance to the treatment is on the rise. About 4% to as many as about 20% of people in 4 countries reporting data—Malawi, Mozambique, Uganda, and Ukraine—who had not achieved viral suppression exhibited resistance while taking the drug as part of their antiretroviral therapy, a recent report by the WHO found.
Læs mere Tjek på PubMedJournal of the American Medical Association, 29.04.2024
Tilføjet 29.04.2024
Deaths associated with excessive alcohol use have been rising over the past 20 years. But during 2020-2021 they went up dramatically—from an average of about 138 000 deaths during 2016-2017 to more than 178 000 deaths during the COVID-19 pandemic. The change represents a 29% increase in lives lost, according to results published in the MMWR.
Læs mere Tjek på PubMedJournal of the American Medical Association, 29.04.2024
Tilføjet 29.04.2024
This Medical News article is an interview with JAMA Editor in Chief Kirsten Bibbins-Domingo and Virologist Davey Smith, head of the Division of Infectious Diseases and Global Public Health at the University of California, San Diego.
Læs mere Tjek på PubMedJournal of the American Medical Association, 29.04.2024
Tilføjet 29.04.2024
This study discusses whether facilitated telemedicine for hepatitis C treatment increases cure rates compared with standard-of-care referral to hepatitis specialists.
Læs mere Tjek på PubMedBloom, J. E., Nehme, E., Paratz, E. D., Dawson, L., Nelson, A. J., Ball, J., Eliakundu, A., Voskoboinik, A., Anderson, D., Bernard, S., Burrell, A., Udy, A. A., Pilcher, D., Cox, S., Chan, W., Mihalopoulos, C., Kaye, D., Nehme, Z., Stub, D.
BMJ Open, 29.04.2024
Tilføjet 29.04.2024
ObjectivesWe aimed to assess the healthcare costs and impact on the economy at large arising from emergency medical services (EMS) treated non-traumatic shock. DesignWe conducted a population-based cohort study, where EMS-treated patients were individually linked to hospital-wide and state-wide administrative datasets. Direct healthcare costs (Australian dollars, AUD) were estimated for each element of care using a casemix funding method. The impact on productivity was assessed using a Markov state-transition model with a 3-year horizon. SettingPatients older than 18 years of age with shock not related to trauma who received care by EMS (1 January 2015–30 June 2019) in Victoria, Australia were included in the analysis. Primary and secondary outcome measuresThe primary outcome assessed was the total healthcare expenditure. Secondary outcomes included healthcare expenditure stratified by shock aetiology, years of life lived (YLL), productivity-adjusted life-years (PALYs) and productivity losses. ResultsA total of 21 334 patients (mean age 65.9 (±19.1) years, and 9641 (45.2%) females were treated by EMS with non-traumatic shock with an average healthcare-related cost of $A11 031 per episode of care and total cost of $A280 million. Annual costs remained stable throughout the study period, but average costs per episode of care increased (Ptrend=0.05). Among patients who survived to hospital, the average cost per episode of care was stratified by aetiology with cardiogenic shock costing $A24 382, $A21 254 for septic shock, $A19 915 for hypovolaemic shock and $A28 057 for obstructive shock. Modelling demonstrated that over a 3-year horizon the cohort lost 24 355 YLLs and 5059 PALYs. Lost human capital due to premature mortality led to productivity-related losses of $A374 million. When extrapolated to the entire Australian population, productivity losses approached $A1.5 billion ($A326 million annually). ConclusionThe direct healthcare costs and indirect loss of productivity among patients with non-traumatic shock are high. Targeted public health measures that seek to reduce the incidence of shock and improve systems of care are needed to reduce the financial burden of this syndrome.
Læs mere Tjek på PubMedHardman, K., Davies, A., Demetri, A., Clayton, G., Bakhbakhi, D., Birchenall, K., Barnfield, S., Fraser, A., Burden, C., McGuinness, S., Miller, R., Merriel, A.
BMJ Open, 29.04.2024
Tilføjet 29.04.2024
ObjectivesTo explore and characterise maternity healthcare professionals’ (MHCPs) experience and practice of shared decision-making (SDM), to inform policy, research and practice development. DesignQualitative focus group study. SettingLarge Maternity Unit in the Southwest of England. ParticipantsMHCPs who give information relating to clinical procedures and pregnancy care relating to labour and birth and are directly involved in decision-making conversations were purposively sampled to ensure representation across MHCP groups. Data collectionA semistructured topic guide was used. Data analysisReflexive thematic analysis was undertaken. ResultsSeven focus groups were conducted, comprising a total of 24 participants (3–5 per group). Two themes were developed: contextualising decision-making and controversies in current decision-making. Contextual factors that influenced decision-making practices included lack of time and challenges faced in intrapartum care. MHCPs reported variation in how they approach decision-making conversations and asked for more training on how to consistently achieve SDM. There were communication challenges with women who did not speak English. Three controversies were explored: the role of prior clinical experience, the validity of informed consent when women were in pain and during life-threatening emergencies and instances where women declined medical advice. ConclusionsWe found that MHCPs are committed to SDM but need better support to deliver it. Structured processes including Core Information Sets, communication skills training and decision support aids may help to consistently deliver SDM in maternity care.
Læs mere Tjek på PubMedKadiyala, Gayatri Nikhila; Telwatte, Sushama; Wedrychowski, Adam; Janssens, Julie; Kim, Sun Jin; Kim, Peggy; Deeks, Steven; Wong, Joseph K.; Yukl, Steven A.
AIDS, 29.04.2024
Tilføjet 29.04.2024
Objectives: Some drugs that augment cell-intrinsic defenses or modulate cell death/survival pathways have been reported to selectively kill cells infected with HIV or SIV, but comparative studies are lacking. We hypothesized that these drugs may differ in their ability to kill cells infected with intact and defective proviruses. Design: To investigate this hypothesis, drugs were tested ex vivo on Peripheral Blood Mononuclear Cells (PBMC) from nine ART-suppressed individuals. Methods: We tested drugs currently in clinical use or human trials, including auranofin (p53 modulator), interferon alpha2A, interferon gamma, acitretin (RIG-I inducer), GS-9620/vesatolimod (TLR7 agonist), nivolumab (PD-1 blocker), obatoclax (Bcl-2 inhibitor), birinapant (IAP inhibitor), bortezomib (proteasome inhibitor), and INK128/sapanisertib (mTOR[c]1/2 inhibitor). After six days of treatment, we measured cell counts/viabilities and quantified levels of total, intact, and defective HIV DNA by droplet digital PCR (Intact Proviral DNA Assay). Results: Obatoclax reduced intact HIV DNA (median = 27–30% of DMSO) but not defective or total HIV DNA. Other drugs showed no statistically significant effects. Conclusions: Obatoclax and other Bcl-2 inhibitors deserve further study in combination therapies aimed at reducing the intact HIV reservoir in order to achieve a functional cure and/or reduce HIV-associated immune activation.
Læs mere Tjek på PubMedFilip, Iulia
AIDS, 29.04.2024
Tilføjet 29.04.2024
Siyue JiaZundong YinHongxing PanFuzhen WangXiaoqiang LiuQing WangLi ZhangJihai TangHao YangJiangbo DuZhiguo WangPengfei JinZhihang PengRong TangGuodong KangXuewen WangSimin LiWeixiao WangJingxin LiHongbing ShenFengcai Zhua NHC Key Laboratory of Enteric Pathogenic Microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, People’s Republic of Chinab National Vaccine Innovation Platform and Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, People’s Republic of Chinac China Center for Disease Control and Prevention, Beijing, People’s Republic of Chinad Yunnan Provincial Center for Disease Control and Prevention, Kunming, People’s Republic of Chinae Chongqing Provincial Center for Disease Control and Prevention, Chongqing, People’s Republic of Chinaf Shandong Provincial Center for Disease Control and Prevention, Jinan, People’s Republic of Chinag Anhui Provincial Center for Disease Control and Prevention, Hefei, People’s Republic of Chinah Hunan Provincial Center for Disease Control and Prevention, Changsha, People’s Republic of Chinai School of Public Health, Southeast University; Nanjing, People’s Republic of Chinaj Canming Medical Technology Co., Ltd, Shanghai, People’s Republic of China
Emerg Microbes Infect, 29.04.2024
Tilføjet 29.04.2024
Coburn, Sally B.; Pimentel, Noel; Leyden, Wendy; Kitahata, Mari; Moore, Richard D.; Althoff, Keri N.; Gill, M. John; Lang, Raynell; Horberg, Michael A.; D’Souza, GypsyAmber; Hussain, Shehnaz K.; Dubrow, Robert; Novak, Richard M.; Rabkin, Charles S.; Park, Lesley S.; Sterling, Timothy R.; Neugebauer, Romain S.; Silverberg, Michael J.; for the North American AIDS Cohort Collaboration on Research and Design of the International Epidemiologic Databases to Evaluate AIDS
Journal of Acquired Immune Deficiency Syndromes, 29.04.2024
Tilføjet 29.04.2024
Background: The effect of initial antiretroviral therapy (ART) class on cancer risk in people with HIV (PWH) remains unclear. Setting: Cohort study of 36,322 PWH enrolled (1996-2014) in the North American AIDS Cohort Collaboration on Research and Design. Methods: We followed individuals from ART initiation (protease inhibitor [PI]-, non-nucleoside reverse transcriptase inhibitor [NNRTI]-, or integrase strand transfer inhibitor [INSTI]-based) until incident cancer, death, loss-to-follow-up, 12/31/2014, 85 months (intention-to-treat analyses [ITT]), or 30 months (per-protocol [PP] analyses). Cancers were grouped (non-mutually exclusive) as: any cancer, AIDS-defining cancers (ADC), non-AIDS-defining cancers (NADC), any infection-related cancer, and common individual cancer types. We estimated adjusted hazard ratios (aHR) comparing cancer risk by ART class using marginal structural models emulating ITT and PP trials. Results: We observed 17,004 PWH (954 cancers) with PI-based (median 6 years follow-up), 17,536 (770 cancers) with NNRTI-based (median 5 years follow-up) and 1,782 (29 cancers) with INSTI-based ART (median 2 years follow-up). Analyses with 85 months follow-up indicated no cancer risk differences. In truncated analyses, risk of ADCs (aHR 1.33; 95% CI 1.00, 1.77 [PP-analysis]) and NADCs (aHR 1.23; 95% CI 1.00, 1.51[ITT-analysis]) were higher comparing PIs vs. NNRTIs. Conclusions: Results with longer-term follow-up suggest being on a PI- versus NNRTI-based ART regimen does not affect cancer risk. We observed shorter-term associations that should be interpreted cautiously and warrant further study. Further research with longer duration of follow-up that can evaluate INSTIs, the current first-line recommended therapy, is needed to comprehensively characterize the association between ART class and cancer risk. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedD’Antoni, Michelle L.; Andreatta, Kristen; Chang, Silvia; Cox, Stephanie; Hindman, Jason T.; Avihingsanon, Anchalee; Martin, Hal; VanderVeen, Laurie A.; Callebaut, Christian
Journal of Acquired Immune Deficiency Syndromes, 29.04.2024
Tilføjet 29.04.2024
Background: In the Phase 3 ALLIANCE study, both bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) and dolutegravir plus emtricitabine/tenofovir disoproxil fumarate (DTG + F/TDF) achieved high rates of HIV-1 RNA suppression through Week 96 in adults with HIV-1 and hepatitis B virus (HBV) initiating treatment (NCT03547908). Here, we quantify preexisting HIV-1 resistance, evaluate its effect on HIV-1 virologic suppression, and describe postbaseline HIV-1 resistance through Week 96. Methods: Preexisting HIV-1 resistance was assessed by historical and/or screening genotyping. HIV-1 RNA suppression to
Læs mere Tjek på PubMedAudet, Carolyn M.; Graves, Erin; Shepherd, Bryan E.; Prigmore, Heather L.; Brooks, Hannah L.; Emílio, Almiro; Matino, Ariano; Paulo, Paula; Diemer, Matthew A.; Frisby, Michael; Sack, Daniel E.; Aboobacar, Arifo; Barreto, Ezequiel; Van Rompaey, Sara; De Schacht, Caroline
Journal of Acquired Immune Deficiency Syndromes, 29.04.2024
Tilføjet 29.04.2024
Introduction: There is evidence that a supportive male partner facilitates maternal HIV testing during pregnancy, increases maternal ART initiation and adherence, and increases HIV-free infant survival. Most male partner engagement clinical strategies have focused on increasing uptake of couple-based HIV testing and counseling. We delivered a couple-based care and treatment intervention to improve of ART adherence in expectant couples living with HIV. Methods: We implemented a cluster randomized controlled trial for seroconcordant couples living with HIV, comparing retention (patient’s medication possession ratio) in HIV care for a couple-based care and treatment intervention versus standard of care services in rural Mozambique. The intervention included couple-based treatment, couple-based education and skills building, and couple-peer educator support. Results: We recruited 1080 couples to participate in the study. Using a linear mixed effect model with a random effect for clinic, the intervention had no impact on the medication possession ratio among women at 12 months. However, the intervention increased men’s medication ratio by 8.77%. Our unadjusted logistic regression model found the odds of an infant seroconverting in the intervention group was 30% less than in the control group, but the results were not statistically significant. Discussion: Our intervention resulted in no difference in maternal outcomes, but improved medication possession ratio among male partners. We provide a community/clinic-based treatment framework that can improve outcomes among male partners. Further work needs to be done to improve social support for pregnant women and to facilitate prevention of vertical transmission to infants among couples living with HIV. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedNeary, Jillian; Njuguna, Irene; Wagner, Anjuli D.; Richardson, Barbra A.; Chebet, Daisy; Langat, Agnes; Ngugi, Evelyn; Benki-Nugent, Sarah; Moraa, Hellen; Hawes, Stephen E.; Overbaugh, Julie; Slyker, Jennifer A.; Lehman, Dara A.; Wamalwa, Dalton; John-Stewart, Grace
Journal of Acquired Immune Deficiency Syndromes, 29.04.2024
Tilføjet 29.04.2024
Background: Identifying determinants of longitudinal HIV viral load (VL) trajectories using group-based trajectory modeling (GBTM) can inform clinical strategies and mechanisms of non-adherence among children. Methods: Children under 12 months of age who were newly diagnosed with HIV were enrolled in the Optimizing Pediatric HIV Therapy (OPH; NCT00428116) from 2007-2010. Children initiated antiretroviral therapy (ART) at enrollment, and VL was assessed every 3 months for 24 months post-ART and 6-monthly thereafter up to 8 years of age. VL trajectory groups were defined using GBTM. Fisher’s exact and Kruskal-Wallis tests were used to determine correlates of each trajectory group compared to the sustained-low VL group. Results: Five VL trajectory groups were identified among 89 children with 522 VL visits from 6-24 months: sustained-low VL (63% of children), sustained-very-high (16%), sustained-high (9%), low-to-high (7%), and high-with-periods-of-low (6%). Children in the sustained-high group were more frequently on a first-line protease inhibitor (PI)-based regimen (63% vs 38%; p=0.03) and had younger caregivers (median: 22 vs 28 years; p=0.02). Among 54 children with 560 VL visits followed from 48-96 months, 5 trajectory groups were identified: sustained-low (74%), mid-range (4%), periods-of-low (7%), high-to-low (7%), and sustained-high (7%). Those in the high-to-low group had younger caregivers (21 vs 29 years; p=0.01). Conclusions: GBTM identified unique VL patterns among children with unsuppressed VL. Caregiver and regimen-related characteristics were associated with patterns of non-suppression. Younger caregivers may benefit from tailored counseling to help them support child ART adherence. Palatable regimens are necessary for viral suppression among children with HIV. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedNoorman, Maaike A.J.; de Wit, John B.F.; Marcos, Tamika A.; Stutterheim, Sarah E.; Jonas, Kai J.; Den Daas, Chantal
Journal of Acquired Immune Deficiency Syndromes, 29.04.2024
Tilføjet 29.04.2024
Objective: As the developments towards HIV cure are gaining prominence, engagement of people with HIV (PWH) becomes crucial. This study aims to gain deeper insight into how PWH engage with HIV cure (research) by exploring their perspectives regarding awareness, importance, and meaning of HIV cure (research). Methods: Semi-structured interviews were conducted with 30 purposively sampled PWH in the Netherlands. Interviews were transcribed verbatim and thematic data analysis was undertaken. Results: The overall necessity for an HIV cure was high, but personal perceived necessity varied based on participants’ lived experiences with HIV. Most participants saw less personal necessity due to their high quality of life, while those more affected by their HIV status expressed a stronger need for a cure. Participants held high expectations for an HIV cure, considering viral eradication as the only cure. Lack of awareness of potential HIV cure strategies and techniques shaped concerns. Antiretroviral treatment-free viral suppression was met with concerns and not considered a cure, but rather an improved form of treatment. Engagement with HIV cure manifested in various forms and levels, with only a few participants actively engaged or willing to participate in HIV cure clinical research. Most participants were interested but inactive and unsure about participating in HIV cure clinical research. Conclusions: PWH’s social engagement in HIV cure (research) is shaped by their perceived necessity and concerns. Understanding these perceptions can increase social engagement. Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.
Læs mere Tjek på PubMedMurphy, 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 PubMedMutetwa, Tinaye; Liu, Yuxin; Silvera, Richard; Evans, Michelle; Yurich, Michael; Tripodi, Joseph; Leonard, Issa; Houldsworth, Jane; Gümüş, Zeynep; Bowcock, Anne M.; Sigel, Keith; Gaisa, Michael; Polak, Paz
Journal of Acquired Immune Deficiency Syndromes, 29.04.2024
Tilføjet 29.04.2024
BACKGROUND: People living with HIV (PLWH) have substantially increased incidence of anal precancer and cancer. There are very little data regarding genomic disturbances in anal precancers among PLWH. Here, we identified specific chromosomal variants in anal squamous intraepithelial lesions. METHODS: We collected 63 anal biopsy specimens (27 low-grade intraepithelial lesions [LSIL] and 36 high-grade intraepithelial lesions [HSIL]) from PLWH obtained as part of anal cancer screening in our NYC-based health system. Data on patient demographics, anal cytological and high-risk human papillomavirus (HR-HPV) diagnoses were collected. Specimens were tested for a panel of chromosomal alterations associated with HPV-induced oncogenesis using Fluorescence In-Situ Hybridization (FISH) and analyses compared the associations of these alterations with clinical characteristics. RESULTS: Gains of 3q26, 5p15, 20q13 and cen7 were detected in 42%, 31%, 31%, and 19% of HSIL compared to 7%, 0%, 4%, and 0% of LSIL, respectively. Where at least one abnormality was seen, 89% had a 3q26 gain. In lesions with 5p15 gains, 20q13 gains co-occurred in 91% of cases, while cen7 gain only co-occurred with the other three alterations. Sensitivity and specificity of any alteration to predict HSIL was 47% (95% CI: 30-65%) and 93% (95% CI: 76%-99%) respectively. CONCLUSIONS: Genomic alterations seen in HPV-associated cancers may help distinguish anal LSIL from HSIL. 3q26 amplification may be an early component of anal carcinogenesis, preceding 5p16, 20q13 and/or chr7. IMPACT: We share insights on potential genomic biomarkers for discriminating high-risk anal precancers. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedRosenthal, Mark; Patterson, Wendy; Rajulu, Deepa T.
Journal of Acquired Immune Deficiency Syndromes, 29.04.2024
Tilføjet 29.04.2024
Background: Late HIV diagnosis is associated with a wide range of negative outcomes. This study aims to identify characteristics of individuals who received a concurrent diagnosis (CDX) in New York State (NYS) so that more effective interventions can be developed to encourage earlier testing among these populations. Methods: The NYS HIV registry was used to identify people who received a CDX from 2016 – 2021. A CDX was a diagnosis that met the criteria for a stage 3 HIV infection within 30 days of the initial HIV diagnosis. Sex at birth, race/ethnicity, transmission risk group, age at diagnosis, region of residence at diagnosis, urbanicity of zip code of diagnosis, and type of diagnosing facility were used as covariates. Bivariate and multivariate risk ratios were calculated to quantify associations between CDX and covariates. Results: There were 14,866 people newly diagnosed with HIV in NYS from 2016 – 2021, of which 19.0% had a CDX. Those with female sex at birth, IDU, or MSM/IDU risk were less likely to have a CDX. Increased age, Asian race/ethnicity, residence outside of New York City, and diagnosis at inpatient facilities or emergency rooms were associated with an increased likelihood of a CDX. Conclusion: Populations with the highest proportions of CDX were ones that made up a small percentage of all new HIV diagnoses and may not be benefiting as much from current HIV prevention efforts. There are complex interactions between many factors including geographic and social characteristics which may lead to delayed diagnostic testing. 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 PubMedBennett, Christopher L; Saxena, Monica; Boothroyd, Derek; Mahmoud-Werthmann, Sally; Lin, Michelle P
Journal of Acquired Immune Deficiency Syndromes, 29.04.2024
Tilføjet 29.04.2024
BECKER, Marissa; MISHRA, Sharmistha; BHATTACHARJEE, Parinita; MUSYOKI, Helgar; TENNAKOON, Aruni; LEUNG, Stella; CHEUK, Eve; LORWAY, Rob; ISAC, Shajy; MA, Huiting; CHOLETTE, Francois; SANDSTROM, Paul; GICHANGI, Peter; MWATELAH, Ruth; MCKINNON, Lyle; BLANCHARD, James; PICKLES, Michael; the Transitions Study Team
Journal of Acquired Immune Deficiency Syndromes, 29.04.2024
Tilføjet 29.04.2024
Background: The design of HIV prevention programs for adolescent girls and young women (AGYW) are informed by data on who is at highest risk, and where they can be reached. Places (hotspots) associated with selling sex are an established outreach strategy for sex work programs, but could be used to reach other AGYW at high risk. Setting: This study took place in Mombasa, Kenya. Methods: We conducted a cross-sectional, bio-behavioural survey among (N=1,193) sexually active AGYW aged 14-24 years recruited at hotspots. We compared HIV prevalence by sub-group (sex work, SW; transactional sex, TS; and non-transactional sex, NTS), stratified by hotspot type (venues and non-venues). We examined whether associations between HIV prevalence and hotspot/subgroup remained after adjustment for individual-level risk factors, and estimated HIV prevalence ratio (PR) with and without adjustment for these individual-level factors. Results: Overall HIV prevalence was 5.6%, 5.3% in venues and 7.3% in non-venues. Overall SW HIV prevalence was two-fold higher than among participants engaged in NTS. After adjusting for age and individual-level risk factors, HIV prevalence was 2.72 times higher among venue-based SWs (95% CI: 1.56-4.85) and 2.11 times higher among non-venue AGYW not engaged in SW (95% CI: 0.97-4.30) compared to venue-based AGYW not engaged in SW. Conclusion: AGYW who sell sex remain at high risk of HIV across types of hotspots. The residual pattern of elevated HIV burden by AGWY subgroup and hotspot type suggests that unmeasured, network-level factors underscore differential risks. As such, hotspots constitute a “place” to reach AGYW at high risk of HIV. Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.
Læs mere Tjek på PubMedMcCrimmon, Tara; Collins, Lauren F.; Pereyra, Margaret; Platamone, Corbin; Perez-Brumer, Amaya; Shaffer, Victoria A.; Kerrigan, Deanna; Sheth, Anandi N; Cohen, Mardge H; Hanna, David B.; Ramirez, Catalina; Gange, Stephen J.; Rana, Aadia; Tamraz, Bani; Goparaju, Lakshmi; Wilson, Tracey E; Alcaide, Maria; Philbin, Morgan M.
Journal of Acquired Immune Deficiency Syndromes, 29.04.2024
Tilføjet 29.04.2024
Iannone, V.; Ciccullo, A.; Moschese, D.; Giacomelli, A.; Fabbiani, M.; Lagi, F.; Papalini, C.; De Vito, A.; Cossu, M.V.; Di Giambenedetto, S.; Borghetti, A.
Journal of Acquired Immune Deficiency Syndromes, 29.04.2024
Tilføjet 29.04.2024