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American Journal of Tropical Medicine and Hygiene, 15.09.2021
Tilføjet 15.09.2021
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 105Issue: 3Pages: 545-546
Læs mere Tjek på PubMedAmerican Journal of Tropical Medicine and Hygiene, 15.09.2021
Tilføjet 15.09.2021
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 105Issue: 3Pages: 547-548
Læs mere Tjek på PubMedAmerican Journal of Tropical Medicine and Hygiene, 15.09.2021
Tilføjet 15.09.2021
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 105Issue: 3Pages: 549-550
Læs mere Tjek på PubMedAmerican Journal of Tropical Medicine and Hygiene, 15.09.2021
Tilføjet 15.09.2021
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 105Issue: 3Pages: 551-552
Læs mere Tjek på PubMedAmerican Journal of Tropical Medicine and Hygiene, 15.09.2021
Tilføjet 15.09.2021
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 105Issue: 3Pages: 553-554
Læs mere Tjek på PubMedAmerican Journal of Tropical Medicine and Hygiene, 15.09.2021
Tilføjet 15.09.2021
Journal Name: The American Journal of Tropical Medicine and HygieneVolume: 105Issue: 3Pages: 555-556
Læs mere Tjek på PubMedDreher, A., Pietrowsky, R., Loerbroks, A.
BMJ Open, 15.09.2021
Tilføjet 15.09.2021
Objectives
The COVID-19 pandemic has posed great challenges to medical professionals worldwide. Dental assistants (DAs) are at exceptionally high risk of infection with SARS-CoV-2 due to frequent and close patient contact and involvement in various high-risk dental procedures. This study aimed to investigate attitudes, stressors and work outcomes among DAs from all over Germany at the peak of cases in spring 2020.
Design
Cross-sectional study. Descriptive analysis and logistic regression.
Setting
Dental, maxillofacial surgery and orthodontic practices across Germany, April 2020.
Participants
Participants aged 18 years and above and currently working as DAs in Germany.
Primary and secondary outcome measures
A self-devised online questionnaire was employed comprising questions on SARS-CoV-2-related attitudes, stressors and work outcomes. Validated scales assessed symptoms of depression and anxiety.
Results
Among 1481 participating DAs (median age 35 years, 98.4% female, 91.8% working in dental practices), major stressors were uncertainty about the pandemic’s temporal scope (97.9% agreement, n=1450), uncertainty about one’s financial situation (87.8%, n=1301), uncertainty about how to act correctly (87.6%, n=1298) and thoughts about a possible infection during work (83.8%, n=1241). Forty-two per cent of DAs (n=622) felt sufficiently prepared for dealing with patients with SARS-CoV-2. Only 17.5% (n=259) agreed that material for personal protection was sufficiently available. Multivariable logistic regression analyses suggested that working in a dental practice, compared with orthodontic and maxillofacial surgery practices, was significantly associated with uncertainty about one’s financial situation (OR 2.13 (95% CI 1.33 to 3.44)) and with the reported availability of personal protective equipment (PPE) (0.55 (0.36 to 0.84)).
Conclusions
Training about correct behaviour of DAs during future infectious disease outbreaks is needed, especially for DAs working in dental practices. In the future, it will also be necessary to strengthen supply chains to ensure that PPE is sufficiently available in a timely manner.
Læs mere Tjek på PubMedHirner, S., Pigoga, J. L., Naidoo, A. V., Calvello Hynes, E. J., Omer, Y. O., Wallis, L. A., Bills, C. B.
BMJ Open, 15.09.2021
Tilføjet 15.09.2021
Objectives
Purposefully designed and validated screening, triage, and severity scoring tools are needed to reduce mortality of COVID-19 in low-resource settings (LRS). This review aimed to identify currently proposed and/or implemented methods of screening, triaging, and severity scoring of patients with suspected COVID-19 on initial presentation to the healthcare system and to evaluate the utility of these tools in LRS.
Design
A scoping review was conducted to identify studies describing acute screening, triage, and severity scoring of patients with suspected COVID-19 published between 12 December 2019 and 1 April 2021. Extracted information included clinical features, use of laboratory and imaging studies, and relevant tool validation data.
Participant
The initial search strategy yielded 15 232 articles; 124 met inclusion criteria.
Results
Most studies were from China (n=41, 33.1%) or the United States (n=23, 18.5%). In total, 57 screening, 23 triage, and 54 severity scoring tools were described. A total of 51 tools–31 screening, 5 triage, and 15 severity scoring—were identified as feasible for use in LRS. A total of 37 studies provided validation data: 4 prospective and 33 retrospective, with none from low-income and lower middle-income countries.
Conclusions
This study identified a number of screening, triage, and severity scoring tools implemented and proposed for patients with suspected COVID-19. No tools were specifically designed and validated in LRS. Tools specific to resource limited contexts is crucial to reducing mortality in the current pandemic.
Læs mere Tjek på PubMedZhang, M., Li, Y., Fan, Z., Shen, D., Huang, X., Yu, Q., Liu, M., Ren, F., Wang, X., Dai, L., Wang, P., Ye, H., Shi, J., Yang, X., Zhang, S., Zhang, J.
BMJ Open, 15.09.2021
Tilføjet 15.09.2021
Objectives
The health-related quality of life (HRQoL) and utilities of patients with chronic hepatitis B (CHB) virus infection, including compensated cirrhosis (CC), decompensated cirrhosis (DC) and different stages of hepatocellular carcinoma (HCC), have not been well described in China. This study aimed to evaluate HRQoL and utilities and provide parameters for the economic evaluation of CHB-related diseases.
Methods
We conducted a multicentre cross-sectional and study to measure the HRQoL of patients with CHB, CC, DC and HCC using the Chinese short form (SF) 36 health survey V.2. The utilities were extracted based on the SF-six dimension scoring model. Multivariable regression analyses identified the effects on HRQoL.
Results
A total of 1071 patients (639 with CHB, 125 with CC, 85 with DC and 222 with HCC) were invited to complete the questionnaire. Physical HRQoL was not impaired in the CHB stage, while mental HRQoL was significantly impaired. Physical composite summary scores have a more significant decrease than mental composite summary scores at the advanced stages (CC, DC and HCC). The utility scores of CHB only, CC, DC and HCC were 0.773, 0.750, 0.683 and 0.640, respectively. The utility scores in the early, middle and terminal stages of HCC were 0.656, 0.635 and 0.615, respectively.
Conclusion
Slowing the progress of CHB-related diseases and providing psychological support early are the key points to improving the quality of life with the diseases. The utility values estimated in this study can provide a vital instrument for cost-effectiveness studies on CHB-related diseases.
Læs mere Tjek på PubMedWade, A. N., Payne, C. F., Berkman, L., Chang, A., Gomez-Olive, F. X., Kabudula, C., Kahn, K., Salomon, J. A., Tollman, S., Witham, M., Davies, J.
BMJ Open, 15.09.2021
Tilføjet 15.09.2021
Objectives
Multimorbidity is associated with mortality in high-income countries. Our objective was to investigate the relationship between multimorbidity (≥2 of the following chronic medical conditions: hypertension, diabetes, dyslipidaemia, anaemia, HIV, angina, depression, post-traumatic stress disorder, alcohol dependence) and all-cause mortality in an older, rural black South African population. We further investigated the relationship between HIV multimorbidity (HIV as part of the multimorbidity cluster) and mortality, while testing for the effect of frailty in all models.
Design
Population cohort study.
Setting
Agincourt subdistrict of Mpumalanga province, South Africa.
Participants
4455 individuals (54.7% female), aged ≥40 years (median age 61 years, IQR 52–71) and resident in the study area.
Primary and secondary outcome measures
The primary outcome measure was time to death and the secondary outcome measure was likelihood of death within 2 years of the initial study visit. Mortality was determined during annual population surveillance updates.
Results
3157 individuals (70.9%) had multimorbidity; 29% of these had HIV. In models adjusted for age and sociodemographic factors, multimorbidity was associated with greater risk of death (women: HR 1.72; 95% CI: 1.18 to 2.50; men: HR 1.46; 95% CI: 1.09 to 1.95) and greater odds of dying within 2 years (women: OR 2.34; 95% CI: 1.32 to 4.16; men: OR 1.51; 95% CI: 1.02 to 2.24). HIV multimorbidity was associated with increased risk of death compared with non-HIV multimorbidity in men (HR 1.93; 95% CI: 1.05 to 3.54), but was not statistically significant in women (HR 1.85; 95% CI: 0.85 to 4.04); when detectable, HIV viral loads were higher in men (p=0.021). Further adjustment for frailty slightly attenuated the associations between multimorbidity and mortality risk (women: HR 1.55; 95% CI: 1.06 to 2.26; men: HR 1.36; 95% CI: 1.01 to 1.82), but slightly increased associations between HIV multimorbidity and mortality risk.
Conclusions
Multimorbidity is associated with mortality in this older black South African population. Health systems which currently focus on HIV should be reorganised to optimise identification and management of other prevalent chronic diseases.
Læs mere Tjek på PubMedChan-Cuzydlo, A., Harrison, D. J., Pike, B. L., Currie, B. J., Mayo, M., Salvador, M. G., Hulsey, W. R., Azzarello, J., Ellis, J., Kim, D., King-Lewis, W., Smith, J. N., Rodriguez, B., Maves, R. C., Lawler, J. V., Schully, K. L.
BMJ Open, 15.09.2021
Tilføjet 15.09.2021
Purpose
In 2012, US Marines and Sailors began annual deployments to Australia to participate in joint training exercises with the Australian Defence Force and other partners in the region. During their training, US service members are exposed to a variety of infectious disease threats not normally encountered by American citizens. This paper describes a cohort of US Marines and Sailors enrolled during five rotations to Australia between 2016 and 2020.
Participants
Study participation is strictly voluntary. Group informational sessions are held prior to deployment to describe the study structure and goals, as well as the infectious disease threats that participants may encounter while in Australia. All participants provided written informed consent. Consented participants complete a pre-deployment questionnaire to collect data including basic demographic information, military occupational specialty, travel history, family history, basic health status and personal habits such as alcohol consumption. Blood is collected for serum, plasma and peripheral blood mononuclear cells (PBMC) processing. Data and specimen collection is repeated up to three times: before, during and after deployment.
Findings to date
From the five rotations that comprised the 2016–2020 Marine Rotational Force-Darwin, we enrolled 1289 volunteers. Enrolments during this period were overwhelmingly white male under the age of 24 years. Most of the enrollees were junior enlisted and non-commissioned officers, with a smaller number of staff non-commissioned officers and commissioned officers, and minimal warrant officers. Over half of the enrollees had occupational specialty designations for infantry.
Future plans
In the future, we will screen samples for serological evidence of infection with Burkholderia pseudomallei, Coxiella burnetii, Ross River virus, SARS-CoV-2 and other operationally relevant pathogens endemic in Australia. Antigenic stimulation assays will be performed on PBMCs collected from seropositive individuals to characterise the immune response to these infections in this healthy American population.
Læs mere Tjek på PubMedRalph, A. P., Webb, R., Moreland, N. J., McGregor, R., Bosco, A., Broadhurst, D., Lassmann, T., Barnett, T. C., Benothman, R., Yan, J., Remenyi, B., Bennett, J., Wilson, N., Mayo, M., Pearson, G., Kollmann, T., Carapetis, J. R.
BMJ Open, 15.09.2021
Tilføjet 15.09.2021
Introduction
The absence of a diagnostic test for acute rheumatic fever (ARF) is a major impediment in managing this serious childhood condition. ARF is an autoimmune condition triggered by infection with group A Streptococcus. It is the precursor to rheumatic heart disease (RHD), a leading cause of health inequity and premature mortality for Indigenous peoples of Australia, New Zealand and internationally.
Methods and analysis
‘Searching for a Technology-Driven Acute Rheumatic Fever Test’ (START) is a biomarker discovery study that aims to detect and test a biomarker signature that distinguishes ARF cases from non-ARF, and use systems biology and serology to better understand ARF pathogenesis. Eligible participants with ARF diagnosed by an expert clinical panel according to the 2015 Revised Jones Criteria, aged 5–30 years, will be recruited from three hospitals in Australia and New Zealand. Age, sex and ethnicity-matched individuals who are healthy or have non-ARF acute diagnoses or RHD, will be recruited as controls. In the discovery cohort, blood samples collected at baseline, and during convalescence in a subset, will be interrogated by comprehensive profiling to generate possible diagnostic biomarker signatures. A biomarker validation cohort will subsequently be used to test promising combinations of biomarkers. By defining the first biomarker signatures able to discriminate between ARF and other clinical conditions, the START study has the potential to transform the approach to ARF diagnosis and RHD prevention.
Ethics and dissemination
The study has approval from the Northern Territory Department of Health and Menzies School of Health Research ethics committee and the New Zealand Health and Disability Ethics Committee. It will be conducted according to ethical standards for research involving Indigenous Australians and New Zealand Māori and Pacific Peoples. Indigenous investigators and governance groups will provide oversight of study processes and advise on cultural matters.
Læs mere Tjek på PubMedInfection, 15.09.2021
Tilføjet 15.09.2021
Abstract
Purpose
Blood culture contamination is still a frequently observed event and may lead to unnecessary antibiotic prescriptions and additional hazards and costs. However, in patients hospitalized in tertiary care, true bacteremias for pathogens that are classically considered as contaminants can be observed. We assessed the diagnostic accuracy of procalcitonin for differentiating blood culture contamination from bacteremia in patients with positive blood cultures for potential contaminants.
Methods
We carried out a retrospective, cross-sectional, observational study on consecutive patients hospitalized between January 2016 and May 2019 at the University Hospital of Nancy and who had a positive peripheral blood culture for a pathogen classically considered as a potential contaminant.
Results
During the study period, 156 patients were screened, and 154 were retained in the analysis. Among the variables that were significantly associated with a diagnosis of blood culture contamination in univariate analyses, four were maintained in multivariate logistic regression analysis: a number of positive blood culture bottles ≤ 2 (OR 23.76; 95% CI 1.94–291.12; P = 0.01), procalcitonin < 0.1 ng/mL (OR 14.88; 95% CI 1.62–136.47; P = 0.02), non-infection-related admission (OR 13.00; 95% CI 2.17–77.73; P = 0.005), and a percentage of positive blood culture bottles ≤ 25% (OR 12.15; 95% CI 2.02–73.15; P = 0.006).
Conclusions
These data provide new evidence on the usefulness of plasma procalcitonin as a reliable diagnostic biomarker in the diagnostic algorithm of peripheral blood culture contamination among patients hospitalized in tertiary care.
Clinical trial
ClinicalTrials.gov #NCT04573894.
Læs mere Tjek på PubMedInfection, 15.09.2021
Tilføjet 15.09.2021
Abstract
Purpose
Since the first Italian case of SARS-CoV-2 was detected in Lombardy (Northern Italy) Italy quickly became one of the worst-affected European countries, with a severe impact on health-care workers (HCWs). In the first epidemic, HCWs accounted for 12% of all national COVID-19 cases. We evaluated the burden of COVID-19 among HCWs and other non-health-care workers (nHCWs) in a large Italian hospital.
Methods
From March 1st to May 31st 2020, we performed a retrospective study at ASST Civil Hospital, in the Province of Brescia, Lombardy. The study population included all hospital personnel (n = 9265), categorized by professional status.
Results
A SARS-CoV-2 test was performed in 3572 workers (38.5%), with a positive result in 552 (5.9% of all hospital personnel). The temporal trend of SARS-CoV-2 cases in hospital staff broadly reflected that in the community, with a great majority of infections occurred during March 2020 (87.7%). From April onward, a steep decrease of positive cases was observed among hospital personnel, while in the community the decrease was much slower. Medical doctors (8.9%) and nurses (8.5%) were the most affected professional categories with a significantly higher risk of SARS-CoV-2 infection (OR 1.436 and OR 1.410, respectively p < 0.0001). HCWs in COVID-19 units presented a significantly higher risk of infection compared to HCWs in non-COVID units (p < 0.001).
Conclusion
HCWs were severely affected by the COVID-19 epidemic, probably associated with an overwhelming burden of work and lack of preparedness in prevention of nosocomial transmission of the infection. The rapid decrease of COVID-19 spread in the hospital, registered before the one in the community, suggests that the adopted preventive measures were effective.
Læs mere Tjek på PubMedInfection, 14.09.2021
Tilføjet 15.09.2021
Ignacio Barandalla, Carmen Alvarez, Pablo Barreiro, Carmen de Mendoza, Rubén González-Crespo, Vicente Soriano
International Journal of Infectious Diseases, 15.09.2021
Tilføjet 15.09.2021
The recent global spreading of SARS-CoV-2 infection in humans is unprecedented in medicine (Morens et al., 2020). At the end of June 2021, over 180 million cases had been reported worldwide with nearly 4 million deaths. In Spain, these figures were of nearly 4 million confirmed cases and over 80,000 deaths. In the absence of effective antiviral agents against SARS-CoV-2, the advent of vaccines has been eagerly awaited. The first vaccines achieved emergency approval in December 2020 after proving significant protection for development of severe COVID-19 in clinical trials [Polack et al.
Læs mere Tjek på PubMedVimvara Vacharathit, Sirawat Srichatrapimuk, Suwimon Manopwisedjaroen, Suppachok Kirdlarp, Chanya Srisaowakarn, Chavachol Setthaudom, Nanthicha Inrueangsri, Prapaporn Pisitkun, Mongkol Kunakorn, Suradej Hongeng, Somnuek Sungkanuparph, Arunee Thitithanyanont
International Journal of Infectious Diseases, 15.09.2021
Tilføjet 15.09.2021
‘Coronavirus Disease 2019’ (COVID-19), caused by the highly transmissible and pathogenic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has so far infected about 220 million people worldwide, leading to more than 4.6 million deaths within a period of 21 months. In Thailand, approximately 1.3 million cases and over 13,000 deaths have been confirmed at the time of writing (2021). The ongoing COVID-19 pandemic has taken a significant toll on global public health and economy, calling for a deeper understanding of immune correlates of protection against SARS-CoV-2 that may be vital for implementation of mitigation strategies and development of treatments and vaccines.
Læs mere Tjek på PubMedTom Lutalo, Aminah Nalumansi, Denis Olara, John Kayiwa, Bernard Ogwang, Emmanuel Odwilo, Christine Watera, Stephen Balinandi, Jocelyn Kiconco, Joweria Nakaseegu, Jennifer Serwanga, Bernard Kikaire, Deogratius Ssemwanga, Brendah Abiko, Christopher Nsereko, Matthew Cotten, Joshua Buule, Julius Lutwama, Robert Downing, Pontiano Kaleebu
International Journal of Infectious Diseases, 15.09.2021
Tilføjet 15.09.2021
Coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. Globally as of September 1st, 2021, there have been nearly 218 million cases reported to WHO with over 4.5 million deaths while in Uganda 99,408 cases with over 3000 deaths have been recorded (WHO 2021). Since this evaluation, the number of new cases and deaths continued to rise.
Læs mere Tjek på PubMedAngela Choi, Matthew Koch, Kai Wu, Laurence Chu, LingZhi Ma, Anna Hill, Naveen Nunna, Wenmei Huang, Judy Oestreicher, Tonya Colpitts, Hamilton Bennett, Holly Legault, Yamuna Paila, Biliana Nestorova, Baoyu Ding, David Montefiori, Rolando Pajon, Jacqueline M. Miller, Brett Leav, Andrea Carfi, Roderick McPhee, Darin K. Edwards
Nature, 15.09.2021
Tilføjet 15.09.2021
Nature Medicine, Published online: 15 September 2021; doi:10.1038/s41591-021-01527-y
Preliminary and exploratory analyses show that a third dose of the COVID-19 vaccine mRNA-1273 or variant-modified boosters can boost levels of neutralizing antibodies against SARS-CoV-2 variants.
Læs mere Tjek på PubMedIttai Dayan, Holger R. Roth, Aoxiao Zhong, Ahmed Harouni, Amilcare Gentili, Anas Z. Abidin, Andrew Liu, Anthony Beardsworth Costa, Bradford J. Wood, Chien-Sung Tsai, Chih-Hung Wang, Chun-Nan Hsu, C. K. Lee, Peiying Ruan, Daguang Xu, Dufan Wu, Eddie Huang, Felipe Campos Kitamura, Griffin Lacey, Gustavo César de Antônio Corradi, Gustavo Nino, Hao-Hsin Shin, Hirofumi Obinata, Hui Ren, Jason C. Crane, Jesse Tetreault, Jiahui Guan, John W. Garrett, Joshua D. Kaggie, Jung Gil Park, Keith Dreyer, Krishna Juluru, Kristopher Kersten, Marcio Aloisio Bezerra Cavalcanti Rockenbach, Marius George Linguraru, Masoom A. Haider, Meena AbdelMaseeh, Nicola Rieke, Pablo F. Damasceno, Pedro Mario Cruz e Silva, Pochuan Wang, Sheng Xu, Shuichi Kawano, Sira Sriswasdi, Soo Young Park, Thomas M. Grist, Varun Buch, Watsamon Jantarabenjakul, Weichung Wang, Won Young Tak, Xiang Li, Xihong Lin, Young Joon Kwon, Abood Quraini, Andrew Feng, Andrew N. Priest, Baris Turkbey, Benjamin Glicksberg, Bernardo Bizzo, Byung Seok Kim, Carlos Tor-Díez, Chia-Cheng Lee, Chia-Jung Hsu, Chin Lin, Chiu-Ling Lai, Christopher P. Hess, Colin Compas, Deepeksha Bhatia, Eric K. Oermann, Evan Leibovitz, Hisashi Sasaki, Hitoshi Mori, Isaac Yang, Jae Ho Sohn, Krishna Nand Keshava Murthy, Li-Chen Fu, Matheus Ribeiro Furtado de Mendonça, Mike Fralick, Min Kyu Kang, Mohammad Adil, Natalie Gangai, Peerapon Vateekul, Pierre Elnajjar, Sarah Hickman, Sharmila Majumdar, Shelley L. McLeod, Sheridan Reed, Stefan Gräf, Stephanie Harmon, Tatsuya Kodama, Thanyawee Puthanakit, Tony Mazzulli, Vitor Lima de Lavor, Yothin Rakvongthai, Yu Rim Lee, Yuhong Wen, Fiona J. Gilbert, Mona G. Flores, Quanzheng Li
Nature, 15.09.2021
Tilføjet 15.09.2021
Nature Medicine, Published online: 15 September 2021; doi:10.1038/s41591-021-01506-3
Federated learning, a method for training artificial intelligence algorithms that protects data privacy, was used to predict future oxygen requirements of symptomatic patients with COVID-19 using data from 20 different institutes across the globe.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.09.2021
Tilføjet 15.09.2021
Abstract
Background
The coronavirus disease 2019 (COVID-19) has caused a global pandemic, resulting in considerable mortality. The risk factors, clinical treatments, especially comprehensive risk models for COVID-19 death are urgently warranted.
Methods
In this retrospective study, 281 non-survivors and 712 survivors with propensity score matching by age, sex, and comorbidities were enrolled from January 13, 2020 to March 31, 2020.
Results
Higher SOFA, qSOFA, APACHE II and SIRS scores, hypoxia, elevated inflammatory cytokines, multi-organ dysfunction, decreased immune cell subsets, and complications were significantly associated with the higher COVID-19 death risk. In addition to traditional predictors for death risk, including APACHE II (AUC = 0.83), SIRS (AUC = 0.75), SOFA (AUC = 0.70) and qSOFA scores (AUC = 0.61), another four prediction models that included immune cells subsets (AUC = 0.90), multiple organ damage biomarkers (AUC = 0.89), complications (AUC = 0.88) and inflammatory-related indexes (AUC = 0.75) were established. Additionally, the predictive accuracy of combining these risk factors (AUC = 0.950) was also significantly higher than that of each risk group alone, which was significant for early clinical management for COVID-19.
Conclusions
The potential risk factors could help to predict the clinical prognosis of COVID-19 patients at an early stage. The combined model might be more suitable for the death risk evaluation of COVID-19.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.09.2021
Tilføjet 15.09.2021
Abstract
Background
The microbiological diagnosis of pulmonary tuberculosis (Tb) in a pediatric population is hampered by both low pathogen burden and noncompliance with sputum sampling. Although endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been found useful for the evaluation of mediastinal pathologies in adults, for children, sparse data are available. Here, we have evaluated EBUS-TBNA as a diagnostic procedure in children and adolescents with suspected pulmonary Tb.
Methods
In this retrospective analysis, we reviewed the charts of unaccompanied refugee minors (URM) who were admitted between January 2016 and July 2018 and who, during their initial medical screening upon arrival in Germany, were found to have abnormal radiological pulmonary and mediastinal findings and/or immunological results indicative of Tb. For each patient, basic sociodemographic data, clinical features and data on diagnostic procedures performed were assessed. These included imaging, immunodiagnostic tests and microbiological data derived from sputum, bronchoalveolar lavage, EBUS-TBNA, bronchoscopy and pleural fluid sampling. All patients who underwent invasive sampling procedures were included in the study.
Results
Out of 42 URM with suspected Tb, 34 fulfilled the study’s inclusion criteria. Ages ranged from 14 to 17 years. All were of African origin, with 70.0% coming from Somalia, Eritrea and Ethiopia. Among the 21 patients for whom EBUS-TBNA was performed, the diagnostic yield was high: 66.7% positive results (MTb detected either by acid-fast stain, culture or PCR in 4.8, 42.9 and 61.9% of samples, respectively). Multidrug-resistant MTb was found in two patients from Somalia. No complications were associated with the procedure. Overall, pulmonary Tb was diagnosed in 29 patients (85.3%), miliary Tb in two patients (5.9%) and latent Tb in three patients (8.8%).
Conclusions
EBUS-TBNA is a sensitive and safe method with high diagnostic yield in the evaluation of pediatric patients with mediastinal pathology and suspected Tb.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.09.2021
Tilføjet 15.09.2021
Abstract
Background
Granulomatosis with polyangiitis (GPA), also known as Wegener’s granulomatosis, is an idiopathic systemic disease typically affecting the lungs, although other organs may also be involved.
Case presentation
A 28-year-old male was admitted to Baqiyatallah university hospital in Teheran (Iran) after a 3-week history of fever and productive cough. The patient gradually developed fatigue, arthralgia, hematuria, nausea, vomiting, dyspnea, hemoptysis, weight loss, oliguria and then anuria. Chest-X-ray (CXR) and computerized tomography scan revealed cavitating nodular opacities in the right lung lobe. Furthermore, plasma creatinine increased from 2.2 to 4 mg/dl in a few days. Histopathological examination of kidney biopsy revealed peri-glomerular and peri-vascular inflammation, degeneration and necrosis of the tubular epithelial lining, red blood cell casts, distorted glomerular structure, fibrin thrombi, segmental breaks of the glomerular basal membrane, disruption of Bowman's capsular membrane and crescent formation of the affected glomeruli. An abnormal CXR, an abnormal urinary sediment and a typical kidney histology were used as criteria to diagnose glomerulonefritis with poliangiitis (GPA). Bronchoalveolar lavage smear and PCR turned out positive for mycobacterium tuberculosis. After 3 months of treatment for (GPA) and tuberculosis the patient developed headache and seizure. Cerebral Magnetic Resonance Venography revealed cerebral venous thrombosis of the sinus transverse and sigmoid.
Conclusions
Tuberculosis may coexist with GPA, as it occurred in our patient. Since a crescentic glomerulonephritis can progress to renal failure, clinicians should always be aware of potential multiple conditions when considering differential diagnoses.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.09.2021
Tilføjet 15.09.2021
Abstract
Background
Robust evidenced treatment strategy for Coronavirus disease 2019 (COVID-19) has not been established yet. Early, targeted, comprehensive management approach can be essential.
Methods
A lopinavir/ritonavir (LPV/r)-based antiviral treatment was administered to the patients with computed tomography (CT)-documented pneumonia. Medical records of patients with COVID-19, previously discharged or hospitalized for ≥ 21 days at the Seoul Medical Center from January 29 to April 15, 2020 were reviewed to analyze clinical and virological outcomes. Patients were divided into two groups (PCR-Negative conversion group vs. Non-negative conversion group and requiring oxygen group vs. Non-requiring oxygen group).
Results
In total, 136 patients with a mean age of 41.8 ± 18.2 years were included with median 3-day delay of hospitalization after illness. Thirteen (9.56%) were initially asymptomatic, and 5 (3.67%) were persistently asymptomatic. Eighty-five (62.5%) had CT-documented pneumonia, 94% of whom received LPV/r treatments. A total of 53 patients (38.97%) had negative polymerase chain reaction (PCR) results within 28 days. Eight (9.4%) out of 85 pneumonic patients received oxygen supplementation. Patients with initial lower respiratory symptoms showed significant delay in PCR negative conversion (> 28 days) (odds ratio [OR] 0.166; 95% confidence interval [CI] 0.067–0.477; P < 0.001). However, antiviral treatment for pneumonic patients was significantly related with early conversion within 28 days (OR 3.049; 95% CI 1.128–8.243; P = 0.028). Increasing age increased the likelihood of oxygen supplementation requirement in the pneumonic patient group (OR 1.108; 95% CI 1.021–1.202; P = 0.014).
Conclusions
Early, pneumonia targeted LPV/r-based antiviral therapy resulted in a significantly higher probability of negative conversion of PCR within 28 days compared to symptomatic treatment.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.09.2021
Tilføjet 15.09.2021
Abstract
Background
Emergence of drug resistant tuberculosis (DR-TB) has aggravated the tuberculosis (TB) public health burden worldwide and especially in low income settings. We present findings from a predominantly nomadic population in Karamoja, Uganda with a high-TB burden (3500 new cases annually) and sought to determine the prevalence, patterns, factors associated with DR-TB.
Methods
We used mixed methods of data collection. We enrolled 6890 participants who were treated for tuberculosis in a programmatic setting between January 2015 and April 2018. A cross sectional study and a matched case control study with conditional logistic regression and robust standard errors respectively were used to the determine prevalence and factors associated with DR-TB. The qualitative methods included focus group discussions, in-depth interviews and key informant interviews.
Results
The overall prevalence of DR-TB was 41/6890 (0.6%) with 4/64,197 (0.1%) among the new and 37/2693 (1.4%) among the previously treated TB patients respectively. The drug resistance patterns observed in the region were mainly rifampicin mono resistant (68.3%) and Multi Drug-Resistant Tuberculosis (31.7%). Factors independently associated with DR-TB were previous TB treatment, adjusted odds ratio (aOR) 13.070 (95%CI 1.552–110.135) and drug stock-outs aOR 0.027 (95%CI 0.002–0.364). The nomadic lifestyle, substance use, congested homesteads and poor health worker attitudes were a great challenge to effective treatment of TB.
Conclusion
Despite having the highest national TB incidence, Karamoja still has a low DR-TB prevalence. Previous TB treatment and drug stock outs were associated with DR-TB. Regular supply of anti TB medications and health education may help to stem the burden of TB disease in this nomadic population.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.09.2021
Tilføjet 15.09.2021
Abstract
Background
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) constitutes a major health burden worldwide due to high mortality rates and hospital bed shortages. SARS-CoV-2 infection is associated with several laboratory abnormalities. We aimed to develop and validate a risk score based on simple demographic and laboratory data that could be used on admission in patients with SARS-CoV-2 infection to predict in-hospital mortality.
Methods
Three cohorts of patients from different hospitals were studied consecutively (developing, validation, and prospective cohorts). The following demographic and laboratory data were obtained from medical records: sex, age, hemoglobin, mean corpuscular volume (MCV), platelets, leukocytes, sodium, potassium, creatinine, and C-reactive protein (CRP). For each variable, classification and regression tree analysis were used to establish the cut-off point(s) associated with in-hospital mortality outcome based on data from developing cohort and before they were used for analysis in the validation and prospective cohort. The covid-19 score was calculated as a sum of cut-off points associated with mortality outcome.
Results
The developing, validation, and prospective cohorts included 129, 239, and 497 patients, respectively (median age, 71, 67, and 70 years, respectively). The following cut of points associated with in-hospital mortality: age > 56 years, male sex, hemoglobin < 10.55 g/dL, MCV > 92.9 fL, leukocyte count > 9.635 or < 2.64 103/µL, platelet count, < 81.49 or > 315.5 103/µL, CRP > 51.14 mg/dL, creatinine > 1.115 mg/dL, sodium < 134.7 or > 145.4 mEq/L, and potassium < 3.65 or > 6.255 mEq/L. The AUC of the covid-19 score for predicting in-hospital mortality was 0.89 (0.84–0.95), 0.850 (0.75–0.88), and 0.773 (0.731–0.816) in the developing, validation, and prospective cohorts, respectively (P < 0.001The mortality of the prospective cohort stratified on the basis of the covid-19 score was as follows: 0–2 points,4.2%; 3 points, 15%; 4 points, 29%; 5 points, 38.2%; 6 and more points, 60%.
Conclusion
The covid-19 score based on simple demographic and laboratory parameters may become an easy-to-use, widely accessible, and objective tool for predicting mortality in hospitalized patients with SARS-CoV-2 infection.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.09.2021
Tilføjet 15.09.2021
Abstract
Background
The prognosis of patients hospitalized with community-acquired pneumonia (CAP) with regards to intensive care unit (ICU) admission, short- and long-term mortality is correlated with patient’s comorbidities. For patients hospitalized for CAP, including P-CAP, we assessed the prognostic impact of comorbidities known as at-risk (AR) or high-risk (HR) of pneumococcal CAP (P-CAP), and of the number of combined comorbidities.
Methods
Data on hospitalizations for CAP among the French 50+ population were extracted from the 2014 French Information Systems Medicalization Program (PMSI), an exhaustive national hospital discharge database maintained by the French Technical Agency of Information on Hospitalization (ATIH). Their admission diagnosis, comorbidities (nature, risk type and number), other characteristics, and their subsequent hospital stays within the year following their hospitalization for CAP were analyzed. Logistic regression models were used to assess the associations between ICU transfer, short- and 1-year in-hospital mortality and all covariates.
Results
From 182,858 patients, 149,555 patients aged ≥ 50 years (nonagenarians 17.8%) were hospitalized for CAP in 2014, including 8270 with P-CAP. Overall, 33.8% and 90.5% had ≥ 1 HR and ≥ 1 AR comorbidity, respectively. Cardiac diseases were the most frequent AR comorbidity (all CAP: 77.4%). Transfer in ICU occurred for 5.4% of CAP patients and 19.4% for P-CAP. Short-term and 1-year in-hospital mortality rates were 10.9% and 23% of CAP patients, respectively, significantly lower for P-CAP patients: 9.2% and 19.8% (HR 0.88 [95% CI 0.84–0.93], p < .0001). Both terms of mortality increased mostly with age, and with the number of comorbidities and combination of AR and HR comorbidities, in addition of specific comorbidities.
Conclusions
Not only specific comorbidities, but also the number of combined comorbidities and the combination of AR and HR comorbidities may impact the outcome of hospitalized CAP and P-CAP patients.
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