Abstract Background Recent reports from Thailand reveal a substantial surge in Plasmodium knowlesi cases over the past decades, with a more than eightfold increase in incidence by 2023 compared to 2018. This study investigates temporal changes in genetic polymorphism associated with the escalating transmission of P. knowlesi malaria in Thailand over time using the prominent vaccine candidate, pkmsp1 as a marker. Methods Twenty-five P. knowlesi samples collected in 2018–2023 were sequenced for the 42-kDa region of pkmsp1 and compared with 24 retrieved sequences in 2000–2009, focusing on nucleotide diversity, natural selection, recombination rate, and population differentiation. Results Seven unique haplotypes were identified in recent samples, compared to 15 in earlier samples. Nucleotide and haplotype diversity were lower in recent samples (π = 0.016, Hd = 0.817) than in earlier samples (π = 0.018, Hd = 0.942). Significantly higher synonymous substitution rates were observed in both sample sets (dS–dN = 2.77 and 2.43, p 

Abstract Objectives The key objective of this study was to assess the validity of a commercially available in-house Lymphocyte Transformation Test (LTT) as a diagnostic parameter and indicator of disease activity/therapeutic efficacy in the context of Lyme neuroborreliosis (LNB). Methods A prospective dual-centre study was conducted from 05/14 − 01/18. With respect to Borrelia-LTT a comparison was made between patients suffering from confirmed acute LNB and patients being affected by inflammatory neurologic diseases, defining the control group: Bell‘s palsy, viral meningitis, herpes zoster, Guillain-Barré-Syndrome and Encephalomyelitis disseminate. Furthermore, we investigated the LTT within the LNB group at the time of admission and again 12 weeks (+/- one week) later - after appropriate antibiotic treatment. Results Cases included 15 patients with LNB and 58 participants in the control group. With regard to Borrelia-LTT we calculated a low sensitivity of 40% and a moderate specificity of 91% for LNB. Additionally, LTT-levels three months after adequate antibiotic therapy did not correlate with the therapeutic response of LNB patients. Conclusions The present study shows that LTT is neither appropriate for LNB detection nor suitable as a follow-up marker. …

Abstract Objective We hypothesized that previously healthy infants 

When sequalae persist for longer than three months after SARS-CoV-2, it is commonly referred to as Post-COVID, Long COVID or Post-acute sequalae of COVID-19 (PASC) [1]. In the Netherlands, the prevalence of PASC was estimated at 12.7% at 3 to 6 months by comparing pre-infection and post-infection symptoms [2]. Studies have shown that the variant of SARS-CoV-2 infection influences PASC prevalence substantially. Generally, the wild-type and Alpha (B.1.1.7) variant were associated with higher PASC prevalence estimates than Delta (B.1.617.2), itself significantly higher than Omicron (B.1.1.529) variants [2, 3].

Cardiovascular implant-associated infections (CVIAI) present a major challenge, with mortality rates of approximately 15% for cardiac implantable electronic devices (CIEDs) and 15% to 80% for prosthetic valve endocarditis (PVE) and vascular graft or endograft infections (VGEI).

ObjectiveTo present the most recent data on urinary calculi characteristics in the southern region of China and explore the effects of sociodemographic, clinical and laboratory characteristics on stone composition to fill the research gap. SettingA retrospective observational study was performed in Shenzhen between December 2019 and August 2022. ParticipantsA total of 858 calculi samples from patients with urolithiasis were analysed via infrared spectroscopy. MethodsThe stone was classified by the European Association of Urology guidelines and the Mayo Clinic stone classification practices. Multivariate logistic regression models were conducted to evaluate the association between different characteristics and urinary stone composition. ResultsWe found that the majority of these patients with urolithiasis were under 60. Almost half of the stone samples (49.4%) were single constitute, and calcium oxalate stone accounted for the highest proportion (80.0%), followed by infection stone (10.0%) and uric acid stone (4.9%). Of these, 78.0% were collected from males, with a male-to-female ratio of 3.54:1; the majority (95.0%) of calculi localisation was in the upper urinary tract. Multivariate analysis found that age, gender, history of urolithiasis, kidney disease, anatomical location and urinary pH influenced urinary stone composition. ConclusionsThe effective prevention of urolithiasis is the key to this working-age population. These findings may supply significant evidence for understanding the underlying aetiology of urolithiasis and offer clues for effectively preventing and treating urinary calculi. …

ObjectivesWorldwide, a number of studies have been conducted to assess the prevalence of adherence to secondary antibiotic prophylaxis and to identify the associated factors (reasons) for poor adherence among patients with rheumatic heart disease or acute rheumatic fever (RHD/ARF). However, results were highly inconsistent with a prevalence ranging from 10% to 93%; and the reported reasons or associated factors have not been systematically reviewed. Therefore, this study aimed to assess the prevalence of adherence to secondary antibiotic prophylaxis among patients with RHD/ARF; and to review the associated factors (reasons) for poor adherence. DesignSystematic review and meta-analysis. Data sourcesPubMed/Medline, Google Scholar, Cochrane Review and African Journals Online databases. Eligibility criteriaArticles published in English from 1 January 2005 to 1 December 2022 and reported the prevalence of adherence using ≥80% cut-off points were included. Data extraction and synthesisData were extracted using the Microsoft Excel and analysed by STATA V.11.0. A meta-analysis was conducted using the weighted inverse-variance random-effects model. Reasons for poor adherence were identified through thematic analysis. Results33 articles with a total sample size of 7158 patients were included. The pooled prevalence of adherence to secondary antibiotic prophylaxis among patients with RHD/ARF was found to be 58.5% (95% CI: 48.2% to 68.7%; I2=99.2%; p

IntroductionHuman papillomavirus (HPV) infection is the most prevalent sexually transmitted infection worldwide. HPV vaccination is an important tool to prevent and control HPV infection and its complications. Despite carrying the severe burden of disease, HPV vaccine coverage in Africa remains low. The aim of the current review is to evaluate the factors associated with HPV vaccination acceptance among adolescent men and women, young men and women, parents/caregivers, men who have sex with men, healthcare workers and programme managers in Africa. Methods and analysisWe will include peer-reviewed quantitative studies. We will search PubMed, Scopus, PsycInfo, Web of Science and Cochrane Central Register of Controlled Trials, with no language restriction, to identify eligible studies. Two review authors will independently screen the titles and abstracts of the search output in Covidence to select potentially eligible studies. The same two reviewers will independently screen the full-text of all identified potentially eligible articles to identify studies meeting inclusion criteria. Two review authors will independently extract data from eligible studies using a predefined data extraction form. Two review authors will independently assess the risk of bias in each included study, using the Effective Public Health Practice Project ‘Quality Assessment Tool for Quantitative Studies’. We will assess the quality of evidence using the method for Grading of Recommendations Assessment, Development and Evaluation. Ethics and disseminationEthical approval is not required for this study because we will use already published data. The results of this review will be disseminated through peer-reviewed publication and conference presentation. PROSPERO registration numberCRD42023475810. …

IntroductionClimate change impacts the circumpolar region (including northern Canada) at a greater magnitude than other parts of the world. This affects food (in)security as well as food sovereignty. This scoping review aims to map the methods of measuring food (in)security and food sovereignty across northern Canada and the circumpolar region in support of the Yukon Government’s climate change adaptation strategy. Methods and analysisWe will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews, and work will be conducted according to the Joanna Briggs Institute (JBI) manual chapter on scoping reviews. Academic librarians develop the academic literature and grey literature search strategies, and the search strategies are further revised through iterative stages of peer review. The search strategy includes 7 academic literature databases, 11 grey literature databases, over 50 websites and the University of Toronto Libraries catalogue. Covidence, an evidence synthesis software, will be used for screening and extraction. The extraction chart will be developed and piloted by our team. A minimum of two reviewers will conduct screening, and conflicts will be resolved through discussion. Data will be extracted by one reviewer and verified by a second. Conflicts will be resolved through discussion or by a third reviewer. Ethics and disseminationThis project does not require ethical approval as it is secondary research; data will be extracted from published academic research papers, dissertations, and publicly available reports and documents. Our dissemination plan includes presentations at conferences, submission to international peer-reviewed journals and a workshop on the search strategies. …

ObjectivesTo estimate thresholds for defining meaningful within-patient improvement from baseline to weeks 13–24 and interpreting meaningfulness of between-group difference for the non-transfusion-dependent beta-thalassaemia patient-reported outcome (NTDT-PRO) tiredness/weakness (T/W) and shortness of breath (SoB) scores. A secondary objective was to determine the symptom severity threshold for the NTDT-PRO T/W domain to identify patients with symptomatic T/W. DesignPooled blinded data from the phase 2, double-blind, placebo-controlled, randomised BEYOND trial in NTDT (NCT03342404) were used. Anchor-based analyses supplemented with distribution-based analyses and empirical cumulative distribution function (eCDF) curves were applied. Distribution-based analyses and receiver operating characteristic curves were used to estimate between-group difference and symptomatic thresholds, respectively. SettingGreece, Italy, Lebanon, Thailand, the UK and the USA. ParticipantsAdults (N=145; mean age 39.9 years) with NTDT who were transfusion-free ≥8 weeks before randomisation. MeasuresScore changes from baseline to weeks 13–24 in PROs used as anchors (correlation coefficient ≥0.3): NTDT-PRO T/W and SoB scores, Patient Global Impression of Severity, Functional Assessment of Chronic Illness Therapy–Fatigue (Fatigue Subscale, item HI12 and item An2) and Short Form Health Survey version 2. ResultsThe eCDF curves support the use of estimates from the improvement by one level group for all anchors to determine the threshold(s) for meaningful within-patient improvement. Mean (median) changes from these groups and estimates from distribution-based analyses suggest that a ≥1-point reduction in the NTDT-PRO T/W or SoB domains represents a clinically meaningful improvement. Meaningful between-group difference threshold ranges were 0.53–1.10 for the T/W domain and 0.65–1.15 for the SoB domain. The optimal symptomatic threshold for the T/W domain (by maximum Youden’s index) was ≥3 points. ConclusionsThe thresholds proposed may support the use of NTDT-PRO in assessing and interpreting treatment effects in clinical studies and identifying patients with NTDT in need of symptom relief. …

BackgroundEarly in the COVID-19 pandemic, numerous clinical trials were initiated. Although concerns were raised regarding the quality of the trials, the eventual research output yielded from the trials remains unknown. The objective of this study was to include all clinical trials registered on ClinicalTrials.gov during the first 6 months of the pandemic and assess if and where their results had been reported, their completion and discontinuation rates, achieved enrolment and changes made to the primary outcome after trial registration. MethodsWe included all interventional studies related to COVID-19 first registered on ClinicalTrials.gov between 1 January 2020 and 1 July 2020. We systematically searched for trial results, reported through 15 May 2023, in scientific publications, preprints and ClinicalTrials.gov. We assessed the achieved trial enrolment, trial discontinuation (reaching

BackgroundMusculoskeletal joint complaints (MSCs) are the most common extraintestinal manifestation of inflammatory bowel disease (IBD). We aimed to investigate the effect of MSC on the health-related quality of life (QoL) in patients with IBD. DesignA survey-based cross-sectional study among adult Dutch IBD patients. SettingPrimary care, secondary care and patient association. ParticipantsIn total, 635 IBD patients were included. The mean age was 46.3 (SD 14.2) years, and 35% were male. OutcomeMSC was defined as suffering from any joint complaints. QoL was measured using the IBD questionnaire and a 36-item short form health survey questionnaire. MethodsA univariate analysis was performed to estimate the impact of various factors, such as demographic characteristics, setting, type of IBD and fatigue, which was followed by a multiple regression analysis to adjust for the confounding factors. ResultsOf the 635 IBD patients, 332 suffered from Crohn’s disease (CD) and 303 from ulcerative colitis (UC). After adjusting for confounding factors, MSC was independently associated with reduced QoL among IBD patients (β=–10.6, 95% CI –15.2 to –6.1), both in CD (β=–8.3, 95% CI –14.6 to –2.1) and UC (β=–13.9, 95% CI –20.5 to –7.3). 11% of the IBD patients had a rheumatological diagnosis. QoL in these patients was significantly lower compared with IBD patients with non-rheumatological MSC. ConclusionsIBD patients with MSC are associated with a lower QoL, explicitly in patients with a rheumatological diagnosis. Prospective research is necessary to evaluate the causality and suitable interventions to increase QoL in these multimorbid patients. …

IntroductionDespite the availability of a safe and effective measles vaccine in Ethiopia, the country has experienced recurrent and significant measles outbreaks, with a nearly fivefold increase in confirmed cases from 2021 to 2023. The WHO has identified being unvaccinated against measles as a major factor driving this resurgence of cases and deaths. Consequently, this study aimed to apply robust machine learning algorithms to predict the key factors contributing to measles vaccination dropout. MethodsThis study utilised data from the 2016 Ethiopian Demographic and Health Survey to evaluate measles vaccination dropout. Eight supervised machine learning algorithms were implemented: eXtreme Gradient Boosting (XGBoost), Random Forest, Gradient Boosting, Support Vector Machine, Decision Tree, Naïve Bayes, K-Nearest Neighbours and Logistic Regression. Data preprocessing and model development were performed using R language V.4.2.1. The predictive models were evaluated using accuracy, precision, recall, F1-score and area under the curve (AUC). Unlike previous studies, this research utilised Shapley values to interpret individual predictions made by the top-performing machine learning model. ResultsThe XGBoost algorithm surpassed all classifiers in predicting measles vaccination dropout (Accuracy and AUC values of 73.9% and 0.813, respectively). The Shapley Beeswarm plot displayed how each feature influenced the best model’s predictions. The model predicted that the younger mother’s age, religion-Jehovah/Adventist, husband with no and mother with primary education, unemployment of the mother, residence in the Oromia and Somali regions, large family size and older paternal age have a strong positive impact on the measles vaccination dropout. ConclusionThe measles dropout rate in the country exceeded the recommended threshold of

IntroductionGlobally, long-distance truck drivers’ (LDTDs) risk of exposure to HIV infections is higher compared with other populations in transit. Thus, several HIV prevention interventions have been implemented, though to a narrower extent compared with other most at-risk populations. Consequently, the effectiveness of such interventions is not well understood. Therefore, a review is warranted to inform policymakers on the most effective HIV prevention interventions targeted for LDTDs. Methods and analysisThe Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines were followed. Original peer-reviewed interventional studies involving LDTDs of either gender aged above 18 years, and reporting findings on HIV prevention interventions from any part of the world will be included. Non-empirical research studies like systematic reviews, literature reviews and scoping reviews will be excluded. A comprehensive search will be done from PubMed, Cumulated Index to Nursing and Allied Health Literature and other five databases to identify eligible studies. The Rayyan online platform will be used for the screening of titles and abstracts. For the meta-analysis, a random-effects meta-analysis using the ‘metafor’ package in R software will be done. Where specific studies may not report adequate data for meta-analysis, their findings will be presented qualitatively. The Cochrane Collaboration tool and Joanna Brigs Checklist will be used to assess the quality and risk of bias in the included studies. Ethics and disseminationA formal ethical approval is not required for this systematic review and meta-analysis. The findings will be presented at scientific conferences and published in open-access peer-reviewed journals to reach policymakers, stakeholders and the scientific community. PROSPERO registration numberCRD42024505542. …

IntroductionBy 2030, an estimated 42% of the world’s adolescent girls and young women (AGYW) will live in sub-Saharan Africa (SSA), where a quarter of AGYW pregnancies are undesired and AGYW represent 75% of new HIV infections. Most AGYW in SSA use short-acting contraceptive methods, including many who rely solely on condoms, which results in variable patterns of protection against undesired pregnancies and HIV. Dynamics of contraceptive use and HIV prevention efforts are poorly understood but the DYnamics of Contraception in Eswatini study will contribute to the understanding of the complex relationship between sexual behaviours, risk perception and HIV and pregnancy prevention. Methods and analysisAll AGYW 18–24 years who participated in a 2021 nationally representative, population-based (face-to-face) HIV survey, consented to future research and provided a mobile phone number will be contacted for enrolment. Consenting AGYW will complete a baseline questionnaire and be surveyed biweekly for 2 years. The three objectives of the study are to (1) investigate how changing individual context (schooling, income, residential mobility) impact contraceptive use; (2) examine the relationship between pregnancy desires and contraceptive use and (3) test whether changes in a woman’s perception of her HIV risk changes her probability of contraceptive use and HIV protective behaviours. Data collection will take place from March 2024 to March 2026 via computer-assisted telephone interviews. During recruitment (March–April 2024), two interviewers called 794 AGYW, of whom 326 completed the baseline questionnaire (41%) and 321 consented to biweekly follow-up (40% American Association for Public Opinion Research response rate #1). Analyses will mainly use hybrid within-between logistic regression models. Ethics and disseminationThis protocol was reviewed and approved by the Eswatini National Health Research Review Board in 2024 and Columbia University Medical Center Institutional Review Board in 2023. Findings from the study will inform the Eswatini Ministry of Health approaches to mitigating undesired pregnancies and HIV among AGYW. Second, few examples exist of high-frequency longitudinal data collection in SSA, and this study will contribute to the survey method knowledge. Finally, the rich dataset will available for secondary data analysis. …

ObjectiveThis study assessed the trends and patterns of antimicrobial consumption (AMC) from 2020 to 2021, 2021–2022 and 2022–2023 at the Benjamin Mkapa Zonal Referral Hospital (BMH) in Dodoma, Tanzania. DesignA retrospective cross-sectional study was conducted to collect AMC data for three financial years with respective denominators. The data were computed using the AMC Tool 2019 v1.9.0 and defined daily dose per 1000 inhabitants per day (DID). SettingThe BMH, Dodoma, Tanzania. ParticipantsThis study surveyed quantities of antimicrobials procured at the BMH. It did not have any human participants. Outcome measuresAMC was quantified in DID. The comparisons were made based on the DID of all surveyed antimicrobials, taking into account oral and parenteral administration and based on pharmacological classes. Further, DIDs were presented based on the 2023 WHO Access (A), Watch (W) and Reserve (R) (AWaRe) classification. ResultsIn 29 assessed antimicrobials, the DIDs for 2020–2021, 2021–2022 and 2022–2023 were 3.0852, 3.5892 and 3.9213, respectively. The average DID per year was 3.5319, with a mean of 2.4207±1.9765 DID per year. The topmost consumed antimicrobials over the 3 years (doxycycline, azithromycin, amoxicillin/beta-lactamase inhibitors, ampicillin/cloxacillin, amoxicillin/flucloxacillin, ceftriaxone, nitrofurantoin and clarithromycin) account over 90% of consumption. The most highly consumed therapeutic classes were beta-lactam antibacterial penicillins (34.71%), macrolides, lincosamides, streptogramins and others (25.75%), followed by tetracycline (23.88%). The AWaRe categorisation and antimicrobials not recommended (ANR) distribution were as follows: Access-51.61%, Watch-31.96%, Reserve-0.00%, and ANR-16.43%, respectively. ConclusionFor every 1000 patients attending the BMH per day, our study found 2.4207±1.9765 DIDs of an antimicrobial were consumed. The most consumed antimicrobials include doxycycline, azithromycin, amoxicillin/beta-lactamase inhibitor, ceftriaxone and metronidazole. To combat antimicrobial resistance effectively, it is imperative to institute a hospital policy for antimicrobial stewardship that prioritises the utilisation of a hospital formulary and antibiograms for the procurement of antimicrobials at the BMH. …

ObjectivesTo compare aetiology, microbiological isolates and antibiotic susceptibilities of endophthalmitis between children and adults. DesignRetrospective observational study. ParticipantsPatients admitted to Zhongshan Ophthalmic Center between January 2013 and December 2019 with clinically diagnosed endophthalmitis were included. Outcome measuresThe aetiology, microbiological isolates and antibiotic susceptibilities of endophthalmitis were analysed. ResultsOf 1803 patients, 430 (23.8%) were aged ≤16 years. In both children and adults, the main aetiology was trauma (85.6% vs 64.7%, p

PurposeThe Management of Post-transplant Infections in Collaborating Hospitals (MATCH) programme, initiated in 2011 and still ongoing, was created to 1) optimise the implementation of existing preventive strategies against viral infections in solid organ transplant (SOT) recipients and allogenic haematopoietic stem-cell transplant (HSCT) recipients and 2) advance research in the field of transplantation by collecting data from a multitude of sources. ParticipantsAll SOT and HSCT recipients at Copenhagen University Hospital, Rigshospitalet, are followed in MATCH. By February 2021, a total of 1192 HSCT recipients and 2039 SOT recipients have been included. Participants are followed life long. An automated electronic data capture system retrieves prospective data from nationwide registries. Data from the years prior to transplantation are also collected. Findings to dateData entries before and after transplantation include the following: biochemistry: 13 995 222 and 26 127 817; microbiology, cultures: 242 023 and 410 558; other microbiological analyses: 265 007 and 566 402; and pathology: 170 884 and 200 394. There are genomic data on 2431 transplant recipients, whole blood biobank samples from 1003 transplant recipients and faeces biobank samples from 207 HSCT recipients. Clinical data collected in MATCH have contributed to 50 scientific papers published in peer-reviewed journals and have demonstrated success in reducing cytomegalovirus disease in SOT recipients. The programme has established international collaborations with the Swiss Transplant Cohort Study and the lung transplant cohort at Toronto General Hospital. Future plansEnrolment into MATCH is ongoing with no planned end date for enrolment or follow-up. MATCH will continue to provide high-quality data on transplant recipients and expand and strengthen international collaborations. …

ObjectivesTo examine trajectories of functional limitations, fatigue, health-related quality of life (HRQL) and societal costs of patients referred to long COVID clinics. DesignA population-based longitudinal cohort study using real-time user data. Setting35 specialised long COVID clinics in the UK. Participants4087 adults diagnosed with long COVID in primary or secondary care deemed suitable for rehabilitation and registered in the Living With Covid Recovery (LWCR) programme between 4 August 2020 and 5 August 2022. Main outcome measuresGeneralised linear mixed models were fitted to estimate trajectories of functional limitations, using the Work and Social Adjustment Scale (WSAS); scores of ≥20 indicate moderately severe limitations. Other outcomes included fatigue using the Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-F) reversed score (scores of ≥22 indicate impairment), HRQL using the EQ-5D-5L, and long COVID-related societal costs, encompassing healthcare costs and productivity losses. ResultsThe mean WSAS score at 6 months after registration in the LWCR was 19.1 (95% CI 18.6, 19.6), with 46% of the participants (95% CI 40.3%, 52.4%) reporting a WSAS score above 20 (moderately severe or worse impairment). The mean change in the WSAS score over the 6-month period was –0.86 (95% CI –1.32, –0.41). The mean reversed FACIT-F score at 6 months was 29.1 (95% CI 22.7, 35.5) compared with 32.0 (95% CI 31.7, 32.3) at baseline. The mean EQ-5D-5L score remained relatively constant between baseline (0.63, 95% CI 0.62, 0.64) and 6 months (0.64, 95% CI 0.59, 0.69). The monthly societal cost per patient related to long COVID at 6 months was £931, mostly driven by the costs associated with working days lost. ConclusionsIndividuals referred to long COVID clinics in the UK reported small improvements in functional limitations, fatigue, HRQL and ability to work within 6 months of registering in the LWCR programme. …

Abstract Background Gulosibacter massiliensis is a new species of gram-positive, short rod-shaped, aerobic, oxidase-negative, and catalase-positive bacteria, which was discovered in human peripheral blood and named recently in 2022. Currently, the clinical reports on G. massiliensis are limited, and its pathogenic ability and infectivity remain unclear. Case presentation We isolated G. massiliensis from the exudate of an emergency traumatic wound of the right foot of a 54-year-old man. The patient stepped into a gutter with the right foot, causing a wound with exposed bone, oozing blood, and local infection. Through timely surgical treatment and active debridement and nursing, the wound healed smoothly, and the patient was discharged from the hospital uneventfully. This strain could not be accurately identified using conventional biochemical reactions or matrix-assisted laser desorption ionization time-of-flight mass spectrometry analysis in our clinical laboratory. Finally, the strain was identified correctly using 16 S ribosomal RNA gene sequencing and historical data of Gulosibacter spp., and its drug susceptibility results were reported. Conclusion Reports on clinical infection or isolation of G. massiliensis are limited. This is the first study reporting its isolation from wound secretions. It is a rare opportunistic infectious bacterium. Further clinical research will help us understand its infectivity and pathogenicity. This report could guide the treatment and laboratory detection of local wound infections caused by G. massiliensis. …

Abstract Background As the number of HIV-infected patients increased, the number of patients requiring general surgery has subsequently increased. However, impairment of immune function due to HIV infection increases the risk of postoperative surgical-site infection and significant harm to patient health. This study aimed to examine the risk factors for surgical-site infection after general surgery. Methods The patients’ data were from Zunyi fourth hospital medical information system. Machine learning based Boruta algorithm were used for variable screening. Univariable and multivariable logistic regression and restricted cubic spline analysis were performed to examine the relationship between significant variables and surgical-site infection. Results A total of 125 general surgery postoperative HIV-infected patients participated in the study. Surgical-site pathogen culture identified Escherichia coli, Klebsiella pneumoniae, and mixed bacteria as the three most common pathogens causing Surgical-site infection. Univariable and multivariable logistic regression analysis to adjust for risk factors identified type III surgical incision (OR = 9.92, 95% CI = 1.28–76.75) and elevated preoperative white blood cell (WBC) count (OR = 1.30, 95% CI = 1.12–1.51) as independent risk factors for postoperative surgical-site infection, whereas CD4 + T lymphocyte count greater than 400 cells/µL was identified as a protective factor (OR = 0.23, 95% CI = 0.09–0.60) while. The restricted cubic spline analysis results directly reflected the dose-response relationship between continuous variables and postoperative surgical-site infection. Conclusions Type III incision and an elevated WBC count pose a higher risk of postoperative surgical-site infection. A CD4 + T lymphocyte counts greater than 400 cells/µL provided a protective effect of lower risk of surgical site infection. Preoperative serum neutrophil percentage, albumin level, red blood cell count, and serum urea level within a specific range were beneficial in reducing the risk of incisional infections. Our research provides a theoretical basis for clinical practice. …

Abstract Background Respiratory disease outbreaks frequently occur in settings where individuals are in close contact, for example, schools and factories. However, the transmission patterns of oropharyngeal microbiota among healthy individuals living in clusters are unclear. Therefore, we aimed to investigate the respiratory tract bacteria distribution and transmission patterns among individuals in close contact. Methods A total of 36 freshmen from Peking University Medical School participated in the study. We collected pharyngeal swabs on the first day of enrollment, 15, 30, and 60 days after cohabitation. DNA was extracted from the swabs and subjected to high-throughput sequencing to profile the microbial composition. Statistical analyses were performed to assess diversity and significance. Results Neisseriaceae, Prevotellaceae, and Streptococcaceae were the most abundant bacterial families detected. Over time, changes were observed in the bacterial communities, with a tendency for increased similarity between dormitory room members. By day 60 of cohabitation, the bacterial communities appeared to be more similar compared to the baseline (prior to cohabitation). The transmission patterns included spreading with colonization, spreading without colonization, and non-spreading. Bacteria belonging to the core genera are most likely to spread and colonize easily. Conclusion The risk of healthy cohabitants acquiring respiratory pathogens through close contact may be overestimated in epidemiological studies. Therefore, monitoring the spread of core genera that are easily transmitted and colonized is crucial for effective prevention of respiratory pathogen transmission. …

Volume 15, Issue 1, December 2024 .

A supportive mentorship has long-lasting effects on shaping students\' personal and professional development. Here, we outline important aspects of mentoring and indicators of good mentors, focusing on effective mutualistic interaction. We believe that traditional academic advice should be expanded to include supportive group mentoring to foster future top scientific talent.

Science Advances, Volume 10, Issue 46, November 2024.

Abstract Enterohemorrhagic Escherichia coli (EHEC) is a foodborne pathogen that infects humans by colonizing the large intestine. Upon reaching the large intestine, EHEC mediates local signal recognition and the transcriptional regulation of virulence genes to promote adherence and colonization in a highly site-specific manner. Two-component systems (TCSs) represent an important strategy used by EHEC to couple external stimuli with the regulation of gene expression, thereby allowing EHEC to rapidly adapt to changing environmental conditions. An increasing number of studies published in recent years have shown that EHEC senses a variety of host- and microbiota-derived signals present in the human intestinal tract and coordinates the expression of virulence genes via multiple TCS-mediated signal transduction pathways to initiate the disease-causing process. Here, we summarize how EHEC detects a wide range of intestinal signals and precisely regulates virulence gene expression through multiple signal transduction pathways during the initial stages of infection, with a particular emphasis on the key roles of TCSs. This review provides valuable insights into the importance of TCSs in EHEC pathogenesis, which have relevant implications for the development of antibacterial therapies against EHEC infection.

Publication date: Available online 12 November 2024 Source: Infectious Disease Modelling Author(s): Chinmoy Roy Rahul, Rob Deardon …

by Luigi Micillo, Pier-Alexandre Rioux, Esteban Mendoza, Sebastian L. Kübel, Nicola Cellini, Virginie Van Wassenhove, Simon Grondin, Giovanna Mioni …

by Giacomo Zoppi, Luca Candeloro, Lara Savini, Vittoria Colizza, Mario Giacobini Animal movements are a key factor in the spread of pathogens. Consequently, network analysis of animal movements is a well-developed and well-studied field. The relationships between animals facilitate the diffusion of infectious agents and, in particular, shared environments and close interactions can facilitate cross-species transmission. Cattle are often the focus of these studies since they are among the most widely distributed and traded species globally. This remains true for Italy as well, but with an important additional consideration. Indeed, another important productive reality in the peninsula is buffalo farming. These farms have an interesting characteristic: approximately two-thirds of them also rear cattle. This coexistence between cattle and buffalo could have an impact on the diffusion of pathogens. Given that buffalo farms are often overlooked in the literature, the primary goal of this work is to investigate the potential consequences of omitting buffalo from cattle network analyses. To investigate this impact, we will focus on Q fever, a disease that can infect both species and is present on the Italian territory and for which the impact of the buffalo population has not been thoroughly studied, and simulate its spread to the farms of both species through compartmental models. Our analysis reveals that despite the significant difference in network sizes, the unique characteristic of Italian buffalo farms makes the buffalo network essential for a comprehensive understanding of bovine disease dynamics in Italy.

by Amira Amer, Aimina Ayoub, Émilie Brousseau, Nathalie Auger Background Risk factors for influenza complications in women are poorly understood. We examined the association between pregnancy outcomes and risk of influenza hospitalization up to three decades later. Methods We analyzed a cohort of 1,421,531 pregnant women who delivered in Quebec, Canada between 1989 and 2021. Patients were followed over time beginning at the first delivery. The main exposure measures included obstetric complications such as preeclampsia, gestational diabetes, and preterm birth. The main outcome was influenza hospitalization up to 32 years later. We used adjusted Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between obstetric complications and risk of influenza hospitalization following pregnancy. Results A total of 4,016 women were hospitalized for influenza during 32 years of follow-up. Influenza hospitalization was more frequent among women with pregnancy complications than women without complications (18.0 vs 14.1 per 100,000 person-years). Compared with no pregnancy complication, women with gestational diabetes (HR 1.48, 95% CI 1.30–1.69), preeclampsia (HR 1.45, 95% CI 1.28–1.65), placental abruption (HR 1.36, 95% CI 1.12–1.66), preterm birth (HR 1.40, 95% CI 1.27–1.55), cesarean section (HR 1.22, 95% CI 1.13–1.31), and severe maternal morbidity (HR 1.43, 95% CI 1.22–1.68) had a greater risk of influenza hospitalization later in life. These pregnancy outcomes were associated with severe influenza infections requiring critical care. Conclusions Women with pregnancy complications have an elevated risk of severe influenza complications later in life and have potential to benefit from seasonal vaccination to prevent influenza hospitalization. …

by Christoph Schlee, Christine Uecker, Özlem Öznur, Nina Bauer, Jost Langhorst Background Crohn’s disease (CD) is a type of inflammatory bowel disease (IBD) that is prevalent worldwide and associated with reduced quality of life for patients. Multimodal therapy approaches, which emphasize lifestyle modifications such as mindfulness and stress reduction, can be promising in enhancing health-related quality of life for IBD patients. However, research on multimodal therapy approaches for CD remains insufficient. Method This qualitative interview study is part of a mixed-methods approach that is embedded in a randomized controlled trial. It investigates the impact of a comprehensive 10-week day clinic lifestyle modification program on the health condition and quality of life of CD patients. Telephone interviews (n = 19) were conducted three months after the program to examine individuals’ viewpoints on the intervention, including perceived changes and transfer of elements into daily life. Reflexive thematic analysis was performed using MAXQDA software. Results The results indicate that CD can have very individual and comprehensive impacts (psychological, physical, social), leading to reduced perceived quality of life and well-being. By participating in the program, patients wanted to find self-help options to complement conventional pharmacotherapy and actively manage their disease. Patients expressed high satisfaction with the program, feeling it provided valuable support for daily disease management. They were able to integrate adequate therapy elements into their routines to complement their care. Patients recognized significant improvements in various domains, mainly in the psychological domain, e.g., improved self-efficacy, symptom management, and, also partly physical/symptomatic and social improvements. Conclusion A multimodal stress reduction and lifestyle modification day clinic appears to be beneficial as a complementary therapy for CD patients. It offers additional options and helps patients to address individual symptoms and needs, improve their understanding of the disease and their quality of life. Although promising, further research is needed to assess its long-term effects. Trial registration ClinicalTrials.gov, identifier: NCT05182645. …

by Kirsty Officer, Juan Carlos Arango-Sabogal, Simon Dufour, Konstantin P. Lyashchenko, Jonathan Cracknell, Shaun Thomson, Sokleaph Cheng, Kris Warren, Bethany Jackson Effective control of tuberculosis (TB) depends on early diagnosis of disease, yet available tests are unable to perfectly detect infected individuals. In novel hosts diagnostic testing methods for TB are extrapolated from other species, with unknown accuracy. The primary challenge to evaluating the accuracy of TB tests is the lack of a perfect reference test. Here we use a Bayesian latent class analysis approach to evaluate five tests available for ante-mortem detection of pulmonary TB in captive sun bears and Asiatic black bears in Southeast Asia. Using retrospective results from screening of 344 bears at three rescue centres, we estimate accuracy parameters for thoracic radiography, a serological assay (DPP VetTB), and three microbiological tests (microscopy, PCR (Xpert MTB/RIF, Xpert MTB/RIF Ultra), mycobacterial culture) performed on bronchoalveolar lavage samples. While confirming the high specificities (≥ 0.99) of the three microbiological tests, our model demonstrated their sub-optimal sensitivities (…

Infection and Immunity, Ahead of Print.

Infection and Immunity, Ahead of Print.

Infection and Immunity, Ahead of Print.

Infection and Immunity, Ahead of Print.

As the mankind counters the ongoing COVID‐19 pandemic by the novel severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2), it simultaneously witnesses the emergence of mpox virus (MPXV) that signals at global spread and could potentially lead to another pandemic. Although MPXV has existed for more than 50 years now with most of the human cases being reported from the endemic West and Central African regions, the disease is recently being reported in non‐endemic regions too that affect more than 50 countries. Controlling the spread of MPXV is important due to its potential danger of a global spread, causing severe morbidity and mortality. The article highlights the transmission dynamics, zoonosis potential, complication and mitigation strategies for MPXV infection, and concludes with suggested ‘one health’ approach for better management, control and prevention. Bibliometric analyses of the data extend the understanding and provide leads on the research trends, the global spread, and the need to revamp the critical research and healthcare interventions. Globally published mpox‐related literature does not align well with endemic areas/regions of occurrence which should ideally have been the scenario. Such demographic and geographic gaps between the location of the research work and the endemic epicentres of the disease need to be bridged for greater and effective translation of the research outputs to pubic healthcare systems, it is suggested.

Cerebrospinal fluid (CSF) viral escape rarely occurs when HIV is detected in the CSF, while it is undetectable in the blood plasma or detectable in CSF at levels that exceed those in the blood plasma. We conducted this review to comprehensively synthesise its clinical presentation, diagnosis, management strategies and treatment outcomes. A review registered with PROSPERO (CRD42023475311) searched evidence across PubMed/MEDLINE, Embase, Web of Science, Scopus, and Google Scholar to gather articles (case reports/series) that report on CSF viral escape in people living with HIV (PLHIV) on antiretroviral therapy (ART). The quality of studies was assessed based on the domains of selection, ascertainment, causality, and reporting. A systematic search identified 493 articles and 27 studies that include 21 case reports, and six case series were involved in the review. The studies reported 62 cases of CSF viral escape in PLHIV. The majority were men (66.67%), with a median age of 43 (range: 28–73) years. Approximately, 31 distinct symptoms were documented, mostly being cognitive dysfunction, gait abnormalities, and tremors (12.51%). Diagnosis involved blood and CSF analysis, magnetic resonance imaging, and neuropsychological assessments. Over 36 ART regimens were employed, with a focus on ART intensification; almost one‐third of the regimens contained Raltegravir (integrase strand transfer inhibitor). The outcomes showed 64.49% full recovery, 30.16% partial recovery, and 4.76% died. When neuropsychological symptoms manifest in PLHIV, monitoring for CSF viral escape is essential, regardless of plasma viral suppression. Personalised treatment strategies, particularly ART intensification, are strongly advised for optimising treatment outcomes in PLHIV diagnosed with CSF HIV escape.

Serious adverse events following vaccination include medical complications that require hospitalisation. The live varicella vaccine that was approved by the Food and Drug Administration in the United States in 1995 has an excellent safety record. Since the vaccine is a live virus, adverse events are more common in immunocompromised children who are vaccinated inadvertently. This review includes only serious adverse events in children considered to be immunocompetent. The serious adverse event called varicella vaccine meningitis was first reported in a hospitalised immunocompetent child in 2008. When we carried out a literature search, we found 15 cases of immunocompetent children and adolescents with varicella vaccine meningitis; the median age was 11 years. Eight of the children had received two varicella vaccinations. Most of the children also had a concomitant herpes zoster rash, although three did not. The children lived in the United States, Greece, Germany, Switzerland, and Japan. During our literature search, we found five additional cases of serious neurological events in immunocompetent children; these included 4 cases of progressive herpes zoster and one case of acute retinitis. Pulses of enteral corticosteroids as well as a lack of herpes simplex virus antibody may be risk factors for reactivation in immunocompetent children. All 20 children with adverse events were treated with acyclovir and recovered; 19 were hospitalised and one child was managed as an outpatient. Even though the number of neurological adverse events remains exceedingly low following varicella vaccination, we recommend documentation of those caused by the vaccine virus.

Alzheimer\'s disease (AD) is a real and current scientific and societal challenge. Alzheimer\'s disease is characterised by a neurodegenerative neuroinflammatory process, but the etiopathogenetic mechanisms are still unclear. The possible infectious aetiology and potential involvement of Herpes viruses as triggers for the formation of extracellular deposits of amyloid beta (Aβ) peptide (amyloid plaques) and intraneuronal aggregates of hyperphosphorylated and misfold could be a possible explanation. In fact, the possible genetic interference of Herpes viruses with the genome of the host neuronal cell or the stimulation of the infection to a continuous immune response with a consequent chronic inflammation could constitute those mechanisms underlying the development of AD, with possible implications in the understanding and management of the disease. Herpes viruses could be significantly involved in the pathogenesis of AD and in particular, their ability to reactivate in particular conditions such as immunocompromise and immunosenescence, could explain the neurological damage characteristic of AD. Our review aims to evaluate the state of the art of knowledge and perspectives regarding the potential relationship between Herpes viruses and AD, in order to be able to identify the possible etiopathogenetic mechanisms and the possible therapeutic implications.

Cytomegalovirus (CMV) belongs to the Herpesviridae family and is also known as human herpesvirus type 5. It is a common virus that usually doesn\'t cause any symptoms in healthy individuals. However, once infected, the virus remains in the host\'s body for life and can reactivate when the host\'s immune system weakens. This virus has been linked to several neurological disorders, including Alzheimer\'s disease, Parkinson\'s disease, Autism spectrum disorder, Huntington\'s disease (HD), ataxia, Bell\'s palsy (BP), and brain tumours, which can cause a wide range of symptoms and challenges for those affected. CMV may influence inflammation, contribute to brain tissue damage, and elevate the risk of moderate‐to‐severe dementia. Multiple studies suggest a potential association between CMV and ataxia in various conditions, including Guillain‐Barré syndrome, chronic inflammatory demyelinating polyneuropathy, acute cerebellitis, etc. On the other hand, the evidence regarding CMV involvement in BP is conflicting, and also early indications of a link between CMV and HD were challenged by subsequent research disproving CMV\'s presence. This systematic review aims to comprehensively investigate any link between the pathogenesis of CMV and its potential role in neurological disorders and follows the preferred reporting items for systematic review and meta‐analysis checklist. Despite significant research into the potential links between CMV infection and various neurological disorders, the direct cause‐effect relationship is not fully understood and several gaps in knowledge persist. Therefore, continued research is necessary to gain a better understanding of the role of CMV in neurological disorders and potential treatment avenues.

COVID‐19 as a pan‐epidemic is waning but there it is imperative to understand virus interaction with oral tissues and oral inflammatory diseases. We review periodontal disease (PD), a common inflammatory oral disease, as a driver of COVID‐19 and oral post‐acute‐sequelae conditions (PASC). Oral PASC identifies with PD, loss of teeth, dysgeusia, xerostomia, sialolitis‐sialolith, and mucositis. We contend that PD‐associated oral microbial dysbiosis involving higher burden of periodontopathic bacteria provide an optimal microenvironment for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. These pathogens interact with oral epithelial cells activate molecular or biochemical pathways that promote viral adherence, entry, and persistence in the oral cavity. A repertoire of diverse molecules identifies this relationship including lipids, carbohydrates and enzymes. The S protein of SARS‐CoV‐2 binds to the ACE2 receptor and is activated by protease activity of host furin or TRMPSS2 that cleave S protein subunits to promote viral entry. However, PD pathogens provide additional enzymatic assistance mimicking furin and augment SARS‐CoV‐2 adherence by inducing viral entry receptors ACE2/TRMPSS, which are poorly expressed on oral epithelial cells. We discuss the mechanisms involving periodontopathogens and host factors that facilitate SARS‐CoV‐2 infection and immune resistance resulting in incomplete clearance and risk for ‘long‐haul’ oral health issues characterising PASC. Finally, we suggest potential diagnostic markers and treatment avenues to mitigate oral PASC.

Influenzavirus is among the most relevant candidates for a next pandemic. We review here the phylogeny of former influenza pandemics, and discuss candidate lineages. After briefly reviewing the other existing antiviral options, we discuss in detail the evidences supporting the efficacy of passive immunotherapies against influenzavirus, with a focus on convalescent plasma.