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Malaria Journal, 5.02.2022
Tilføjet 5.02.2022
Abstract
Progress in gene drive research has engendered a lively discussion about community engagement and the ethical standards the work hinges on. While there is broad agreement regarding ethical principles and established best practices for conducting clinical public health research, projects developing area-wide vector control technologies and initiating ambitious engagement strategies raise specific questions: who to engage, when to engage, and how? When responding to these fundamental questions, with few best practices available for guidance, projects need to reflect on and articulate the ethical principles that motivate and justify their approach. Target Malaria is a not-for-profit research consortium that aims to develop and share malaria control and elimination technology. The consortium is currently investigating the potential of a genetic technique called gene drive to control populations of malaria vectoring mosquito species Anopheles gambiae. Due to the potentially broad geographical, environmental impact of gene drive technology, Target Malaria has committed to a robust form of tailored engagement with the local communities in Burkina Faso, Mali, and Uganda, where research activities are currently taking place. This paper presents the principles guiding Target Malaria’s engagement strategy. Herein the authors (i) articulate the principles; (ii) explain the rationale for selecting them; (iii) share early lessons about the application of the principles. Since gene drive technology is an emerging technology, with few best practices available for guidance, the authors hope by sharing these lessons, to add to the growing literature regarding engagement strategies and practices for area-wide vector control, and more specifically, for gene drive research.
Læs mere Tjek på PubMedMalaria Journal, 5.02.2022
Tilføjet 5.02.2022
Abstract
Background
Congenital malaria, which is caused by vertical transmission of malaria parasites, is a potentially fatal condition. Despite Africa’s high malaria burden, congenital malaria is not routinely screened for, and thus may go undiagnosed. Malaria, if not treated promptly, can quickly progress to severe forms and result in death. Severe congenital malaria is believed to be uncommon in neonates due to maternal antibodies, fetal haemoglobin, and the placenta’s sieving effect. The majority of reported cases were classified as having severe anaemia. Following a thorough review of the literature, only one case of congenital cerebral malaria (CCM) has been reported, and it was misdiagnosed.
Case presentation
A 5-day-old Nigerian neonate born to an apparently healthy mother initially displayed characteristics consistent with neonatal sepsis and severe neonatal hyperbilirubinaemia. He quickly developed characteristics consistent with meningitis. Surprisingly, the peripheral blood film revealed evidence of malaria parasites, which was immediately confirmed by Giemsa-stained thick and thin blood film microscopy for malaria. The patient was diagnosed with congenital cerebral malaria. The medication was modified to parenteral artesunate followed by oral artemisinin combination therapy. The neonate recovered fully and had no neurological deficits on follow up.
Conclusion
Because CCM and infant meningitis have similar clinical presentations, CCM could be misdiagnosed and lead to death if there isn’t a high index of suspicion.
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Malaria Journal, 5.02.2022
Tilføjet 5.02.2022
Abstract
Background
In sub-Saharan Africa, house design and ventilation affects the number of malaria mosquito vectors entering houses. This study hypothesized that indoor light from a CDC-light trap, visible from outside a hut, would increase entry of Anopheles arabiensis, an important malaria vector, and examined whether ventilation modifies this effect.
Methods
Four inhabited experimental huts, each situated within a large chamber, were used to assess how light and ventilation affect the number of hut-entering mosquitoes in Tanzania. Each night, 300 female laboratory-reared An. arabiensis were released inside each chamber for 72 nights. Nightly mosquito collections were made using light traps placed indoors. Temperature and carbon dioxide concentrations were measured using data loggers. Treatments and sleepers were rotated between huts using a randomized block design.
Results
When indoor light was visible outside the huts, there was an 84% increase in the odds of collecting mosquitoes indoors (Odds ratio, OR = 1.84, 95% confidence intervals, 95% CI 1.74–1.95, p < 0.001) compared with when it was not. Although the odds of collecting mosquitoes in huts with closed eaves (OR = 0.54, 95% CI 0.41–0.72, p < 0.001) was less than those with open eaves, few mosquitoes entered either type of well-ventilated hut. The odds of collecting mosquitoes was 99% less in well-ventilated huts, compared with poorly-ventilated traditional huts (OR = 0.01, 95% CI 0.01–0.03, p < 0.001). In well-ventilated huts, indoor temperatures were 1.3 °C (95% CI 0.9–1.7, p < 0.001) cooler, with lower carbon dioxide (CO2) levels (mean difference = 97 ppm, 77.8–116.2, p < 0.001) than in poorly-ventilated huts.
Conclusion
Although light visible from outside a hut increased mosquito house entry, good natural ventilation reduces indoor carbon dioxide concentrations, a major mosquito attractant, thereby reducing mosquito-hut entry.
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BMC Infectious Diseases, 4.02.2022
Tilføjet 5.02.2022
Abstract
Background
A new more highly sensitive rapid diagnostic test (HS-RDT) for Plasmodium falciparum malaria (Alere™/Abbott Malaria Ag P.f RDT [05FK140], now called NxTek™ Eliminate Malaria Ag Pf) was launched in 2017. The test has already been used in many research studies in a wide range of geographies and use cases.
Methods
In this study, we collate all published and available unpublished studies that use the HS-RDT and assess its performance in (i) prevalence surveys, (ii) clinical diagnosis, (iii) screening pregnant women, and (iv) active case detection. Two individual-level data sets from asymptomatic populations are used to fit logistic regression models to estimate the probability of HS-RDT positivity based on histidine-rich protein 2 (HRP2) concentration and parasite density. The performance of the HS-RDT in prevalence surveys is estimated by calculating the sensitivity and positive proportion in comparison to polymerase chain reaction (PCR) and conventional malaria RDTs.
Results
We find that across 18 studies, in prevalence surveys, the mean sensitivity of the HS-RDT is estimated to be 56.1% (95% confidence interval [CI] 46.9–65.4%) compared to 44.3% (95% CI 32.6–56.0%) for a conventional RDT (co-RDT) when using nucleic acid amplification techniques as the reference standard. In studies where prevalence was estimated using both the HS-RDT and a co-RDT, we found that prevalence was on average 46% higher using a HS-RDT compared to a co-RDT. For use in clinical diagnosis and screening pregnant women, the HS-RDT was not significantly more sensitive than a co-RDT.
Conclusions
Overall, the evidence presented here suggests that the HS-RDT is more sensitive in asymptomatic populations and could provide a marginal improvement in clinical diagnosis and screening pregnant women. Although the HS-RDT has limited temperature stability and shelf-life claims compared to co-RDTs, there is no evidence to suggest, given this test has the same cost as current RDTs, it would have any negative impacts in terms of malaria misdiagnosis if it were widely used in all four population groups explored here.
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BMC Infectious Diseases, 4.02.2022
Tilføjet 5.02.2022
Abstract
Background
People living with HIV, who take antiretroviral therapy (ART), often enjoy long and healthy lives, but this therapy has well known metabolic adverse effects. Physical activity is found to be an important factor in improving these physiological parameters. This study aimed to determine physical activity level and associated factors among HIV patients in Ethiopia.
Methods
An institutional based cross sectional study was conducted from May to June 2019. We selected a total of 422 adult HIV patients, attending antiretroviral therapy clinics in three selected hospitals in Southern Ethiopia. Data were collected at routine care consultations by nine trained nurses using a pre-tested structured questionnaire. The level of physical activity was measured by the international physical activity questionnaire (IPAQ).
Result
The mean age of participants was 38.7 ± 9.13 years. Of the participants, 68% were physically inactive, with a higher proportion of inactive women (74%) than men (61%) [(AOR = 1.64, 95% CI (1.07, 2.53)]. In addition, urban vs. rural residents [(AOR = 2.57, 95% CI (1.16, 5.72)] and patients who were on ART for ≥ 24 months [(AOR = 1.88, 95% CI (1.15, 3.08)] had higher odds of having a low physical activity level.
Conclusion
Most people living with HIV and receiving ART have low physical activity levels. Especially female and urban living patients and those with longer treatment duration have low levels of physical activity. More insight is needed on the reasons for physical inactivity among HIV patients and physical activity programs for HIV patients in low-income countries need to be developed.
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BMC Infectious Diseases, 4.02.2022
Tilføjet 5.02.2022
Abstract
Background
COVID-19 pandemic is the major public health problem in the world actually. It’s associated with high morbidity and mortality. To date, no therapeutic measure has a curative potential. Hydroxychloroquine (HCQ) is a drug with immunomodulatory properties that has demonstrated antiviral efficacy in in vitro experiments, with conflicting results in in vivo studies.
Methods
A single-center, prospective and interventional study, that evaluates the impact on mortality of the HCQ use in 154 patients hospitalized with COVID-19 in a Brazilian public hospital. The study also aims to determine prognostic factors that predict mortality, ICU admission and endotracheal intubation in this population.
Results
154 patients diagnosed with COVID-19 confirmed by RT-PCR and hospitalized were included. There was a male predominance (87/154, 56.5%), median age 60 years and 88% (136/154) had comorbidities. Among these, 76% (117/154) were admitted to the ICU and 29.2% (45/154) experienced EOT. The OMR was 51.3% (79/154). There was no difference in mortality between patients treated with HCQ (N = 95) and non-HCQ (N = 59) (44.1% × 55.8%, p = 0.758). In univariate analysis, age ≥ 60 years (HR 3.62, p < 0.001), need for mechanical ventilation (HR 2.17, p = 0.001), ≥ 2 comorbidities (HR 1.83, p = 0.049), SAH (HR: 1.56, p = 0.054) were predictors of mortality, as well as no use of prophylactic or therapeutic heparin (HR 3.60, p = 0.02). Multivariate analysis identified admission to the ICU (HR 8.98, p = 0.002) and advanced age (HR 3.37, p < 0.01) as independent predictors of mortality, although, use of heparin (HR 0.25, p = 0.001) was independently associated with a favorable outcome.
Conclusion
This study confirmed the absence of a benefit associated with the use of HCQ in Brazilian patients hospitalized with COVID-19. However, prophylactic or therapeutic heparin was an independent predictor for reducing mortality in this population.
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BMC Infectious Diseases, 4.02.2022
Tilføjet 5.02.2022
Abstract
Background
Given the importance of viral suppression in ending the HIV epidemic in the US and elsewhere, an optimal predictive model of viral status can help clinicians identify those at risk of poor viral control and inform clinical improvements in HIV treatment and care. With an increasing availability of electronic health record (EHR) data and social environmental information, there is a unique opportunity to improve our understanding of the dynamic pattern of viral suppression. Using a statewide cohort of people living with HIV (PLWH) in South Carolina (SC), the overall goal of the proposed research is to examine the dynamic patterns of viral suppression, develop optimal predictive models of various viral suppression indicators, and translate the models to a beta version of service-ready tools for clinical decision support.
Methods
The PLWH cohort will be identified through the SC Enhanced HIV/AIDS Reporting System (eHARS). The SC Office of Revenue and Fiscal Affairs (RFA) will extract longitudinal EHR clinical data of all PLWH in SC from multiple health systems, obtain data from other state agencies, and link the patient-level data with county-level data from multiple publicly available data sources. Using the deidentified data, the proposed study will consist of three operational phases: Phase 1: “Pattern Analysis” to identify the longitudinal dynamics of viral suppression using multiple viral load indicators; Phase 2: “Model Development” to determine the critical predictors of multiple viral load indicators through artificial intelligence (AI)-based modeling accounting for multilevel factors; and Phase 3: “Translational Research” to develop a multifactorial clinical decision system based on a risk prediction model to assist with the identification of the risk of viral failure or viral rebound when patients present at clinical visits.
Discussion
With both extensive data integration and data analytics, the proposed research will: (1) improve the understanding of the complex inter-related effects of longitudinal trajectories of HIV viral suppressions and HIV treatment history while taking into consideration multilevel factors; and (2) develop empirical public health approaches to achieve ending the HIV epidemic through translating the risk prediction model to a multifactorial decision system that enables the feasibility of AI-assisted clinical decisions.
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Antonin C. André, Matthieu Laborde, Benoit S. Marteyn
Trends in Microbiology, 4.02.2022
Tilføjet 5.02.2022
Bacterial and fungal pathogens face various microenvironmental conditions during infection. In addition to acidosis, nutrient consumption, and hypercapnia, pathogen infections are associated with hypoxia, which is induced by bacterial and fungal respiration during the formation of foci of infection or biofilms. Consequently, the in vivo interaction between host immune cells and pathogens is anticipated to occur mainly under low-oxygen conditions. Various infectious disease models have reported that pathogens benefit from hypoxia, which dampens the oxygen-dependent antimicrobial activities of macrophages and neutrophils, such as the production of reactive oxygen species (ROS).
Læs mere Tjek på PubMedJavier Barranco-Trabi, Stephen Morgan, Seema Singh, Jimmy Hill, Alexander Kayatani, Victoria Mank, Holly Nesmith, Heather Omara, Louis Tripoli, Michael Lustik, Jennifer Masel, Sharon Chi, Viseth Ngauy
PLoS One Infectious Diseases, 4.02.2022
Tilføjet 4.02.2022
by Javier Barranco-Trabi, Stephen Morgan, Seema Singh, Jimmy Hill, Alexander Kayatani, Victoria Mank, Holly Nesmith, Heather Omara, Louis Tripoli, Michael Lustik, Jennifer Masel, Sharon Chi, Viseth Ngauy
Health inequalities based on race are well-documented, and the COVID-19 pandemic is no exception. Despite the advances in modern medicine, access to health care remains a primary determinant of health outcomes, especially for communities of color. African-Americans and other minorities are disproportionately at risk for infection with COVID-19, but this problem extends beyond access alone. This study sought to identify trends in race-based disparities in COVID-19 in the setting of universal access to care. Tripler Army Medical Center (TAMC) is a Department of Defense Military Treatment Facility (DoD-MTF) that provides full access to healthcare to active duty military members, beneficiaries, and veterans. We evaluated the characteristics of individuals diagnosed with SARS-CoV-2 infection at TAMC in a retrospective, case-controlled (1:1) study. Most patients (69%) had received a COVID-19 test within 3 days of symptom onset. Multivariable logistic regression analyses were used to identify factors associated with testing positive and to estimate adjusted odds ratios. African-American patients and patients who identified as “Other” ethnicities were two times more likely to test positive for SARS-CoV-2 relative to Caucasian patients. Other factors associated with testing positive include: younger age, male gender, previous positive test, presenting with >3 symptoms, close contact with a COVID-19 positive patient, and being a member of the US Navy. African-Americans and patients who identify as “Other” ethnicities had disproportionately higher rates of positivity of COVID-19. Although other factors contribute to increased test positivity across all patient populations, access to care does not appear to itself explain this discrepancy with COVID-19.
Læs mere Tjek på PubMedLebapotswe B. Tlale, Lesego Gabaitiri, Lorato K. Totolo, Gomolemo Smith, Orapeleng Puswane-Katse, Eunice Ramonna, Basego Mothowaeng, John Tlhakanelo, Tiny Masupe, Goabaone Rankgoane-Pono, John Irige, Faith Mafa, Samuel Kolane
PLoS One Infectious Diseases, 4.02.2022
Tilføjet 4.02.2022
by Lebapotswe B. Tlale, Lesego Gabaitiri, Lorato K. Totolo, Gomolemo Smith, Orapeleng Puswane-Katse, Eunice Ramonna, Basego Mothowaeng, John Tlhakanelo, Tiny Masupe, Goabaone Rankgoane-Pono, John Irige, Faith Mafa, Samuel Kolane
Background The COVID-19 disease burden continues to be high worldwide and vaccines continue to be developed to help combat the pandemic. Acceptance and risk perception for COVID-19 vaccines is unknown in Botswana despite the government’s decision to roll out the vaccine nationally. Objectives This study aims to assess the acceptance rate and risk perception of COVID-19 vaccines amongst the general population in Botswana. Methods We interviewed 5300 adults in Botswana from 1–28 February 2021 using self-administered questionnaires. The main outcomes of the study were vaccine acceptance and hesitancy rates. Demographic, experiential and socio-cultural factors were explored for their association with outcome variables. Results Two-thirds of the participants were females (3199), with those aged 24–54 making the highest proportion (61%). The acceptance rate of COVID-19 vaccine was 73.4% (95% CI: 72.2%-74.6%) with vaccine hesitancy at 31.3% (95% CI: 30.0%-32.6%). When the dependent variable was vaccine acceptance, males had higher odds of accepting the vaccine compared to females (OR = 1.2, 95% CI: 1.0, 1.4). Individuals aged 55–64 had high odds of accepting the vaccine compared to those aged 65 and above (OR = 1.2, 95% CI: 0.6, 2.5). The odds of accepting the vaccine for someone with primary school education were about 2.5 times that of an individual with post graduate level of education. Finally, individuals with comorbidities had higher odds (OR = 1.2, 95% CI: 1.0, 1.5) of accepting the vaccine compared to those without any underlying conditions. Conclusion This study demonstrated a high acceptance rate for the COVID-19 vaccine and a low risk perception in Botswana. In order to achieve a high vaccine coverage and ensure a successful vaccination process, there is need to target populations with high vaccine hesitancy rates. A qualitative study to assess the factors associated with vaccine acceptance and hesitancy is recommended to provide an in-depth analysis of the findings.
Læs mere Tjek på PubMedShota Myojin, Kyongsun Pak, Mayumi Sako, Tohru Kobayashi, Takuri Takahashi, Tomimasa Sunagawa, Norihiko Tsuboi, Kenji Ishikura, Masaya Kubota, Mitsuru Kubota, Takashi Igarashi, Ichiro Morioka, Isao Miyairi
PLoS One Infectious Diseases, 4.02.2022
Tilføjet 4.02.2022
by Shota Myojin, Kyongsun Pak, Mayumi Sako, Tohru Kobayashi, Takuri Takahashi, Tomimasa Sunagawa, Norihiko Tsuboi, Kenji Ishikura, Masaya Kubota, Mitsuru Kubota, Takashi Igarashi, Ichiro Morioka, Isao Miyairi
Background The role of antibiotics in the treatment of Shiga toxin-producing Escherichia coli (STEC) infection is controversial. Objectives To evaluate the association between treatment (antibiotics, antidiarrheal agents, and probiotics) for STEC infection and hemolytic uremic syndrome (HUS) development. Patients and methods We performed a population-based matched case-control study using the data from the National Epidemiological Surveillance of Infectious Diseases (NESID) between January 1, 2017 and December 31, 2018. We identified all patients with STEC infection and HUS as cases and matched patients with STEC infection without HUS as controls, with a case-control a ratio of 1:5. Further medical information was obtained by a standardized questionnaire. Multivariable conditional logistic regression model was used. Results 7760 patients with STEC infection were registered in the NESID. 182 patients with HUS and 910 matched controls without HUS were selected. 90 patients with HUS (68 children and 22 adults) and 371 patients without HUS (266 children and 105 adults) were included in the main analysis. The matched ORs of any antibiotics and fosfomycin for HUS in children were 0.56 (95% CI 0.32–0.98), 0.58 (0.34–1.01). The matched ORs for HUS were 2.07 (1.07–4.03), 0.86 (0.46−1.61) in all ages treated with antidiarrheal agent and probiotics. Conclusions Antibiotics, especially fosfomycin, may prevent the development of HUS in children, while use of antidiarrheal agents should be avoided.
Læs mere Tjek på PubMedTilahun Adugna, Emana Getu, Delenasaw Yewhelew
PLoS One Infectious Diseases, 4.02.2022
Tilføjet 4.02.2022
by Tilahun Adugna, Emana Getu, Delenasaw Yewhelew
The intensity of malaria transmission is measured by parous rate, daily survival rate, human blood meal frequency, sporozoite rate, and entomological inoculation rates. Female parous status is a key index of vector competence, adult vector longevity, recruitment rate of adult, and the length of a gonotrophic cycle. Hence, the present study was aimed to investigate the parous rate and the longevity of Anopheles mosquitoes in Bure District, Northwestern Ethiopia. Parous rate was estimated as the number of mosquitoes with parous ovaries divided by the number of females dissected multiplied by 100. Mosquito life expectancy (longevity as d) was estimated by. One way- ANOVA was applied to confirm the presence of parous rate difference in the villages (p < 0.05). A total of 952 unfed hosts-seeking Anopheles mosquitoes was dissected for parous rate determination. The overall parous rate of An. arabiensis in the district was 52.0%, and the highest parous rate was recorded in Shnebekuma than other villages (F 2, 33 = 6.974; p = 0.003). Similarly, the parous rate of An. cinereus showed significant variation among villages (F 2, 33 = 5.044, p = 0.012) and the highest rate (63.0%) was recorded in Bukta. The mean longevity of An. funestus, An. arabiensis, An. coustani, An. squamosus, An. pharoensis, and An. cinereus was 6.5 days, 4.6 days, 3.5 days, 3.7 days, 2.7 days, and 2.2 days, respectively. The longevity of each species was not sufficient to complete the life cycle of malaria parasite for malaria transmission throughout the year because P. falciparum requires from 12–14 day.
Læs mere Tjek på PubMedEmerging Infectious Diseases, 4.02.2022
Tilføjet 4.02.2022
Emerging Infectious Diseases, 4.02.2022
Tilføjet 4.02.2022
Sarah J. Stock, Jade Carruthers, Clara Calvert, Cheryl Denny, Jack Donaghy, Anna Goulding, Lisa E. M. Hopcroft, Leanne Hopkins, Terry McLaughlin, Jiafeng Pan, Ting Shi, Bob Taylor, Utkarsh Agrawal, Bonnie Auyeung, Srinivasa Vittal Katikireddi, Colin McCowan, Josie Murray, Colin R. Simpson, Chris Robertson, Eleftheria Vasileiou, Aziz Sheikh, Rachael Wood
Nature, 4.02.2022
Tilføjet 4.02.2022
Nature Medicine, Published online: 04 February 2022; doi:10.1038/s41591-022-01730-5Author Correction: SARS-CoV-2 infection and COVID-19 vaccination rates in pregnant women in Scotland
Læs mere Tjek på PubMedBourne, T., Kyriacou, C., Shah, H., Ceusters, J., Preisler, J., Metzger, U., Landolfo, C., Lees, C., Timmerman, D.
BMJ Open, 4.02.2022
Tilføjet 4.02.2022
Objective
Assess experience of healthcare professionals (HCPs) working with ultrasound in obstetrics and gynaecology during the evolving SARS-CoV-2 pandemic, given the new and unprecedented challenges involving viral exposure, personal protective equipment (PPE) and well-being.
Design
Prospective cross-sectional survey study.
Setting
Online international survey. Single-best, open box and Hospital Anxiety and Depression Scale (HADS) questions.
Participants
The survey was sent to 35 509 HCPs in 124 countries and was open from 7 to 21 May 2020. 2237/3237 (69.1%) HCPs from 115 countries who consented to participate completed the survey. 1058 (47.3%) completed the HADS.
Primary outcome measures
Overall prevalence of SARS-CoV-2, depression and anxiety among HCPs in relation to country and PPE availability.
Analyses
Univariate analyses were used to investigate associations without generating erroneous causal conclusions.
Results
Confirmed/suspected SARS-CoV-2 prevalence was 13.0%. PPE provision concerns were raised by 74.1% of participants; highest among trainees/resident physicians (83.9%) and among HCPs in Spain (89.7%). Most participants worked in self-perceived high-risk areas with SARS-CoV-2 (67.5%–87.0%), with proportionately more trainees interacting with suspected/confirmed infected patients (57.1% vs 24.2%–40.6%) and sonographers seeing more patients who did not wear a mask (33.3% vs 13.9%–7.9%). The most frequent PPE combination used was gloves and a surgical mask (22.3%). UK and US respondents reported spending less time self-isolating (8.8 days) and lower satisfaction with their national pandemic response (37.0%–43.0%). 19.8% and 8.8% of respondents met the criteria for moderate to severe anxiety and depression, respectively.
Conclusions
Reported prevalence of SARS-CoV-2 in HCPs is consistent with literature findings. Most respondents used gloves and a surgical mask, with a greater SARS-CoV-2 prevalence compared with those using ‘full’ PPE. HCPs with the least agency (trainees and sonographers) were not only more likely to see high-risk patients but also less likely to be protected. A fifth of respondents reported moderate to severe anxiety.
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Sundararajan, K., Bi, P., Milazzo, A., Poole, A., Reddi, B., Mahmood, M. A.
BMJ Open, 4.02.2022
Tilføjet 4.02.2022
Objectives
This study was conducted to explore the perspectives and opinions of intensive care unit (ICU) nurses and doctors at a COVID-19-designated pandemic hospital concerning the preparedness and response to COVID-19 and to consolidate the lessons learnt for crisis/disaster management in the future.
Design
A qualitative study using in-depth interviews (IDIs) and focus group discussions (FGDs). Purposeful sampling was conducted to identify participants. A semistructured guide was used to facilitate IDIs with individual participants. Two FGDs were conducted, one with the ICU doctors and another with the ICU nurses. Thematic analysis identified themes and subthemes informing about the level of preparedness, response measures, processes, and factors that were either facilitators or those that triggered challenges.
Setting
ICU in a quaternary referral centre affiliated to a university teaching COVID-19-designated pandemic hospital, in Adelaide, South Australia.
Participants
The participants included eight ICU doctors and eight ICU nurses for the IDIs. Another 16 clinicians participated in FGDs.
Results
The study identified six themes relevant to preparedness for, and responses to, COVID-19. The themes included: (1) staff competence and planning, (2) information transfer and communication, (3) education and skills for the safe use of personal protective equipment, (4) team dynamics and clinical practice, (5) leadership, and (6) managing end-of-life situations and expectations of caregivers.
Conclusion
Findings highlight that preparedness and response to the COVID-19 crisis were proportionate to the situation’s gravity. More enablers than barriers were identified. However, opportunities for improvement were recognised in the domains of planning, logistics, self-sufficiency with equipment, operational and strategic oversight, communication and managing end-of-life care.
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Raven, J., Wurie, H., Baba, A., Bah, A. J., Dean, L., Hawkins, K., Idriss, A., Kollie, K., Nallo, G. E., Steege, R., Theobald, S.
BMJ Open, 4.02.2022
Tilføjet 4.02.2022
Objective
To explore how gender influences the way community health workers (CHWs) are managed and supported and the effects on their work experiences.
Setting
Two districts in three fragile countries. Sierra Leone—Kenema and Bonthe districts; Liberia—two districts in Grand Bassa county one with international support for CHW activities and one without: Democratic Republic of Congo (DRC)—Aru and Bunia districts in Ituri Province.
Participants and methods
Qualitative interviews with decision-makers and managers working in community health programmes and managing CHWs (n=36); life history interviews and photovoice with CHWs (n=15, in Sierra Leone only).
Results
While policies were put in place in Sierra Leone and Liberia to attract women to the newly paid position of CHW after the Ebola outbreak, these good intentions evaporated in practice. Gender norms at the community level, literacy levels and patriarchal expectations surrounding paid work meant that fewer women than imagined took up the role. Only in DRC, there were more women than men working as CHWs. Gender roles, norms and expectations in all contexts also affected retention and progression as well as safety, security and travel (over long distance and at night). Women CHWs also juggle between household and childcare responsibilities. Despite this, they were more likely to retain their position while men were more likely to leave and seek better paid employment. CHWs demonstrated agency in negotiating and challenging gender norms within their work and interactions supporting families.
Conclusions
Gender roles and relations shape CHW experiences across multiple levels of the health system. Health systems need to develop gender transformative human resource management strategies to address gender inequities and restrictive gender norms for this critical interface cadre.
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Mademilov, M., Mirzalieva, G., Yusuf, Z. K., Orme, M. W., Bourne, C., Akylbekov, A., Jones, A. V., Miah, R. B., Jones, R., Barton, A., Malcolm, D., Sooronbaev, T., Singh, S. J.
BMJ Open, 4.02.2022
Tilføjet 4.02.2022
Objective
After experiencing tuberculosis (TB), many people develop post-tuberculosis lung disease (PTBLD). Pulmonary rehabilitation (PR) centrally comprising of education and exercise is recommended internationally for people living with chronic respiratory diseases. However, no such service exists in Kyrgyzstan. This study investigated the opinions of healthcare professionals who would be expected to be potential future referrers to PR and adults living with PTBLD about what a PR programme could look like in Kyrgyzstan.
Design
A qualitative study using interviews and focus groups. Grounded theory and thematic analysis were used for data collection and analysis.
Participants
63 participants; 15 referrers (12 male, 3 female; 12 pulmonolgists, 3 TB specialists) and 48 adults (26 male, 22 female) living with PTBLD.
Setting
Participants were recruited from hospital settings in Bishkek and Chuy Region, Kygryzstan.
Methods
Fifteen semistructured interviews were conducted with referrers and nine focus group discussions were conducted with adults living with PTBLD.
Results
Five key themes were developed: (1) living with PTBLD; (2) attitude to PR, which emphasised the perceived importance and potential benefits of implemention; (3) barriers/facilitators to PR, which included time and cost, and the importance of appropriate communication in enabling participation; (4) interventional components of PR, which described culturally and demographically appropriate physical activities including rhythmic movements, dance and volleyball; and (5) psychosocial support, which demonstrated the importance of psychological support for patients coping with the effects of stigma.
Conclusions
Potential referrers and adults living with PTBLD expressed their support for the implementation of PR. The culture-specific and population-specific issues highlighted in this work demonstrate the need to address stigma and provide certain types of exercise training/education modules for this specific clinical population. In other respects the currently known attitudes/barriers to PR, identified in Western research, appear to apply. The principles of culturally adapting PR may be helpful for those looking to establish similar clinical services in other low-income and middle-income countries and in Central Asia in particular.
Trial registration number
ISRCTN11122503.
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Conrado Pedebos, Syma Khalid
Nat Rev Microbiol, 4.02.2022
Tilføjet 4.02.2022
Nature Reviews Microbiology, Published online: 04 February 2022; doi:10.1038/s41579-022-00699-9This month’s Under the Lens discusses a few of the growing number of recent molecular simulation studies that have made substantial contributions towards our mechanistic understanding of the spike protein of SARS-CoV-2.
Læs mere Tjek på PubMedLuisa M. Otero, Gisela Medina‐Martinez, Manuel Sepúlveda, Verónica Acevedo, Mayra Toro, Roberto Barrera
Tropical Medicine & International Health, 4.02.2022
Tilføjet 4.02.2022
Fausto Petrelli, Andrea Luciani, Karen Borgonovo, Mara Ghilardi, Maria Chiara Parati, Daniela Petrò, Veronica Lonati, Angelo Pesenti, Mary Cabiddu
Journal of Medical Virology, 4.02.2022
Tilføjet 4.02.2022
Dandan Tian, Yanhong Sun, Huihong Xu, Qing Ye
Journal of Medical Virology, 4.02.2022
Tilføjet 4.02.2022
Ranjan K. Mohapatra, Ruchi Tiwari, Ashish K. Sarangi, d. Rabiul Islam, Chiranjib Chakraborty, Kuldeep Dhama
Journal of Medical Virology, 4.02.2022
Tilføjet 4.02.2022
BMC Infectious Diseases, 3.02.2022
Tilføjet 4.02.2022
Abstract
Background
In people living with HIV/AIDS (PLWHA), initiation of antiretroviral therapy (ART) leads to sustained effective suppression of viral replication and increasing CD4 + T cell count. However, a fraction of ART-treated patients still fail to reach adequate CD4 + T cell number despite a suppressed viral load (VL), and this phenomenon is defined as immunovirological discordance (IVD). In Africa, several studies have reported immunovirological outcomes of antiretroviral therapy, but little is known about IVD occurrence in Female sex workers (FSW). This study aimed to assess the prevalence of IVD and associated factors among a cohort of HIV infected FSW in Burkina Faso.
Methods
We conducted a cohort study from December 2003 to October 2016. Immunovirological discordance was defined as CD4 + T cell gain < 100 cells/µL despite a suppressed VL (VL < 1000 copies/mL) 12 months after ART initiation. The CD4 + T cells were counted using BD FACSCount™ System and point of care Pima™ CD4 + Analyzer. HIV-1 RNA was quantified by real-time polymerase-chain-reaction assay with the use of the ABI 7000 system. We conducted a logistic regression to identify factors associated with discordant responses.
Results
Among the 123 HIV-1 infected FSW having at least 12 months follow-up on ART, 105 (85.4%) achieved HIV-1 RNA suppression. Among the latter 25 gained less than 100 CD4 + T cells within 12 months follow-up. The IVD rate was 23.8% (95%CI 16.04%–33.11%). After adjustment for age, WHO clinical stage and ART regimen including nucleoside/nucleotide reverse transcriptase inhibitors, only baseline CD4 + T cell count between 200 to 350 cells/µL (adjusted OR: 4.15; 95%CI 1.13–15.22) and 350 to 500 cells/µL (adjusted OR: 17.50; 95%CI 2.68–114.31) remain significantly associated with IVD occurrence.
Conclusions
Immunovirological discordance response was common in FSW with proportions close to those observed in the general population. A diagnosis and personalized follow-up of patients who do not achieve full immune reconstitution would make it possible to avoid complications in terms of morbidity and mortality.
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BMC Infectious Diseases, 3.02.2022
Tilføjet 4.02.2022
Abstract
Background
Global antiretroviral therapy has entered a new era. Integrase strand transfer inhibitor (INSTI) has become the first choice in acquired immunodeficiency syndrome (AIDS) treatment. Because INSTI has high antiviral efficacy, rapid virus inhibition, and good tolerance. However, INSTIs may increase the risk of obesity. Each INSTI has its unique impact on weight gain in patients with human immunodeficiency virus (HIV)/AIDS. This study systematically assessed different INSTIs in causing significant weight gain in HIV/AIDS patients by integrating data from relevant literature.
Methods
PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), China Science and Technology Journal Database (VIP), and Wanfang databases were searched to find studies on the influence of different INSTIs in weight gain. Data on weight change were extracted, and a network meta-analysis was performed.
Results
Eight studies reported weight changes in HIV/AIDS patients were included. Results of the network meta-analysis showed that the weight gain of HIV/AIDS patients treated with Dolutegravir (DTG) was significantly higher than that of Elvitegravir (EVG) [MD = 1.13, (0.18–2.07)]. The consistency test results showed no overall and local inconsistency, and no significant difference in the results of the direct and indirect comparison was detected (p > 0.05). The rank order of probability was DTG (79.2%) > Bictegravir (BIC) (77.9%) > Raltegravir (RAL) (33.2%) > EVG (9.7%), suggesting that DTG may be the INSTI drug that causes the most significant weight gain in HIV/AIDS patients.
Conclusion
According to the data analysis, among the existing INSTIs, DTG may be the drug that causes the most significant weight gain in HIV/AIDS patients, followed by BIC.
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BMC Infectious Diseases, 3.02.2022
Tilføjet 4.02.2022
Abstract
Background
Although global surveillance of antimicrobial resistance (AMR) is considered key in the containment of AMR, data from low- and middle-income countries, especially from sub-Saharan Africa, are scarce. This study describes epidemiology of bloodstream infections and antimicrobial resistance rates in a secondary care hospital in Benin.
Methods
Blood cultures were sampled, according to predefined indications, in BacT/ALERT FA Plus and PF Plus (bioMérieux, Marcy-l’Etoile, France) blood culture bottles (BCB) in a district hospital (Boko hospital) and to a lesser extent in the University hospital of Parakou. These BCB were incubated for 7 days in a standard incubator and twice daily inspected for visual signs of growth. Isolates retrieved from the BCB were processed locally and later shipped to Belgium for reference identification [matrix-assisted laser desorption/ionization time-of-flight spectrometry (MALDI-TOF)] and antibiotic susceptibility testing (disk diffusion and E-tests).
Results
From October 2017 to February 2020, 3353 BCB were sampled, corresponding to 3140 blood cultures (212 cultures consisting of > 1 BCB) and 3082 suspected bloodstream infection (BSI) episodes. Most of these cultures (n = 2471; 78.7%) were sampled in children < 15 years of age. Pathogens were recovered from 383 (12.4%) cultures, corresponding to 381 confirmed BSI. 340 of these pathogens were available and confirmed by reference identification. The most common pathogens were Klebsiella pneumoniae (n = 53; 15.6%), Salmonella Typhi (n = 52; 15.3%) and Staphylococcus aureus (n = 46; 13.5%). AMR rates were high among Enterobacterales, with resistance to third-generation cephalosporins in 77.6% of K. pneumoniae isolates (n = 58), 12.8% of Escherichia coli isolates (n = 49) and 70.5% of Enterobacter cloacae isolates (n = 44). Carbapenemase production was detected in 2 Escherichia coli and 2 Enterobacter cloacae isolates, all of which were of the New Delhi metallo-beta lactamase type. Methicillin resistance was present in 22.4% of S. aureus isolates (n = 49).
Conclusion
Blood cultures were successfully implemented in a district hospital in Benin, especially among the pediatric patient population. Unexpectedly high rates of AMR among Gram-negative bacteria against commonly used antibiotics were found, demonstrating the clinical and scientific importance of clinical bacteriology laboratories at this level of care.
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Lancet Infectious Diseases, 4.02.2022
Tilføjet 4.02.2022
Lange C, Böttger EC, Cambau C et al. Consensus management recommendations for less common non-tuberculous mycobacterial pulmonary diseases. Lancet Infect Dis 2022; published online Jan 25. https://doi.org/10.1016/S1473-3099(21)00586-7—In this Review, Dr Lorenzo Guglielmetti affiliation should have been Sorbonne University, Centre for Immunology and Infectious Diseases, Paris, France; and National Reference Centre for Mycobacteria and Antimycobacterial Resistance, AP-HP GHU Nord, Mycobacteriology, Inserm, IAME UMR 1137, University of Paris, France.
Læs mere Tjek på PubMedKaren H Keddy
Lancet Infectious Diseases, 4.02.2022
Tilføjet 4.02.2022
With data derived from meta-analyses of disease burdens in 73 countries eligible for support from Gavi, the Vaccine Alliance, Birger and colleagues have shown that introduction of routine immunisation of children from age 9 months with typhoid conjugate vaccines (TCVs), with a catch-up programme up to age 15 years, would avert 66·7 million cases and 826 000 deaths caused by typhoid fever over a 10-year period.1
Læs mere Tjek på PubMedRuthie Birger, Marina Antillón, Joke Bilcke, Christiane Dolecek, Gordon Dougan, Andrew J Pollard, Kathleen M Neuzil, Isabel Frost, Ramanan Laxminarayan, Virginia E Pitzer
Lancet Infectious Diseases, 4.02.2022
Tilføjet 4.02.2022
Our results indicate the benefits of prioritising TCV introduction for countries with a high avertable burden of antimicrobial-resistant typhoid fever.
Læs mere Tjek på PubMedNiels Bohse Hendriksen
Trends in Microbiology, 3.02.2022
Tilføjet 4.02.2022
The European Union (EU) has adopted regulation 2019/1009 on fertilizing products with effect from July 2022. However, conflicts exist between the identity of microorganisms designated as biostimulants in the regulation and their affiliation according to recent phylogenetic sequence-based systematics. Here the problems are described, and possible solutions are proposed.
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