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Ingen søgeord valgt.
30 emner vises.
Ayinalem Alemu, Zebenay Workneh Bitew, Getu Diriba, Getachew Seid, Kirubel Eshetu, Musse Tadesse Chekol, Nega Berhe, Balako Gumi
International Journal of Infectious Diseases, 21.05.2022
Tilføjet 21.05.2022
Kohne, Joseph G.; MacLaren, Graeme; Cagino, Leigh; Boonstra, Philip S.; Brodie, Daniel; Barbaro, Ryan P.
Critical Care Medicine, 26.10.2022
Tilføjet 21.05.2022
Objectives:
The use of extracorporeal membrane oxygenation (ECMO) in patients with COVID-19 has been supported by major healthcare organizations, yet the role of specific management strategies during ECMO requires further study. We sought to characterize tracheostomy practices, complications, and outcomes in ECMO-supported patients with acute respiratory failure related to COVID-19.
Design:
Retrospective cohort study.
Setting:
ECMO centers contributing to the Extracorporeal Life Support Organization Registry.
Patients:
Patients 16 years or older receiving venovenous ECMO for respiratory support for: 1) COVID-19 in 2020 and 2021 (through October 2021) and 2) pre-COVID-19 viral pneumonia in 2019.
Interventions:
None.
Measurements and Main Results:
We identified 7,047 patients who received ECMO support for acute respiratory failure related to COVID-19. A total of 32% of patients were recorded as having a tracheostomy procedure during ECMO, and 51% had a tracheostomy at some point during hospitalization. The frequency of tracheostomy was similar in pre-COVID-19 viral pneumonia, but tracheostomies were performed 3 days earlier compared with patients with COVID-19 (median 6.7 d [interquartile range [IQR], 3.0–12.0 d] vs 10.0 d [IQR, 5.0–16.5 d]; p < 0.001). More patients were mobilized with pre-COVID-19 viral pneumonia, but receipt of a tracheostomy during ECMO was associated with increased mobilization in both cohorts. More bleeding complications occurred in patients who received a tracheostomy, with 9% of patients with COVID-19 who received a tracheostomy reported as having surgical site bleeding.
Conclusions:
Tracheostomies are performed in COVID-19 patients receiving ECMO at rates similar to practices in pre-COVID-19 viral pneumonia, although later during the course of ECMO. Receipt of a tracheostomy was associated with increased patient mobilization. Overall mortality was similar between those who did and did not receive a tracheostomy.
Læs mere Tjek på PubMedLonze, Bonnie E.; Spiegler, Peter; Wesson, Russell N.; Alachkar, Nada; Petkova, Eva; Weldon, Elaina P.; Dieter, Rebecca A.; Li, Yi; Quinn, Max; Mattoo, Aprajita; Soomro, Irfana; Cohen, Steven M.; Leung, Sherry; Deterville, Cecilia L.; Landrum, B. Mark; Ali, Muhammad Imran; Cohen, David J.; Singer, Andrew L.; Sen, Ayan; Chong, Edward; Hochman, Judith S.; Troxel, Andrea B.; Montgomery, Robert A.
Critical Care Medicine, 26.10.2022
Tilføjet 21.05.2022
Objectives:
We designed this study to test whether clazakizumab, a direct interleukin-6 inhibitor, benefits patients hospitalized with severe or critical COVID-19 disease accompanied by hyperinflammation.
Design:
Multicenter, randomized, double-blinded, placebo-controlled, seamless phase II/III trial.
Setting:
Five U.S. medical centers.
Patients:
Adults inpatients with severe COVID-19 disease and hyperinflammation.
Interventions:
Eighty-one patients enrolled in phase II, randomized 1:1:1 to low-dose (12.5 mg) or high-dose (25 mg) clazakizumab or placebo. Ninety-seven patients enrolled in phase III, randomized 1:1 to high-dose clazakizumab or placebo.
Measurements and Main Results:
The primary outcome was 28-day ventilator-free survival. Secondary outcomes included overall survival ,frequency and duration of intubation, and frequency and duration of ICU admission. Per Data Safety and Monitoring Board recommendations, additional secondary outcomes describing clinical status and status changes, as measured by an ordinal scale, were added. Bayesian cumulative proportional odds, logistic, and Poisson regression models were used. The low-dose arm was dropped when the phase II study suggested superiority of the high-dose arm. We report on 152 patients, 74 randomized to placebo and 78 to high-dose clazakizumab. Patients receiving clazakizumab had greater odds of 28-day ventilator-free survival (odds ratio [OR] = 3.84; p [OR > 1] 99.9%), as well as overall survival at 28 and 60 days (OR = 1.75; p [OR > 1] 86.5% and OR = 2.53; p [OR > 1] 97.7%). Clazakizumab was associated with lower odds of intubation (OR = 0.2; p [OR] < 1; 99.9%) and ICU admission (OR = 0.26; p [OR < 1] 99.6%); shorter durations of ventilation and ICU stay (risk ratio [RR] < 0.75; p [RR < 1] > 99% for both); and greater odds of improved clinical status at 14, 28, and 60 days (OR = 2.32, p [OR > 1] 98.1%; OR = 3.36, p [OR > 1] 99.6%; and OR = 3.52, p [OR > 1] 99.8%, respectively).
Conclusions:
Clazakizumab significantly improved 28-day ventilator-free survival, 28- and 60-day overall survival, as well as clinical outcomes in hospitalized patients with COVID-19 and hyperinflammation.
Læs mere Tjek på PubMedInfection, 20.05.2022
Tilføjet 21.05.2022
Abstract
Purpose
Omicron is rapidly spreading as a new SARS-CoV-2 variant of concern (VOC). The question whether this new variant has an impact on SARS-CoV-2 rapid antigen test (RAT) performance is of utmost importance. To obtain an initial estimate regarding differences of RATs in detecting omicron and delta, seven commonly used SARS-CoV-2 RATs from different manufacturers were analysed using cell culture supernatants and clinical specimens.
Methods
For this purpose, cell culture-expanded omicron and delta preparations were serially diluted in Dulbecco’s modified Eagle’s Medium (DMEM) and the Limit of Detection (LoD) for both VOCs was determined. Additionally, clinical specimens stored in viral transport media or saline (n = 51) were investigated to complement in vitro results with cell culture supernatants. Ct values and RNA concentrations were determined via quantitative reverse transcription polymerase chain reaction (RT-qPCR).
Results
The in vitro determination of the LoD showed no obvious differences in detection of omicron and delta for the RATs examined. The LoD in this study was at a dilution level of 1:1,000 (corresponding to 3.0—5.6 × 106 RNA copies/mL) for tests I–V and at a dilution level of 1:100 (corresponding to 3.7—4.9 × 107 RNA copies/mL) for tests VI and VII. Based on clinical specimens, no obvious differences were observed between RAT positivity rates when comparing omicron to delta in this study setting. Overall positivity rates varied between manufacturers with 30–81% for omicron and 42–71% for delta. Test VII was only conducted in vitro with cell culture supernatants for feasibility reasons. In the range of Ct < 23, positivity rates were 50–100% for omicron and 67–93% for delta.
Conclusion
In this study, RATs from various manufacturers were investigated, which displayed no obvious differences in terms of analytical LoD in vitro and RAT positivity rates based on clinical samples comparing the VOCs omicron and delta. However, differences between tests produced by various manufacturers were detected. In terms of clinical samples, a focus of this study was on specimens with high virus concentrations. Further systematic, clinical and laboratory studies utilizing large datasets are urgently needed to confirm reliable performance in terms of sensitivity and specificity for all individual RATs and SARS-CoV-2 variants.
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BMC Infectious Diseases, 21.05.2022
Tilføjet 21.05.2022
Abstract
Background
Contact patterns play a key role in the spread of respiratory infectious diseases in human populations. During the COVID-19 pandemic, the regular contact patterns of the population have been disrupted due to social distancing both imposed by the authorities and individual choices. Many studies have focused on age-mixing patterns before the COVID-19 pandemic, but they provide very little information about the mixing patterns in the COVID-19 era. In this study, we aim at quantifying human heterogeneous mixing patterns immediately after lockdowns implemented to contain COVID-19 spread in China were lifted. We also provide an illustrative example of how the collected mixing patterns can be used in a simulation study of SARS-CoV-2 transmission.
Methods and results
In this work, a contact survey was conducted in Chinese provinces outside Hubei in March 2020, right after lockdowns were lifted. We then leveraged the estimated mixing patterns to calibrate a mathematical model of SARS-CoV-2 transmission. Study participants reported 2.3 contacts per day (IQR: 1.0–3.0) and the mean per-contact duration was 7.0 h (IQR: 1.0–10.0). No significant differences in average contact number and contact duration were observed between provinces, the number of recorded contacts did not show a clear trend by age, and most of the recorded contacts occurred with family members (about 78%). The simulation study highlights the importance of considering age-specific contact patterns to estimate the COVID-19 burden.
Conclusions
Our findings suggest that, despite lockdowns were no longer in place at the time of the survey, people were still heavily limiting their contacts as compared to the pre-pandemic situation.
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BMC Infectious Diseases, 21.05.2022
Tilføjet 21.05.2022
Abstract
Background
There is a limited understanding of how diarrhoeal cases across other household members influence the likelihood of diarrhoea in young children (aged 1–4 years).
Methods
We surveyed 16,025 individuals from 3421 households in 17 villages in Uganda. Using logistic regressions with standard errors clustered by household, diarrhoeal cases within households were used to predict diarrhoeal outcomes in young children. Regressions were adjusted for socio-demographic, water, sanitation, and hygiene (WASH), and ecological covariates. Selection bias for households with (1632/3421) and without (1789/3421) young children was examined.
Results
Diarrhoeal prevalence was 13.7% (2118/16,025) across all study participants and 18.5% (439/2368) in young children. Young children in households with any other diarrhoeal cases were 5.71 times more likely to have diarrhoea than young children in households without any other diarrhoeal cases (95% CI: 4.48–7.26), increasing to over 29 times more likely when the other diarrhoeal case was in another young child (95% CI: 16.29–54.80). Diarrhoeal cases in older household members (aged ≥ 5 years) and their influence on the likelihood of diarrhoea in young children attenuated with age. School-aged children (5–14 years) had a greater influence on diarrhoeal cases in young children (Odds Ratio 2.70, 95% CI: 2.03–3.56) than adults of reproductive age (15–49 years; Odds Ratio 1.96, 95% CI: 1.47–2.59). Diarrhoeal cases in individuals aged ≥ 50 years were not significantly associated with diarrhoeal outcomes in young children (P > 0.05). These age-related differences in diarrhoeal exposures were not driven by sex. The magnitude and significance of the odds ratios remained similar when odds ratios were compared by sex within each age group. WASH factors did not influence the likelihood of diarrhoea in young children, despite influencing the likelihood of diarrhoea in school-aged children and adults. Households with young children differed from households without young children by diarrhoeal prevalence, household size, and village WASH infrastructure and ecology.
Conclusions
Other diarrhoeal cases within households strongly influence the likelihood of diarrhoea in young children, and when controlled, removed the influence of WASH factors. Future research on childhood diarrhoea should consider effects of diarrhoeal cases within households and explore pathogen transmission between household members.
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BMC Infectious Diseases, 20.05.2022
Tilføjet 21.05.2022
Abstract
Background
Quantification of acquisition routes of antibiotic resistant bacteria (ARB) is pivotal for understanding transmission dynamics and designing cost-effective interventions. Different methods have been used to quantify the importance of transmission routes, such as relative risks, odds ratios (OR), genomic comparisons and basic reproduction numbers. We systematically reviewed reported estimates on acquisition routes’ contributions of ARB in humans, animals, water and the environment and assessed the methods used to quantify the importance of transmission routes.
Methods
PubMed and EMBASE were searched, resulting in 6054 articles published up until January 1st, 2019. Full text screening was performed on 525 articles and 277 are included.
Results
We extracted 718 estimates with S. aureus (n = 273), E. coli (n = 157) and Enterobacteriaceae (n = 99) being studied most frequently. Most estimates were derived from statistical methods (n = 560), mainly expressed as risks (n = 246) and ORs (n = 239), followed by genetic comparisons (n = 85), modelling (n = 62) and dosage of ARB ingested (n = 17). Transmission routes analysed most frequently were occupational exposure (n = 157), travelling (n = 110) and contacts with carriers (n = 83). Studies were mostly performed in the United States (n = 142), the Netherlands (n = 87) and Germany (n = 60). Comparison of methods was not possible as studies using different methods to estimate the same route were lacking. Due to study heterogeneity not all estimates by the same method could be pooled.
Conclusion
Despite an abundance of published data the relative importance of transmission routes of ARB has not been accurately quantified. Links between exposure and acquisition are often present, but the frequency of exposure is missing, which disables estimation of transmission routes’ importance. To create effective policies reducing ARB, estimates of transmission should be weighed by the frequency of exposure occurrence.
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Teixeira GS, Andrade AA, Torres LR, Couto‐Lima D, Moreira OC, Abreu RS, Waghabi MC, de Souza EM
Journal of Medical Virology, 21.05.2022
Tilføjet 21.05.2022
Qing‐Lei Zeng, Zu‐Jiang Yu, Jun Lv, Hong‐Xu Zhang, Bin Wang, Xiao‐Ping Dong, Zhi‐Min Chen, Guang‐Lin Cui, Fanpu Ji
Journal of Medical Virology, 21.05.2022
Tilføjet 21.05.2022
Núria Soldevila, Luca Basile, Ana Martínez, Núria Torner, M Ángeles Marcos, MMar Mosquera, Andrés Antón, Cristina Andrés, Cristina Rius, Tomàs Pumarola, Ángela Domínguez, and the PIDIRAC Surveillance of Hospitalized Cases of Severe Influenza in Catalonia Working Group
Journal of Medical Virology, 20.05.2022
Tilføjet 21.05.2022
Alok Kumar Tembhurne, Amita Maheshwari, Himangi Warke, Hemangi Chaudhari, Shilpa C Kerkar, Kedar Deodhar, Bharat Rekhi, Jayanti Mania‐Pramanik
Journal of Medical Virology, 20.05.2022
Tilføjet 21.05.2022
Fu‐lu Chu, Chen Li, Li Chen, Bo Dong, Yang Qiu, Yiqing Liu
Journal of Medical Virology, 20.05.2022
Tilføjet 21.05.2022
Brecht Ingelbeen, Delphin M. Phanzu, Marie-France Phoba, Mi Y.N. Budiongo, Neamin M. Berhe, Frédéric K. Kamba, Lisette Kalonji, Bijou Mbangi, Liselotte Hardy, Bieke Tack, Justin Im, Leonardo W. Heyerdahl, Raquel Inocencio Da Luz, Marc J.M. Bonten, Octavie Lunguya, Jan Jacobs, Placide Mbala, Marianne A.B. van der Sande
Clinical Microbiology and Infection, 20.05.2022
Tilføjet 21.05.2022
In the Democratic Republic of Congo and other low-resource countries, community-acquired pathogens are increasingly resistant to most locally available antibiotics. To guide efforts to optimize antibiotic use to limit antibiotic resistance, we quantified healthcare provider–specific and community-wide antibiotic use.
Læs mere Tjek på PubMedUrsula Hofer
Nat Rev Microbiol, 20.05.2022
Tilføjet 21.05.2022
Nature Reviews Microbiology, Published online: 20 May 2022; doi:10.1038/s41579-022-00750-9This study used engineered bacteria to record the transcriptional responses of transiting bacteria in the gut environment.
Læs mere Tjek på PubMedUrsula Hofer
Nat Rev Microbiol, 20.05.2022
Tilføjet 21.05.2022
Nature Reviews Microbiology, Published online: 20 May 2022; doi:10.1038/s41579-022-00749-2A study in mice shows that antibiotic treatment predisposes to invasive fungal infection through gut dysbiosis and barrier dysfunction.
Læs mere Tjek på PubMedZobrist S, Oliveira-Silva M, Vieira A, et al.
Journal of Infectious Diseases, 20.05.2022
Tilføjet 21.05.2022
AbstractBackgroundPoint-of-care and decentralized testing for SARS-CoV-2 is critical to inform public health responses. Performance evaluations in priority use cases such as contact tracing can highlight trade-offs in test selection and testing strategies.MethodsA prospective diagnostic accuracy study was conducted among close contacts of COVID-19 cases in Brazil. Two anterior nares swabs (ANS), a nasopharyngeal swab (NPS), and saliva were collected at all visits. Vaccination history and symptoms were assessed. Household contacts were followed longitudinally. Three rapid antigen tests and one molecular method were evaluated for usability and performance against reference RT-PCR on NPS.ResultsFifty index cases and 214 contacts (64 household) were enrolled. Sixty-five contacts were RT-PCR positive during at least one visit. Vaccination did not influence viral load. Gamma variants were most prevalent; Delta emerged increasingly during implementation. Overall sensitivity of evaluated tests ranged from 33%–76%. Performance was higher among symptomatic cases and cases with Ct < 34 and lower among oligo/asymptomatic cases. Assuming a 24-hour time-to-result for RT-PCR, the cumulative sensitivity of an ANS rapid antigen test was >70% and almost 90% after four days.ConclusionsThe near immediate time-to-result for antigen tests significantly offsets lower analytical sensitivity in settings where RT-PCR results are delayed or unavailable.
Læs mere Tjek på PubMedWu D, Chen Y, sun L, et al.
Journal of Infectious Diseases, 20.05.2022
Tilføjet 21.05.2022
Nalin D.
Journal of Infectious Diseases, 18.05.2022
Tilføjet 21.05.2022
Vection S, O'Callaghan D, Keriel A.
FEMS Microbiology Reviews, 20.05.2022
Tilføjet 21.05.2022
AbstractThe eukaryotic protein CD98hc (also known as 4F2, FRP-1 or SLC3A2) is a membrane glycoprotein and one of the heavy chains of the family of heterodimeric amino acids transporters. It can associate with any of 6 different light chains to form distinct amino acid transporters. CD98hc is also involved in mediation of intracellular integrin signaling. Besides its physiological roles in the development of the placenta and the immune system, CD98hc is important during pathological processes such as tumorigenesis and host-pathogen interaction. Since its first identification as Fusion Regulatory Protein 1 regulating cell fusion in cells infected by the Newcastle disease virus, CD98hc has been reported to be mediating many viral, apicomplexan, and bacterial infectious processes. In this review we describe the role of CD98hc and its associated light chains in bacterial, apicomplexan, and viral pathogenesis. We also discuss the consequences of infection on the expression and localization of these proteins. The identification of the cellular processes in which CD98hc is involved during pathogenesis highlights the key role of this host protein in infectious diseases.
Læs mere Tjek på PubMedTordoff DM, Dombrowski JC, Ramchandani MS, et al.
Clinical Infectious Diseases, 20.05.2022
Tilføjet 21.05.2022
AbstractBackgroundIn 2018, the municipal Sexual Health Clinic in Seattle implemented trans-inclusive questions about sexual behavior, anatomy, gender-affirming surgeries, and STI symptoms in the clinic’s computer-assisted self-interview (CASI) to improve care for transgender and non-binary (TNB) patients.MethodsWe calculated test positivity and the proportion of TNB patient visits that received testing for HIV, syphilis, pharyngeal, rectal and urogenital gonorrhea (GC) and chlamydia (CT) before (5/2016-12/2018) and after (12/2018-2/2020) implementation of new CASI questions. We then calculated the proportion of asymptomatic patients who received anatomic-site specific screening based on reported exposures.ResultsThere were 434 TNB patients with 489 and 337 clinic visits during the two periods, respectively. Non-binary patients assigned male at birth (AMAB) had the highest prevalence of GC (10% pharyngeal, 14% rectal, 12% urogenital). Transgender women, transgender men, and non-binary people AMAB had a high prevalence of rectal CT (10%, 9%, and 13%, respectively) and syphilis (9%, 5%, and 8%). Asymptomatic transgender women, transgender men and non-binary patients AMAB who reported exposures were more likely to receive extragenital GC/CT screening compared to non-binary patients assigned female at birth. After implementing trans-inclusive medical history questions, there was a 33% increase in the number of annual TNB patient visits, but no statistically significant increase HIV/STI testing among TNB patients.ConclusionsTNB people at our clinic had a high prevalence of extragenital STIs and syphilis. Implementation of trans-inclusive medical history questions at a clinic that serves cisgender and transgender patients was feasible and important for improving the quality of affirming and inclusive sexual healthcare.
Læs mere Tjek på PubMedRobinson J.
Clinical Infectious Diseases, 20.05.2022
Tilføjet 21.05.2022
Tenforde MW, Self WH, Zhu Y, et al.
Clinical Infectious Diseases, 17.05.2022
Tilføjet 21.05.2022
AbstractBackgroundCOVID-19 mRNA vaccines were authorized in the United States in December 2020. Although vaccine effectiveness (VE) against mild infection declines markedly after several months, limited understanding exists on the long-term durability of protection against COVID-19-associated hospitalization.MethodsCase control analysis of adults (≥18 years) hospitalized at 21 hospitals in 18 states March 11 – December 15, 2021, including COVID-19 case patients and RT-PCR-negative controls. We included adults who were unvaccinated or vaccinated with two doses of a mRNA vaccine before the date of illness onset. VE over time was assessed using logistic regression comparing odds of vaccination in cases versus controls, adjusting for confounders. Models included dichotomous time (<180 vs ≥180 days since dose two) and continuous time modeled using restricted cubic splines.Results10,078 patients were included, 4906 cases (23% vaccinated) and 5172 controls (62% vaccinated). Median age was 60 years (IQR 46–70), 56% were non-Hispanic White, and 81% had ≥1 medical condition. Among immunocompetent adults, VE <180 days was 90% (95%CI: 88–91) vs 82% (95%CI: 79–85) at ≥180 days (p < 0.001). VE declined for Pfizer-BioNTech (88% to 79%, p < 0.001) and Moderna (93% to 87%, p < 0.001) products, for younger adults (18-64 years) [91% to 87%, p = 0.005], and for adults ≥65 years of age (87% to 78%, p < 0.001). In models using restricted cubic splines, similar changes were observed.ConclusionIn a period largely pre-dating Omicron variant circulation, effectiveness of two mRNA doses against COVID-19-associated hospitalization was largely sustained through 9 months.
Læs mere Tjek på PubMedNoémie de Cacqueray, Déborah Hirt, Yi Zheng, Emmanuelle Bille, Pierre Louis Leger, Jérôme Rambaud, Julie Toubiana, Anais Chosidow, Sophie Vimont, Delphine Callot, Laurent Chouchana, Agathe Béranger, Jean Marc Tréluyer, Sihem Benaboud, Mehdi Oualha
Clinical Microbiology and Infection, 20.05.2022
Tilføjet 20.05.2022
Cefepime is commonly used in pediatric intensive care units (PICUs), where unpredictable variations in the patients’ pharmacokinetic (PK) variables may require drug dose adjustments. The objectives of the present study were to build a population PK model for cefepime in critically ill children and to optimize individual initial dosing regimens.
Læs mere Tjek på PubMedThomas C. Brachert, Thomas Felis, Cyril Gagnaison, Marlene Hoehle, Markus Reuter, Philipp M. Spreter
Science Advances, 20.05.2022
Tilføjet 20.05.2022
Science Advances, <a href='https://www.science.org/toc/sciadv/8/20'>Volume 8, Issue 20</a>, May 2022.
Læs mere Tjek på PubMedLivo F. Esemu, Honore Awanakam, Dieudonne Nanfa, Michael Besong, Idriss Tsayem, Celine Nguefeu Nkenfou, Jude Bigoga, Rose Leke, Sobngwi Eugene, Lishomwa C. Ndhlovu, Gabriel Ekali Loni
PLoS One Infectious Diseases, 20.05.2022
Tilføjet 20.05.2022
by Livo F. Esemu, Honore Awanakam, Dieudonne Nanfa, Michael Besong, Idriss Tsayem, Celine Nguefeu Nkenfou, Jude Bigoga, Rose Leke, Sobngwi Eugene, Lishomwa C. Ndhlovu, Gabriel Ekali Loni
Human immunodeficiency virus (HIV)-1 infection during pregnancy reduces the transplacental transfer of protective maternal antibodies needed to confer immunity during early postnatal life. However, the mediation of MicroRNA in this dysregulation is not well understood MicroRNAs 3181 and 199a have been shown to mediate neonatal Fc receptor (FcRn)-like transmembrane antibody transfer and endocytosis respectively but their expression levels in the placenta and plasma in women living with HIV have not been extensively investigated. The objective of this study was to determine how the expression levels of miR-3181 and miR-199a in the placenta and plasma are affected in women chronically infected with HIV who are on antiretroviral therapy (ART) and are virally suppressed at delivery. In this pilot case-control study, plasma and placenta biopsies were obtained from 36 (18 HIV+ and 18 HIV-) Cameroonian women at delivery. MicroRNAs 3181 and 199a expression levels were measured using RT-qPCR, data was analyzed using SPSS22.0 and R 3.60, and p values below 0.05 were considered statistically significant. All the HIV-infected women were on known ART regimens and were virally suppressed. There was no significant difference in the levels of miR-3181 (p>0.05) in the placenta and plasma amongst HIV-infected and HIV uninfected women. The expression levels of miR-199a were significantly greater in the plasma compared to the placenta of HIV+ (p = 0.00005) and HIV- (p = 0.027) women. Moreover, there was a significantly higher (p = 0.02) level of miR-199a in the plasma of women with HIV and their uninfected counterparts. Linear regression models adjusted for systolic pressure showed no significant difference (p>0.05) in the levels of miR-199a and miR-3181 in both the placenta and plasma due to HIV infection. Our findings suggest that even though ART uptake and viral suppression might help in maintaining miR3181 and miR199a levels in the placenta of women with HIV at comparative levels to those of their HIV negative counterparts, the significantly higher levels of miR-199a in the plasma of women with HIV compared to the placenta might highlight lurking systemic dangers and requires further investigation.
Læs mere Tjek på PubMedRebecca N. Evans, Jessica Harris, Chris A. Rogers, Alasdair MacGowan
PLoS One Infectious Diseases, 20.05.2022
Tilføjet 20.05.2022
by Rebecca N. Evans, Jessica Harris, Chris A. Rogers, Alasdair MacGowan
Objective The aim of this study was to emulate the MERINO trial of piperacillin-tazobactam vs meropenem for the definitive treatment of bloodstream infection (BSI) caused by ceftriaxone-nonsusceptible E coli or Klebsiella spp. Methods Data from an observational study of BSI and a randomised controlled trial of a rapid diagnostic in BSI were used to emulate the MERINO trial. The primary outcome of the emulated trial was 28-day mortality after blood culture. Outcomes were compared using logistic regression adjusted for propensity score for emulated intervention. Results Of the 6,371 observational study and RCT participants, 1,968 had a bloodstream infection with E. coli or Klebsiella spp. of which 121 met the eligibility criteria. In the emulated trial, a total of 14/82 patients (17.1%) allocated to piperacillin-tazobactam met the primary outcome compared with 6/39 (15.4%) in the meropenem group (unadjusted odds ratio 1.13 (95% CI 0.40 to 3.21)). After adjustment for propensity score, the odds ratio increased to 1.31 (95% CI 0.40 to 4.26). This difference is in the same direction but of a smaller magnitudethan observed in the MERINO trial, where 30-day mortality was met by 23/187 patients (12.3%) in the piperacillin-tazobactam and 7/191 (3.7%) in the meropenem group (unadjusted odds ratio of 3.69 (95% CI 1.48 to 10.41)). Conclusions The mortality rate in an emulated trial population was more than double the mortality rate in the MERINO trial. The methodology used attempts to address the concern that previous results could be explained by biases such as selection bias and uncontrolled confounding and provides information on how a trial such as the MERINO trial may have performed in the NHS.
Læs mere Tjek på PubMedMalathi Murugesan, Prasad Mathews, Hema Paul, Rajiv Karthik, Joy John Mammen, Priscilla Rupali
PLoS One Infectious Diseases, 20.05.2022
Tilføjet 20.05.2022
by Malathi Murugesan, Prasad Mathews, Hema Paul, Rajiv Karthik, Joy John Mammen, Priscilla Rupali
Background The emergence of newer variants with the immune escape potential raises concerns about breakthroughs and re-infections resulting in future waves of infection. We examined the protective effect of prior COVID-19 disease and vaccination on infection rates among a cohort of healthcare workers (HCW) in South India during the second wave driven mainly by the delta variant. Methods and findings Symptomatic HCWs were routinely tested by RT-PCR as per institutional policy. Vaccination was offered to all HCWs in late January, and the details were documented. We set up a non-concurrent cohort to document infection rates and estimated protective efficacy of prior infection and vaccination between 16th Apr to 31st May 2021, using a Cox proportional hazards model with time-varying covariates adjusting for daily incidence. Between June 2020 and May 2021, 2735 (23.9%) of 11,405 HCWs were infected, with 1412, including 32 re-infections, reported during the second wave. 6863 HCWs received two doses of vaccine and 1905 one dose. The protective efficacy of prior infection against symptomatic infection was 86.0% (95% CI 76.7%–91.6%). Vaccination combined with prior infection provided 91.1% (95% CI 84.1%–94.9%) efficacy. In the absence of prior infection, vaccine efficacy against symptomatic infection during the second wave was 31.8% (95% CI 23.5%– 39.1%). Conclusions Prior infection provided substantial protection against symptomatic re-infection and severe disease during a delta variant driven second wave in a cohort of health care workers.
Læs mere Tjek på PubMedDania AL-Najjar
PLoS One Infectious Diseases, 20.05.2022
Tilføjet 20.05.2022
by Dania AL-Najjar
This study aims to explore the effects of COVID-19 indicators and the oil price crash on the Saudi Exchange (Tadawul) Trading Volume and Tadawul Index (TASI) for the period from January 1, 2020, to December 2, 2020. The independent variable is oil price, and the COVID-19 indicators are lockdown, first and second decreases of Repo and Reverse Repo rates, Saudi government response, and cumulative deceased cases. The study adopts two phases. In the first phase, linear regression is used to identify the most influential variables affecting Trading volume and TASI. According to the results, the trading volume model is significant with an adjusted R2 of 65.5% and a standard error of 81. The findings of this model indicate a positive effect of cumulative deceased cases and first decrease of Repo and Reverse Repo rates and a negative effect of oil prices on Trading Volume. The TASI model is significant with an adjusted R2 of 86% and a standard error of 270. The results of this model indicate that lockdown and first decrease of Repo and Reverse Repo rates have a significant negative effect on TASI while the cumulative decrease in cases and oil prices have a positive effect on TASI. In the second phase, linear regression, and neural network predictors (with and without validation) are applied to predict the future TASI values. The neural network model indicates that the neural networks can achieve the best results if all independent variables are used together. By combining the collected results, the study finds that oil price has the most substantial effect on the changes in TASI as compared to the COVID-19 indicators. The results indicate that TASI rapidly follows the changes in oil prices.
Læs mere Tjek på PubMedChotiman Chinvararak, Nitchawan Kerdcharoen, Wisarat Pruttithavorn, Nongnuch Polruamngern, Thanin Asawaroekwisoot, Wanida Munsukpol, Pantri Kirdchok
PLoS One Infectious Diseases, 20.05.2022
Tilføjet 20.05.2022
by Chotiman Chinvararak, Nitchawan Kerdcharoen, Wisarat Pruttithavorn, Nongnuch Polruamngern, Thanin Asawaroekwisoot, Wanida Munsukpol, Pantri Kirdchok
Objectives This study aimed to measure the prevalence of burnout syndrome, anxiety, depression, and post-traumatic disorders (PTSD), as well as examine their associated factors among Thai healthcare workers (HCWs) during COVID-19 outbreak. Method We employed a multiple-method design at a tertiary-care hospital in Bangkok between May 22, 2021 and June 30, 2021 by using an online survey. The information included demographic characteristics, work details, perceived support, PTSD symptoms, Maslach Burnout Inventory: General Survey (MBI-GS), General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire (PHQ-2 and PHQ-9), and narrative response to an open-ended question. The associated factors of mental health problems were analysed by multiple logistic regression analyses. The qualitative data were analysed by the content analysis method. Results A total of 986 HCWs (89.1% female; mean age = 34.89 ± 11.05 years) responded to the survey. 16.3%,16%, and 53.5% of respondents had a high level of emotional exhaustion, depersonalisation, and diminished personal achievement, respectively. 33.1%, 13.8%, and 2.3% of respondents had anxiety, depression, and PTSD. Risk factors of emotional exhaustion were male sex (ORadj = 2.29), nurses (ORadj = 3.04), doctors (ORadj = 4.29), working at COVID-19 inpatient unit (ORadj = 2.97), and working at COVID-19 intensive care unit (ORadj = 3.00). Additionally, preexisting mental illness was associated with anxiety (ORadj = 2.89), depression (ORadj = 3.47), and PTSD (ORadj = 4.06). From qualitative analysis, participants reported that these factors would improve their mental health: supportive and respectful colleagues, appropriate financial compensation, reduced workload, clarity of policy and communication channel, and adequate personal protective equipment. Conclusions Thai HCWs experienced negative mental health outcomes during the COVID-19 pandemic substantially. This issue needs attention and actions should be implemented to support them.
Læs mere Tjek på PubMedAaron Trimble, Kirby Zeman, Jihong Wu, Agathe Ceppe, William Bennett, Scott Donaldson
PLoS One Infectious Diseases, 20.05.2022
Tilføjet 20.05.2022
by Aaron Trimble, Kirby Zeman, Jihong Wu, Agathe Ceppe, William Bennett, Scott Donaldson
Background Cystic fibrosis (CF) is an inherited disorder causing impaired mucociliary clearance within the respiratory tract, and is associated with bronchiectasis, chronic respiratory infections, and early death. Airway clearance therapies have long been a cornerstone of management of individuals with CF, although evidence supporting their use is lacking. We designed a randomized controlled trial to quantitatively compare the effects of different forms of airway clearance on mucociliary clearance. Methods Three different physiotherapy methods to augment cough-clearance were studied in addition to cough-clearance alone: high-frequency chest-wall oscillating vest, oscillatory positive expiratory pressure, and whole-body vibration. We used gamma scintigraphy after inhalation of radiolabeled particles to quantify mucus clearance before, during, and after physiotherapy. As secondary endpoints, we measured concentrations of small molecules in exhaled breath that may impact mucus clearance. Results Ten subjects were enrolled and completed study procedures. No differences were identified between any method of airway clearance, including cough clearance alone. We did identify changes in certain small molecule concentrations in exhaled breath following airway clearance. Conclusions Due to the limitations of this study, we do not believe the negative results suggest a change in clinical practice with regard to airway clearance. Findings pertaining to small molecules in exhaled breath may serve as future opportunities for study.
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