Abstract Background Hospital-associated infection (HAI) is an important issue in intensive care units (ICUs). We still lack direct evidence on whether the ICU patients and/or the medical system can benefit from single isolated laminar-air-flow (LAF) wards. Methods High-touched-surface (HTS) swabs from 5 sites in two kinds of wards with different ventilation systems were longitudinally collected for 16 S rRNA sequencing and Type IIB restriction site-associated DNA sequencing for Microbiome (2bRAD-M). Samples were collected for 3 months. The clinical data of patients admitted to different wards during the sampling time and the whole year were collected and compared. Results The α-diversity of single wards with isolated LAF was significantly higher than open regions without LAF (p

Abstract Shortly after the first case of SARS-CoV-2 was diagnosed a public health emergency (PHE) was declared and a multi-agency response was initiated within the US federal government to create and propagate testing capacity. As part of this response, an unprecedented program designated Rapid Acceleration of Diagnostics (RADx) Tech was established by the National Institutes of Health (NIH) to facilitate the development of point-of-care tests for the COVID-19. The RADx Tech Clinical Studies Core (CSC), located at the University of Massachusetts Chan Medical School (UMass Chan), with partnering academic, private, and non-governmental organizations around the country, was tasked with developing clinical studies to support this work. This manuscript details development of a biorepository specifically focused on the collection and storage of samples designed for diagnostic platform development. It highlights the unified collection and annotation process that enabled gathering a diverse set of samples. This diversity encompasses the geography and backgrounds of the participants as well as sample characteristics such as variant type and RT-PCR cycle threshold (CT) value of the corresponding reference sample on a uniform clinical reference platform. …

Abstract Background Schistosoma japonicum, the causative agent of schistosomiasis, heavily relies on its single intermediate host, the Oncomelania hupensis snail, for its life cycle. Controlling these snails effectively plays a pivotal role in curbing the transmission and prevalence of this disease. While prior research has extensively investigated the impact of environmental factors such as temperature and vegetation on snail survival, growth, and reproduction, the contribution of water physicochemical properties has been notably underexplored. This study presents laboratory experiments designed to comprehensively explore the influence of water physicochemical properties on snail survival, offering valuable insights into environmental factors for more precise predictions of snail distribution. Methods We meticulously conducted laboratory snail survival experiments using water from different sources (river water/tap water), and employed a statistical approach amalgamating principal component analysis with Cox regression to preliminarily investigate the effects of different water physicochemical properties on the survival of snails. Results Our analysis indicates that after a 6-month laboratory snail survival experiment, the survival rate in the tap water group was significantly higher than that in the river water group for infected snails (χ2 = 7.74, p = 0.005), while the difference in survival rates for non-infected snails was not statistically significant (χ2 = 0.61, p = 0.434). The Principal Component-Cox regression analysis revealed that in the infected snail group, total phosphorus, pH value, five-day biochemical oxygen demand, conductivity, and nitrite were protective factors for snail survival, while phosphate and total nitrogen were risk factors. In the non-infected snail group, total phosphorus, pH value, five-day biochemical oxygen demand, conductivity, and nitrite were protective factors for snail survival, and total nitrogen, ammonia nitrogen, phosphate, and nitrate were risk factors. Conclusions This study underscores the substantial impact of water quality’s physicochemical properties on snail survival. The effects of water quality on snails are complex, and maintaining an appropriate level of organic matter content and controlling the pH value at a weak alkalescency level prove beneficial for snail survival. These findings hold significant promise for advancing our understanding of snail-borne diseases and optimizing control strategies. …

Abstract Background Influenza is a major cause of morbidity and mortality. Influenza A virus (IAV) is one of the most important pathogens causing influenza and often causes global pandemics due to its tendency to mutate. We aim to use epidemiology based on wastewater and respiratory specimens to understand the occurrence of influenza A virus infections in Taiyuan City. Methods A retrospective epidemiology surveillance was carried out at the First Hospital of Shanxi Medical University (FHSMU) and five wastewater treatment plants (WTPs) in Taiyuan city from 2023 to 2024. Reverse transcription real-time fluorescence quantitative polymerase chain reaction (RT-qPCR) was used to detect influenza A viruses in wastewater and respiratory specimens. High-throughput whole genome sequencing was performed on 17 strains obtained in this study, and subsequent analyses included characterization, phylogenetic construction, amino acid mutation analysis, and antigenic structural variability assessment. Results 520 wastewater samples and 1,203 throat swab samples were collected. We detected RNA concentration from pH1N1 and H3N2 viruses in wastewater and got 17 genome sequences (5 of pH1N1 and 12 of H3N2) in respiratory specimens. Whole-genome sequencing showed co-prevalence of pH1N1 viruses in the branches of 6B.1 A.5a.2a.1 and H3N2 viruses in the branches of 3 C.2a1b.2a.2a.3a.a in Taiyuan from 2023 to 2024. Moreover, a HA mutation (N138D), predicted to be of high phenotypic consequence, was found in 8 Taiyuan H3N2 sequences. Conclusion This study highlights the predominant presence of pH1N1 and H3N2 strains in Taiyuan. The analysis also identified amino acid site variations in the HA antigenic epitopes in H3N2 strains, which may contribute to immune escape. …

Abstract Background Intestinal parasitic infections (IPIs) are serious global public health issues, especially in low and middle-income countries. These parasites can cause high morbidity and mortality, especially in immunocompromised individuals, and can easily be transmitted by consumption of contaminated food or water or by penetration of skin and mucous membranes. Methods We retrospectively analyzed all archived data from stool examination reports at the Parasitology Unit of Precise Health Diagnostic Services, Berekum for the prevalence and trends of parasitic infections spanning a period of 9 years (2013–2021). The data was retrieved and exported to IBM SPSS v.26 for statistical analysis. Descriptive data was summarized as proportions and presented in tables and charts. Pearson Chi-Square test (χ2) or Fisher’s exact test was used to test for a statistical association between demographic factors and intestinal parasitic infections. P value was significant at

Abstract Background Intestinal parasitic (IP) infections caused by helminths are among the most significant public health concerns that mainly affect deprived people in Sub-Sahara African countries. The current study aimed to determine the prevalence and associated risk factors of intestinal parasitic helminths among patients attending Mekaneselam hospital. Method In this cross-sectional study conducted from August 2022 to February 2023, stool specimens were collected and examined microscopically to detect intestinal helminths using direct wet-mount and formal-ether concentration techniques. A structured questionnaire was employed to obtain information regarding the socio-demographic characteristics and associated risk factors. Data were analyzed via appropriate univariate and multivariable logistic regression methods using SPSS version 25.0. Result The overall prevalence of the parasitic helminths was 51 (12.6%) out of 404 patients attending in Mekaneselam town during the study period. In this study, seven species of intestinal helminths were detected, with Ascaris lumbricoides (5.7%) being the most prevalent followed by Trichuris trichiura (2.2%). Significant positive associations were observed between intestinal helminths infection and the socio-demographic characteristics including marital status (χ2 = 7.97, p = 0.047), educational level (χ2 = 9.34, p = 0.025) and residence (χ2 = 3.90, p = 0.048). The odds of being infected with IP were three times higher among divorced patients than married individuals (AOR = 3.21, CI = 1.15–8.96, p = 0.03). Illiterate individuals were three times (AOR = 2.61, CI = 1.24–5.49, p = 0.011) and those who attended primary school were two times (AOR = 2.3, CI = 1.029–5.143, p = 0.042), more likely to have helminthic infections. Participants who did not wash their hands after using the toilet were five times more likely to acquire IP helminths than those who did (AOR = 4.36, CI = 2.83–6.72, p = 0.000). In the case of the feeding habit, study subjects who ate unwashed vegetables were more likely to acquire helminths than those who did not eat unwashed vegetables (AOR = 5. 43, CI = 4.33–23.77, p = 0.000). Conclusion This study highlighted a substantial prevalence of intestinal helminths infections (12.6%) in the study area, warranting the urgent need for attention and interventions from relevant public health authorities. …

Proceedings of the National Academy of Sciences, Volume 121, Issue 46, November 2024.

Proceedings of the National Academy of Sciences, Volume 121, Issue 46, November 2024.

Proceedings of the National Academy of Sciences, Volume 121, Issue 46, November 2024.

Proceedings of the National Academy of Sciences, Volume 121, Issue 46, November 2024.

Proceedings of the National Academy of Sciences, Volume 121, Issue 46, November 2024.

Proceedings of the National Academy of Sciences, Volume 121, Issue 46, November 2024.

Proceedings of the National Academy of Sciences, Volume 121, Issue 46, November 2024.

Objective: The possible differences in comorbidity burden were examined between people with longstanding HIV infection and those with shorter HIV duration of the same calendar age. Design: We performed a single-centre retrospective cohort analysis comparing long-term HIV survivors (LTS) diagnosed with HIV before 1996 (pre-HAART), with an age-matched and gender-matched group diagnosed after 2006 [modern ART era (mART)]. Methods: Demographic and outcome data up to 1 May 2023 were obtained from electronic health records as well as from digitalized paper charts. Nine comorbidity domains were defined to overlook the comorbidity burden as on 1 May 2023: cardiovascular, musculoskeletal, neurological, oncological, liver, pulmonary, renal, psychiatric/cognitive, and metabolic. Results: Eighty-eight LTS and 88 people diagnosed in the modern ART era were included in the analysis. Median age in both groups was 60 years. LTS had a higher mean number of comorbidity domains than controls (2.6 vs. 1.9; P = .001). In both LTS and mART groups, metabolic and cardiovascular comorbidity was most prevalent (metabolic 70.5 and 52.3%, respectively, cardiovascular 44.3 and 38.6%, respectively). When stratified according to age, the distribution of the number of comorbidities for LTS roughly resembled the 10 years older mART subgroup. In a multivariate analysis, total ART duration and age were found to be statistically significantly associated with the number of comorbidity domains. Conclusion: Our analysis suggests that LTS have a higher comorbidity burden compared with people diagnosed in the modern ART era of similar calendar age. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

Objectives: To understand the extent of racial disparities in SARS-CoV-2 vaccination among PWH and those vulnerable to HIV infection and to estimate the contributions of medical mistrust and vaccine-hesitant attitudes to these disparities. Design: Quantitative data analyses in a racially and gender diverse, mixed-serostatus prospective cohort, the MACS/WIHS Combined Cohort Study. Methods: Interviewer-assisted questionnaires assessed SARS-CoV-2 vaccination, medical mistrust, and vaccine-hesitant attitudes from March 2021—September 2022 (n=3948). Longitudinal analyses assessed effects of sociodemographics on medical mistrust and vaccine-hesitant attitudes. A hierarchical multivariable logistic regression assessed effects of these co-factors on SARS-CoV-2 vaccination. Causal mediation models assessed whether a) medical mistrust mediated the relationship between Black identity and vaccine-hesitant attitudes, and b) vaccine-hesitant attitudes mediated the relationship between Black identity and SARS-CoV-2 non-vaccination. Results: Participants’ mean age was 56.7; 55.3% were Black, 52.6% cisgender female, 62.6% PWH. 10.1% reported never receiving SARS-CoV-2 vaccinations (13.4% of Black and 4.5% of white participants). Black-identified participants had higher odds of non-vaccination than white participants (aOR = 1.72; 95% CI: 1.08, 2.72). Medical mistrust mediated the relationship between Black identity and vaccine-hesitant attitudes, accounting for 46.0% of the effect (p …

Objective: To identify predictors of HIV acquisition in Botswana. Design: We applied machine learning approaches to identify HIV risk predictors using existing data from a large, well-characterized HIV incidence cohort. Methods: We applied machine learning (randomForestSRC) to analyze data from a large population-based HIV incidence cohort enrolled in a cluster-randomized HIV prevention trial in 30 communities across Botswana. We sought to identify the most important risk factors for HIV acquisition, starting with 110 potential predictors. Results: During a median 29-month follow-up of 8,551 HIV-negative adults, 147 (1.7%) acquired HIV. Our machine learning analysis found that for females, the most important variables for predicting HIV acquisition were the use of injectable hormonal contraception, frequency of sex in the prior 3 months with the most recent partner and residing in a community with HIV prevalence of 29% or higher. For the small proportion (0.3%) of females who had all three risk factors, their estimated probability of acquiring HIV during 29 months of follow-up was 34% (approximate annual incidence of 14%). For males, non-long-term relationships with the most recent partner and community HIV prevalence of 34% or higher were the most important HIV risk predictors. The 6% of males who had both risk factors had a 5.1% probability of acquiring HIV during the follow-up period (approximate annual incidence of 2.1%). Conclusions: Machine learning approaches allowed us to analyze a large number of variables to efficiently identify key factors strongly predictive of HIV risk. These factors could help target HIV prevention interventions in Botswana. Clinical Trials Registration: NCT01965470 Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

Abstract Long-acting injectable cabotegravir plus rilpivirine (LA CAB/RPV) is currently US Food and Drug Administration (FDA)-approved and HIV treatment guideline-endorsed as a switch strategy for patients with HIV (PWH) who are virologically suppressed on oral ART without a history of treatment failure. Recent changes to the International Antiviral Society-USA (IAS-USA) and U.S. Department of Health and Human Services’ (DHHS) Panel on Antiretroviral Guidelines recommend the consideration of LA CAB/RPV in select PWH with viremia who are unable to achieve suppression with oral ART due to suboptimal medication adherence. In this article, we review the existing data on this off-label use of LA CAB/RPV, discuss the motivations and specific caveats implicit in the guidelines change, and propose next steps in exploring this novel treatment in this vulnerable patient population.

by Supriyo Ghosh, Amlan Jyoti Ghosh, Rejuan Islam, Sagar Sarkar, Tilak Saha Hepatic complications are the major health issues associated with dietary intake of calorie saturated food e.g. high-fat diet (HFD). Recent studies have revealed the beneficial effects of probiotics in HFD fed mice with hepatic complications. Some probiotic Lactic acid bacteria (LAB) e.g. Lactobacillus plantarum have drawn our attention in managing hepatic complications. Here, we aim to elucidate the protective effects of L. plantarum KAD strain, isolated from ethnic fermented food ‘Kinema’ in HFD-fed mice as, a preventive approach. Eighteen Swiss albino mice were equally divided into 3 groups: Normal Diet (ND), negative control (HFD), and HFD-fed with oral L. plantarum KAD supplementation (LP). All the experimental groups were subjected to specific diet according to grouping for eight weeks. After completion of the regime, subjects were anesthetized and sacrificed. Organs, blood, and fecal samples were collected and stored appropriately. Physical indices, including body weight gain, organ co-efficients were calculated along with assessment of glycemic, lipidomic, hepatic, oxidative stress, inflammatory, and histological parameters. Gut microbiota analysis was performed using 16s V3-V4 fecal metagenomic profiling, and sequencing were done using Illumina Miseq system. Oral administration of L. plantarum KAD is found to significantly (p…

by Wenxiang Qing, Yujie Qian Background To investigated the link between the systemic immunity-inflammation index (SII), a new inflammatory biomarker, and the risk of abnormal glucose regulation in non-diabetic population. Methods Using data from the 2005–2016 National Health and Nutrition Examination Survey (NHANES), we conducted a cross-sectional study on non-diabetic adults with data on SII and glucose regulation markers. We analyzed the relationship between SII and indicators of glucose regulation, including fasting plasma glucose, fasting insulin, hemoglobin A1c, oral glucose tolerance test (OGTT), and states of abnormal glucose regulation like impaired glucose tolerance (IGT), insulin resistance, and prediabetes. Results Adjusting for confounders, higher SII levels were significantly associated with a higher OGTT and a greater likelihood of IGT (OR = 2.673, 95% CI: 1.845, 3.873). In subgroup analysis, participants without hyperlipidemia in the highest SII quartile had a 240% higher odds of IGT compared to those in the lowest quartile (OR = 3.407, 95%CI: 1.995, 5.820), an association not observed in those with hyperlipidemia (p for interaction < 0.05). Conclusions SII emerges as a useful biomarker for identifying IGT in non-diabetic individuals, specifically in those without hyperlipidemia. …

by John Gilmore, David Comer, David J. Field, Randal Parlour, Adam Shanley, Chris Noone Background In May 2022, a global surge in mpox cases, typically endemic to Western and Central Africa, particularly affected gay, bisexual, and other men who have sex with men (gbMSM). This study examines gbMSM communities’ experiences and perceptions around Ireland’s public health response to the outbreak. Methods A cross-sectional mixed-methods online survey was conducted. Qualitative data were analysed using reflexive thematic analysis informed by critical realism. Findings A total of 163 gay and bisexual men took part in the survey. Participants accessed information from diverse sources, reporting varying levels of trustworthiness. Overall, participants were well-informed. Four themes were developed from the qualitative data: (1) Perceptions of the mpox response: divergence in urgency, priority, and care; (2) The mpox outbreak as a sign of otherness for gbMSM; (3) The potential for othering through mpox prevention practices; and (4) mpox, memory and fear. Discussion While community-led initiatives were effective, significant challenges included stigmatisation, discrimination, and mistrust towards public health institutions, influenced by institutionalised homophobia. The study underscores the need for inclusive, culturally sensitive, and transparent public health strategies. Conclusion The mpox outbreak highlights the importance of robust community collaboration in public health interventions. Future strategies must ensure equitable access to information, vaccination, and care, and address broader structural inequalities to foster trust and engagement within affected communities. …

by Julien Brisson, Mariangela Castro-Arteaga, Dorothy Apedaile, Amaya Perez-Brumer Introduction Pre-exposure prophylaxis (PrEP) stands as an effective tool in preventing HIV transmission among individuals at risk of HIV infection. However, the effectiveness of daily oral PrEP is contingent on the adherence of its users, which can pose a challenge for many individuals. Various studies have explored different interventions aimed at bolstering PrEP adherence. One recurring type of intervention revolves around digital communication (e.g., SMS, mobile applications) to send reminders for PrEP usage. The objective of our systematic review and meta-analysis is to address the following research question: What is the effectiveness of digital communication interventions in enhancing daily oral PrEP adherence among individuals at a heightened risk of HIV infection? This paper presents our study protocol. Method and analysis We will conduct searches across four health-related databases: Embase, PubMed, Web of Science, and PsycINFO. We will also explore other sources, including clinical trials registries and grey literature. Our search will be restricted to original randomized controlled trials published in English, French, and Spanish conducted since 2012, when PrEP was approved, to today. To ensure rigor, three reviewers will perform the systematic review and meta-analysis. This systematic review will adhere to the guidelines outlined in the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Our primary outcome of interest is proper daily oral PrEP adherence, which we will measure using association metrics (e.g., odds ratios). Discussion This review will offer insights into the effectiveness of utilizing digital communication methods to assist individuals at risk of HIV in improving their PrEP adherence. Protocol registration number International Prospective Register for Systematic Reviews (PROSPERO) number CRD42023471269. …

by Basha Ayele, Adane Mihret, Zeleke Mekonnen, Tesfaye Sisay Tessema, Kalkidan Melaku, Maeruf Fetu Nassir, Abaysew Ayele, Dawit Hailu Alemayehu, Getenet Beyene Background Shigellosis is an acute gastroenteritis infection and one of Ethiopia’s most common causes of morbidity and mortality, especially in children under five. Antimicrobial resistance (AMR) has spread quickly among Shigella species due to inappropriate antibiotic use, inadequacies of diagnostic facilities, and unhygienic conditions. This study aimed to characterize Shigella sonnei (S. sonnei) using whole genome sequence (WGS) analysis in Addis Ababa, Ethiopia. Methods The raw reads were quality-filtered and trimmed, and a minimum length of 50bp was retained and taxonomically classified using MiniKraken version 1. The whole genome data were aligned with Antibiotic Resistance Gene (ARG) sequences of the Comprehensive Antibiotic Resistance Database (CARD) by Resistance Gene Identifier (RGI). Plasmids were analyzed using the PlasmidFinder tool version 2.1. Additionally, AMR and virulence genes were screened at the Centre for Genomic Epidemiology (CGE) web-based server. Results All isolates in our investigation contained genes encoding blaEC-8 and blaZEG-1. Here, 60.7% of the isolates were phenotypically sensitive to cefoxitin among the blaEC-8 genes detected in the genotyping analysis, whereas all isolates were completely resistant to amoxicillin and erythromycin phenotypically. The study also identified genes that conferred resistance to trimethoprim (dfrA). Plasmid Col156 and Col (BS512) types were found in all isolates, while IncFII and Col (MG828) plasmids were only identified in one isolate. Conclusion This study found that many resistant genes were present, confirming the high variety in S. sonnei strains and hence a divergence in phylogenetic relationships. Thus, combining WGS methods for AMR prediction and strain identification into active surveillance may be beneficial for monitoring the spread of AMR in S. sonnei and detecting the potential emergence of novel variations. …

by Conghui Zhang, Qingfeng Ma, Wei Wang, Hui Song, Xue Wang, Fengxia Xu, Chengliang Zhu, Xinghui Liu Glutamine cyclase, an enzyme involved in posttranslational modifications, is encoded by the glutaminyl-peptide cyclotransferase (QPCT) gene. Gene microarray analysis revealed that the QPCT gene was highly expressed in HepG2.2.15 cells compared with that in HepG2 cells. The serum expression level of the QPCT gene was detected by ELISA and was significantly greater in HBV-infected patients than in healthy controls. The mRNA and protein expression levels of the QPCT gene were markedly greater in the HBV-expressing cell lines (HepG2.2.15, and HepG2 and Huh7 cells transfected with the pBlu-HBV plasmid) than in the HepG2 and Huh7 cells. The levels of HBV pgRNA and HBV-DNA copy number, as well as the levels of HBeAg and HBsAg, also increased in the HepG2 and Huh7 cell lines cotransfected with the QPCT gene expression plasmid and the HBV 1.3-fold plasmid. Our study indicated that HBV can promote the expression of the QPCT gene, which in turn promotes the expression and replication of HBV.

by Nimer S. Alkhatib, Abdulaali R. Almutairi, Majid Almadi, Shiraz Halloush, Yazed Sulaiman H. Al-Ruthia, Omar Rashdan, Samah Al-Shatnawi, Nahla A. Azzam, Mahmoud H. Mosli, Amal M. Badawoud, Majed S. Al Yami, Abdulaziz Alhossan, Ibtisam AlHarbi Background The Saudi Food and Drug Authority (SFDA) has approved the subcutaneous (SC) administration of infliximab, presenting a more convenient alternative with reduced outpatient visits and diminished expenses compared to the intravenous (IV) administration. However, the financial implications of this formulation have not been examined from the perspective of Saudi payers. Methods and materials A prevalence-based budget impact model was developed to evaluate the financial effects of introducing \'environment without\' versus \'with infliximab SC.\' The model’s time horizon spanned over 2 years (2021–2023), aligning with the biennial national pharmaceutical procurement cycle. The comparison focused on infliximab SC versus all available formulations of infliximab IV in the Saudi market for two inflammatory bowel diseases (IBD): Ulcerative Colitis (UC) and Crohn’s Disease (CD). Treatment comparators’ comparability and dose escalations were substantiated by published studies, utilizing dosing information from the summary of product characteristics. Drug acquisition costs were derived from SFDA registered prices, with IV formulation administration costs included. Scenario analysis assessed the budget impact of infliximab SC introduction at uptake rates ranging from 0% to 100%. Results Introducing infliximab SC demonstrated cost-saving potential in the treatment of IBD. At 100% uptake with UC patients for 2 years, infliximab SC resulted in savings of -SAR-31.9 million (-SAR29,145 per patient). Similarly, for CD, introducing infliximab SC at 100% uptake over 2 years yielded savings of -SAR106.2 million (-SAR36,585 per patient). Conclusion This study reveals that infliximab SC is associated with cost-saving potential when compared to infliximab IV formulations available in Saudi Arabia. Future research should address uncertainties related to real-world comparative effectiveness, the convenience of administration, patient tolerability, and physician acceptance of the SC formulation of infliximab, alongside comparisons with other TNF-alpha inhibitors. …

by Sung Yeon Hwang, Inkyu Kim, Byuk Sung Ko, Seung Mok Ryoo, Eunah Han, Hui Jai Lee, Daun Jeong, Tae Gun Shin, Kyuseok Kim, on behalf of the Korean Shock Society We developed a modified cardiovascular (CV) Sequential Organ Failure Assessment (SOFA) score using an emergency department-based cohort data, incorporating norepinephrine equivalent dose and lactate to represent current clinical practice patterns for vasopressor utilization and the diagnostic significance of lactate, respectively. In this study, we sought to validate this modified CV-SOFA score in intensive care unit patients with suspected infection using the Marketplace for Medical Information in Intensive Care (MIMIC)-IV database. This was a retrospective study that utilized data from the MIMIC-IV database. Modified CV/total SOFA score and original CV/total SOFA score were compared for predicting in-hospital mortality. Area under the receiver operating characteristic curve (AUROC) and the calibration curve were employed to evaluate discrimination and calibration, respectively. A total of 29,618 ICU patients with suspected infections was analyzed. The in-hospital mortality rate was 12.4% (n = 3,675). Modified CV-SOFA score (AUROC 0.667; 95% confidence interval [CI] 0.657–0.677 vs. 0.663; 95% CI 0.654–0.673; p = 0.283) and modified total SOFA score (0.784 [95% CI 0.776–0.793] vs. 0.785 [95% CI 0.777–0.793], p = 0.490) did not differ significantly from the original CV-SOFA score and original total SOFA score, respectively. The calibration curve of the original CV-SOFA score was inferior to that of the modified CV-SOFA score. The modified CV- and total SOFA scores were better calibrated than the original CV- and total SOFA scores, but their discriminative performance was not significantly different. Further studies of the modified CV-SOFA score in different settings and populations are required to assess the generalizability of this score.

by Ana L. Vives-Rodriguez, Anna Marin, Kylie A. Schiloski, Gabor P. Hajos, Adolfo Di Crosta, Irene Ceccato, Pasquale La Malva, Diana C. Anderson, Naheer Lahdo, Kaleigh Donnelly, Jiali Dong, Sabrina Kasha, Colleen Rooney, Judith Dayaw, Gabrielle Marton, Audrey Wack, Vanessa Hanger, Renée DeCaro, Alberto Di Domenico, Katherine W. Turk, Rocco Palumbo, Andrew E. Budson Background Social isolation and loneliness have both been associated with psychological health and cognitive decline in older adults. This study investigated the impact of social interaction through remote communication technologies during the COVID-19 pandemic on the cognitive and psychological status of older adults with and without cognitive impairment. Methods Participants were recruited from Boston (USA) and Chieti (Italy). The study used a randomized single-blinded controlled crossover design with an intervention (remote social conversations with research staff over 20-minute video or telephone calls three times per week) and a passive control condition, each one of 4-weeks duration. The primary outcome was a composite cognitive score change from baseline to week 4. Secondary outcomes included scales for mood, anxiety, and loneliness. Results Out of 196 participants recruited from April 2020 to April 2021, 17% dropped out. Based on the blind MoCA, 52% had cognitive impairment, and 25% were at risk of social isolation according to the Lubben social network scale. We observed that larger social networks were linked to better cognitive status and lower depression and anxiety levels, while loneliness was directly associated to depression severity. Older adults with cognitive impairment exhibited higher levels of depression and anxiety and were at greater risk for social isolation. In terms of the intervention, 91% preferred telephone over video calls. The intervention did not lead to improvements in cognitive or psychological scores. Conclusions More work is needed to assess the utility of this intervention for the support of a heterogenous cross-cultural sample of older adults at-risk for social isolation, including individuals with cognitive impairment. Future research should explore longer intervention periods, categorize participants by call type, and target those meeting social isolation criteria. Trial registration ClinicalTrials.gov NCT04480112. …

Abstract Background In 2020, Malawi had 6.9 million malaria cases and 2551 deaths, mainly in children under five years of age. The 2017–2022 Malawi malaria control strategic plan promoted the consistent use of insecticide-treated nets through free distribution and mass campaigns. Despite widespread availability of the control strategy plan, Chikwawa District continues to suffer from high malaria burden especially among under five children, due to inconsistent insecticide-treated (ITN) net usage. For this reason, this study aimed at exploring caregivers’ perceptions on insecticide-treated net utilisation and also find out about its effectiveness among those who consistently use them. Methods This study used a sequential exploratory mixed methods design. The data used for quantitative analysis was drawn from the population of under-five children’s caregivers within the catchment area of Chikwawa district hospital. The sample size was 96 participants, as determined by Cochran’s formula. The data collection lasted from December 2023 to April 2024 and included four in-depth interviews and three focus group discussions to address the objectives qualitatively. Results The study revealed that 91.67% of households used ITNs, with 87.50% using them daily. The significant factors influencing ITN utilisation included the number of nets, user satisfaction, perceived impact, user habits, acquisition method, and usage frequency (all p values 

Antimicrobial Agents and Chemotherapy, Ahead of Print.

Abstract Introduction Drug-sensitive TB (DS-TB) is treated with isoniazid, rifampicin, ethambutol, and pyrazinamide. Factors like fast-metabolizing enzymes, malabsorption, and drug interactions can influence serum drug levels. Current TB treatment guidelines recommend weight-adapted dosing without considering sex differences. This study examines drug levels of isoniazid and rifampicin in TB patients treated between 2019 and 2023 at our center focusing on sex-specific aspects. Methods Patients diagnosed with TB and available serum levels of isoniazid or rifampicin between 2019 and 2023 were retrospectively identified. Serum levels were measured using liquid chromatography–mass spectrometry and high-performance liquid chromatography. Patients were stratified by sex and a linear regression mixed effect model was used to assess predictors for different serum levels. Results The study included 281 single therapeutic drug monitoring (TDM) measurements from 59 patients (28 women, 47.5%). For isoniazid, no sex-specific differences in serum drug levels were identified. On the other hand, female sex was a significant predictor of higher rifampicin plasma levels (coefficient 4.16, 95% CI 0.74–7.59, p = 0.009). Only 38.2% of rifampicin serum level measurements in male patients were within target range, the majority (40/68, 58.8%) were below range and only 2 (2.9%) TDM-levels were above range. Women displayed higher overall rifampicin serum levels than men (median 13.7 mg/l vs. 7.1 mg/l, p = 0.04), although weight adjusted doses were not significantly different (median 10.0 mg/kg vs. 9.8 mg/kg p = 0.56). Adverse effects were noted in 42.9% (42/98) of measurements in women and 29.5% (54/183) of measurements in men (p = 0.03). Discussion Rifampicin levels were significantly lower in men compared to women, despite weight-adjusted dosing. Clinicians should consider TDM and potential sex differences when treating patients with TB. …

Journal of Medical Virology, Volume 96, Issue 11, November 2024.

Journal of Medical Virology, Volume 96, Issue 11, November 2024.

Journal of Medical Virology, Volume 96, Issue 11, November 2024.

This Medical News article discusses the latest research linking shingles and other infections to a higher risk of dementia and the vaccines against them to a lower risk.

In Reply We thank Drs Ben Salem and Ghariani for their comments about targeting TRMP8, the cold receptor, in the treatment of itch. We share an interest in this target, and our Review mentioned menthol, which is the prototype of TRMP8 agonists used for centuries to treat different types of itch. However, in our Review we decided to exclusively discuss treatments that are available in the US to treat itch. The TRMP8 agonists mentioned, icilin and cryosim-1, are not commercially available in the US. Although historically TRMP8 receptor activation has been considered to inhibit itch of different types, we have found that with psoriatic itch and, in particular, psoriatic scalp itch, TRMP8 is overexpressed in the skin and highly correlates with itch intensity. Additionally, a subpopulation of patients with atopic dermatitis report that cold exposure exacerbates their itch, and only 30% of patients with atopic dermatitis reported that cold reduces their itch. This highlights the need for studies to better understand which patients with pruritus (neuropathic, immunologic, or mixed etiology) may benefit from these agents. Moreover, in our clinical experience, the antipruritic effect of menthol and other currently available cooling agents is typically limited to minutes. We believe that additional studies using new TRMP8-specific agonists may help to identify the patients who will benefit the most from activation of cold receptors for the treatment of itch.

This study examines the prescribing trends of 3 oral preexposure prophylaxis medications and a long-acting injectable option from 2013 to 2023.

This JAMA Insights discusses the expanding PrEP options for preventing HIV, including the considerations for initiation and follow-up and implementation challenges of these medications.

To the Editor In the research and operations niche of hospital capacity strain and preparedness, although surges have historically been defined according to an unexpected large number of patients (eg, a mass casualty event), many have argued for a more nuanced definition that also includes any number of patients with high acuity (or higher acuity than the norm for the treating location) or with unique care needs (such as enhanced personal protective equipment or specialized personnel), or any isolated or simultaneous loss of resources (such as during a natural disaster), and any combination of these, locally or regionally.

In Reply We appreciate Dr Anesi’s interest in our Research Letter, which reported that ransomware attacks disrupting care delivery in targeted hospitals in California from 2014 to 2020 led to an increase in emergency department visits at nearby facilities.

This JAMA Patient Page describes doxycycline postexposure prophylaxis (doxyPEP), a medication prescribed to prevent certain sexually transmitted bacterial infections in people at increased risk.

This Viewpoint summarizes the factors contributing to increased risk of severe outcomes and hospitalization associated with COVID-19 among older adults, stresses the importance of assessing COVID-19 risk before infection occurs, calls for all immunocompromised older adults to be considered for COVID-19 treatment, and details 3 recommended COVID-19 therapies.

How to manage fever in the neurocritical care unit in patients with acute stroke was clearly a question in need of an answer. The association of fever burden with poor outcome for diverse conditions in the neurocritical care unit has been well described. However, distinguishing association from causation has been difficult, with prior randomized trials of hypothermia in various neurologic injuries showing neither clear benefit nor harm. Additionally, while it might seem nuanced to those unfamiliar with this field, fever control requires an entirely different approach from interventions to achieve hypothermia. Guidelines are available to support the logistics of providing this therapy and the neurocritical care community who manage these patients have gained expertise in temperature control over the past 20 years, while testing targeted temperature management in a wide variety of neurologic injuries, including cardiac arrest, traumatic brain injury, severe stroke, and spinal cord injury.

This clinical trial compares fever prevention targeted to 37.0 °C for 14 days vs standardized tiered fever treatment on functional outcomes in critically ill patients with stroke.