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Abstract

Purpose

Infective endocarditis (IE) is a severe bacterial infection. As a measure of prevention, the administration of antibiotic prophylaxis (AP) prior to dental procedures was recommended in the past. However, between 2007 and 2009, guidelines for IE prophylaxis changed all around the word, limiting or supporting the complete cessation of AP. It remains unclear whether AP is effective or not against IE.

Methods

We conducted a systematic review whether the administration of AP in adults before any dental procedure, compared to the non-administration of such drugs, has an effect on the risk of developing IE. We searched for studies in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via OVID, and EMBASE. Two different authors filtered articles independently and data extraction was performed based on a pre-defined protocol.

Results

The only cohort study meeting our criteria included patients at high-risk of IE. Analysis of the extracted data showed a non-significant decrease in the risk of IE when high-risk patients take AP prior to invasive dental procedures (RR 0.39, p-value 0.11). We did not find other studies including patients at low or moderate risk of IE. Qualitative evaluation of the excluded articles reveals diversity of results and suggests that most of the state-of-the-art articles are underpowered.

Conclusions

Evidence to support or discourage the use of AP prior to dental procedures as a prevention for IE is very low. New high-quality studies are needed, even though such studies would require big settings and might not be immediately feasible.

…

Tropical Medicine &International Health, Accepted Article.

Tropical Medicine &International Health, Accepted Article.

Objective:

To test whether substance use mediates the associations between gender-based violence (GBV) and suboptimal adherence to antiretroviral therapy (ART), and GBV and poor engagement in care, among women living with HIV (WLHIV) in the United States (US).

Design:

We analyzed longitudinal data collected among 1717 WLHIV in the Women's Interagency HIV Study (WIHS).

Methods:

From 2013 to 2017, WLHIV completed semi-annual assessments on GBV, substance use, and HIV treatment and care. Adjusted multilevel logistic regression models were built to estimate the impact of GBV on; suboptimal (…

Background:

Feminizing hormonal therapy (FHT) and HIV potentially alter cardiovascular disease (CVD) risk in transgender women (TW).

Methods:

TW were enrolled in Los Angeles, CA and Houston, TX and frequency-matched to Multicenter AIDS Cohort Study cisgender men (CM) on age, race, substance use and abacavir use. Biomarkers of CVD risk and inflammation were assessed via ELISA. Wilcoxon rank sum and Fisher's exact tests compared TW and CM. Multivariable linear regression assessed factors associated with biomarker concentrations.

Results:

TW (HIV+ n = 75, HIV- n = 47) and CM (HIV+ n = 40, HIV- n = 40) had mean age 43-45 years; TW/CM were 90%/91% non-Hispanic Black, Hispanic, or Multi-racial, 26%/53% obese, and 34%/24% current smokers; 67% of TW were on FHT. Among PLWH, TW had higher median extracellular newly-identified receptor for advanced glycation end-products (EN-RAGE), lipoprotein-associated phospholipase A2 (LpPLA2), oxidized LDL (oxLDL), soluble TNF receptor type (sTNFR) I/II, interleukin (IL)-8 and plasminogen activator inhibitor (PAI)-1, but lower soluble CD14, von Willebrand factor (vWF) and endothelin (ET)-1 levels than CM. Findings were similar for participants without HIV (all p …

Objectives:

Hepatic steatosis is a leading cause of cirrhosis and hepatocellular carcinoma and is highly prevalent in persons with HIV (PWH). However, most studies of hepatic steatosis diagnosis in PWH have focused on those at high risk. We determined the accuracy of vibration-controlled transient elastography (VCTE) with controlled attenuation parameter (CAP) in detecting mild or greater hepatic steatosis as compared with the noninvasive gold standard magnetic resonance spectroscopy (MRS) in PWH.

Methods:

Among 149 participants with and without HIV, we evaluated test characteristics of CAP and calculated serum indices Hepatic Steatosis Index (HSI) and STEATO-ELSA in identifying 3T MRS-measured hepatic steatosis (defined as a liver fat fraction ≥5%).

Results:

Most participants were women and over half were African American. Median BMI was 27 kg/m2. Hepatic steatosis prevalence by MRS and CAP (cutoff 248 dB/m) was 36 and 47%, respectively. CAP had an AUROC of 0.82, and the at least 248 dB/m cutoff yielded a sensitivity, specificity, positive-predictive value, and negative-predictive value of 83, 72, 61, and 88%, respectively. These test characteristics were not statistically different from the optimal cutoff of at least 252 dB/m. Higher waist circumference, greater visceral adipose tissue, heavy alcohol use, and VCTE scans flagged as having the probe positioned too low were associated with CAP and MRS discordance. Serum indices of hepatic steatosis had slightly worse performance characteristics than CAP.

Conclusion:

CAP may be an effective alternative to MRS for noninvasive hepatic steatosis assessment in PWH. The commonly used CAP at least 248 dB/m to diagnose hepatic steatosis can be used in PWH.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Introduction:

Standard-of-care antiretroviral treatment (ART) monitoring in low- and middle-income countries consists of annual determination of HIV-RNA viral load (VL) with confirmatory VL testing in case of viral rebound. We evaluated an intensified monitoring strategy of three-monthly VL testing with additional drug exposure and drug resistance testing in case of viral rebound.

Methods:

We performed an open-label RCT at a rural South African healthcare clinic, enrolling adults already receiving or newly initiating first-line ART. During 96 weeks follow-up, intervention participants received three-monthly VL testing and sequential point-of-care drug exposure testing and DBS-based drug resistance testing in case of rebound >1000 copies/mL. Control participants received standard-of-care monitoring according to WHO-guidelines.

Results:

501 participants were included, of whom 416 (83.0%) were randomised at 24 weeks. 401 participants were available for intention-to-treat analysis. Viral rebound occurred in 9.0% (18/199) of intervention participants in 11.9% (24/202) of controls (p=0.385). Time to detection of rebound was 375 days [IQR: 348–515] in intervention participants and 360 days [IQR: 338–464] in controls (HR: 0.88 [95%confidenceinterval(CI):0.46–1.66]; p = 0.683). Duration of viral rebound was 87 days [IQR: 70–110] in intervention participants and 101 days [IQR: 78–213] in controls (p = 0.423). In the control arm, 3 patients with confirmed failure were switched to second-line ART. In the intervention arm, of 3 patients with confirmed failure, switch could initially be avoided in 2 cases.

Conclusions:

Three-monthly VL testing did not significantly reduce the duration of viraemia when compared to standard-of-care annual VL testing, providing randomised trial evidence in support of annual VL monitoring.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Objective:

To examine type 2 diabetes mellitus incidence and associated risk factors among people with HIV (PWH).

Design:

A retrospective clinical cohort study of PWH at a Southeastern US academic HIV clinic between 2008 and 2018.

Methods:

PWH who attended at least two clinic visits were evaluated with demographic and clinical data extracted from the electronic medical record (EMR). Diabetes was defined as: (1) Hgb A1C ≥ 6.5% and/or 2 glucose results >200 mg/dl (at least 30 days apart), (2) diagnosis of diabetes in the EMR, or (3) exposure to diabetes medication. Time to diabetes incidence was computed from the entire clinic population for each year. Multivariable Cox proportional hazard regression models with time-dependent covariates were created to evaluate the independent association between covariates and time to incident diabetes.

Results:

Among 4113 PWH, we identified 252 incident cases of diabetes. Incidence increased from 1.04 incidents per 1000 PY in 2008, to 1.55 incidents per 1000 PY in 2018. Body mass index (Hazard Ratio [HR] 10.5 (6.2,17.7)), liver disease (HR1.9 (1.2,3.1)), steroid exposure (HR1.5 (1.1,1.9)), and use of Integrase Inhibitors (HR1.5 (1.1,2.0)) were associated with incident diabetes. Additional associated factors included lower CD4 cell counts, duration of HIV infection, exposure to non-statin lipid lowering therapy, and dyslipidemia.

Conclusions:

Rapidly increasing incident diabetes rates among PWH were associated with both traditional and HIV-related associated risk factors, particularly body weight, steroid exposure, and use of Integrase Inhibitors. Notably, several of the risk factors identified are modifiable and can be targeted for intervention.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

In pregnant women antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein cross the placenta and can be detected in cord-blood at the time of delivery. We measured SARS-CoV-2 full-length anti-spike IgG in blood samples collected from women living with HIV (WLWHIV) and without HIV when presenting for labour, and from paired cord-blood samples.

Anti-spike IgG was measured in maternal blood at delivery on the Luminex platform. Cord-blood samples from newborns of women in with detectable anti-spike IgG were analysed. The IgG geometric mean concentrations (GMCs) and the percentage of cord-blood samples with detectable anti-spike IgG were compared between WLWHIV and without HIV.

A total of 184 maternal and cord-blood pairs were analysed, including 47 WLWHIV and 137 without HIV. There was no difference in anti-spike GMCs between WLWHIV and without HIV (157 binding antibody units [BAU]/mL vs 187 BAU/mL; p = 0.17). Cord-blood samples from newborns of WLWHIV had lower GMCs compared with those without HIV (143 BAU/mL vs. 205 BAU/mL; p = 0.033). Cord-to-maternal blood antibody ratio was 1.0 and similar between the two HIV groups. In WLWHIV, those ≤30 years old had lower cord-to-maternal blood antibody ratio (0.75 vs. 1.10; p = 0.037) and their newborns had lower cord-blood GMCs (94 BAU/mL vs 194 BAU/mL; p = 0.04) compared to the older women.

Conclusions:

Independently of maternal HIV infection status there was efficient transplacental transfer of anti-spike antibodies. The GMCs in cord-blood from newborns of WLWHIV were lower than those in HIV-unexposed newborns.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Objective:

Non-governmental organisations (NGOs) in Ukraine have provided HIV testing, treatment, and condom distribution for men who have sex with men (MSM). HIV prevalence among MSM in Ukraine is 5.6%. We estimated the impact and cost-effectiveness of MSM-targeted NGO activities in Ukraine.

Design:

A mathematical model of HIV transmission among MSM was calibrated to data from Ukraine (2011–2018).

Methods:

The model, designed before the 2022 Russian invasion of Ukraine, evaluated the impact of 2018 status quo (SQ) coverage levels of 28% of MSM being NGO clients over 2016–2020 and 2021–2030 compared to no NGO activities over these time periods. Impact was measured in HIV incidence and infections averted. We compared the costs and disability adjusted life years [DALYs] for the SQ and a counterfactual scenario (no NGOs 2016–2020, but with NGOs thereafter) until 2030 to estimate the mean incremental cost-effectiveness ratio (ICER, cost per DALY averted).

Results:

Without NGO activity over 2016–2020, the HIV incidence in 2021 would have been 44% (95%CrI: 36%-59%) higher than with SQ levels of NGO activity, with 25% (21–30%) more incident infections occurring over 2016–2020. Continuing with SQ NGO coverage levels will decrease HIV incidence by 41% over 2021–2030, whereas it will increase by 79% (60–120%) with no NGOs over this period and 37% (30–51%) more HIV infections will occur. Compared to if NGO activities had ceased over 2016–2020 (but continued thereafter), the SQ scenario averts 14,918 DALYs over 2016–2030 with a mean ICER of US$600.15 per DALY averted.

Conclusions:

MSM-targeted NGOs in Ukraine have prevented considerable HIV infections and are highly cost-effective compared with a willingness-to-pay threshold of 50% of Ukraine's 2018 GDP (US$1,548).

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Objective:

Access to viral load measurements is constrained in resource-limited settings. A lateral flow urine tenofovir (TFV) rapid assay (UTRA) for patients whose regimens include TFV offers an affordable approach to frequent adherence monitoring.

Design:

We conducted a cross-sectional study of patients to assess the utility of UTRA to predict virologic failure, defined as a viral load greater than 400 copies/ml.

Methods:

We assessed urine TFV among 113 participants at increased risk of viral failure (who had previous viral failure on this regimen or had previously been ≥30 days out of care), comparing low genetic-barrier efavirenz (EFV) regimens (n = 60) to dolutegravir (DTG)-boosted or ritonavir-boosted protease inhibitor (PI/r)-based high genetic-barrier regimens (n = 53). Dried blood spots (DBS) for TFV-diphosphate and plasma for TFV concentrations were collected, with drug resistance assessed if viral failure present.

Results:

Among 113 participants, 17 of 53 received DTG or PI/r had viral failure at the cross-sectional visit, with 11 (64.7%) demonstrating an undetectable urine TFV; the negative-predictive value (NPV) of undetectable UTRA for viral failure was 85% (34/40); none of the 16 sequenced had dual class drug resistance. In those treated with EFV regimens the sensitivity was lower, as only 1 (4.8%) of 21 with viral failure had an undetectable UTRA (P …

Objective(s)

: Suppression of viral replication in patients on antiretroviral therapy (ART) is determined by plasma viral load (pVL) measurement. Whenever pVL reaches values below the limit of quantification, the qualitative parameter ’target detected’ or ’target not detected’ is available but often not reported to the clinician. We investigated whether qualitative pVL measurements can be used to estimate the viral reservoir size.

Design:

The study recruited 114 people with HIV (PWH) who are stable on ART between 2016 and 2018. The percentage of pVL measurements qualitatively reported as ’target detected’ (PTD) within a 2-year period was calculated.

Methods:

t-DNA and US-RNA were used to estimate viral reservoir size and were quantified on peripheral blood mononuclear cells (PBMCs) using droplet digital PCR.

Results:

A median of 6.5 pVL measurements over a 2-year period was evaluated for each participant to calculate PTD. A positive correlation was found between t-DNA and PTD (r = 0.24; P = 0.011) but not between US-RNA and PTD (r = 0.1; P = 0.3). A significantly lower PTD was observed in PWH with a small viral reservoir, as estimated by t-DNA less than 66 copies/106 PBMCs and US-RNA less than 10 copies/106 PBMCs, compared with PWH with a larger viral reservoir (P = 0.001). We also show that t-DNA is detectable whenever PTD is higher than 56% and that ART regimen does not affect PTD.

Conclusion:

Our study shows that PTD provides an efficient parameter to preselect participants with a small viral reservoir based on already available pVL data for future HIV cure trials.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Background:

We examined change in antiretroviral treatment (ART) adherence after breastfeeding (BF) cessation using hair tenofovir (TFV) concentrations as an objective metric of medication consumption.

Methods:

A subset of postpartum women in Zimbabwe randomized in IMPAACT PROMISE to take ART while BF and post BF cessation had hair TFV measured longitudinally. Using linear mixed effect models, we estimated differences in hair TFV levels following BF cessation, accounting for trends in levels over time regardless of BF status and change in slope following breastfeeding cessation. We also estimated the relative risk of viremia (>50 copies/mL) per doubling of hair TFV concentration.

Results:

Among 55 women (median age 26, IQR 24-29), hair TFV levels (n=305) were available for a median of 9 visits per woman between 3-29 months postpartum. Hair TFV levels ranged from undetected to 0.25 ng/mg (median 0.04 ng/mg). Controlling for trends since delivery (decline of 2.2% per month, 95%CI: -5.3-1.0), TFV levels averaged 24.4% higher (95%CI: -5.1-63.1;) post BF cessation than during BF, with no change in slope (0.0% per month, 95%CI: -3.8-3.9;). Postpartum, 42% of women were ever viremic. Higher TFV levels were strongly protective; relative risk of viremia per doubling of TFV was 0.52 (95%CI: 0.43-0.63; p<0.0001).

Conclusions:

Leveraging an objective metric of ART use, we observed modestly declining adherence across the postpartum period, but no additional decline associated with breastfeeding cessation. High viremia frequency and varying postpartum TFV levels observed highlight the importance of enhanced adherence support with viral load monitoring among postpartum women.

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.

Background:

There is no established cryptococcal antigen (CrAg) screening guideline for people with HIV who are antiretroviral therapy-experienced but have poor virologic control. We assessed factors associated with CrAg screening and describe missed opportunities for earlier testing.

Setting:

Ambulatory clinics affiliated with Montefiore Medical Center, Bronx, N.Y.

Methods:

This was a retrospective chart review of CrAg screening among asymptomatic people with HIV with absolute CD4 count≤200cells/mm3 and HIV viral load (VL) >200copies/ml receiving HIV care from 2015 to 2020. We used Cox proportional hazards regression to identify predictors of screening, including longitudinal CD4 count and HIV VL as time-varying covariables. Among cases of diagnosed cryptococcosis, we assessed for opportunities for earlier diagnosis.

Results:

Screening CrAg was performed in 2.9% of 2,201 individuals meeting inclusion criteria. Compared to those not screened, those who were screened had a shorter duration of HIV infection (0.09 vs. 5.1 years; P=0.001) and lower absolute CD4 counts (12 vs. 24 cells/mm3; p<0.0001). In a multivariable model stratified by median HIV duration, CD410,000 (HR, 15.0; 95% CI, 4.16-54.0) and shorter duration of HIV infection (HR, 0.60; 95% CI, 0.42-0.86) were associated with screening for those with HIV…

Background:

Exclusive breastfeeding is recommended for women living with HIV (WLWH) in low-income - but not in high-income - countries, where milk substitutes are preferred. Some guidelines for high-income countries opted for a shared decision making process regarding breastfeeding in optimal scenarios with adherence to antiretroviral therapy (cART), suppressed maternal viral load (mVL) and clinical monitoring. While vertical transmission (VT) risk under cART is estimated below 1% in low-income settings, data from high-income countries is rare.

Methods:

We retrospectively analyzed all 181 live births from WLWH at the LMU Munich university hospital perinatal center in Germany between 01/2016 and 12/2020. We focused on VT, suppressed mVL and optimal scenario rates, breastfeeding frequency, cART regimens and infant prophylaxis. All women were counseled according to current guidelines, foremost recommending avoidance of breastfeeding.

Results:

In the 5-year cohort, no VT was observed. 151 WLWH (83.4%) decided not to breastfeed, even in optimal scenarios. 30 infants (16.6%) were nursed, out of which 25 were within an optimal scenario, while in 5 cases breastfeeding was performed with a detectable VL in pregnancy or the postpartum period. All WLWH were treated with cART at delivery, and 91.7% sustained suppressed mVL. Zidovudine infant prophylaxis was given between 2 and 8 weeks but not necessarily over the whole breastfeeding duration and was declined from 5 breastfeeding WLWH.

Conclusion:

While the cohort is too small to assess VT risk through breastfeeding with cART-suppressed mVL, breastfeeding might be an alternative even in high-income countries, but further studies are needed.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Nature Medicine, Published online: 15 August 2022; doi:10.1038/s41591-022-01937-6An individualized, heterologous chimpanzee adenovirus (ChAd68) and self-amplifying mRNA-based neoantigen vaccine is safe and well tolerated in patients, warranting further studies to test its potential to rescue response to checkpoint blockade in tumors of low immune reactivity.

Antimicrobial Agents and Chemotherapy, Ahead of Print. …

Antimicrobial Agents and Chemotherapy, Ahead of Print. …

Antimicrobial Agents and Chemotherapy, Ahead of Print. …

Antimicrobial Agents and Chemotherapy, Ahead of Print. …

by Hashem A. KilaniI, Mo’ath F. Bataineh, Ali Al-Nawayseh, Khaled Atiyat, Omar Obeid, Maher M. Abu-Hilal, Taiysir Mansi, Maher Al-Kilani, Mahfoodha Al-Kitani, Majed El-Saleh, Ruba M. Jaber, Ahmad Sweidan, Mawaheb Himsi, Iyad Yousef, Faten Alzeer, Monther Nasrallah, Ayesha S. Al Dhaheri, Abdulsalam Al-Za’abi, Osama Allala, Laila Al-Kilani, Asma M. Alhasan, Mohamed Ghieda, Yasir Najah, Saad Alsheekhly, Ahmad Alhaifi, Raghda Shukri, Jamal Al Adwani, Mostafa Waly, Laila Kilani, Leen H. Kilani, Ahmad S. al Shareef, Areej Kilani…

by Karen Cortés-Sarabia, Armando Cruz-Rangel, Alejandro Flores-Alanis, Marcela Salazar-García, Samuel Jiménez-García, Griselda Rodríguez-Martínez, Juan Pablo Reyes-Grajeda, Rosa Isela Rodríguez-Téllez, Genaro Patiño-López, Israel Parra-Ortega, Oscar Del Moral-Hernández, Berenice Illades-Aguiar, Miguel Klünder-Klünder, Horacio Márquez-González, Adrián Chávez-López, Victor M. Luna-Pineda

Severe acute respiratory syndrome (SARS)-coronavirus (CoV)-2 infection in children and adolescents primarily causes mild or asymptomatic coronavirus disease 2019 (COVID-19), and severe illness is mainly associated with comorbidities. However, the worldwide prevalence of COVID-19 in this population is only 1%–2%. In Mexico, the prevalence of COVID-19 in children has increased to 10%. As serology-based studies are scarce, we analyzed the clinical features and serological response (SARS-CoV-2 structural proteins) of children and adolescents who visited the Hospital Infantil de México Federico Gómez (October 2020–March 2021). The majority were 9-year-old children without comorbidities who were treated as outpatients and had mild-to-moderate illness. Children aged 6–10 years and adolescents aged 11–15 years had the maximum number of symptoms, including those with obesity. Nevertheless, children with comorbidities such as immunosuppression, leukemia, and obesity exhibited the lowest antibody response, whereas those aged 1–5 years with heart disease had the highest levels of antibodies. The SARS-CoV-2 spike receptor-binding domain-localized peptides and M and E proteins had the best antibody response. In conclusion, Mexican children and adolescents with COVID-19 represent a heterogeneous population, and comorbidities play an important role in the antibody response against SARS-CoV-2 infection.

by Zenawi Zeramariam Araia, Fitsum Kibreab, Abiel Abraham Kibrom, Amanuel Hadgu Mebrahtu, Michael Goitom Girmatsion, Yonatan Woldu Teklehiwet, Araia Berhane Mesfin

Background Eritrea has achieved the global target (90%) for tuberculosis (TB) treatment success rate. Though, events of unsuccessful TB treatment outcomes (death, treatment failure, lost to follow up and not evaluated) could lead to further TB transmission and the development of resistant strains. Hence, factors related to these events should be explored and addressed. This study aims to fill the gap in evidence by identifying the determinants of unsuccessful TB treatment outcomes in Eritrea’s Northern Red Sea region. Methods A retrospective cohort study was conducted in Eritrea’s Northern Red Sea region. Data collected using a data extraction tool was analyzed using Stata version 13. Frequencies, proportions, median and standard deviations were used to describe the data. Furthermore, univariable and multivariable logistic regression analysis were performed to determine the risk factors for unsuccessful TB treatment outcomes. Crude odds ratio (COR) and adjusted odds ratio (AOR) with their 95% confidence interval (CI) presented and p-value < 0.05 was considered statistically significant. Results Among 1227 TB patients included in this study, 9.6% had unsuccessful TB treatment outcomes. In multivariable logistic regression analysis, TB cases 55–64 years old (AOR: 2.75[CI: 1.21–6.32], p = 0.016) and those ≥ 65 years old (AOR: 4.02[CI: 1.72–9.45], p = 0.001) had 2.7 and 4 times higher likelihood of unsuccessful TB treatment outcome respectively. In addition, HIV positive TB patients (AOR: 5.13[CI: 1.87–14.06], p = 0.002) were 5 times more likely to have unsuccessful TB treatment outcome. TB treatment in Ghindae Regional Referral Hospital (AOR: 5.01[2.61–9.61], p < 0.001), Massawa Hospital (AOR: 4.35[2.28–8.30], p< 0.001) and Nakfa Hospital (AOR: 2.53[1.15–5.53], p = 0.021) was associated with 5, 4 and 2.5 higher odds of unsuccessful TB treatment outcome respectively. Conclusion In this setting, old age, HIV co-infection and health facility were the independent predictors of unsuccessful TB treatment outcome.…

by Andargew Yohannes Ashamo, Abebaw Bekele, Adane Petrose, Tsegaye Gebreyes, Eyob Kebede Etissa, Amsalu Bekele, Deborah Haisch, Neil W. Schluger, Hanan Yusuf, Tewodros Haile, Negussie Deyessa, Dawit Kebede

Background Various reports suggested that pre-existing medical illnesses, including hypertension and other demographic, clinical, and laboratory factors, could pose an increased risk of disease severity and mortality among COVID-19 patients. This study aimed to assess the relation of hypertension and other factors to the severity of COVID-19 pneumonia in patients discharged from Eka Kotebe Hospital in June-September, 2020. Methods This is a single-center case-control study of 265 adult patients discharged alive or dead, 75 with a course of severe COVID-19 for the cases arm and 190 with the non-severe disease for the control arm. Three age and sex-matched controls were selected randomly for each patient on the case arm. Chi-square, multivariable binary logistic regression, and odds ratio (OR) with a 95% confidence interval was used to assess the association between the various factors and the severity of the disease. A p-value of…

Abstract

Background

Because the clinical patterns and symptoms that persist after a COVID-19 infection are diverse, a diagnosis of post-acute COVID-19 syndrome (PACS) is difficult to implement. The current research project therefore aims to evaluate the feasibility and the practicability of a comprehensive, interdisciplinary, and cross-sectoral treatment program consisting of a low-threshold online screening and holistic assessment for PACS. Furthermore, it aims to evaluate digital interventions and the use of so-called personal guides that may help to facilitate the recovery of PACS.

Methods

This German study consists of a low-threshold online screening for PACS where positively screened participants will be supported throughout by personal pilots. The personal pilots are aimed at empowering patients and helping them to navigate through the study and different treatment options. Patients will then be randomly assigned either to an intervention group (IG) or an active control group (ACG). The IG will receive a comprehensive assessment of physiological and psychological functioning to inform future treatment. The ACG does not receive the assessment but both groups will receive a treatment consisting of an individual digital treatment program (digital intervention platform and an intervention via a chatbot). This digital intervention is based on the needs identified during the assessment for participants in the IG. Compared to that, the ACG will receive a more common digital treatment program aiming to reduce PACS symptoms. Importantly, a third comparison group (CompG) will be recruited that does not receive any treatment. A propensity score matching will take place, ensuring comparability between the participants. Primary endpoints of the study are symptom reduction and return to work. Secondary outcomes comprise, for example, social participation and activities in daily life. Furthermore, the feasibility and applicability of the online screening tool, the holistic assessment, digital trainings, and personal pilots will be evaluated.

Discussion

This is one of the first large-scale studies to improve the diagnosis and the care of patients with PACS by means of empowerment. It is to be evaluated whether the methods utilized can be used for the German and international population.

Trial registration ClinicalTrials.gov Identifier: NCT05238415; date of registration: February 14, 2022

…

Abstract

Background

Malaria rapid diagnostic tests (RDTs) have expanded diagnostic service to remote endemic communities in Ethiopia, where 70% of malaria services per annum are reliant on them. However, diagnostic strategies are threatened by Plasmodium falciparum parasites with deletions of the histidine-rich protein 2 and/or 3 (pfhrp2/3) genes. Studies have reported pfhrp2/3 gene deletion prevalence in Ethiopia that exceeds the WHO recommended threshold to switch to non-HRP2 targeted RDTs for detection of P. falciparum. Therefore, RDTs that target alternative antigens, such as P. falciparum lactate dehydrogenase (PfLDH) are increasingly in programmatic use.

Methods

Malaria suspected patients visiting health facilities of Amhara, Tigray, Gambella, and Oromia regions of Ethiopia were screened by community health workers using Carestart Pf/Pv (HRP2/Pv-LDH) and SD-Bioline Pf (HRP2 for Pf/LDH for Pf) RDTs. Dried blood spot (DBS) samples were collected from selected patients for molecular and serological analysis. The clinical data and RDT results were recorded on standard forms, entered into EpiInfo, and analysed using STATA. The Pf-LDH detecting RDT results were compared with real-time PCR and bead-based immunoassay to determine their diagnostic performance.

Results

The 13,172 (56% male and 44% female, median age of 19 years ranging from 1 to 99 year) study participants were enrolled and tested with PfHRP2 and PfLDH detection RDTs; 20.6% (95% CI: 19.6 to 21.6) were P. falciparum RDT positive. A subset of samples (n = 820) were previously tested using P. falciparum lactate dehydrogenase (pfldh) quantitative real-time PCR, and 456 of these further characterized using bead-based immunoassay. The proportion of samples positive for P. falciparum by the PfHRP2 Carestart and SD-Bioline RDTs were 66% (539/820) and 59% (481/820), respectively; 68% (561/820) were positive for the PfLDH band on the SD-Bioline RDT. The sensitivity and specificity of the PfLDH RDT band were 69% and 38%, respectively, versus pfldh qPCR; and 72% and 36%, respectively, versus PfLDH detection by immunoassay. Among samples with results for RDT, qPCR, and immunoassay, higher proportions of P. falciparum were recorded by pfldh qPCR (90%, 411/456) and PfLDH immunoassay (88%, 363/413) compared to the PfLDH band on the SD-Bioline RDT (74.6%, 340/456).

Conclusion and recommendation

Both PfHRP2 RDTs detected fewer P. falciparum cases than PfLDH, and fewer cases than qPCR or immunoassay. The poor sensitivity and specificity of the PfLDH RDT compared to qPCR and to immunoassay in this study raises concern. Continuous operator training and RDTs quality assurance programme to ensure quality diagnostic services are recommended.

…

American Journal of Respiratory and Critical Care Medicine, Volume 206, Issue 4, Page 368-369, August 15, 2022. …

American Journal of Respiratory and Critical Care Medicine, Volume 206, Issue 4, Page 377-378, August 15, 2022. …

American Journal of Respiratory and Critical Care Medicine, Volume 206, Issue 4, Page 440-448, August 15, 2022. …

American Journal of Respiratory and Critical Care Medicine, Volume 206, Issue 4, Page 503-506, August 15, 2022. …

American Journal of Respiratory and Critical Care Medicine, Volume 206, Issue 4, Page 506-509, August 15, 2022. …

American Journal of Respiratory and Critical Care Medicine, Volume 206, Issue 4, Page 511-514, August 15, 2022. …