Nyt fra tidsskrifterne
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Klik på knappen for at kopiere eller tryk på linket nedenfor.
Kopieret til udklipsholder!
Ingen søgeord valgt.
37 emner vises.
Xufeng Xie Tianbao Lv Dianjun Wu Haozhe Shi Shilei Zhang Xunde Xian George Liu Wenlong Zhang Yongguo Cao aDepartment of Clinical Veterinary Medicine, College of Veterinary Medicine, Jilin University, Changchun, 130062, People’s Republic of China bKeyLaboratory for Zoonosis Research, Ministry of Education, College of Veterinary Medicine, Jilin University, Changchun, People’s Republic of China cInstitute of Cardiovascular Sciences and Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Peking University, Beijing 100191, China.
Infection and Immunity, 13.12.2021
Tilføjet 14.12.2021
Infection and Immunity, <a href='https://journals.asm.org/toc/iai/0/ja'>Volume 0, Issue ja</a>, -Not available-.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.12.2021
Tilføjet 14.12.2021
Abstract
Background
Infection with measles virus (MeV) causes immunosuppression and increased susceptibility to other infectious diseases. Only few studies reported a duration of immunosuppression, with varying results. We investigated the effect of immunosuppression on the incidence of hospital admissions for infectious diseases in Vietnamese children.
Methods
We used retrospective data (2005 to 2015; N = 4419) from the two pediatric hospitals in Ho Chi Minh City, Vietnam. We compared the age-specific incidence of hospital admission for infectious diseases before and after hospitalization for measles. We fitted a Poisson regression model that included gender, current age, and time since measles to obtain a multiplicative effect measure. Estimates were transformed to the additive scale.
Results
We observed two phases in the incidence of hospital admission after measles. The first phase started with a fourfold increased rate of admissions during the first month after measles, dropping to a level quite comparable to children of the same age before measles. In the second phase, lasting until at least 6 years after measles, the admission rate decreased further, with values up to 20 times lower than in children of the same age before measles. However, on the additive scale the effect size in the second phase was much smaller than in the first phase.
Conclusion
The first phase highlights the public health benefits of measles vaccination by preventing measles and immune amnesia. The beneficial second phase is interesting, but its strength strongly depends on the scale. It suggests a complicated interaction between MeV infection and the host immunity.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.12.2021
Tilføjet 14.12.2021
Abstract
Background
While the overall burden of malaria is still high, the global technical strategy for malaria advocates for two sets of interventions: vector control-based prevention and diagnosis and prompt effective treatment of malaria cases. This study aimed to assess the performance of malaria interventions on malaria infection and anaemia in irrigated areas in Sudan.
Methods
Based on the Sudan 2016 national malaria indicator survey, data for two states (Gezira and Sennar), characterized by large-irrigated schemes, were analysed. Four community-level malaria interventions were used as contextual variables: utilization of malaria diagnosis, utilization of Artemisinin-based combination therapy (ACT), utilization of long-lasting insecticidal nets (LLINs) and coverage with indoor residual spraying (IRS). Association between these interventions and two outcomes: malaria infection and anaemia, was assessed separately. Malaria infection was assessed in all age groups while anaemia was assessed in children under 5 years. Multilevel multiple logistic regression analysis were conducted.
Results
Among 4478 individuals involved in this study distributed over 47 clusters, the overall malaria infection rate was 3.0% and 56.5% of the children under 5 years (total = 322) were anaemic. Except for IRS coverage (69.6%), the average utilization of interventions was relatively low: 52.3% for utilization of diagnosis, 33.0% for utilization of ACTs and 18.6% for LLINs utilization. The multi-level multiple logistic regression model showed that only IRS coverage was associated with malaria infection (Odds ratio 0.83 per 10% coverage, 95%Confidence Interval (95%CI) 0.74–0.94, p = 0.003) indicating that a higher level of IRS coverage was associated with less malaria infection. Anaemia was not associated with any intervention (all p values larger than 0.1).
Conclusions
Malaria transmission in Gezira and Sennar areas is low. IRS, with insecticide to which vectors are susceptible, is an effective malaria control intervention in irrigated schemes. Community utilization of other interventions was not associated with malaria infection in this study. This may be due to the low utilization of these interventions. However, individual use of LLINs provide personal protection. This study failed to establish an association between anaemia and malaria control interventions in low transmission areas. The higher level of malaria infection in urban areas is a cause for concern.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.12.2021
Tilføjet 14.12.2021
Abstract
Background
Bacterial infective endocarditis caused by Proteus mirabilis is rare and there are few cases in the literature. The natural history and treatment of this disease is not as clear but presumed to be associated with complicated urinary tract infection (cUTI).
Case presentation
A 65-year-old female with a history of rheumatoid arthritis, factor V Leiden hypercoagulability, and prior saddle pulmonary embolism presented to the emergency department following a mechanical fall. Computed Tomography showed evidence of acute/subacute splenic emboli. Complicated UTI was likely secondary to a ureteral stone. Blood and urine cultures also grew out P. mirabilis. Transthoracic echocardiography revealed a mobile echogenic density on the anterior mitral valve (MV) leaflet consistent with a vegetation. The patient underwent MV replacement, and P. mirabilis was isolated from the surgically removed valve.
Conclusions
We hypothesize that the patient’s immunocompromised status following steroid and Janus Kinase inhibitor usage for rheumatoid arthritis contributed to Gram-negative bacteremia following P. mirabilis UTI, ultimately seeding the native MV. Additional studies with larger numbers of Proteus endocarditis cases are needed to investigate an association between immunosuppression and Proteus species endocarditis.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.12.2021
Tilføjet 14.12.2021
Abstract
Background
Eczema herpeticum (EH) is a severe skin complication caused by human simplex virus (HSV) infection concomitant with immune dysfunction and dermatological conditions, mainly atopic dermatitis. We present the first case of EH subsequent to sepsis-related immunological suppression in pregnancy.
Case presentation
Septic shock developed in a 30-year-old primiparous woman at 14 weeks of pregnancy during admission for hyperemesis gravidarum. Although her life-threatening status due to sepsis improved by prompt treatment, on day 3 of treatment in the intensive care unit, blisters suddenly erupted on her face and neck and spread over her body. EH was diagnosed according to HSV type-1 antigen positivity and a past medical history of EH and atopic dermatitis. Antiviral agents were administered immediately, with positive results. Her general condition improved quickly, without central nervous system defects. This is the first report of EH following septic shock in early pregnancy. At present, we speculate that EH develops as a complication due to immunological changes in the late phase of sepsis because sepsis is mainly characterized by both an inflammatory state in the acute phase and an immunosuppressive state in the late phase. Pregnancy can also contribute to its pathogenesis, as it causes an immunosuppressive state. Mortality due to EH is relatively high; in this case, a history of EH and atopic dermatitis contributed to the initiation of prompt medical interventions for the former, with improvement in the patient’s severe condition. The combination of immunological changes in sepsis and pregnancy can cause HSV reactivation, resulting in EH recurrence.
Conclusions
In conclusion, if dermatological symptoms develop in a pregnant woman with a history of EH and/or atopic dermatitis treated for sepsis, EH should be suspected based not only on clinical features but also on immunological changes along with sepsis, and prompt medical interventions should be initiated.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.12.2021
Tilføjet 14.12.2021
Abstract
Background
Cross-border malaria in Laiza City of Myanmar seriously affected Yingjiang County of China and compromised reaching the goal of malaria elimination by 2020. Since 2017, a pilot project on 3 + 1 strategy of joint cross-border malaria prevention and control was carried out for building a malaria buffer in these border areas. Here, 3 were the three preventive lines in China where different focalized approaches of malaria elimination were applied and + 1 was a defined border area in Myanmar where the integrated measures of malaria control were adopted.
Methods
A 5-year retrospective analysis (2015 to 2019) was conducted that included case detection, parasite prevalence and vector surveillance. Descriptive statistics was used and the incidence or rates were compared. The annual parasite incidence and the parasite prevalence rate in + 1 area of Myanmar, the annual importation rate in Yingjiang County of China and the density of An. minimus were statistically significant indictors to assess the effectiveness of the 3 + 1 strategy.
Results
In + 1 area of Myanmar from 2015 to 2019, the averaged annual parasite incidence was (59.11 ± 40.73)/1000 and Plasmodium vivax accounted for 96.27% of the total confirmed cases. After the pilot project, the annual parasite incidence dropped 89% from 104.77/1000 in 2016 to 12.18/1000 in 2019, the microscopic parasite prevalence rate dropped 100% from 0.34% in 2017 to zero in 2019 and the averaged density of An. Minimus per trap-night dropped 93% from 1.92 in June to 0.13 in September. The submicroscopic parasite prevalence rate increased from 1.15% in 2017 to 1.66% in 2019 without significant difference between the two surveys (P = 0.084). In Yingjiang County of China, neither indigenous nor introduced case was reported and 100% cases were imported from Myanmar since 2017. The averaged annual importation rate from 2015 to 2019 was (0.47 ± 0.15)/1000. After the pilot project, the annual importation rate dropped from 0.59/1000 in 2016 to 0.28/1000 in 2019 with an overall reduction of 53% in the whole county. The reduction was 67% (57.63/1000 to 18.01/1000) in the first preventive line, 52% (0.20/1000 to 0.10/1000) in the second preventive line and 36% (0.32/1000 to 0.22/1000) in the third preventive line. The averaged density of An. Minimus per trap-night in the first preventive line dropped 94% from 2.55 in June to 0.14 in September, without significant difference from that of + 1 area of Myanmar (Z value = − 1.18, P value = 0.24).
Conclusion
The pilot project on 3 + 1 strategy has been significantly effective in the study areas and a buffer zone of border malaria was successfully established between Laiza City of Myanmar and Yingjiang County of China.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.12.2021
Tilføjet 14.12.2021
Abstract
Background
Primary amoebic meningoencephalitis (PAM) is a rare, acute and fatal disease of the central nervous system caused by infection with Naegleria fowleri (Heggie, in Travel Med Infect Dis 8:201–6, 2010). Presently, the majority of reported cases in the literature have been diagnosed through pathogen detection pathogens in the cerebrospinal fluid (CSF). This report highlights the first case of pediatric PAM diagnosed with amoeba infiltration within CSF and bloodstream of an 8-year-old male child, validated through meta-genomic next-generation sequencing (mNGS).
Case presentation
An 8-year-old male child was admitted to hospital following 24 h of fever, headache and vomiting and rapidly entered into a coma. CSF examination was consistent with typical bacterial meningitis. However, since targeted treatment for this condition proved to be futile, the patient rapidly progressed to brain death. Finally, the patient was referred to our hospital where he was confirmed with brain death. CSF and blood samples were consequently analyzed through mNGS. N. fowleri was detected in both samples, although the sequence copy number in the blood was lower than for CSF. The pathogen diagnosis was further verified by PCR and Sanger sequencing.
Conclusions
This is the first reported case of pediatric PAM found in mainland China. The results indicate that N. fowleri may spread outside the central nervous system through a damaged blood–brain barrier.
Læs mere Tjek på PubMedBMC Infectious Diseases, 13.12.2021
Tilføjet 14.12.2021
Abstract
Background
Patients with primary brain abscess often present with atypical symptoms, and the outcome varies. We investigated the demographic, laboratory, and neuroimaging features of patients with brain abscess at our hospital and identified factors associated with their outcomes.
Methods
We retrospectively collected the data of patients diagnosed with primary brain abscess at our hospital between January 2011 and December 2020. Their clinical characteristics, predisposing factors, laboratory and neuroimaging findings, treatment, and outcome were analyzed.
Results
Of the 57 patients diagnosed with primary abscess, 51 (89.47%) were older than 40 years, and 42 (73.68%) were male. Only eight patients (14.04%) showed the classical triad of headache, fever, and focal neurological deficit. Fifteen patients (26.31%) had comorbidities, of which diabetes mellitus was the most common. Positive intracranial purulent material cultures were obtained in 46.15% of the patients, and gram-negative enteric bacteria were found in 33.33% of them, with Klebsiella pneumoniae being the most frequently observed. Surgical treatment, most commonly in the form of stereotactic drainage, was received by 54.39% of the patients. Good outcomes were achieved in 75.44% of the patients. Multivariate logistic regression analysis showed that patients with headaches were more likely to have a poor outcome (odds ratio 6.010, 95% confidence interval 1.114–32.407, p = 0.037).
Conclusions
Male patients and those older than 40 years were more susceptible to brain abscess than female patients and those younger than 40 years, respectively. Only a few patients showed the classical triad of clinical symptoms. Diabetes mellitus was the most common comorbidity. Positive intracranial specimens’ culture results were uncommon, with gram-negative enteric bacteria, especially Klebsiella pneumoniae, being the main organisms found. Most patients had a good outcome, and the presence of headache may influence the outcome.
Læs mere Tjek på PubMedLinthwaite, Blake; Kronfli, Nadine; Marbaniang, Ivan; Ruppenthal, Luciana; Lessard, David; Engler, Kim; Lebouché, Bertrand; Cox, Joseph; and the CVIS clinical team
AIDS, 10.12.2021
Tilføjet 14.12.2021
Background:
Negative health outcomes associated with being out of HIV care (OOC) warrant reengagement strategies. We aimed to assess effectiveness of Lost & Found (L&F), a clinic-based intervention to identify and reengage OOC patients.
Methods:
Developed and delivered using implementation science, L&F consists of two core elements: i) identification, operationalized through nurse validation of a real-time list of possible OOC patients; and ii) contact, via nurse-led phone calls. It was delivered over a 12-month period (2018–2019) at the Chronic Viral Illness Service, McGill University Health Centre (CVIS-MUHC) during a type-II implementation-effectiveness hybrid pilot study. Descriptive outcomes of interest were identification as possibly OOC, OOC confirmation, contact, and successful reengagement. We present results from a pre-post analysis comparing overall reengagement to the year prior, using robust Poisson regression controlled for sex, age, and Canadian birth. Time to reengagement is reported using a Cox proportional hazards model.
Results:
Over half (56%; 1312/2354) of CVIS-MUHC patients were identified as possibly OOC. Among these, 44% (n = 578) were followed elsewhere, 19% (n = 249) engaged in care, 3% (n = 33) deceased, 2% (n = 29) otherwise not followed, and 32% (n = 423) OOC. Of OOC patients contacted (85%; 359/423), 250 (70%) reengaged and 40 (11%) had upcoming appointments; the remainder were unreachable, declined care, or missed given appointments. Pre-post results indicate people who received L&F were 1.18 (95%CI: 1.02–1.36) times more likely to reengage, and reengaged a median 55 days (95%CI: 14–98) sooner.
Conclusion:
L&F may be a viable clinic-based reengagement intervention for OOC patients. More robust evaluations are needed.
Correspondence to Joseph Cox, MD, MSc, McGill University, Montreal, Quebec Canada. Tel: +514 934 1934; fax: +514 843 2092; e-mail: joseph.cox@mcgill.ca
Received 2 January, 2021
Revised 30 November, 2021
Accepted 5 December, 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 PubMedBeer, Linda; Tie, Yunfeng; Dasgupta, Sharoda; McManus, Tim; Chowdhury, Pranesh P.; Weiser, John; for the Medical Monitoring Project
AIDS, 10.12.2021
Tilføjet 14.12.2021
Objective:
To evaluate whether reported prevalence of unemployment, subsistence needs, and symptoms of depression and anxiety among adults with diagnosed HIV during the COVID-19 pandemic were higher than expected.
Design:
The Medical Monitoring Project (MMP) is a complex sample survey of adults with diagnosed HIV in the United States.
Methods:
We analyzed 2015–2019 MMP data using linear regression models to calculate expected prevalence, along with corresponding prediction intervals (PI), for unemployment, subsistence needs, depression, and anxiety for June–November 2020. We then assessed whether observed estimates fell within the expected prediction interval for each characteristic, overall and among specific groups.
Results:
Overall, the observed estimate for unemployment was higher than expected (17% vs 12%) and exceeded the upper limit of the PI. Those living in households with incomes > = 400% of FPL were the only group where the observed prevalence of depression and anxiety during the COVID-19 period was higher than the PIs; in this group, the prevalence of depression was 9% compared with a predicted value of 5% (75% higher) and the prevalence of anxiety was 11% compared with a predicted value 5% (137% higher). We did not see elevated levels of subsistence needs, although needs were higher among Black and Hispanic compared with White persons.
Conclusions:
Efforts to deliver enhanced employment assistance to persons with HIV and provide screening and access to mental health services among higher income persons may be needed to mitigate the negative effects of the US COVID-19 pandemic.
Correspondence to Linda Beer, PhD, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS-E46, Atlanta, GA 30329. Tel: +404 639 5268; fax: +404 639 8640; e-mail: LBeer@cdc.gov
Received 16 September, 2021
Revised 10 November, 2021
Accepted 22 November, 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 PubMedGirometti, Nicolò; McCormack, Sheena; Tittle, Victoria; McOwan, Alan; Whitlock, Gary; on behalf of the 56 Dean Street Collaborative Group
AIDS, 10.12.2021
Tilføjet 14.12.2021
Introduction:
Pre-exposure prophylaxis (PrEP) is contributing to achieve a reduction in HIV diagnoses in men having sex with men (MSM). Albeit infrequent, HIV infections in the context of recent PrEP exposure represent a clinical challenge.
Methods:
Data on recent PrEP use and possible reasons leading to HIV infection were analysed in individuals newly diagnosed with HIV at 56 Dean Street clinic in 2016–2020. Demographics, immune-virological parameters, genotypic resistance test results and treatment management in this group were compared with those not reporting recent PrEP exposure using Mann-Whitney U test and Fisher's exact test.
Results:
52/1030 (5%) individuals reported recent PrEP exposure at HIV diagnosis; 98% were MSM, median age 34 years (IQR 28–42), 65% of white ethnicity, 65% non-UK-born. 35% reported PrEP intake the day before testing HIV positive, 46% reported sub-optimal PrEP adherence since their last negative HIV test result. 33/52 (63%) were self-sourcing PrEP and 9/52 (17%) reported issues with its supply. Recent PrEP use was associated to lower HIV viral load and higher CD4+cell-count at baseline than in counterparts non-recently exposed to PrEP (p
Læs mere Tjek på PubMedSchneider, John A.; Hayford, Christina; Hotton, Anna; Tabidze, Irina; Wertheim, Joel O.; Ramani, Santhoshini; Hallmark, Camden; Morgan, Ethan; Janulis, Patrick; Khanna, Aditya; Ozik, Jonathan; Fujimoto, Kayo; Flores, Rey; D’aquila, Rich; Benbow, Nanette
AIDS, 10.12.2021
Tilføjet 14.12.2021
Objectives:
We examined whether molecular cluster membership was associated with public health identification of HIV transmission potential among named partners in Chicago.
Design:
Historical cohort study
Methods:
We matched and analyzed HIV surveillance and partner services data from HIV diagnoses (2012–2016) prior to implementation of cluster detection and response interventions. We constructed molecular clusters using HIV-TRACE at a pairwise genetic distance threshold of 0·5% and identified clusters exhibiting recent and rapid growth according to the CDC's definition (3 new cases diagnosed in past year). Factors associated with identification of partners with HIV transmission potential were examined using multivariable Poisson regression.
Results:
There were 5,208 newly diagnosed index clients over this time period. Average age of index clients in clusters was 28; 47% were Black, 29% Latinx/Hispanic, 6% female and 89% men who have sex with men (MSM). Of the 537 named partners, 191 (35·6%) were linked to index cases in a cluster and of those 16% were either new diagnoses or viremic. There was no statistically significant difference in the probability of identifying partners with HIV transmission potential among index clients in a rapidly growing cluster versus those not in a cluster (adjusted Relative Risk 1·82, (0·81–4·06)).
Conclusion:
Partner services that were initiated from index clients in a molecular cluster yielded similar new HIV case finding or identification of those with viremia as did interviews with index clients not in clusters. It remains unclear whether these findings are due to temporal disconnects between diagnoses and cluster identification, unobserved cluster members, or challenges with partner services implementation.
Correspondence to John A. Schneider, MD, MPH, Section of Infectious Diseases and Global Health, Departments of Medicine and Public Health Sciences, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL 60637, USA. Tel: +773 702 8349; fax: +773 702 8998; e-mail: jschnei1@medicine.bsd.uchicago.edu
Received 10 August, 2021
Revised 1 November, 2021
Accepted 8 November, 2021
Copyright © 2021 Wolters Kluwer Health, Inc.
Læs mere Tjek på PubMedCaro-Vegas, Carolina; Ramirez, Catalina; Landis, Justin; Adimora, Adaora A.; Strickler, Howard; French, Audrey L.; Ofotokun, Igho; Fischl, Margaret; Seaberg, Eric C.; Wang, Chia-ching J.; Spence, Amanda B.; Dittmer, Dirk P.
AIDS, 10.12.2021
Tilføjet 14.12.2021
Objective:
This study compared the mutation profile and tumor mutational burden (TMB) in women living with HIV (WLWH) diagnosed with lung adenocarcinoma (n = 8) or breast ductal neoplasm (n = 13) that were enrolled into the Women's Interagency and HIV Study (WIHS).
Design:
Previous studies tend to focus on single-institutions based on sample availability, while this study is based on a representative, multi-center cohort that represents the racial and ethnic composition of women with HIV in the United States
Methods:
The study sequenced the complete human exome of n = 26 cancer samples from HIV+ women, using Ion torrent next generation sequencing. The study cohort was compared to a HIV- cohort obtained from the Genomic Data Commons Data Portal of the NCI.
HIV+ and HIV- cohorts were compared using ion torrent next-generation sequencing.
Results:
There were no differences in known cancer mutations between breast cancer and lung cancer that developed in WLWH and those that developed in HIV seronegative (HIV-) women; however, WLWH presented a significantly higher tumor mutational burden (TMB) in comparison to HIV- patients. 75% of lung cancers and 61% of breast cancers were defined as TMB-high (more than 10 mutation/mb of DNA).
Conclusions:
This study affirms the recommendation that WLWH be included in clinical trials of novel treatments for these cancers. While these data are preliminary, the high TMB in WLHV suggests, paradoxically, that this immune challenged population may benefit greatly from immune checkpoint inhibitor therapies.
Correspondence to Dirk P. Dittmer, PhD, 450 West Drive, CB 7295, Chapel Hill, NC 27599, USA. Tel.: (919) 966-7962; fax: +(919) 962-8103; e-mail: dirk_dittmer@med.unc.edu.
Received 30 September, 2021
Revised 8 November, 2021
Accepted 22 November, 2021
Copyright © 2021 Wolters Kluwer Health, Inc.
Læs mere Tjek på PubMedDalla-Pozza, Paul; Hentzien, Maxime; Allavena, Clotilde; Maindreville, Anne DOE de; Bouiller, Kévin; Valantin, Marc-Antoine; Lafont, Emmanuel; Zaegel-Faucher, Olivia; Cheret, Antoine; Martinblondel, Guillaume; Cotte, Laurent; Bani-Sadr, Firouzé; the Dat’AIDS study group
AIDS, 10.12.2021
Tilføjet 14.12.2021
Progressive multifocal leukoencephalopathy (PML) has rarely been reported in people living with HIV (PLHIV) with long-term HIV immune-virological control.
We describe the clinical and biological characteristics of patients with confirmed PML among PLHIV with a CD4 cell count >200/mm3 and an undetectable HIV RNA viral load after at least 6 months of combined antiretroviral therapy (cART) at the time of PML diagnosis, in the large French multicenter Dat’AIDS cohort.
Among 571 diagnoses of PML reported in the Dat’AIDS cohort between 2000 and 2019, 10 cases (1.75%) occurred in PLHIV with a CD4 cell count >200/mm3 and an undetectable HIV RNA viral load after at least 6 months of cART. Median CD4 cell count at PML diagnosis was 395/mm3 [IQR 310; 477]. The median duration between the last detectable HIV viral load and the PML diagnosis was 41.1 months [IQR 8.2; 67.4]. Only one patient treated with rituximab-based chemotherapy for a large B-cell lymphoma had an established risk factor for PML. Among the 9 others patients with no apparent severe immunodeficiency, multiple factors of impaired immunity could have led to the development of PML: HCV co-infection (n = 6), cirrhosis (n = 4), HHV-8 co-infection (n = 3) with Kaposi's sarcoma (n = 2) in association with Castleman's disease (n = 1) and indolent IgA multiple myeloma (n = 1).
This study highlights that factors other than low CD4 cell count and high HIV viral load may be associated with the occurrence of PML. Further studies are warranted to investigate in greater detail the immunologic characteristics of PLHIV with immune-virological control who develop PML.
Correspondence to Prof. Firouzé Bani-Sadr, Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, CHU Robert Debré, Avenue du Général Koenig, 51092 Reims, France. Tel: +(33) 3 26 78 71 89; fax: +(+33) 3 26 78 40 90; e-mail: fbanisadr@chu-reims.fr.
Received 3 September, 2021
Revised 12 November, 2021
Accepted 30 November, 2021
Copyright © 2021 Wolters Kluwer Health, Inc.
Læs mere Tjek på PubMedMontebatsi, Milton; Lavoie, Marie-Claude C.; Blanco, Natalia; Marima, Reson; Sebina, Kagiso; Mangope, Justin; Ntwayagae, Ookeditse; Whittington, Anna; Letebele, Mpho; Lekone, Phenyo; Hess, Kristen L.; Thomas, Vasavi; Ramaabya, Dinah; Ramotsababa, Mareko; Stafford, Kristen A.; Ndwapi, Ndwapi
AIDS, 10.12.2021
Tilføjet 14.12.2021
Background:
In 2019, the Botswana Ministry of Health and Wellness (MOHW) implemented an HIV national Reboot program, which was needed for refocusing and intensifying efforts for achieving epidemic control. The strategies deployed as part of Reboot were reviewed and evaluated for their effect on same-day and within-seven-days (fast-track initiation) antiretroviral therapy (ART) initiation among adults newly identified with HIV.
Methods:
We conducted a retrospective cohort analysis of patients aged 18 years or older who were newly diagnosed with HIV from October 2018 to September 2019 across 41 health facilities. We used generalized linear mixed models, adjusting for clustering by facility, to assess the association of the Reboot with same-day or within-seven-days ART initiation (fast-track initiation).
Results:
From October 2018 to January 2019, 28% (636/2,269) of newly diagnosed HIV patients were initiated the same day of diagnosis, and 56% (1,260/2,269) were initiated within seven days. Following the launch of Reboot (February to September 2019), 59% (2,092/3,553) were initiated the same day of diagnosis, and 77% (2,752/3,553) were initiated within seven days. Clients were 2.08 (aRR 95% CI 1.79–2.43) times more likely to be initiated the same day of diagnosis and 1.39 (aRR 95% CI 1.28–1.52) times more likely to be initiated within seven days than before Reboot after adjusting for sex and age.
Conclusion:
In Botswana, a multifaceted national intervention improved timely ART initiation. Identifying and implementing different client-centered strategies to facilitate ART initiation is critical to preventing AIDS-related complications and prevent ongoing transmission.
Correspondence to Milton Montebatsi, Project Director, BPACE, Botswana–University of Maryland School of Medicine Health Initiative (Bummhi) I Plot 70667, Fairscape Precinct, Unit 1B, 3rd Floor, Fairgrounds, Gaborone. e-mail: mmontebatsi@bummhi.org
Received 7 July, 2021
Revised 30 September, 2021
Accepted 15 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 PubMedNikanjam, Mina; Tran, Lana; Chadwick, Ellen G.; Bwakura-Dangarembizi, Mutsa; Moore, Carolyn Bolton; Samson, Pearl; Spector, Stephen A.; Chakhtoura, Nahida; Jean-Philippe, Patrick; Frenkel, Lisa; Zimmer, Bonnie; Benns, Alex; Libous, Jennifer; Capparelli, Edmund V.
AIDS, 10.12.2021
Tilføjet 14.12.2021
Objective:
Dosing efavirenz (EFV) in children less than 3 years of age is challenging due to large variability in drug levels. This study evaluated differences in pharmacokinetics (PK) with TB therapy, formulation, age, and CYP2B6 genotype.
Design:
PK data from three IMPAACT/PACTG studies (P382, P1021, P1070) for children initiating therapy less than 40 months of age were evaluated.
Methods:
PK data were combined in a population PK model. Exposure from the 2-week PK visit was compared to changes in viral RNA between the Week 0 and Week 4 visits.
Results:
The model included 103 participants (19 on TB therapy). CYP2B6 516 genotype information was available for 82 participants (TT: 15, GT: 28, GG: 39). Median age at the first PK visit was 17.0 months (range: 2.0 to 39.0 months). Liquid formulation led to a 42% decrease in bioavailability compared to opened capsules. TB therapy (isoniazid [INH] and rifampin) led to a 29% decreased clearance, however Monte Carlo simulations demonstrated the majority of participants on TB therapy receiving standard EFV dosing to be in the target AUC range. Clearance was 5.3-fold higher for GG than TT genotype and 3.3-fold higher for GT than TT genotype. Age did not have a significant effect on CL in the final model. Initial viral RNA decay was lower for patients in the lowest quartile of exposures (AUCs) than for higher quartiles (p = 0.013).
Conclusion:
EFV dosing should account for CYP2B6 516 genotype and formulation, but does not require adjustment for concurrent TB therapy.
Correspondence to Edmund V. Capparelli, PharmD, 9500 Gilman Drive MC 0657, UC San Diego, La Jolla, CA 92093-0657. Tel: +858 246 2750; fax: +858 534 5611; e-mail: ecapparelli@ucsd.edu
Received 3 July, 2021
Revised 2 November, 2021
Accepted 9 November, 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 PubMedRawlings, Stephen A.; Torres, Felix; Wells, Alan; Lisco, Andrea; Fitzgerald, Wendy; Margolis, Leonid; Gianella, Sara; Vanpouille, Christophe
AIDS, 10.12.2021
Tilføjet 14.12.2021
Objective:
HIV infection disrupts the cytokine network and this disruption is not completely reversed by antiretroviral therapy (ART). Characterization of cytokine changes in blood and genital secretions is important for understanding HIV pathogenesis and the mechanisms of HIV sexual transmission. Here, we characterized the cytokine network in individuals longitudinally sampled before they began ART and after achieving suppression of HIV RNA.
Methods:
We measured concentrations of 34 cytokine/chemokines using multiplex bead-based assay in blood and seminal plasma of 19 men with HIV-1 prior to and after viral suppression. We used Partial Least Squares Discriminant Analysis (PLS-DA) to visualize the difference in cytokine pattern between the time points. Any cytokines with VIP scores exceeding 1 were deemed important in predicting suppression status and were subsequently tested using Wilcoxon Signed Rank Tests.
Results:
PLS-DA projections in blood were fairly similar before and after viral suppression. In contrast, the difference in PLS-DA projection observed in semen emphasizes that the immunological landscape and immunological needs are very different before and after ART in the male genital compartment. When tested individually, four cytokines were significantly different across time points in semen (MIG, IL-15, IL-7, I-TAC), and two in blood (MIG and IP-10).
Conclusions:
Viral suppression with ART impacts the inflammatory milieu in seminal plasma. In contrast, the overall effect on the network of cytokines in blood was modest, but consistent with prior analyses. These results identify specific changes in the cytokine networks in semen and blood as the immune system acclimates to chronic, suppressed HIV infection.
Correspondence to Christophe Vanpouille, PhD, Eunice Kennedy Shriver National Institute of Child Health and Human Development: National Institute of Child Health and Human Development, Bethesda, Maryland United States. Tel.: +301 594 0826; e-mail: Vanpouic@mail.nih.gov.
Received 23 July, 2021
Revised 12 November, 2021
Accepted 30 November, 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 PubMedCheng Wang
Frontiers in Immunology, 26.10.2022
Tilføjet 14.12.2021
Macrophages are important immune cells in innate immunity, and have remarkable heterogeneity and polarization. Under pathological conditions, in addition to the resident macrophages, other macrophages are also recruited to the diseased tissues, and polarize to various phenotypes (mainly M1 and M2) under the stimulation of various factors in the microenvironment, thus playing different roles and functions. Liver diseases are hepatic pathological changes caused by a variety of pathogenic factors (viruses, alcohol, drugs, etc.), including acute liver injury, viral hepatitis, alcoholic liver disease, metabolic-associated fatty liver disease, liver fibrosis, and hepatocellular carcinoma. Recent studies have shown that macrophage polarization plays an important role in the initiation and development of liver diseases. However, because both macrophage polarization and the pathogenesis of liver diseases are complex, the role and mechanism of macrophage polarization in liver diseases need to be further clarified. Therefore, the origin of hepatic macrophages, and the phenotypes and mechanisms of macrophage polarization are reviewed first in this paper. It is found that macrophage polarization involves several molecular mechanisms, mainly including TLR4/NF-κB, JAK/STATs, TGF-β/Smads, PPARγ, Notch, and miRNA signaling pathways. In addition, this paper also expounds the role and mechanism of macrophage polarization in various liver diseases, which aims to provide references for further research of macrophage polarization in liver diseases, contributing to the therapeutic strategy of ameliorating liver diseases by modulating macrophage polarization.
Læs mere Tjek på PubMedJohn Turnidge, Iain J. Abbott
Clinical Microbiology and Infection, 13.12.2021
Tilføjet 14.12.2021
After three years of internal discussion and external international consultation [1], EUCAST introduced revised definitions of susceptibility test categories [2]. Its primary aim was to eliminate the ambiguity associated with the old “intermediate (I)” category, which could variously mean one of four things: uncertain therapeutic effect, susceptible if higher dosages are used, susceptible if the agent is concentrated at the site of infection, a buffer zone to reduce mis-categorisation due to technical factors (natural assay variation).
Læs mere Tjek på PubMedChengzuo Xie, Haojie Ding, Jianzu Ding, Yangji Xue, Shaohong Lu, Hangjun Lv
Journal of Medical Virology, 14.12.2021
Tilføjet 14.12.2021
Kenneth Iregbu, Angela Dramowski, Rebecca Milton, Emmanuel Nsutebu, Stephen R C Howie, Mallinath Chakraborty, Pascal M Lavoie, Ceire E Costelloe, Peter Ghazal
Lancet Infectious Diseases, 14.12.2021
Tilføjet 14.12.2021
Neonates and children in low-income and middle-income countries (LMICs) contribute to the highest number of sepsis-associated deaths globally. Interventions to prevent sepsis mortality are hampered by a lack of comprehensive epidemiological data and pathophysiological understanding of biological pathways. In this review, we discuss the challenges faced by LMICs in diagnosing sepsis in these age groups. We highlight a role for multi-omics and health care data to improve diagnostic accuracy of clinical algorithms, arguing that health-care systems urgently need precision medicine to avoid the pitfalls of missed diagnoses, misdiagnoses, and overdiagnoses, and associated antimicrobial resistance.
Læs mere Tjek på PubMedKaren H Keddy, Senjuti Saha, Samuel Kariuki, John Bosco Kalule, Farah Naz Qamar, Zoya Haq, Iruka N Okeke
Lancet Infectious Diseases, 14.12.2021
Tilføjet 14.12.2021
Diarrhoea is an important cause of morbidity and mortality in children from low-income and middle-income countries (LMICs), despite advances in the management of this condition. Understanding of the causes of diarrhoea in children in LMICs has advanced owing to large multinational studies and big data analytics computing the disease burden, identifying the important variables that have contributed to reducing this burden. The advent of the mobile phone has further enabled the management of childhood diarrhoea by providing both clinical support to health-care workers (such as diagnosis and management) and communicating preventive measures to carers (such as breastfeeding and vaccination reminders) in some settings.
Læs mere Tjek på PubMedMalaria Journal, 13.12.2021
Tilføjet 14.12.2021
Abstract
Background
Molecular diagnostic tools have been incorporated in insecticide resistance monitoring programmes to identify underlying genetic basis of resistance and develop early warning systems of vector control failure. Identifying genetic markers of insecticide resistance is crucial in enhancing the ability to mitigate potential effects of resistance. The knockdown resistance (kdr) mutation associated with resistance to DDT and pyrethroids, the acetylcholinesterase-1 (ace-1R) mutation associated with resistance to organophosphates and carbamates and 2La chromosomal inversion associated with indoor resting behaviour, were investigated in the present study.
Methods
Anopheles mosquitoes sampled from different sites in Kenya and collected within the context of malaria vector surveillance were analysed. Mosquitoes were collected indoors using light traps, pyrethrum spray and hand catches between August 2016 and November 2017. Mosquitoes were identified using morphological keys and Anopheles gambiae sensu lato (s.l.) mosquitoes further identified into sibling species by the polymerase chain reaction method following DNA extraction by alcohol precipitation. Anopheles gambiae and Anopheles arabiensis were analysed for the presence of the kdr and ace-1R mutations, while 2La inversion was only screened for in An. gambiae where it is polymorphic. Chi-square statistics were used to determine correlation between the 2La inversion karyotype and kdr-east mutation.
Results
The kdr-east mutation occurred at frequencies ranging from 0.5 to 65.6% between sites. The kdr-west mutation was only found in Migori at a total frequency of 5.3% (n = 124). No kdr mutants were detected in Tana River. The ace-1R mutation was absent in all populations. The 2La chromosomal inversion screened in An. gambiae occurred at frequencies of 87% (n = 30), 80% (n = 10) and 52% (n = 50) in Baringo, Tana River and Migori, respectively. A significant association between the 2La chromosomal inversion and the kdr-east mutation was found.
Conclusion
The significant association between the 2La inversion karyotype and kdr-east mutation suggests that pyrethroid resistant An. gambiae continue to rest indoors regardless of the presence of treated bed nets and residual sprays, a persistence further substantiated by studies documenting continued mosquito abundance indoors. Behavioural resistance by which Anopheles vectors prefer not to rest indoors may, therefore, not be a factor of concern in this study’s malaria vector populations.
Læs mere Tjek på PubMedInfection, 13.12.2021
Tilføjet 13.12.2021
Abstract
Purpose
The Coronavirus disease 2019 (COVID-19) pandemic is one of the most devastating global problems. Regarding the lack of disease-specific treatments, repurposing drug therapy is currently considered a promising therapeutic approach in pandemic situations. Recently, the combination therapy of Janus kinase (JAK) inhibitor baricitinib has been authorized for emergency COVID-19 hospitalized patients; however, this strategy's safety, drug-drug interactions, and cellular signaling pathways remain a tremendous challenge.
Methods
In this study, we aimed to provide a deep insight into the baricitinib combination therapies in severe COVID-19 patients through reviewing the published literature on PubMed, Scopus, and Google scholar databases. We also focused on cellular and subcellular pathways related to the synergistic effects of baricitinib plus antiviral agents, virus entry, and cytokine storm (CS) induction. The safety and effectiveness of this strategy have also been discussed in moderate to severe forms of COVID-19 infection.
Results
The severity of COVID-19 is commonly associated with a dysregulated immune response and excessive release of pro-inflammatory agents, resulting in CS. It has been shown that baricitinib combined with antiviral agents could modulate the inflammatory response and provide a series of positive therapeutic outcomes in hospitalized adults and pediatric patients (age ≥ two years old).
Conclusion
Baricitinib plus the standard of care treatment might be a potential strategy in hospitalized patients with severe COVID-19.
Læs mere Tjek på PubMedOng, K. I. C., Khattignavong, P., Keomalaphet, S., Iwagami, M., Brey, P., Kano, S., Jimba, M.
BMJ Open, 13.12.2021
Tilføjet 13.12.2021
Objectives
This mixed methods study was conducted to explore the barriers and facilitators for health-seeking behaviours in a malaria endemic district in Lao PDR.
Design
A convergent mixed methods design.
Setting
Two malaria endemic villages in Thapangthong district, Savannakhet Province, Lao PDR.
Participants
Villagers and healthcare workers in the two villages in Thapangthong district.
Methods
In the quantitative part, a pretested questionnaire was used to identify the health-seeking behaviours of the villagers. In the qualitative part, focus group discussions were employed to explore health-seeking behaviours of the villagers and in-depth interviews were used to explore the perceptions of the healthcare workers. Descriptive statistics were computed and multiple logistic regressions were used to identify the factors associated with perceived severity and perceived susceptibility. Thematic analysis was used to analyse the qualitative data. Quantitative and qualitative results were integrated in joint displays.
Results
In the quantitative part, data were collected from 313 villagers from both villages. For malaria, 96.0% and 98.2% of villagers from villages A and B, respectively, would first seek treatment at public health facilities. Villagers who have not experienced malaria before were more likely to perceive that the consequences of malaria were serious compared with those who have experienced malaria before (adjusted OR=1.69, 95% CI: 1.03 to 2.75). However, qualitative data showed that villagers faced problems such as lack of medicines and medical equipment. Healthcare workers also mentioned the lack of manpower and equipment in the in-depth interviews. Nevertheless, villagers still preferred to seek treatment at the health center as the National Health Insurance was introduced.
Conclusions
Public health facility usage was high but barriers existed. Effective policy and enabling environment such as the introduction of the National Health Insurance could help accelerate the progress towards the malaria elimination goal. Moreover, the benefits could go beyond the context of malaria.
Læs mere Tjek på PubMedSpiers, J., Buszewicz, M., Chew-Graham, C., Dunning, A., Taylor, A. K., Gopfert, A., Van Hove, M., Teoh, K. R.-H., Appleby, L., Martin, J., Riley, R.
BMJ Open, 13.12.2021
Tilføjet 13.12.2021
Objectives
This paper reports findings exploring junior doctors’ experiences of working during the COVID-19 pandemic in the UK.
Design
Qualitative study using in-depth interviews with 15 junior doctors. Interviews were audio-recorded, transcribed, anonymised and imported into NVivo V.12 to facilitate data management. Data were analysed using reflexive thematic analysis.
Setting
National Health Service (NHS) England.
Participants
A purposive sample of 12 female and 3 male junior doctors who indicated severe depression and/or anxiety on the DASS-21 questionnaire or high suicidality on Paykel’s measure were recruited. These doctors self-identified as having lived experience of distress due to their working conditions.
Results
We report three major themes. First, the challenges of working during the COVID-19 pandemic, which were both personal and organisational. Personal challenges were characterised by helplessness and included the trauma of seeing many patients dying, fears about safety and being powerless to switch off. Work-related challenges revolved around change and uncertainty and included increasing workloads, decreasing staff numbers and negative impacts on relationships with colleagues and patients. The second theme was strategies for coping with the impact of COVID-19 on work, which were also both personal and organisational. Personal coping strategies, which appeared limited in their usefulness, were problem and emotion focused. Several participants appeared to have moved from coping towards learnt helplessness. Some organisations reacted to COVID-19 collaboratively and flexibly. Third, participants reported a positive impact of the COVID-19 pandemic on working practices, which included simplified new ways of working—such as consistent teams and longer rotations—as well as increased camaraderie and support.
Conclusions
The trauma that junior doctors experienced while working during COVID-19 led to powerlessness and a reduction in the benefit of individual coping strategies. This may have resulted in feelings of resignation. We recommend that, postpandemic, junior doctors are assigned to consistent teams and offered ongoing support.
Læs mere Tjek på PubMedMohamed, S. F., Uthman, O. A., Mutua, M. K., Asiki, G., Abba, M. S., Gill, P.
BMJ Open, 13.12.2021
Tilføjet 13.12.2021
Background
The burden of uncontrolled hypertension in sub-Saharan Africa (SSA) is high and hypertension is known to coexist with other chronic diseases such as kidney disease, diabetes among others. This is the first systematic review and meta-analysis to determine the burden of uncontrolled hypertension among patients with comorbidities in SSA.
Methods
A comprehensive search was conducted on MEDLINE, Excerpta Medica Database (Embase) and Web of Science to identify all relevant articles published between 1 January 2000 and 17 June 2021. We included studies that reported on the prevalence of uncontrolled hypertension among people in SSA who report taking antihypertensive treatment and have another chronic condition. A random-effects meta-analysis was performed to obtain the pooled estimate of the prevalence of uncontrolled hypertension among patients with comorbid conditions while on treatment across studies in SSA.
Results
In all, 20 articles were included for meta-analyses. Eleven articles were among diabetic patients, five articles were among patients with HIV, two were among patients with stroke while chronic kidney disease and atrial fibrillation had one article each. The pooled prevalence of uncontrolled hypertension among patients with comorbidities was 78.6% (95% CI 71.1% to 85.3%); I² 95.9%, varying from 73.1% in patients with stroke to 100.0% in patients with atrial fibrillation. Subgroup analysis showed differences in uncontrolled hypertension prevalence by various study-level characteristics
Conclusion
This study suggests a high burden of uncontrolled hypertension in people with comorbidities in SSA. Strategies to improve the control of hypertension among people with comorbidities are needed.
PROSPERO registration number
CRD42019108218.
Læs mere Tjek på PubMedLou, B., Guo, J., Liu, Y., Xiong, C., Shi, J., Zhou, C.
BMJ Open, 13.12.2021
Tilføjet 13.12.2021
Introduction
Previous studies have shown mixed results that delirium may result in a high risk of adverse clinical outcomes in patients with COVID-19. The aim of this meta-analysis is to summarise the evidence of prevalence, classification, risk factors and outcomes impact of delirium in adult patients with COVID-19.
Methods
A systematic search will be performed in PubMed, EMBase, ISI Knowledge via Web of Science and preprint databases (MedRxiv and BioRxiv) (from inception until June 2021) to identify all cohort studies concerning delirium in adult patients with COVID-19. The primary outcome will be the prevalence of delirium with different classifications (hyperactive, hypoactive or mixed type). The secondary outcomes will include the association of risk factors and the association with all-cause mortality during hospitalisation. Univariable or multivariable meta-regression and subgroup analyses will be conducted for the study design and patient characteristics. Sensitivity analyses were used to assess the robustness of our results by removing each included study at one time to obtain and evaluate the remaining overall estimates of primary and secondary outcomes.
Ethics and dissemination
Ethical approval is not an essential element for the systematic review protocol in accordance with the Institutional Review Board /Independent Ethics Committee of Beijing Hospital. This meta-analysis will be disseminated through a peer-reviewed journal for publication.
PROSPERO registration number
CRD42020224871.
Læs mere Tjek på PubMedJiang, J., Wan, R., He, S., Wu, Y., Shen, Z., Chen, G., Sun, S., Yan, W., Zheng, S.
BMJ Open, 13.12.2021
Tilføjet 13.12.2021
Objectives
Biliary atresia (BA) is regarded as a serious neonatal hepatobiliary disease, and its aetiology and pathogenesis remain unclear. Epidemiological studies are limited, especially for the data from China. This study aims to explore risk factors of BA and provide new evidence to improve understanding of its aetiology.
Design
This is a case–control study from 1 January 2015 to 31 December 2016.
Setting
Cases were consecutively recruited from an urban tertiary care academic children’s hospital in Shanghai, China, while the controls were recruited from a community hospital in Shanghai through a random sampling system.
Participants
721 patients suspected for BA who planned to take the diagnostic surgery were enrolled preoperatively. 613 were diagnosed with BA and recruited into the case group. Meanwhile, 688 infants without any observed major congenital anomalies or jaundice were enrolled. Finally, 594 valid questionnaires from the case group and 681 from the control group were obtained.
Primary and secondary outcome measures
Standardised questionnaires were used for data collection. Multivariate logistic regression analysis was performed to evaluate associations reported as ORs and precision, by adjusting covariates.
Results
Anxiety or stress during pregnancy was strongly associated with increased risk of BA (OR 8.36 (95% CI: 4.08 to 17.15); p<0.001), respectively. Lower birth weight, fathers from ethnic minorities of China, older age of fathers, lower income of parents, and exposure to infection, diseases and medication during pregnancy all made differences.
Conclusions
Social factors including the educational and economic background and its related anxiety and stress during pregnancy might be noticed in the occurrence of BA. Maternal infections during pregnancy in the prevalence of BA were demonstrated.
Trial registration number
ChiCTR-IPR-15005885.
Læs mere Tjek på PubMedPragman, A. A., Fieberg, A. M., Reilly, C. S., Wendt, C.
BMJ Open, 13.12.2021
Tilføjet 13.12.2021
Objectives
Determine the effect of twice-daily chlorhexidine oral rinses on oral and lung microbiota biomass and respiratory symptoms.
Setting
Single centre.
Participants
Participants were aged 40–85 with chronic obstructive pulmonary disease (COPD) and chronic productive cough or COPD exacerbation within the last year. Exclusions included antibiotics in the previous 2 months and/or those with less than four teeth. Forty-four participants were recruited and 40 completed the study.
Intervention
Participants were randomised 1:1 to twice-daily 0.12% chlorhexidine oral rinses versus placebo for 2 months along with daily diaries. St. George’s Respiratory Questionnaire (SGRQ), blood tests, oral rinse and induced sputum were collected at randomisation and the final visit.
Primary and secondary outcomes
Primary outcome was a change in oral and sputum microbiota biomass. Secondary outcomes included: sputum and oral microbiota Shannon and Simpson diversity and taxonomy; inflammatory markers; Breathlessness, Cough and Sputum Scale and SGRQ scores.
Results
Neither the oral microbiota nor the sputum microbiota biomass decreased significantly in those using chlorhexidine compared with placebo (oral microbiota mean log10 difference (SE)=–0.103 (0.23), 95% CI –0.59 to 0.38, p=0.665; sputum microbiota 0.80 (0.46), 95% CI –0.15 to 1.75, p=0.096). Chlorhexidine decreased both oral and sputum microbiota alpha (Shannon) diversity (linear regression estimate (SE) oral: –0.349 (0.091), p=0.001; sputum –0.622 (0.169), p=0.001). Chlorhexidine use did not decrease systemic inflammatory markers compared with placebo (C reactive protein (chlorhexidine 1.8±7.5 vs placebo 0.4±6.8, p=0.467), fibrinogen (22.5±77.8 vs 10.0±77.0, p=0.406) or leucocytes (0.2±1.8 vs 0.5±1.8, p=0.560)). Chlorhexidine use decreased SGRQ scores compared with placebo (chlorhexidine –4.7±8.0 vs placebo 1.7±8.9, p=0.032).
Conclusions
We did not detect a significant difference in microbiota biomass due to chlorhexidine use. Chlorhexidine decreased oral and sputum microbiota alpha diversity and improved respiratory health-related quality of life compared with placebo.
Trial registration
NCT02252588.
Læs mere Tjek på PubMedPartinen, M., Holzinger, B., Morin, C. M., Espie, C., Chung, F., Penzel, T., Benedict, C., Bolstad, C. J., Cedernaes, J., Chan, R. N. Y., Dauvilliers, Y., De Gennaro, L., Han, F., Inoue, Y., Matsui, K., Leger, D., Cunha, A. S., Merikanto, I., Mota-Rolim, S., Nadorff, M., Plazzi, G., Schneider, J., Sieminski, M., Wing, Y.-K., Bjorvatn, B.
BMJ Open, 13.12.2021
Tilføjet 13.12.2021
Objectives
Sleep is important for human health and well-being. No previous study has assessed whether the COVID-19 pandemic impacts sleep and daytime function across the globe.
Methods
This large-scale international survey used a harmonised questionnaire. Fourteen countries participated during the period of May–August 2020. Sleep and daytime problems (poor sleep quality, sleep onset and maintenance problems, nightmares, hypnotic use, fatigue and excessive sleepiness) occurring ‘before’ and ‘during’ the pandemic were investigated. In total, 25 484 people participated and 22 151 (86.9%) responded to the key parameters and were included. Effects of COVID-19, confinement and financial suffering were considered. In the fully adjusted logistic regression models, results (weighted and stratified by country) were adjusted for gender, age, marital status, educational level, ethnicity, presence of sleep problems before COVID-19 and severity of the COVID-19 pandemic in each country at the time of the survey.
Results
The responders were mostly women (64%) with a mean age 41.8 (SD 15.9) years (median 39, range 18–95). Altogether, 3.0% reported having had COVID-19; 42.2% reported having been in confinement; and 55.9% had suffered financially. All sleep and daytime problems worsened during the pandemic by about 10% or more. Also, some participants reported improvements in sleep and daytime function. For example, sleep quality worsened in about 20% of subjects and improved in about 5%. COVID-19 was particularly associated with poor sleep quality, early morning awakening and daytime sleepiness. Confinement was associated with poor sleep quality, problems falling asleep and decreased use of hypnotics. Financial suffering was associated with all sleep and daytime problems, including nightmares and fatigue, even in the fully adjusted logistic regression models.
Conclusions
Sleep problems, fatigue and excessive sleepiness increased significantly worldwide during the first phase of the COVID-19 pandemic. Problems were associated with confinement and especially with financial suffering.
Læs mere Tjek på PubMedSentis, A., Montoro-Fernandez, M., Lopez-Corbeto, E., Egea-Cortes, L., Nomah, D. K., Diaz, Y., Garcia de Olalla, P., Mercuriali, L., Borrell, N., Reyes-Uruena, J., Casabona, J., The Catalan HIV and STI Surveillance Group, Sentis, Lopez, Gonzalez, Lugo, Bonamusa, Reyes, Casabona, Garcia de Olalla, Mercuriali, Masdeu, Ros, Rius, Company, Danes, Camps, Vileu, Ferrus, Borrell, Minguell, Ferras, Parron, Modol, Martinez, Godoy, Tarres, J Perez, Boldu, Barrabeig, Donate, Clotet, Sala, Carol, Guadalupe-Fernandez, Mendioroz, Ciruela, Carmona, Mansilla, Martinez, Hernandez
BMJ Open, 13.12.2021
Tilføjet 13.12.2021
Objectives
To describe the epidemiology of sexually transmitted infections (STIs), identify and characterise socio-epidemiological clusters and determine factors associated with HIV coinfection.
Design
Retrospective population-based cohort.
Setting
Catalonia, Spain.
Participants
42 283 confirmed syphilis, gonorrhoea, chlamydia and lymphogranuloma venereum cases, among 34 600 individuals, reported to the Catalan HIV/STI Registry in 2017–2019.
Primary and secondary outcomes
Descriptive analysis of confirmed STI cases and incidence rates. Factors associated with HIV coinfection were determined using logistic regression. We identified and characterized socio-epidemiological STI clusters by Basic Health Area (BHA) using K-means clustering.
Results
The incidence rate of STIs increased by 91.3% from 128.2 to 248.9 cases per 100 000 population between 2017 and 2019 (p<0.001), primarily driven by increase among women (132%) and individuals below 30 years old (125%). During 2017–2019, 50.1% of STIs were chlamydia and 31.6% gonorrhoea. Reinfections accounted for 10.8% of all cases and 6% of cases affected HIV-positive individuals. Factors associated with the greatest likelihood of HIV coinfection were male sex (adjusted OR (aOR) 23.69; 95% CI 16.67 to 35.13), age 30–39 years (versus <20 years, aOR 18.58; 95% CI 8.56 to 52.13), having 5–7 STI episodes (vs 1 episode, aOR 5.96; 95% CI 4.26 to 8.24) and living in urban areas (aOR 1.32; 95% CI 1.04 to 1.69). Living in the most deprived BHAs (aOR 0.60; 95% CI 0.50 to 0.72) was associated with the least likelihood of HIV coinfection. K-means clustering identified three distinct clusters, showing that young women in rural and more deprived areas were more affected by chlamydia, while men who have sex with men in urban and less deprived areas showed higher rates of STI incidence, multiple STI episodes and HIV coinfection.
Conclusions
We recommend socio-epidemiological identification and characterisation of STI clusters and factors associated with HIV coinfection to identify at-risk populations at a small health area level to design effective interventions.
Læs mere Tjek på PubMedReid, J. C., Costa, A. P., Duong, M., Ho, T., Kruisselbrink, R., Raina, P., Kirkwood, R., Jones, A., Corriveau, S., Griffith, L. E., Haider, S., Marcucci, M., Markle-Reid, M., Morrison, H., Raghavan, N., Schumacher, C., Vrkljan, B., Junek, M., Martin, L., Patel, A., Girolametto, C., Pitre, T., Beauchamp, M. K., On behalf of the COREG Investigators
BMJ Open, 13.12.2021
Tilføjet 13.12.2021
Introduction
COVID-19 is an international public health crisis with more than 132 million infections worldwide. Beyond acute infection, emerging data indicate patients diagnosed with COVID-19 may experience persistent sequelae similar to survivors of sepsis or acute respiratory syndromes, including mobility limitations and fatigue. However, there is limited evidence on the trajectory of functional recovery in those hospitalised with COVID-19. The primary aim of the Coronavirus Registry Functional Recovery (COREG-FR) study is to understand the trajectory of functional recovery among individuals hospitalised for COVID-19 over the medium (up to 6 months) and longer term (6–12 months) that will guide clinical care and optimal management of serious COVID-19 illness and recovery.
Methods and analysis
COREG-FR is a multicentre longitudinal cohort study. We will enrol a minimum of 211 adults age 18 years and older with COVID-19 from five hospitals. Participants will be followed from admission to hospital as an inpatient, to hospital discharge, and at 3-month, 6-month, 9-month and up to 12-month post-hospital discharge. We will conduct telephone interviews at ward admission and discharge, and telephone interviews plus in-person assessments of physical function and lung function at all remaining follow-ups. Our primary outcome is the Activity Measure for Post-Acute Care mobility scale measured at all time points. We will conduct linear mixed effects regression analyses to explore determinants of functional outcomes after COVID-19 illness. Subgroup analyses based on age (≤65 vs >65 years), frailty status (Clinical Frailty Scale score ≤4 vs >5) and variants of concern will be conducted.
Ethics and dissemination
COREG-FR has been approved by Research Ethics Boards at participating sites. We will disseminate this work through peer-reviewed manuscripts, presentations at national and international meetings and through the established COREG website (www.coregontario.ca). COREG-FR is designed as a data platform for future studies evaluating COVID-19 recovery.
Trial registration number
NCT04602260; Pre-results.
Læs mere Tjek på PubMedAkingboye, A., Mahmood, F., Amiruddin, N., Reay, M., Nightingale, P., Ogunwobi, O. O.
BMJ Open, 13.12.2021
Tilføjet 13.12.2021
Objective
Susceptibility of patients with cancer to COVID-19 pneumonitis has been variable. We aim to quantify the risk of hospitalisation in patients with active cancer and use a machine learning algorithm (MLA) and traditional statistics to predict clinical outcomes and mortality.
Design
Retrospective cohort study.
Setting
A single UK district general hospital.
Participants
Data on total hospital admissions between March 2018 and June 2020, all active cancer diagnoses between March 2019 and June 2020 and clinical parameters of COVID-19-positive admissions between March 2020 and June 2020 were collected. 526 COVID-19 admissions without an active cancer diagnosis were compared with 87 COVID-19 admissions with an active cancer diagnosis.
Primary and secondary outcome measures
30-day and 90-day post-COVID-19 survival.
Results
In total, 613 patients were enrolled with male to female ratio of 1:6 and median age of 77 years. The estimated infection rate of COVID-19 was 87 of 22 729 (0.4%) in the patients with cancer and 526 of 404 379 (0.1%) in the population without cancer (OR of being hospitalised with COVID-19 if having cancer is 2.942671 (95% CI: 2.344522 to 3.693425); p<0.001). Survival was reduced in patients with cancer with COVID-19 at 90 days. R-Studio software determined the association between cancer status, COVID-19 and 90-day survival against variables using MLA. Multivariate analysis showed increases in age (OR 1.039 (95% CI: 1.020 to 1.057), p<0.001), urea (OR 1.005 (95% CI: 1.002 to 1.007), p<0.001) and C reactive protein (CRP) (OR 1.065 (95% CI: 1.016 to 1.116), p<0.008) are associated with greater 30-day and 90-day mortality. The MLA model examined the contribution of predictive variables for 90-day survival (area under the curve: 0.749); with transplant patients, age, male gender and diabetes mellitus being predictors of greater mortality.
Conclusions
Active cancer diagnosis has a threefold increase in risk of hospitalisation with COVID-19. Increased age, urea and CRP predict mortality in patients with cancer. MLA complements traditional statistical analysis in identifying prognostic variables for outcomes of COVID-19 infection in patients with cancer. This study provides proof of concept for MLA in risk prediction for COVID-19 in patients with cancer and should inform a redesign of cancer services to ensure safe delivery of cancer care.
Læs mere Tjek på PubMedPaul Adepoju
Nature, 13.12.2021
Tilføjet 13.12.2021
Nature Medicine, Published online: 13 December 2021; doi:10.1038/d41591-021-00073-x
As data emerge that boosters may help to protect against Omicron, the supply of vaccines to Africa is further squeezed. But fears of the COVID-19 variant may increase uptake, which is worryingly low in some countries.
Læs mere Tjek på PubMedSophie Brunner-Ziegler, Tibor Spath, Gabriela Kornek, Franz König, Bernhard Parschalk, Maximilian Schnetzinger, Robert Paul Straßl, Rebeka Savic, Andrea Foit, Helene Resch, Florian Thalhammer
Clinical Microbiology and Infection, 13.12.2021
Tilføjet 13.12.2021
The identification of SARS-CoV-2 antigen or RNA in respiratory specimens ≥14 days after administration of all recommended doses of authorized COVID-19 vaccines is defined as „breakthrough infection“. In the present investigation m-RNA and vector based SARS-CoV-2 vaccines were analysed with respect to postvaccination infections in vaccinated hospital employees.
Læs mere Tjek på PubMedAlex Yee Chau Sim, Ainal Adlin Naffi, Tang Seng Fai, Najma Kori, Wan Asyraf Wan Zaidi, Petrick Periyasamy, Norshamsiah Md Din, Mushawiahti Mustapha, Ayesha Mohd Zain
Journal of Medical Virology, 13.12.2021
Tilføjet 13.12.2021