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Chandwar K, Kumar P, Dhakad U.
Journal of the American Medical Association, 19.10.2021
Tilføjet 19.10.2021
To the Editor We have some concerns about the recent study about rituximab and reduced-dose glucocorticoids vs high-dose glucocorticoids in antineutrophil cytoplasm antibody (ANCA)–associated vasculitis. In addition to the limitations of being an open-label, single-country study recruiting only new patients and having a wide noninferiority margin of −0 percentage points, the patients enrolled in this study were older (more likely to have adverse effects with high-dose glucocorticoids), had a higher proportion of myeloperoxidase (MPO) positivity (which is associated with lower chance of relapse), had a higher mean estimated glomerular filtration rate (eGFR), and had no pulse glucocorticoid therapy compared with the studies mentioned by the authors. The mean eGFR in the reduced-dose glucocorticoid group was 55 mL/min/1.73 m2. Therefore, most of these patients had normal to mildly abnormal kidney function, considering their age. Furthermore, because most patients had microscopic polyangiitis/MPO-ANCA positivity, which is less likely to relapse than those with granulomatosis with polyangiitis/proteinase 3 (PR3)–ANCA positivity, they were likely to remain in remission with reduced-dose glucocorticoids. It would be helpful to know if patients with PR3 positivity had the same response rate as MPO-positive patients in the study. Also, we would be interested to learn how the authors chose the treatment regimen, given that the cumulative glucocorticoid dose in the high-dose group was lower than the cumulative dose in the low-dose glucocorticoid group in the PEXIVAS trial. The patient characteristics in the study by Dr Furuta and colleagues were most similar to those in the ADVOCATE trial, but remission rates in ADVOCATE were higher and patients were younger, had lower mean eGFR, and received a higher cumulative glucocorticoid dose. Patients in the RITUXIVAS trial also had a much higher remission rate with standard-dose glucocorticoids, although the patients were sicker (mean eGFR, 20 mL/min/1.73 m2) and younger, with 60% of patients being PR3 positive.
Læs mere Tjek på PubMedKuehn BM.
Journal of the American Medical Association, 19.10.2021
Tilføjet 19.10.2021
Disruptions in tuberculosis (TB) treatment, HIV prevention, and malaria care during the COVID-19 pandemic threaten to reverse global progress in combating the diseases, according to a report from the Global Fund.
Læs mere Tjek på PubMedCoffey K, Diekema DJ, Morgan DJ.
Journal of the American Medical Association, 19.10.2021
Tilføjet 19.10.2021
A 53-year-old woman presented to the gastroenterology clinic for endoscopy because of submucosal gastric nodule. Reverse transcriptase–polymerase chain reaction SARS-CoV-2 testing before the procedure was positive, and the patient reported testing positive for SARS-CoV-2 30 days prior. What would you do next?
Læs mere Tjek på PubMedSteensels D, Pierlet N, Penders J, et al.
Journal of the American Medical Association, 19.10.2021
Tilføjet 19.10.2021
This study compares the immune responses to the BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) COVID-19 vaccines in health care workers in Belgium.
Læs mere Tjek på PubMedVasan A, Kenyon CC, Roberto CA, et al.
Journal of the American Medical Association, 19.10.2021
Tilføjet 19.10.2021
This study assesses whether participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) differed before and during the COVID-19 pandemic in states with offline vs online electronic benefits transfer debit cards.
Læs mere Tjek på PubMedBMC Infectious Diseases, 19.10.2021
Tilføjet 19.10.2021
Abstract
Background
HIV-infected persons are at increased risk of developing tuberculosis and Isoniazid preventive therapy has been shown to reduce the occurrence of tuberculosis among this group of persons. M-health technology has been reported to increase both knowledge and implementation of various health services including Isoniazid preventive therapy implementation. This study aimed to determine the effect of m-health on health worker knowledge and adherence to isoniazid preventive therapy (IPT) guidelines and on patient knowledge and adherence to isoniazid treatment.
Methods
This was a quasi-experimental study that was carried out in six health facilities in Ebonyi State, southeast Nigeria. Three health facilities were assigned to each arm (intervention and control arms) and all eligible health workers (total population of 45 and 41 in intervention and control arms respectively) were recruited. Data were also collected from 200 patients (100 per arm). The intervention consisted of mobile phone messages and reminders for health workers on the IPT guideline. Chi-square test was carried out at p < 0.05 and 95% confidence interval.
Results
At baseline, 54.5% and 63.4% of health workers in intervention and control arms respectively had good knowledge which improved significantly to 90.2% in the intervention arm after the intervention (χ2 = 14.22, p < 0.0001). At baseline, 61.4% and 90.2% of health workers had good adherence to the guideline in intervention and control arms respectively which also improved in the intervention arm by 28.8% after intervention although not significant(χ2 = 0.37, p = 0.54). More than 50% of the patients in both study arms had poor knowledge, with the intervention arm having a significantly higher proportion of respondents (68.0%) with poor knowledge at baseline (χ2 = 4.71, p = 0.03). The proportion of patients with good knowledge however increased significantly (88.8%) in the intervention arm after intervention (χ2 = 25.65, p < 0.001). Patients had good adherence to IPT in intervention and control arms before (100% and 84.2% respectively) and after (96.6% and 100% respectively) the study. There was no significant difference in adherence among patients in both arms.
Conclusions
Health worker knowledge and practice of guidelines as well as patient knowledge improved in the intervention arm in this study. These findings suggest the consideration for the inclusion of mobile phone reminders in the guideline for tuberculosis prevention among HIV patients.
Læs mere Tjek på PubMedBMC Infectious Diseases, 19.10.2021
Tilføjet 19.10.2021
Abstract
Background
KPC-K.pneumoniae bloodstream infection (KPC-KpBSI) mortality rate in patients with hematological malignancies is reported about 60%. The initial treatment active against KPC-K.pneumoniae is crucial for survival and KPC-K.pneumoniae rectal colonization usually precedes KPC-KpBSI. We evaluated the impact on KPC-KpBSI mortality of the preemptive use of antibiotics active against KPC-K.pneumoniae, as opposed to inactive or standard empiric antibiotics, for the empiric treatment of febrile neutropenia episodes in patients with hematological malignancy identified as KPC-K.pneumoniae intestinal carriers.
Methods
We compared the outcomes of KPC-KpBSIs occurring in high-risk hematological patients known to be colonized with KPC-K.pneumoniae, during two time periods:
March2012-December2013 (Period 1, initial approach to KPC-K.pneumoniae spread) and January2017-October2018 (Period 2, full application of the preemptive strategy). The relative importance of the various prognostic factors that could influence death rates were assessed by forward stepwise logistic regression models.
Results
KPC-KpBSI-related mortality in hematological patients identified as KPC-K.pneumoniae carriers dropped from 50% in Period 1 to 6% in Period 2 (p < 0.01), from 58 to 9% in acute myeloid leukemia carriers(p < 0.01). KPC-KpBSIs developed in patients identified as KPC-K.pneumoniae carriers were initially treated with active therapy in 56% and 100% of cases in Period 1 and Period 2, respectively (p < 0.01), in particular with an active antibiotic combination in 39 and 94% of cases, respectively(p < 0.01). The 61% of KPC-KpBSI observed in Period 1 developed during inactive systemic antibiotic treatment (none in Period 2, p < 0.01), fatal in the 73% of cases. Overall, KPC-KpBSI-related mortality was 88% with no initial active treatment, 11.5% with at least one initial active antibiotic (p < 0.01), 9% with initial active combination. Only the initial active treatment resulted independently associated with survival.
Conclusions
In high-risk hematological patients colonized by KPC-K.pneumoniae, the empiric treatment of febrile neutropenia active against KPC-K.pneumoniae reduced KPC-KpBSI-related mortality to 6% and prevented fatal KPC-KpBSI occurrence during inactive systemic antibiotic treatment.
Læs mere Tjek på PubMedBMC Infectious Diseases, 19.10.2021
Tilføjet 19.10.2021
Abstract
Background
Leptospirosis is a re-emerging disease with vast clinical presentations, that ranges from subclinical or mild to severe and fatal outcomes. Leptospirosis can be managed well if diagnosed earlier, however, similar clinical presentations by several other febrile illnesses or co-infections, and laboratory diagnostic challenges due to the biphasic nature of the illness, often result in mis- or underdiagnosis, thereby lead to severe illness. Identification of clinical predictors for the severe form of the disease plays a crucial role in reducing disease complication and mortality. Therefore, we aimed to determine the clinical predictors associated with severe illness among leptospirosis patients from Central Malaysia through a prospective multicenter observational study.
Methods
A prospective multicenter observational study was performed on patients admitted for clinically suspected leptospirosis. Three hospitals namely Hospital Serdang, Hospital Tengku Ampuan Rahimah and Hospital Teluk Intan were included in the study. Among a total of 165 clinically suspected leptospirosis patients, 83 confirmed cases were investigated for clinical predictors for severe illness. Qualitative variables were performed using χ2 and the relationship between mild and severe cases was evaluated using logistic regression. Multivariable logistic regression was used to predict the independent variable for severity.
Results
Among the 83 patients, 50 showed mild disease and 33 developed severe illness. The mean age of the patients was 41.92 ± 17.99 and most were males (n = 54, 65.06%). We identified mechanical ventilation, acute kidney injury, septic shock, creatinine level of > 1.13 mg/dL, urea > 7 mmol/L, alanine aminotransferase > 50 IU, aspartate aminotransferase > 50 IU, and platelet < 150 × 109/L as factors associated with severe illness. Acute kidney injury, alanine aminotransferase > 50 IU and platelet < 150 × 109/L were defined as the independent factors for severity.
Conclusions
Lungs, liver and kidney involvement and septic shock were found as the prognostic factors for severe leptospirosis. Acute kidney injury, high level of alanine aminotransferase and low level of platelets were found to be independent predictors of severity.
Læs mere Tjek på PubMedBMC Infectious Diseases, 19.10.2021
Tilføjet 19.10.2021
Abstract
Background
Importation of dengue following globalization presents an emerging threat to global health. However, evidence on global geographical sources and the potential of dengue importation globally are lacking. This study aims to systematically review the sources of dengue importation globally and the risk of dengue outbreaks globally.
Methods
This systematic review was conducted in accordance to Cochrane’s PRISMA guidelines. Articles published through 31 December 2019 with laboratory-confirmed dengue imported cases were consolidated from PubMed, EMBASE and Scopus. Sources of dengue importation reported worldwide were analysed by country and geographical regions. Sources of dengue importation into United States of America and Europe specifically were also analysed.
Results
A total of 3762 articles were found. Among which, 210 articles—documenting 14,972 imported dengue cases with reported sources—were eligible. 76.3% of imported cases worldwide were from Asia. 15.7%, 5.6%, 2.0% and 0.1% were imported from the Americas, Africa, Oceania and Europe regions respectively. Imported dengue cases in the U.S. were from Americas (55.3%), Asia (34.7%), Africa (6.7%) and Oceania (3.3%). Imported dengue cases in Europe were from Asia (66.0%), Americas (21.9%), Africa (10.8%) and Oceania (1.1%).
Conclusion
The potential of dengue outbreaks occurring globally, especially among non-endemic regions with dengue-susceptible populations is high. With the expansion of Aedes mosquito population globally due to global warming and globalisation, dengue importation constitutes an emerging global health security threat.
Læs mere Tjek på PubMedBMC Infectious Diseases, 18.10.2021
Tilføjet 19.10.2021
Abstract
Background
Several inflammatory molecules participate in the immune response to malaria. Interleukin (IL)-18 is an inflammatory cytokine activated by NLRP3 inflammasomes. In clinical falciparum malaria, with and without HIV co-infection, data on IL-18 and in particular on its binding protein, IL-18bp, is scarce.
Methods
Clinical data and blood samples were collected from adults in Mozambique with P. falciparum infection, with (n = 70) and without (n = 61) HIV co-infection, from HIV-infected patients with similar symptoms without malaria (n = 58) and from healthy controls (n = 52). In vitro studies were performed in endothelial cells using hemozoin crystals.
Results
(i) IL-18 and IL-18bp were markedly up-regulated during falciparum malaria with particular high levels in malaria patients co-infected with HIV and severe malaria disease. (ii) In the malaria group as a whole, both IL-18 and IL-18bp were positively correlated with disease severity, parasitemia, and endothelial cell activation as assessed by vWF in plasma. (iii) Whereas there was no change in IL-18 levels in malaria patients co-infected with HIV during follow-up, the patients with malaria only had slightly increased IL-18 levels. Further, the IL-18pb levels declined and thereby contributed to an increase in IL-18/IL-18bp ratio in all subgroups of malaria patients. (iv) IL-27, previously shown to be up-regulated in this malaria cohort, markedly induced a release of IL-18bp from endothelial cells in vitro, and notably, this presumably anti-inflammatory effect was counteracted by hemozoin.
Conclusions
Our findings suggest that the IL-18 system could be an important mediator in the immune pathogenesis during falciparum malaria, potentially also representing a target for therapy.
Læs mere Tjek på PubMedBMC Infectious Diseases, 18.10.2021
Tilføjet 19.10.2021
Abstract
Background
Taenia solium, present in most developing countries, infects many individuals and may result in their death. Neurocysticercosis (NCC) develops after invasion of the brain by parasitic larvae. It is the most common parasitic disease of the human central nervous system. On imaging scans it can be similar to brain tumors. We report a patient with a metastatic brain tumor and NCC. The co-presence of NCC was diagnosed based on specific neuroimaging- and epidemiologic findings.
Case presentation
A 36-year-old non-smoking Japanese woman with a history of non-small-cell lung cancer had undergone resection of the lower lobe followed by cytotoxic chemotherapy 2 years before apparently suffering recurrence. A positron emission computed tomography (PET) scan incidentally revealed multiple intracranial cold spots exhibiting differences in their shape and size. On brain magnetic resonance imaging (MRI) scans we observed many different patterns of peripheral edema and gadolinium-enhancing effects. As she had often visited Latin America and Southeast Asia and had eaten raw pork and Kimchi, we suspected that the brain lesions were due to NCC rather than metastatic brain tumors. However, serum immunoblotting assay and DNA analysis were negative for T. solium. Rather than performing resection, we administered albendazole (ABZ) and dexamethasone because her earlier cytotoxic chemotherapy had elicited severe pancytopenia. Except for a single large lesion in the left frontal lobe, this treatment resulted in a significant reduction in the size of these lesions and a decrease in perilesional edema. She underwent resection of the residual lesion 10 months later. Histology revealed it to be a metastatic tumor. Polymerase chain reaction (PCR) assay for NCC was negative. In the course of 11-months follow-up there has been no recurrence.
Conclusion
This is the first presentation of NCC in a Japanese woman with a metastatic brain tumor. NCC was incidentally discovered on PET scans and, based on her travel history and epidemiological findings; it was diagnosed and successfully treated with ABZ. NCC is endemic in most developing countries and as visits to such countries have increased, NCC must be ruled out in patients with multiple cystic nodular brain lesions.
Læs mere Tjek på PubMedBMC Infectious Diseases, 18.10.2021
Tilføjet 19.10.2021
Abstract
Background
The ongoing coronavirus disease 2019 (COVID-19) global pandemic caused by the SARS-CoV-2 virus remains a major threat to public health. At present, it is recommended that patients with known or suspected COVID-19 undergo quarantine or medical observation for 14 days. However, recurrent SARS-CoV-2 RNA positivity and prolonged viral shedding have been documented in convalescent COVID-19 patients, complicating efforts to control viral spread and ensure patient recovery.
Case presentation
We report the case of a patient who experienced two recurrent episodes of SARS-CoV-2 RNA and IgM positivity and viral shedding over 60 days during hospitalization.
Conclusions
This case report demonstrates that relapses of SARS-CoV-2 RNA and IgM positivity may occur even after COVID-19 symptoms have resolved, possibly as a consequence of prolonged viral shedding rather than re-infection.
Læs mere Tjek på PubMedBMC Infectious Diseases, 18.10.2021
Tilføjet 19.10.2021
Abstract
Background
Early detection of clusters of pathogens is crucial for infection prevention and control (IPC) in hospitals. Conventional manual cluster detection is usually restricted to certain areas of the hospital and multidrug resistant organisms. Automation can increase the comprehensiveness of cluster surveillance without depleting human resources. We aimed to describe the application of an automated cluster alert system (CLAR) in the routine IPC work in a hospital. Additionally, we aimed to provide information on the clusters detected and their properties.
Methods
CLAR was continuously utilized during the year 2019 at Charité university hospital. CLAR analyzed microbiological and patient-related data to calculate a pathogen-baseline for every ward. Daily, this baseline was compared to data of the previous 14 days. If the baseline was exceeded, a cluster alert was generated and sent to the IPC team. From July 2019 onwards, alerts were systematically categorized as relevant or non-relevant at the discretion of the IPC physician in charge.
Results
In one year, CLAR detected 1,714 clusters. The median number of isolates per cluster was two. The most common cluster pathogens were Enterococcus faecium (n = 326, 19 %), Escherichia coli (n = 274, 16 %) and Enterococcus faecalis (n = 250, 15 %). The majority of clusters (n = 1,360, 79 %) comprised of susceptible organisms. For 906 alerts relevance assessment was performed, with 317 (35 %) alerts being classified as relevant.
Conclusions
CLAR demonstrated the capability of detecting small clusters and clusters of susceptible organisms. Future improvements must aim to reduce the number of non-relevant alerts without impeding detection of relevant clusters. Digital solutions to IPC represent a considerable potential for improved patient care. Systems such as CLAR could be adapted to other hospitals and healthcare settings, and thereby serve as a means to fulfill these potentials.
Læs mere Tjek på PubMedBMC Infectious Diseases, 18.10.2021
Tilføjet 19.10.2021
Abstract
Background
Maternal sepsis and other maternal infections (MSMI) have considerable impacts on women’s and neonatal health, but data on the global burden and trends of MSMI are limited. Comprehensive knowledge of the burden and trend patterns of MSMI is important to allocate resources, facilitate the establishment of tailored prevention strategies and implement effective clinical treatment measures.
Methods
Based on data from the Global Burden of Disease database, we analysed the global burden of MSMI by the incidence, death, disability-adjusted life year (DALY) and maternal mortality ratio (MMR) in the last 30 years. Then, the trends of MSMI were assessed by the estimated annual percentage change (EAPC) of MMR as well as the age-standardized rate (ASR) of incidence, death and DALY. Moreover, we determined the effect of sociodemographic index (SDI) on MSMI epidemiological parameters.
Results
Although incident cases almost stabilized from 1990 to 2015, the ASR of incidence, death, DALY and MMR steadily decreased globally from 1990 to 2019. The burden of MSMI was the highest in the low SDI region with the fastest downward trends. MSMI is still one of the most important causes of maternal death in the developed world. Substantial diversity of disease burden and trends occurred in different regions and individual countries, most of which had reduced burden and downward trends. The MMR and ASR were negatively correlated with corresponding SDI value in 2019 in 204 countries/territories and 21 regions.
Conclusion
These findings highlight significant improvement in MSMI care in the past three decades, particularly in the low and low-middle SDI regions. However, the increased burden and upward trends of MSMI in a few countries and regions are raising concern, which poses a serious challenge to maternal health. More tailored prevention measures and additional resources for maternal health are urgently needed to resolve this problem.
Læs mere Tjek på PubMedSushma Dahal, Ruiyan Luo, Monica H. Swahn, Gerardo Chowell
International Journal of Infectious Diseases, 19.10.2021
Tilføjet 19.10.2021
Monitoring all-cause excess mortality, above an expected level of total deaths, as a pandemic unfolds is one of the key ways to evaluate its mortality impact (Weinberger et al., 2020). All-cause excess mortality estimates include deaths that are directly or indirectly attributed to the pandemic (CDC, Serfling, 1963). Besides direct deaths due to COVID-19, deaths indirectly attributed to the COVID-19 pandemic include those related to denied or delayed care for acute emergencies (Schirmer et al., 2020) (Maringe et al., 2020) or other chronic conditions (Douglas et al., 2020), the disruption of routine health care services in an overburdened health care system (Roberton et al., 2020), unaddressed mental health concerns including suicide and self-harm (Kawohl and Nordt, 2020, Sahoo et al., 2020), and drug overdoses (Currie et al., 2021).
Læs mere Tjek på PubMedMcGowan, Samuel K.; Sarigiannis, Kalli A.; Fox, Samuel C.; Gottlieb, Michael A.; Chen, Elaine
Critical Care Medicine, 12.10.2021
Tilføjet 19.10.2021
Objectives:
Racial disparities in the United States healthcare system are well described across a variety of clinical settings. The ICU is a clinical environment with a higher acuity and mortality rate, potentially compounding the impact of disparities on patients. We sought to systematically analyze the literature to assess the prevalence of racial disparities in the ICU.
Data Sources:
We conducted a comprehensive search of PubMed/MEDLINE, Scopus, CINAHL, and the Cochrane Library.
Study Selection:
We identified articles that evaluated racial differences on outcomes among ICU patients in the United States. Two authors independently screened and selected articles for inclusion.
Data Extraction:
We dual-extracted study characteristics and outcomes that assessed for disparities in care (e.g., in-hospital mortality, ICU length of stay). Studies were assessed for bias using the Newcastle-Ottawa Scale.
Data Synthesis:
Of 1,325 articles screened, 25 articles were included (n = 751,796 patients). Studies demonstrated race-based differences in outcomes, including higher mortality rates for Black patients when compared with White patients. However, when controlling for confounding variables, such as severity of illness and hospital type, mortality differences based on race were no longer observed. Additionally, results revealed that Black patients experienced greater financial impacts during an ICU admission, were less likely to receive early tracheostomy, and were less likely to receive timely antibiotics than White patients. Many studies also observed differences in patients’ end-of-life care, including lower rates on the quality of dying, less advanced care planning, and higher intensity of interventions at the end of life for Black patients.
Conclusions:
This systematic review found significant differences in the care and outcomes among ICU patients of different races. Mortality differences were largely explained by accompanying demographic and patient factors, highlighting the effect of structural inequalities on racial differences in mortality in the ICU. This systematic review provides evidence that structural inequalities in care persist in the ICU, which contribute to racial disparities in care. Future research should evaluate interventions to address inequality in the ICU.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
The authors have disclosed that they do not have any potential conflicts of interest.
For information regarding this article, E-mail: smcgowan@rush.edu
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedMesotten, Dieter; Meijs, Daniek A. M.; van Bussel, Bas C. T.; Stessel, Björn; Mehagnoul-Schipper, Jannet; Hana, Anisa; Scheeren, Clarissa I. E.; Strauch, Ulrich; van de Poll, Marcel C. G.; Ghossein-Doha, Chahinda; Buhre, Wolfgang F. F. A.; Bickenbach, Johannes; Vander Laenen, Margot; Marx, Gernot; van der Horst, Iwan C. C.; COVID Data Platform (CoDaP) Investigators
Critical Care Medicine, 12.10.2021
Tilføjet 19.10.2021
Objectives:
To investigate healthcare system–driven variation in general characteristics, interventions, and outcomes in coronavirus disease 2019 (COVID-19) patients admitted to the ICU within one Western European region across three countries.
Design:
Multicenter observational cohort study.
Setting:
Seven ICUs in the Euregio Meuse-Rhine, one region across Belgium, The Netherlands, and Germany.
Patients:
Consecutive COVID-19 patients supported in the ICU during the first pandemic wave.
Interventions:
None.
MEASUREMENTS AND MAIN RESULTS:
Baseline demographic and clinical characteristics, laboratory values, and outcome data were retrieved after ethical approval and data-sharing agreements. Descriptive statistics were performed to investigate country-related practice variation. From March 2, 2020, to August 12, 2020, 551 patients were admitted. Mean age was 65.4 ± 11.2 years, and 29% were female. At admission, Acute Physiology and Chronic Health Evaluation II scores were 15.0 ± 5.5, 16.8 ± 5.5, and 15.8 ± 5.3 (p = 0.002), and Sequential Organ Failure Assessment scores were 4.4 ± 2.7, 7.4 ± 2.2, and 7.7 ± 3.2 (p < 0.001) in the Belgian, Dutch, and German parts of Euregio, respectively. The ICU mortality rate was 22%, 42%, and 44%, respectively (p < 0.001). Large differences were observed in the frequency of organ support, antimicrobial/inflammatory therapy application, and ICU capacity. Mixed-multivariable logistic regression analyses showed that differences in ICU mortality were independent of age, sex, disease severity, comorbidities, support strategies, therapies, and complications.
Conclusions:
COVID-19 patients admitted to ICUs within one region, the Euregio Meuse-Rhine, differed significantly in general characteristics, applied interventions, and outcomes despite presumed genetic and socioeconomic background, admission diagnosis, access to international literature, and data collection are similar. Variances in healthcare systems’ organization, particularly ICU capacity and admission criteria, combined with a rapidly spreading pandemic might be important drivers for the observed differences. Heterogeneity between patient groups but also healthcare systems should be presumed to interfere with outcomes in coronavirus disease 2019.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
Prof. Mesotten, Dr. van Bussel, Dr. Stessel, Dr. Mehagnoul-Schipper, Dr. Hana, Dr. Scheeren, Dr. Strauch, Prof. Marx, and Prof. van der Horst contributed to conceptualization and study design. Ms. Meijs, Dr. van Bussel, and CoDaP investigators contributed to data curation. Ms. Meijs and Dr. van Bussel contributed to formal analysis. Prof. Mesotten, Dr. van Bussel, Dr. Stessel, Prof. Marx, and Prof. van der Horst contributed to funding acquisition. Drs. Stessel, Mehagnoul-Schipper, Hana, and Scheeren contributed to investigation. Prof. Mesotten, Dr. van Bussel, and Prof. van der Horst contributed to methodology. CoDaP investigators took responsibility for the resources. Prof. Mesotten, Dr. van Bussel, and Prof. van der Horst contributed to supervision.
Ms. Meijs and Dr. van Bussel contributed to validation. Ms. Meijs, Dr. van Bussel, and Prof. van der Horst contributed to visualization. Prof. Mesotten, Ms. Meijs, Dr. van Bussel, and Prof. van der Horst contributed to writing the original draft. All authors and CoDaP investigators contributed to writing, reviewing, and editing. Ms. Meijs and Dr. van Bussel have verified the underlying data and took responsibility for the integrity of the data and the accuracy of the data analysis.
This paper is part of the CoDaP project funded by Interreg Euregio Meuse-Rhine (EMR) grant number 187. This grant was acquired by Prof. Mesotten, Dr. van Bussel, Dr. Stessel, Prof. Marx, and Prof. van der Horst. Dr. Strauch was also supported by Interreg EMR Pandemric grant number 177.
The authors have disclosed that they do not have any potential conflicts of interest.
The CoDaP Investigators are listed in Appendix 1.
For information regarding this article, E-mail: daniek.meijs@mumc.nl
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedGilissen, Vincent J. H. S.; Koning, Mark V.; Klimek, Markus
Critical Care Medicine, 12.10.2021
Tilføjet 19.10.2021
Objectives:
The ratio between PaO2 and FIO2 is used as a marker for impaired oxygenation and acute respiratory distress syndrome classification. However, any discrepancy between FIO2 and O2 fraction in the alveolus affects the PaO2/FIO2 ratio. Correcting the PaO2/FIO2 ratios using the alveolar gas equation may result in an improved reflection of the pulmonary situation. This study investigates the difference between standard and corrected PaO2/FIO2 in magnitude, its correlation with the mortality of acute respiratory distress syndrome classification, and trends over time.
Design:
A register and a retrospective study combined with the development of a mathematical model to determine the difference between standard and corrected PaO2/FIO2 ratio for various levels of PaCO2 and atmospheric pressure.
Setting:
ICU in a secondary hospital in the Netherlands.
Patients:
Patients admitted to the ICU for pneumonia or acute respiratory distress syndrome. Register cohort: January 1, 2010, till March 1, 2020 (n = 1008). Retrospective cohort: March 1, 2020, till June 1, 2020 (n = 34).
Measurements and Main Results:
The register was used to determine the 7-day ICU mortality per acute respiratory distress syndrome classification based on the standard and corrected PaO2/FIO2 ratio. The retrospective dataset correlated the PaCO2 with PaO2/FIO2 ratio over time in patients with assumed stable oxygenation. The model demonstrated an increased difference between the standard and corrected PaO2/FIO2 ratios by a lower FIO2 and atmospheric pressure and higher PaO2 and PaCO2. Reclassification of severe acute respiratory distress syndrome resulted in an increase in mortality from 28.1% for standard PaO2/FIO2 to 30.6% for corrected PaO2/FIO2 ratios. Acute Physiology and Chronic Health Evaluation scores correlated better with 7-day ICU-mortality when corrected PaO2/FIO2 ratio was used for classification. For patients with FIO2 less than 50% (n = 55), change in PaCO2 correlated with change in PaO2/FIO2 ratio (r = –0.388; p = 0.003).
Interventions:
A corrected PaO2/FIO2 ratio was calculated.
Conclusions:
Correcting the PaO2/FIO2 ratio for the alveolar gas equation predominantly affects patients with high ratios between PaO2 and FIO2 and PaCO2 and at low atmospheric pressure. Using the corrected PaO2/FIO2 ratio for acute respiratory distress syndrome classification results in improved correlation with the 7-day ICU mortality and increases generalization among acute respiratory distress syndrome studies. The authors provide a free, web-based tool.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
All authors contributed equally in different fields. The predominant roles were as follows: Dr. Gilissen contributed to data curation, formal analysis, investigation, methodology, software, visualization, and writing—original draft, writing review, and editing. Dr. Koning contributed to conceptualization, data curation, formal analysis, investigation, methodology, and writing—original draft, writing review, and editing. Dr. Klimek contributed to conceptualization, visualization, writing review, and editing.
The authors have disclosed that they do not have any potential conflicts of interest.
All deidentified data will be shared after approval of a proposal.
For information regarding this article, E-mail: mvkoning@rijnstate.nl
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedTran, Alexandre; Fernando, Shannon M.; Rochwerg, Bram; Cook, Deborah J.; Crowther, Mark A.; Fowler, Robert A.; Alhazzani, Waleed; Siegal, Deborah M.; Castellucci, Lana A.; Zarychanski, Ryan; English, Shane W.; Kyeremanteng, Kwadwo; Carrier, Marc
Critical Care Medicine, 12.10.2021
Tilføjet 19.10.2021
Objective:
To identify prognostic factors for the development of venous thromboembolism in the ICU.
Data Sources:
We searched MEDLINE, EMBASE, and Cochrane CENTRAL from inception to March 1, 2021.
Study Selection:
We included English-language studies describing prognostic factors associated with the development of venous thromboembolism among critically ill patients.
Data Extraction:
Two authors performed data extraction and risk-of-bias assessment. We pooled adjusted odds ratios and adjusted hazard ratios for prognostic factors using random-effects model. We assessed risk of bias using the Quality in Prognosis Studies tool and certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations approach.
Data Synthesis:
We included 39 observational cohort studies involving 729,477 patients. Patient factors with high or moderate certainty of association with increased odds of venous thromboembolism include older age (adjusted odds ratio, 1.15; 95% CI, 1.02–1.29 per 10 yr), obesity (adjusted odds ratio, 1.25; 95% CI, 1.18–1.32), active malignancy (adjusted odds ratio, 1.70; 95% CI, 1.18–2.44), history of venous thromboembolism (adjusted odds ratio, 4.77; 95% CI, 3.42–6.65), and history of recent surgery (adjusted odds ratio, 1.77; 95% CI, 1.26–2.47). ICU-specific factors with high or moderate certainty of association with increased risk of venous thromboembolism include sepsis (adjusted odds ratio, 1.41; 95% CI, 1.12–1.78), lack of pharmacologic venous thromboembolism prophylaxis (adjusted odds ratio, 1.80; 95% CI, 1.14–2.84), central venous catheter (adjusted odds ratio, 2.93; 95% CI, 1.98–4.34), invasive mechanical ventilation (adjusted odds ratio, 1.74; 95% CI, 1.36–2.24), and use of vasoactive medication (adjusted odds ratio, 1.86; 95% CI, 1.23–2.81).
Conclusions:
This meta-analysis provides quantitative summaries of the association between patient-specific and ICU-related prognostic factors and the risk of venous thromboembolism in the ICU. These findings provide the foundation for the development of a venous thromboembolism risk stratification tool for critically ill patients.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
Drs. Tran, Fernando, Rochwerg, and Crowther conceived the idea and designed the study protocol. Drs. Tran and Fernando completed the search and extraction. Drs. Tran and Fernando completed the data analysis. All authors participated in the creation and revision of the article.
Dr. Rochwerg is supported by a Hamilton Health Sciences New Investigator Grant. Dr. Cook is supported by a Canada Research Chair in Critical Care Knowledge Translation. Dr. Crowther has served on advisory boards or as a consultant for Precision Biologicals and Hemostasis Reference Laboratories, has provided educational materials and/or presented for Pfizer, CSL Behring, Diagnostica Stago, and holds the Leo Pharma Chair in Thromboembolism Research at McMaster University. Dr. Crowther received honoraria from Syneos Health. Dr. Fowler is the H. Barrie Fairley Professor of Critical Care at the University Health Network and University of Toronto Interdepartmental Division of Critical Care Medicine. Dr. Siegal has received honoraria from Bayer, Bristol-Meyers Squib (BMS)-Pfizer, Leo Pharma, Novartis, Portola, and Servier and for attending advisory board meetings and educational presentations from Servier. Dr. Siegal reports research funding from Novartis. Dr. Castellucci is supported by a Tier 2 Research Chair in Thrombosis and Anticoagulation Safety from the University of Ottawa, and a Heart and Stroke Foundation of Canada National New Investigator Award. Dr. Castellucci’s institution received funding from The Academy, BMS/Pfizer Alliance, and Amag Pharmaceuticals. Dr. Carrier is supported by a Tier 1 Research Chair in Venous Thrombosis and Cancer from the Department of Medicine at the University of Ottawa. Dr. Carrier reports research funding from BMS, Leo Pharma, Pfizer, BMS, and Valeo and honoraria from Pfizer, Bayer, Bristol-Myers Squibb, Sanofi, Leo Pharma, and Servier. Dr. Kyeremanteng received funding from Edwards LifeSciences (medical advisor). The remaining authors have disclosed that they do not have any potential conflicts of interest.
For information regarding this article, E-mail: aletran@toh.ca
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedFalvey, Jason R.; Murphy, Terrence E.; Leo-Summers, Linda; Gill, Thomas M.; Ferrante, Lauren E.
Critical Care Medicine, 12.10.2021
Tilføjet 19.10.2021
Objectives:
Factors common to socioeconomically disadvantaged neighborhoods, such as low availability of transportation, may limit access to restorative care services for critical illness survivors. Our primary objective was to evaluate whether neighborhood socioeconomic disadvantage was associated with an increased disability burden after critical illness. Our secondary objective was to determine if the effect differed for those discharged to the community compared with those discharged to a facility.
Design:
Longitudinal cohort study with linked Medicare claims data.
Setting:
United States.
Patients:
One hundred ninety-nine older adults, contributing to 239 ICU admissions, who underwent monthly assessments of disability for 12 months following hospital discharge in 13 different functional tasks from 1998 to 2017.
Measurements and Main Results:
Neighborhood disadvantage was assessed using the area deprivation index, a 1–100 ranking evaluating poverty, housing, and employment metrics. Those living in disadvantaged neighborhoods (top quartile of scores) were less likely to self-identify as non-Hispanic White compared with those in more advantaged neighborhoods. In adjusted models, older adults living in disadvantaged neighborhoods had a 9% higher disability burden over the 12 months following ICU discharge compared with those in more advantaged areas (rate ratio, 1.09; 95% Bayesian credible interval, 1.02–1.16). In the secondary analysis adjusting for discharge destination, neighborhood disadvantage was associated with a 14% increase in disability burden over 12 months of follow-up (rate ratio, 1.14; 95% credible interval, 1.07–1.21). Disability burden was 10% higher for those living in disadvantaged neighborhoods and discharged home as compared with those discharged to a facility, but this difference was not statistically significant (interaction rate ratio, 1.10; 95% credible interval, 0.98–1.25).
Conclusions:
Neighborhood socioeconomic disadvantage is associated with a higher disability burden in the 12 months after a critical illness. Future studies should evaluate barriers to functional recovery for ICU survivors living in disadvantaged neighborhoods.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
Drs. Falvey and Ferrante made substantial contributions to the conception or design of the work, and drafted the work. All authors contributed to acquisition, analysis, or interpretation of data for the work; critical revision for important intellectual content; final approval of version to be published; and agreement to be accountable for all aspects of the work.
Supported, in part, by a grant from the National Institute on Aging (R01AG17560).
Dr. Falvey received grant support from a Foundation for Physical Therapy Research Pipeline to Health Services Research Grant, a National Institute on Aging (NIA) training grant T32AG019134, and from the University of Maryland Claude D. Pepper Older Americans Independence Center (P30AG028747). Dr. Murphy is supported by the Yale Claude D. Pepper Older Americans Independence Center (P30AG021342). Dr. Ferrante is supported by a Paul B. Beeson Emerging Leaders Career Development Award in Aging from the NIA (K76AG057023) and the Yale Claude D. Pepper Older Americans Independence Center (P30AG021342). Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, and patent/licensing arrangements) that might pose a conflict of interest in connection with the submitted article. Dr. Falvey’s institution received support for article research from the Foundation for Physical Therapy Research. Drs. Falvey’s, Murphy’s, Gill’s, and Ferrante’s institutions received funding from the National Institutes on Aging (NIA). Drs. Falvey, Murphy, Gill, and Ferrante received support for article research from the National Institutes of Health. Dr. Leo-Summers received support for article research from the NIA.
This work was completed at Yale School of Medicine, New Haven, CT.
For information regarding this article, E-mail: jfalvey@som.umaryland.edu
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Læs mere Tjek på PubMedHiroyasu Kaya, Daisuke Usuda
Journal of Medical Virology, 18.10.2021
Tilføjet 19.10.2021
Malaria Journal, 18.10.2021
Tilføjet 19.10.2021
Abstract
Background
Malaria, pneumonia and diarrhoea continue to be the leading causes of death in children under the age of five years (U5) in Uganda. To combat these febrile illnesses, integrated community case management (iCCM) delivery models utilizing community health workers (CHWs) or drug sellers have been implemented. The purpose of this study is to compare the cost-effectiveness of delivering iCCM interventions via drug sellers versus CHWs in rural Uganda.
Methods
This study was a cost-effectiveness analysis to compare the iCCM delivery model utilizing drug sellers against the model using CHWs. The effect measure was the number of appropriately treated U5 children, and data on effectiveness came from a quasi-experimental study in Southwestern Uganda and the inSCALE cross-sectional household survey in eight districts of mid-Western Uganda. The iCCM interventions were costed using the micro-costing (ingredients) approach, with costs expressed in US dollars. Cost and effect data were linked together using a decision tree model and analysed using the Amua modelling software.
Results
The costs per 100 treated U5 children were US$591.20 and US$298.42 for the iCCM trained-drug seller and iCCM trained-CHW models, respectively, with 30 and 21 appropriately treated children in the iCCM trained-drug seller and iCCM trained-CHW models. When the drug seller arm (intervention) was compared to the CHW arm (control), an incremental effect of 9 per 100 appropriately treated U5 children was observed, as well as an incremental cost of US$292.78 per 100 appropriately treated children, resulting in an incremental cost-effectiveness ratio (ICER) of US$33.86 per appropriately treated U5 patient.
Conclusion
Since both models were cost-effective compared to the do-nothing option, the iCCM trained-drug seller model could complement the iCCM trained-CHW intervention as a strategy to increase access to quality treatment.
Læs mere Tjek på PubMedMalaria Journal, 18.10.2021
Tilføjet 19.10.2021
Abstract
Background
Standard treatment for both uncomplicated and severe malaria is artemisinin derivatives. Delayed parasite clearance times preceded the appearance of artemisinin treatment failures in Southeast Asia. Most worldwide malaria cases are in sub-Saharan Africa (SSA), where clinically significant artemisinin resistance or treatment failure has not yet been detected. The recent emergence of a resistance-conferring genetic mutation in the Plasmodium falciparum parasite in Africa warrants continued monitoring throughout the continent.
Methods
An analysis was performed on data from a retrospective cohort study of Malawian children with cerebral malaria admitted between 2010 and 2019 to a public referral hospital, ascertaining parasite clearance times across years. Data were collected from patients treated for severe malaria with quinine or artesunate, an artemisinin derivative. Parasite density was determined at admission and every subsequent 6 h until parasitaemia was below 1000 parasites/µl.The mean parasite clearance time in all children admitted in any one year was compared to the parasite clearance time in 2014, the first year of artesunate use in Malawi.
Results
The median population parasite clearance time was slower from 2010 to 2013 (quinine-treated patients) compared to 2014, the first year of artesunate use in Malawi (30 h (95% CI: 30–30) vs 18 h (95% CI: 18–24)). After adjustment for admission parasite count, there was no statistically significant difference in the median population parasite clearance time when comparing 2014 with any subsequent year.
Conclusion
Malaria parasite clearance times in Malawian children with cerebral malaria remained constant between 2014 and 2019, arguing against evolving artemisinin resistance in parasites in this region.
Læs mere Tjek på PubMedMalaria Journal, 18.10.2021
Tilføjet 19.10.2021
Abstract
Background
Although malaria and Anopheles mosquito vectors are highly prevalent in Côte d’Ivoire, limited data are available to help understand the malaria vector density and transmission dynamics in areas bordering the country. To address this gap, the Anopheles mosquito species diversity, the members of the Anopheles gambiae complex and the transmission of malaria were assessed in four health districts along the borders of Côte d’Ivoire.
Methods
From July 2016 through December 2016 and July 2017 through December 2017, adult Anopheles mosquitoes were collected in four health districts of Côte d’Ivoire (Aboisso, Bloléquin, Odienné and Ouangolodougou) using standardized window exit trap (WET) and pyrethrum knockdown spray collection (PSC) methods. The collected mosquitoes were identified morphologically at species level and the members of the An. gambiae complex were separated using short interspersed nuclear element-based polymerase chain reaction (SINE-PCR). Anopheles gambiae sensu lato (s.l.), Anopheles funestus s.l. and Anopheles nili specimens were analysed for malaria Plasmodium parasite detection using the cytochrome oxidase I gene (COX-I), and malaria prevalence among human population through local Ministry of Health (MoH) statistical yearbooks.
Results
A total of 281 female Anopheles were collected in Aboisso, 754 in Bloléquin, 1319 in Odienné and 2443 in Ouangolodougou. Seven Anopheles species were recorded including An. gambiae s.l. (94.8–99.1%) as the main vector, followed by An. funestus s.l. (0.4–4.3%) and An. nili (0–0.7%). Among An. gambiae s.l., Anopheles coluzzii represented the predominant species in Aboisso (89.2%) and Bloléquin (92.2%), while An. gambiae sensu stricto (s.s.) was the major species in Odienné (96.0%) and Ouangolodougou (94.2%). The Plasmodium sporozoite infection rate in An. gambiae s.l. was highest in Odienné (11.0%; n = 100) followed by Bloléquin (7.8%, n = 115), Aboisso (3.1%; n = 65) and Ouangologoudou (2.5%; n = 120). In An. funestus s.l., Plasmodium falciparum sporozoite infection rate was estimated at 6.2% (n = 32) in Bloléquin, 8.7% (n = 23) in Odienné. No An. funestus s.l. specimens were found infected with P. falciparum sporozoite infection in Ouangolodougou and Aboisso. No P. falciparum sporozoite was detected in An. nili specimens in the four health districts. Among the local human populations, malaria incidence was higher in Odienné (39.7%; n = 45,376) and Bloléquin (37.6%; n = 150,205) compared to that in Ouangolodougou (18.3%; n = 131,629) and Aboisso (19.7%; n = 364,585).
Conclusion
Anopheles vector species diversity, abundance and Plasmodium sporozoite infection were high within the health districts along the borders of the country of Côte d’Ivoire, resulting in high malaria transmission among the local populations. Anopheles gambiae s.l. and An. funestus s.l. were found to be highly infected with Plasmodium in the health districts of Bloléquin and Odienné where higher malaria incidence was observed than the other districts. This study provides important information that can be used to guide Côte d’Ivoire National Malaria Control Programme for vector control decision-making, mainly in districts that are at the country borders.
Læs mere Tjek på PubMedMalaria Journal, 18.10.2021
Tilføjet 19.10.2021
Abstract
Background
Pyrethroid resistance poses a major threat to the efficacy of insecticide-treated nets (ITNs) in Burkina Faso and throughout sub-Saharan Africa, particularly where resistance is present at high intensity. For such areas, there are alternative ITNs available, including the synergist piperonyl butoxide (PBO)-based ITNs and dual active ingredient ITNs such as Interceptor G2 (treated with chlorfenapyr and alpha-cypermethrin). Before deploying alternative ITNs on a large scale it is crucial to characterize the resistance profiles of primary malaria vector species for evidence-based decision making.
Methods
Larvae from the predominant vector, Anopheles gambiae sensu lato (s.l.) were collected from 15 sites located throughout Burkina Faso and reared to adults for bioassays to assess insecticide resistance status. Resistance intensity assays were conducted using WHO tube tests to determine the level of resistance to pyrethroids commonly used on ITNs at 1×, 5 × and 10 × times the diagnostic dose. WHO tube tests were also used for PBO synergist bioassays with deltamethrin and permethrin. Bottle bioassays were conducted to determine susceptibility to chlorfenapyr at a dose of 100 µg/bottle.
Results
WHO tube tests revealed high intensity resistance in An. gambiae s.l. to deltamethrin and alpha-cypermethrin in all sites tested. Resistance intensity to permethrin was either moderate or high in 13 sites. PBO pre-exposure followed by deltamethrin restored full susceptibility in one site and partially restored susceptibility in all but one of the remaining sites (often reaching mortality greater than 80%). PBO pre-exposure followed by permethrin partially restored susceptibility in 12 sites. There was no significant increase in permethrin mortality after PBO pre-exposure in Kampti, Karangasso-Vigué or Mangodara; while in Seguenega, Orodara and Bobo-Dioulasso there was a significant increase in mortality, but rates remained below 50%. Susceptibility to chlorfenapyr was confirmed in 14 sites.
Conclusion
High pyrethroid resistance intensity in An. gambiae s.l. is widespread across Burkina Faso and may be a predictor of reduced pyrethroid ITN effectiveness. PBO + deltamethrin ITNs would likely provide greater control than pyrethroid nets. However, since susceptibility in bioassays was not restored in most sites following pre-exposure to PBO, Interceptor G2 may be a better long-term solution as susceptibility was recorded to chlorfenapyr in nearly all sites. This study provides evidence supporting the introduction of both Interceptor G2 nets and PBO nets, which were distributed in Burkina Faso in 2019 as part of a mass campaign.
Læs mere Tjek på PubMedLancet Infectious Diseases, 19.10.2021
Tilføjet 19.10.2021
Thompson KM. Polio eradication: what kind of world do we want? Lancet Infect Dis 2021; published online Oct 11. https://doi.org/10.1016/S1473-3099(21)00458-8—In this Comment, the final sentence of the third paragraph has been reworded to “Overall they estimate that, within 6 months, the actual outbreak response campaigns in Africa covered only 11% of the predicted at-risk population of children under 5 years”. This correction has been made to the online version as of oct 18, 2021, and will be made to the printed Comment.
Læs mere Tjek på PubMedCarlos Alvarez-Moreno, Jackie A Cassell, Claudia M Donkor, Michael G Head, Jo Middleton, William Pomat, Bayaki Saka, Robel Yirgu
Lancet Infectious Diseases, 19.10.2021
Tilføjet 19.10.2021
Ivermectin is an oral anti-infective medicine that is integral to neglected tropical disease programmes. It is safe and effective for the treatment and control of lymphatic filariasis, scabies, and onchocerciasis, sometimes as part of a mass drug administration, as recognised in the WHO road map for neglected tropical diseases 2021–30.1 The WHO essential medicines list provides recommendations for minimum medicine needs for a basic health-care system, which includes ivermectin as an anthelmintic, antifilarial, and antiectoparasitic treatment.
Læs mere Tjek på PubMedT Alex Perkins, Quan Minh Tran
Lancet Infectious Diseases, 19.10.2021
Tilføjet 19.10.2021
Although vaccines against pertussis have been in widespread use for several decades, control of this disease has been complicated by several factors. With respect to vaccinology, complications include that the original whole-cell vaccines are effective but associated with undesirable side-effects, that subsequent acellular vaccines have fewer side-effects but offer less protection and durability than whole-cell vaccines, and that the properties of acellular vaccines appear to vary considerably according to formulation and local context.
Læs mere Tjek på PubMedJuliette Paireau, Sophie Guillot, Fatima Aït El Belghiti, Soraya Matczak, Sabine Trombert-Paolantoni, Véronique Jacomo, Muhamed-Kheir Taha, Henrik Salje, Sylvain Brisse, Daniel Lévy-Bruhl, Simon Cauchemez, Julie Toubiana
Lancet Infectious Diseases, 19.10.2021
Tilføjet 19.10.2021
A shorter-lived protection induced by the new vaccine schedule recommended in France since 2013 is associated with an increase of pertussis cases in children aged 2–5 years. If similar findings are observed in other countries and clinical trials, these findings should be considered in future pertussis vaccination policies.
Læs mere Tjek på PubMedDylan Minor Jacob Cavon Thea Johnson Savannah Ontiveros Daniel Gao Mark T. Quinn Benfang Lei Department of Microbiology and Cell Biology, Montana State University, Bozeman, MT 59718
Infection and Immunity, 18.10.2021
Tilføjet 19.10.2021
Infection and Immunity, <a href="https://journals.asm.org/toc/iai/0/ja">Volume 0, Issue ja</a>, -Not available-.
Læs mere Tjek på PubMedJoyce E. Karlinsey Angela M. Fung Norah Johnston Howard Goldfine Stephen J. Libby Ferric C. Fang Departments of Laboratory Medicine and Pathology1, University of Washington School of Medicine, Seattle, Washington Microbiology 2 University of Washington School of Medicine, Seattle, Washington Department of Microbiology3, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
Infection and Immunity, 18.10.2021
Tilføjet 19.10.2021
Infection and Immunity, <a href="https://journals.asm.org/toc/iai/0/ja">Volume 0, Issue ja</a>, -Not available-.
Læs mere Tjek på PubMedY. H. Sun G. Luxardi G. Xu K. Zhu B. Reid B. P. Guo C. B. Lebrilla E. Maverakis M. Zhao 1Department of Dermatology, School of Medicine, University of California, Sacramento, CA 95817, USA. 2Department of Internal Medicine, School of Medicine, University of California, Sacramento, CA 95817, USA. 3Department of Chemistry, University of California, Davis, CA 95616, USA. 4Office of Research, School of Medicine, University of California, Davis, Sacramento, CA 95817, USA. 5Department of Ophthalmology, School of Medicine, University of California, Sacramento, CA 95817, USA.
Infection and Immunity, 18.10.2021
Tilføjet 19.10.2021
Infection and Immunity, <a href="https://journals.asm.org/toc/iai/0/ja">Volume 0, Issue ja</a>, -Not available-.
Læs mere Tjek på PubMedAnita C. Parker Nathaniel L. Seals Cecile L. Baccanale Edson R. Rocha 1Department of Microbiology and Immunology, Brody School of Medicine, East Carolina University, Greenville, NC. 2Department of Comparative Medicine, Brody School of Medicine, East Carolina University, Greenville, NC.
Infection and Immunity, 18.10.2021
Tilføjet 19.10.2021
Infection and Immunity, <a href="https://journals.asm.org/toc/iai/0/ja">Volume 0, Issue ja</a>, -Not available-.
Læs mere Tjek på PubMedKwaku A. Osei Joshua L. Mieher Manisha Patel Jason J. Nichols Champion Deivanayagam 1School of Optometry, Department of Optometry and Vision Science, Birmingham, AL, USA 2School of Medicine, Department of Biochemistry and Molecular Genetics, Birmingham, AL, USA
Infection and Immunity, 18.10.2021
Tilføjet 19.10.2021
Infection and Immunity, <a href="https://journals.asm.org/toc/iai/0/ja">Volume 0, Issue ja</a>, -Not available-.
Læs mere Tjek på PubMedIliano V. Coutinho-Abreu, Jeffrey A. Riffell, Omar S. Akbari
Trends in Parasitology, 18.10.2021
Tilføjet 19.10.2021
Female mosquitoes use chemical and physical cues, including vision, smell, heat, and humidity, to orient toward hosts. Body odors are produced by skin resident bacteria that convert metabolites secreted in sweat into odorants that confer the characteristic body scent. Mosquitoes detect these compounds using olfactory receptors in their antennal olfactory receptor neurons. Such information is further integrated with the senses of temperature and humidity, as well as vision, processed in the brain into a behavioral output, leading to host finding.
Læs mere Tjek på PubMedMarian Loveday, Sindisiwe Hlangu, Lee-Megan Larkan, Helen Cox, Johnny Daniels, Erika Mohr-Holland, Jennifer Furin
PLoS One Infectious Diseases, 18.10.2021
Tilføjet 19.10.2021
by Marian Loveday, Sindisiwe Hlangu, Lee-Megan Larkan, Helen Cox, Johnny Daniels, Erika Mohr-Holland, Jennifer Furin
Background There are few data on the on post-treatment experiences of people who have been successfully treated for rifampicin-resistant (RR-)TB.
Objective To describe the experiences and impact of RR-TB disease and therapy on post-treatment life of individuals who were successfully treated.
Methods In this qualitative study in-depth interviews were conducted among a purposively selected sample from a population of individuals who were successfully treated for RR-TB between January 2008 and December 2018. Interview transcripts and notes were analysed using a thematic network analysis which included grounded theory and a framework for understanding pathophysiological mechanisms for post-TB morbidity and mortality. The analysis was iterative and the coding system developed focused on disease, treatment and post-treatment experiences of individuals. This paper follows the COREQ guidelines.
Results For all 12 participants interviewed, the development of RR-TB disease, its diagnosis and the subsequent treatment were a major disruption to their lives as well as a transformative experience. On diagnosis of RR-TB disease, participants entered a liminal period in which their lives were marked with uncertainty and dominated by physical and mental suffering. Irrespective of how long ago they had completed their treatment, they all remembered with clarity the signs and symptoms of the disease and the arduous treatment journey. Post-treatment participants reported physical, social, psychological and economic changes as consequences of their RR-TB disease and treatment. Many participants reported a diminished ability to perform physical activities and, once discharged from the RR-TB hospital, inadequate physical rehabilitation. For some, these physical limitations impacted on their social life, and ultimately on their psychological health as well as on their ability to earn money and support their families.
Conclusion The experiences and impact of RR-TB disease and therapy on post-treatment life of individuals successfully treated, highlights gaps in the current health care system that need to be addressed to improve the life of individuals post-treatment. A more holistic and long-term view of post-TB health, including the provision of comprehensive medical and social services for post-treatment care of physical ailments, social re-integration and the mitigation of the perceived fear and risk of getting TB again could be a central part of person-centred TB care.
Læs mere Tjek på PubMedSiddiqui, Javeed; Samuel, Shanti K.; Hayward, Brooke; Wirka, Kelly A.; Deering, Kathleen L.; Harshaw, Qing; Phillips, Amy; Harbour, Michael
AIDS, 13.10.2021
Tilføjet 18.10.2021
Objective:
To understand the prevalence of HIV-associated wasting (HIVAW) in the US.
Design:
Medical and pharmacy claims study using IBM® MarketScan® Commercial, Medicare Supplemental and Medicaid Databases.
Methods:
Study period: 7/2012–9/2018 (first HIV diagnosis claim = HIV index date). People living with HIV (PLWH) were excluded if they were aged
Læs mere Tjek på PubMedYan, Helen; Peters, Helen; Thorne, Claire
AIDS, 13.10.2021
Tilføjet 18.10.2021
Objective(s):
To estimate the incidence of neonatal mortality among infants born to women living with HIV in the UK and Ireland in 1998–2017, describe causes of neonatal death (NND) and examine risk factors.
Design:
Population-based surveillance of pregnancies in diagnosed women living with HIV and their infants in the UK and Ireland.
Methods:
Estimated yearly incidence of NND was reported for 1998–2017 and causes coded using the World Health Organization International Classification of Perinatal Mortality. Risk factor analyses used multivariable logistic regression, including delivery year, maternal origin, maternal age, delivery CD4 count and viral load (VL), antiretroviral therapy (ART) at conception, preterm delivery (PTD), injecting drug use and infant sex.
Results:
There were 20,012 live-born infants delivered to 12,684 mothers in 19,601 pregnancies. The overall neonatal mortality rate was 4.10 per 1000 livebirths (95%CI, 3.2–5.0), which was higher than that of the general population. Prematurity was the leading cause of death followed by congenital abnormality. Most NND occurred on the first day of life. ART at conception was associated with significantly reduced NND risk. In a restricted 2007–2017 analysis including VL, PTD and detectable maternal VL were associated with significantly increased NND risk.
Conclusions:
The vertical transmission rate in the UK, at 3 per 1000, is now lower than the neonatal mortality rate among infants born to women with HIV. More research is needed to investigate the complex relationship between ART, preterm delivery and neonatal death in order to improve all perinatal outcomes.
Correspondence to Helen Peters, Population, Practice and Policy Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London; e-mail: Helen.peters@ucl.ac.uk
Received 19 April, 2021
Revised 29 September, 2021
Accepted 5 October, 2021
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://www.AIDSonline.com).
Copyright © 2021 Wolters Kluwer Health, Inc.
Læs mere Tjek på PubMedRonald, Rose; Gartland, Margaret; Li, Zhufang; Zhou, Nannan; Cockett, Mark; Beloor, Jagadish; Lataillade, Max; Ackerman, Peter; Krystal, Mark
AIDS, 13.10.2021
Tilføjet 18.10.2021
Background:
Temsavir (TMR), the active agent of the gp120-directed attachment inhibitor fostemsavir (FTR), the CD4-directed attachment inhibitor ibalizumab (IBA) and the CCR5 antagonist maraviroc (MVC) are ARV agents that target steps in HIV-1 viral entry. Although mechanisms of inhibition of the three agents are different, it is important to understand whether there is potential for cross-resistance between these agents since all involve interactions with gp120.
Methods:
Envelopes derived from plasma samples from participants in the BRIGHTE study who experienced protocol-derived virologic failure (PDVF) and were co-dosed with FTR and either IBA or MVC were analyzed for susceptibility to the agents. Also, CCR5-tropic MVC-resistant envelopes from the MOTIVATE trials were regenerated and studies were performed to understand whether susceptibility to multiple agents were linked.
Results:
The cloned envelopes exhibited reduced susceptibility to TMR and resistance to the co-dosed agent. At PDVF, emergent or pre-existing amino acid substitutions were present at TMR positions of interest. When amino acid substitutions at these positions were reverted to the consensus sequence, full susceptibility to TMR was restored without effecting resistance to the co-dosed agent. In addition, 5 envelopes from MOTIVATE were regenerated and exhibited R5-tropic-MVC-resistance. Only 1 exhibited reduced susceptibility to TMR and it contained an M426L polymorphism. When reverted to 426 M, full sensitivity for TMR was restored, but it remained MVC resistant.
Conclusions:
The data confirm that decreased susceptibility to TMR and resistance to IBA or MVC are not linked and that there is no cross-resistance between either of these two agents and FTR.
Correspondence to Mark Krystal, ViiV Healthcare, 36 East Industrial Road, Branford, CT 06405. Tel: +203 643 6401; e-mail: mark.r.krystal@viivhealthcare.com
Received 11 August, 2021
Revised 21 September, 2021
Accepted 2 October, 2021
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://www.AIDSonline.com).
Copyright © 2021 Wolters Kluwer Health, Inc.
Læs mere Tjek på PubMedOluniyi, Paul E.; Ajogbasile, Fehintola V.; Zhou, Shuntai; Fred-Akintunwa, Iyanuoluwa; Polyak, Christina S.; Ake, Julie A.; Tovanabutra, Sodsai; Iroezindu, Michael; Rolland, Morgane; Happi, Christian T.
AIDS, 13.10.2021
Tilføjet 18.10.2021
Objective:
This study was designed to provide information on the genetic diversity of HIV-1 and drug resistance mutations in Nigeria, as there is limited understanding of variants circulating in the country.
Methods:
We used an advanced next-generation sequencing platform, Primer ID, to: investigate the presence of high and low abundance drug resistance mutations; characterize pre-existing INSTI mutations in ART-experienced but dolutegravir-naive individuals; detect recent HIV-1 infections and characterize subtype diversity from a cohort of people living with HIV-1 (PLWH).
Results:
HIV-1 subtype analysis revealed the predominance of CRF02_AG and subtype G in our study population. At detection sensitivity of 30% abundance, DRMs were identified in 3% of samples. At a sensitivity level of 10%, DRMs were identified in 27.3% of samples. We did not detect any major INSTI mutation associated with dolutegravir-resistance. Only one recent infection was detected in our study population.
Conclusion:
Our study suggests that dolutegravir-containing ARV regimens will be effective in Nigeria. Our study also further emphasizes the high genetic diversity of HIV-1 in Nigeria and that CRF02_AG and subtype G are the dominant circulating forms of HIV-1 in Nigeria. These two circulating forms of the virus are largely driving the epidemic in the country.
Correspondence to Christian T. Happi, PhD, African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Osun State, Nigeria. e-mail: happic@run.edu.ng
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://www.AIDSonline.com).
This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
Copyright © 2021 Wolters Kluwer Health, Inc.
Læs mere Tjek på PubMed