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Achaporn Yipsirimetee, Phornpimon Tipthara, Borimas Hanboonkunupakarn, Rupam Tripura, Dysoley Lek, Krittikorn Kümpornsin, Marcus C. S. Lee, Jetsumon Sattabongkot, Arjen M. Dondorp, Nicholas J. White, Kevin C. Kobylinski, Joel Tarning, Kesinee ChotivanichaDepartment of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, ThailandbMahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, ThailandcCentre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United KingdomdNational Center for Parasitology, Entomology and Malaria Control, Phnom Penh, CambodiaeWellcome Sanger Institute, Wellcome Genome Campus, Hinxton, United KingdomfCalibr, Division of the Scripps Research Institute, La Jolla, California, USAgMahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, ThailandhDepartment of Entomology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
Antimicrobial Agents And Chemotherapy, 21.06.2023
Tilføjet 21.06.2023
Petersen, J. J., Jorgensen, C. K., Faltermeier, P., Siddiqui, F., Feinberg, J., Nielsen, E. E., Torp Kristensen, A., Juul, S., Holgersson, J., Nielsen, N., Bentzer, P., Thabane, L., Kwasi Korang, S., Klingenberg, S., Gluud, C., Jakobsen, J. C.
BMJ Open, 21.06.2023
Tilføjet 21.06.2023
ObjectivesTo assess the effects of interventions authorised by the European Medicines Agency (EMA) or the US Food and Drug Administration (FDA) for prevention of COVID-19 progression to severe disease in outpatients. SettingOutpatient treatment. ParticipantsParticipants with a diagnosis of COVID-19 and the associated SARS-CoV-2 virus irrespective of age, sex and comorbidities. InterventionsDrug interventions authorised by EMA or FDA. Primary outcome measuresPrimary outcomes were all-cause mortality and serious adverse events. ResultsWe included 17 clinical trials randomising 16 257 participants to 8 different interventions authorised by EMA or FDA. 15/17 of the included trials (88.2%) were assessed at high risk of bias. Only molnupiravir and ritonavir-boosted nirmatrelvir seemed to improve both our primary outcomes. Meta-analyses showed that molnupiravir reduced the risk of death (relative risk (RR) 0.11, 95% CI 0.02 to 0.64; p=0.0145, 2 trials; very low certainty of evidence) and serious adverse events (RR 0.63, 95% CI 0.47 to 0.84; p=0.0018, 5 trials; very low certainty of evidence). Fisher’s exact test showed that ritonavir-boosted nirmatrelvir reduced the risk of death (p=0.0002, 1 trial; very low certainty of evidence) and serious adverse events (p
Læs mere Tjek på PubMedAlami, A., Krewski, D., Farhat, N., Mattison, D., Wilson, K., Gravel, C. A., Farrell, P. J., Crispo, J. A. G., Haddad, N., Perez-Lloret, S., Villeneuve, P. J.
BMJ Open, 21.06.2023
Tilføjet 21.06.2023
ObjectiveTo summarise the available evidence on the risk of myocarditis and/or pericarditis following mRNA COVID-19 vaccination, compared with the risk among unvaccinated individuals in the absence of COVID-19 infection. DesignSystematic review and meta-analysis. Data sourcesElectronic databases (Medline, Embase, Web of Science and WHO Global Literature on Coronavirus Disease), preprint repositories (medRxiv and bioRxiv), reference lists and grey literature were searched from 1 December 2020 until 31 October 2022. Study selectionEpidemiological studies of individuals of any age who received at least one dose of an mRNA COVID-19 vaccine, reported a risk of myo/pericarditis and compared the risk of myo/pericarditis to individuals who did not receive any dose of an mRNA COVID-19 vaccine. Data extraction and synthesisTwo reviewers independently conducted screening and data extraction. The rate of myo/pericarditis among vaccinated and unvaccinated groups was recorded, and the rate ratios were calculated. Additionally, the total number of individuals, case ascertainment criteria, percentage of males and history of SARS-CoV-2 infection were extracted for each study. Meta-analysis was done using a random-effects model. ResultsSeven studies met the inclusion criteria, of which six were included in the quantitative synthesis. Our meta-analysis indicates that within 30-day follow-up period, vaccinated individuals were twice as likely to develop myo/pericarditis in the absence of SARS-CoV-2 infection compared to unvaccinated individuals, with a rate ratio of 2.05 (95% CI 1.49–2.82). ConclusionAlthough the absolute number of observed myo/pericarditis cases remains quite low, a higher risk was detected in those who received mRNA COVID-19 vaccinations compared with unvaccinated individuals in the absence of SARS-CoV-2 infection. Given the effectiveness of mRNA COVID-19 vaccines in preventing severe illnesses, hospitalisations and deaths, future research should focus on accurately determining the rates of myo/pericarditis linked to mRNA COVID-19 vaccines, understanding the biological mechanisms behind these rare cardiac events and identifying those most at risk.
Læs mere Tjek på PubMedChipanta, D., Kapambwe, S., Nyondo-Mipando, A. L., Pascoe, M., Amo-Agyei, S., Bohlius, J., Estill, J., Keiser, O.
BMJ Open, 21.06.2023
Tilføjet 21.06.2023
ObjectivesWe examined age, residence, education and wealth inequalities and their combinations on cervical precancer screening probabilities for women. We hypothesised that inequalities in screening favoured women who were older, lived in urban areas, were more educated and wealthier. DesignCross-sectional study using Population-Based HIV Impact Assessment data. SettingEthiopia, Malawi, Rwanda, Tanzania, Zambia and Zimbabwe. Differences in screening rates were analysed using multivariable logistic regressions, controlling for age, residence, education and wealth. Inequalities in screening probability were estimated using marginal effects models. ParticipantsWomen aged 25–49 years, reporting screening. Outcome measuresSelf-reported screening rates, and their inequalities in percentage points, with differences of 20%+ defined as high inequality, 5%–20% as medium, 0%–5% as low. ResultsThe sample size of participants ranged from 5882 in Ethiopia to 9186 in Tanzania. The screening rates were low in the surveyed countries, ranging from 3.5% (95% CI 3.1% to 4.0%) in Rwanda to 17.1% (95% CI 15.8% to 18.5%) and 17.4% (95% CI 16.1% to 18.8%) in Zambia and Zimbabwe. Inequalities in screening rates were low based on covariates. Combining the inequalities led to significant inequalities in screening probabilities between women living in rural areas aged 25–34 years, with a primary education level, from the lowest wealth quintile, and women living in urban areas aged 35–49 years, with the highest education level, from the highest wealth quintile, ranging from 4.4% in Rwanda to 44.6% in Zimbabwe. ConclusionsCervical precancer screening rates were inequitable and low. No country surveyed achieved one-third of the WHO’s target of screening 70% of eligible women by 2030. Combining inequalities led to high inequalities, preventing women who were younger, lived in rural areas, were uneducated, and from the lowest wealth quintile from screening. Governments should include and monitor equity in their cervical precancer screening programmes.
Læs mere Tjek på PubMedMagno, L., Rossi, T. R. A., Castanheira, D., Torres, T. S., Santos, C. C. d., Soares, F., Veloso, V. G., Benedetti, M., Dourado, I.
BMJ Open, 21.06.2023
Tilføjet 21.06.2023
IntroductionThe key tools for mitigating the impact of COVID-19 and reducing its transmission include testing, quarantine and isolation, as well as telemonitoring. Primary healthcare (PHC) can be essential in increasing access to these tools. Therefore, the primary objective of this study is to implement and expand an intervention consisting of COVID-19 testing, isolation, quarantine and telemonitoring (TQT) strategies and other prevention measures at PHC services in highly socioeconomically vulnerable neighbourhoods of Brazil. Methods and analysisThis study will implement and expand COVID-19 testing in PHC services in two large Brazilian capital cities: Salvador and Rio de Janeiro. Qualitative formative research was conducted to understand the testing context in the communities and at PCH services. The TQT strategy was structured in three subcomponents: (1) training and technical support for tailoring the work processes of health professional teams, (2) recruitment and demand creation strategies and (3) TQT. To evaluate this intervention, we will conduct an epidemiological study with two stages: (1) a cross-sectional sociobehavioural survey among individuals from these two communities covered by PHC services, presenting symptoms associated with COVID-19 or being a close contact of a patient with COVID-19, and (2) a cohort of those who tested positive, collecting clinical data. Ethics and disseminationThe WHO Ethics Research Committee (ERC) (#CERC.0128A and #CERC.0128B) and each city’s local ERC approved the study protocol (Salvador, ISC/UFBA: #53844121.4.1001.5030; and Rio de Janeiro, INI/Fiocruz: #53844121.4.3001.5240, ENSP/Fiocruz: #53844121.4.3001.5240 and SMS/RJ #53844121.4.3002.5279). Findings will be published in scientific journals and presented at meetings. In addition, informative flyers and online campaigns will be developed to communicate study findings to participants, members of communities and key stakeholders.
Læs mere Tjek på PubMedSandhu, S., Sharpe, M., Findlay, U., Roe, C., Broggio, J., Spencer, K., Thackray, K.
BMJ Open, 21.06.2023
Tilføjet 21.06.2023
PurposeThe purpose of the Radiotherapy Dataset (RTDS) is to collect consistent and comparable data across all providers of National Health Service (NHS)-funded radiotherapy and to provide intelligence for service planning, commissioning, clinical practice and research. ParticipantsThe RTDS is a mandated dataset requiring providers to collect and submit data monthly for patients treated in England. Data is available from 01 April 2009 to 2 months behind the calendar month. The National Disease Registration Service (NDRS) started receiving data from 01 April 2016. Prior to this, the National Clinical Analysis and Specialised Applications Team (NATCANSAT) were responsible for the RTDS. NDRS holds a copy of the NATCANSAT data for English NHS providers. The RTDS contains clinical information on the primary disease being treated, modality and intent of treatment, dose fractionation and hospital appointment details. Due to constraints in RTDS coding, linkage to the English National Cancer Registration dataset is beneficial. Findings to dateThe RTDS has been linked to the English National Cancer Registration and Systemic Anti-Cancer Therapy (SACT) datasets and to Hospital Episode Statistics (HES) to provide a more complete picture of the patient cancer pathway. Findings include a study to compare outcomes for patients treated with radical radiotherapy, an investigation of factors influencing 30-day mortality, assessing sociodemographic variation in the use of treatment and a study to assess the service impact of the COVID-19 pandemic. A range of other studies have been completed or are ongoing currently. Future plansThe RTDS can be used for a variety of functions including cancer epidemiological studies to investigate inequalities in treatment access; provide service planning intelligence; monitor clinical practice; and support clinical trial design and recruitment. Collection is to continue indefinitely, with regular updates to the data specification to enable capture of more detailed information on radiotherapy planning and delivery.
Læs mere Tjek på PubMedSorano, S., Gore-Langton, G., Opondo, C., Smith, C., Matsui, M., Chaponda, E. B., Chandramohan, D., Chico, R. M.
BMJ Open, 21.06.2023
Tilføjet 21.06.2023
IntroductionMalaria infection and curable sexually transmitted infections and reproductive tract infections (STIs/RTIs) adversely impact pregnancy outcomes. In sub-Saharan Africa, the prevalence of malaria and curable STIs/RTIs is high and, where coinfection is common, combination interventions may be needed to improve pregnancy outcomes. The aim of this systematic review is to estimate the prevalence of malaria and curable STI/RTI coinfection during pregnancy, risk factors for coinfection and prevalence of associated adverse pregnancy outcomes. Methods and analysisWe will use three electronic databases, PubMed, EMBASE and Malaria in Pregnancy Library to identify studies involving pregnant women attending routine antenatal care facilities in sub-Saharan Africa and reporting malaria and curable STI/RTI test results, published in any language since 2000. We will search databases in the second quarter of 2023 and repeat the search before completion of our analyses. The first two authors will screen titles and abstracts, selecting studies that meet inclusion criteria and qualify for full-text screening. If agreement on inclusion/exclusion cannot be reached, the last author will serve as arbiter. We will extract data from eligible publications for a study-level meta-analysis. We will contact research groups of included studies and request individual participant data for meta-analysis. The first two authors will conduct a quality appraisal of included studies using the GRADE system. The last author will adjudicate if the first two authors do not agree on any appraisals. We will conduct sensitivity analyses to test the robustness of effect estimates over time (by decade and half-decade periods), geography (East/Southern Africa vs West/Central Africa), gravidity (primigravidae, secundigravidae, multigravidae), treatment type and dosing frequency, and malaria transmission intensity. Ethics and disseminationWe obtained ethics approval from the London School of Hygiene & Tropical Medicine (LSHTM Ethics Ref: 26167). Results of this study will be disseminated via peer-reviewed publication and presentation at scientific conferences. PROSPERO registration numberCRD42021224294.
Læs mere Tjek på PubMedBMC Infectious Diseases, 21.06.2023
Tilføjet 21.06.2023
Abstract Background Previous studies found minimal evidence and raised controversy about the link between hemoglobin and 28-day mortality in sepsis patients. As a result, the purpose of this study was to examine the association between hemoglobin and 28-day death in sepsis patients by analyzing the Medical Intensive Care IV (MIMIC-IV) database from 2008 to 2019 at an advanced medical center in Boston, Massachusetts. Methods We extracted 34,916 sepsis patients from the MIMIC-IV retrospective cohort database, using hemoglobin as the exposure variable and 28-day death as the outcome variable, and after adjusting for confounders (demographic indicators, Charlson co-morbidity index, SOFA score, vital signs, medication use status (glucocorticoids, vasoactive drugs, antibiotics, and immunoglobulins, etc.)), we investigated the independent effects of hemoglobin and 28-day risk of death by binary logistic regression as well as two-piecewise linear model, respectively. Results Hemoglobin levels and 28-day mortality were shown to be non-linearly related.The inflection points were 104 g/L and 128 g/L, respectively. When HGB levels were between 41 and 104 g/L, there was a 10% decrease in the risk of 28-day mortality (OR: 0.90; 95% CI: 0.87 to 0.94, p-value = 0.0001). However, in the range of 104–128 g/L, we did not observe a significant association between hemoglobin and 28-day mortality (OR: 1.17; 95% CI: 1.00 to 1.35, P value = 0.0586). When HGB was in the range of 128–207 g/L, there was a 7% increase in the risk of 28-day mortality for every 1 unit increase in HGB (OR: 1.07; 95% CI: 1.01 to 1.15, P value = 0.0424). Conclusion In patients with sepsis, baseline hemoglobin was related to a U-shaped risk of 28-day death. When HGB was in the range of 12.8–20.7 g/dL, there was a 7% increase in the risk of 28-day mortality for every 1 unit increase in HGB.
Læs mere Tjek på PubMedBMC Infectious Diseases, 21.06.2023
Tilføjet 21.06.2023
Abstract Background Salmonella enterica serovar Typhi (Salmonella Typhi) is the cause of typhoid fever. Salmonella Typhi may be transmitted through shedding in the stool, which can continue after recovery from acute illness. Shedding is detected by culturing stool, which is challenging to co-ordinate at scale. We hypothesised that sero-surveillance would direct us to those shedding Salmonella Typhi in stool following a typhoid outbreak. Methods In 2016 a typhoid outbreak affected one in four residents of a Nursing School in Malosa, Malawi. The Department of Health asked for assistance to identify nursing students that might spread the outbreak to other health facilities. We measured IgG antibody titres against Vi capsular polysaccharide (anti-Vi IgG) and IgM / IgG antibodies against H:d flagellin (anti-H:d) three and six months after the outbreak. We selected participants in the highest and lowest deciles for anti-Vi IgG titre (measured at visit one) and obtained stool for Salmonella culture and PCR. All participants reported whether they had experienced fever persisting for three days or more during the outbreak (in keeping with the WHO definitions of ‘suspected typhoid’). We tested for salmonellae in the Nursing School environment. Results We obtained 320 paired serum samples from 407 residents. We cultured stool from 25 residents with high anti-Vi IgG titres and 24 residents with low titres. We did not recover Salmonella Typhi from stool; four stool samples yielded non-typhoidal salmonellae; one sample produced a positive PCR amplification for a Salmonella Typhi target. Median anti-Vi and anti-H:d IgG titres fell among participants who reported persistent fever. There was a smaller fall in anti-H:d IgG titres among participants who did not report persistent fever. Non-typhoidal salmonellae were identified in water sampled at source and from a kitchen tap. Conclusion High titres of anti-Vi IgG did not identify culture-confirmed shedding of Salmonella Typhi. There was a clear serologic signal of recent typhoid exposure in the cohort, represented by waning IgG antibody titres over time. The presence of non-typhoidal salmonellae in drinking water indicates sub-optimal sanitation. Developing methods to detect and treat shedding remains an important priority to complement typhoid conjugate vaccination in efforts to achieve typhoid elimination.
Læs mere Tjek på PubMedClinical Infectious Diseases, 20.06.2023
Tilføjet 20.06.2023
Clinical Infectious Diseases, 20.06.2023
Tilføjet 20.06.2023
AbstractAll WHO pre-qualified rabies vaccines for humans are inactivated tissue culture rabies virus formulations produced for intramuscular (IM) administration. Due to costs and vaccine shortage, dose-saving intradermal (ID) administration of rabies post-exposure prophylaxis (PEP) is encouraged by WHO. This study compared the immunogenicity of the ID 2-site, 3-visit IPC PEP regimen to the IM 1-site, 4-visit 4-dose Essen regimen using Verorab vaccine (Sanofi). The development of neutralizing antibodies (nAbs) and T cell response was assessed in 210 patients with a category II or III animal exposure in a rabies-endemic country. At day 28, all participants developed nAbs (≥0.5 IU/mL), irrespective of PEP scheme, age, or administration of rabies immunoglobulin. T cell response and nAb titers were similar for both PEP schemes. This study demonstrated that the 1-week ID IPC regimen is as effective as the 2-week IM 4-dose Essen regimen in inducing an anti-rabies immune response under real-life PEP.
Læs mere Tjek på PubMedNature, 20.06.2023
Tilføjet 20.06.2023
Nature, 20.06.2023
Tilføjet 20.06.2023
Jillian Whelan, Monique Hillenaar, Penny Fraser, Steven Allender, Michelle Jackson, Claudia Strugnell, Colin Bell
PLoS One Infectious Diseases, 20.06.2023
Tilføjet 20.06.2023
by Jillian Whelan, Monique Hillenaar, Penny Fraser, Steven Allender, Michelle Jackson, Claudia Strugnell, Colin Bell Background Calls for the adoption of a systems approach to chronic disease prevention date back at least ten years because of the potential to empower communities to identify and address the complex causes of overnutrition, undernutrition and climate change. Australia, like many countries, has high levels of obesity and extreme climate events. The Reflexive Evidence and Systems interventions to Prevent Obesity and Non-communicable Disease (RESPOND) trial aims to prevent unhealthy weight gain in children in 10 intervention and two pilot communities in north-east Victoria, Australia using community-based participatory approaches informed by systems science. Intervention activities co-designed in 2019 were disrupted by COVID-19 and bushfires. This paper explores the impacts of these ‘shocks’ on the local prevention workforce to implement actions within communities. Methods A case study design involving one-hour online focus groups and an on-line survey (November 2021-February 2022). Purposive sampling was used to achieve diverse representation from RESPOND stakeholders including local council, health services, primary care partnerships and department of health. The focus group interview schedule and survey questions were based on Durlak and DuPre’s implementation factors. Results Twenty-nine participants from seven different communities participated in at least one of nine focus groups to discuss the impacts of COVID-19 and bushfires on localised implementation. Twenty-eight participants (97% of focus group sample) also completed the on-line survey. Implementation of RESPOND stalled or stopped in most communities due to bushfires and/or COVID-19. These shocks resulted in organisational priorities changing, loss of momentum for implementation, redeployment of human resources, culminating in fatigue and exhaustion. Participants reported adaptation of RESPOND, but implementation was slowed due to limited resources. Conclusion Further research is needed to advance risk management strategies and protect resources within health promotion. System shocks such as bushfires and COVID-19 are inevitable, and despite multiple adaptation opportunities, this intervention approach was not ‘shock proof’.
Læs mere Tjek på PubMedElif Everest, Ugur Uygunoglu, Melih Tutuncu, Alper Bulbul, Umut Inci Onat, Mehmetcan Unal, Timucin Avsar, Sabahattin Saip, Ugur Bilge, Eda Tahir Turanli, Aksel Siva
PLoS One Infectious Diseases, 20.06.2023
Tilføjet 20.06.2023
by Elif Everest, Ugur Uygunoglu, Melih Tutuncu, Alper Bulbul, Umut Inci Onat, Mehmetcan Unal, Timucin Avsar, Sabahattin Saip, Ugur Bilge, Eda Tahir Turanli, Aksel Siva Background Predicting the long-term disability outcomes of multiple sclerosis (MS) cases is challenging. Objective We prospectively analysed our previous MS cohort with initial cerebrospinal fluid (CSF) proteomics data to reveal disability markers after 8.2±2.2 years of follow-up. Methods Patients with regular follow-up visits were assigned into two groups: those with an age-related MS severity (ARMSS) score ≥5 (unfavourable course group, N = 27) and ARMSS score 9 lesions) on magnetic resonance imaging, gait disturbance (P = 0.04), and bladder/bowel symptoms (P = 0.01) were significantly higher in the unfavourable course group than in the favourable course group. Optic nerve involvement evident on initial magnetic resonance imaging (P = 0.002) and optic neuritis (P = 0.01) were more frequent in the favourable course group. Conclusion The herein identified initial CSF protein levels, in addition to the clinical and radiological parameters at disease onset, have predictive value for long-term disability in MS cases.
Læs mere Tjek på PubMedAshkan Hassani, Vinton Omaleki, Jeanine Erikat, Elizabeth Frost, Samantha Streuli, Ramla Sahid, Homayra Yusufi, Rebecca Fielding-Miller
PLoS One Infectious Diseases, 20.06.2023
Tilføjet 20.06.2023
by Ashkan Hassani, Vinton Omaleki, Jeanine Erikat, Elizabeth Frost, Samantha Streuli, Ramla Sahid, Homayra Yusufi, Rebecca Fielding-Miller Refugee communities are vulnerable to housing insecurity, which drives numerous health disparity outcomes in a historically marginalized population. The COVID-19 pandemic has only worsened the ongoing affordable housing crisis in the United States while continuing to highlight disparities in health outcomes across populations. We conducted interviewer-administered surveys with refugee and asylum seekers in San Diego County at the height of the COVID-19 pandemic to understand the social effects and drivers of COVID-19 in one of the largest refugee communities in the United States. Staff from a community-based refugee advocacy and research organization administered the surveys from September—November 2020. 544 respondents participated in the survey, which captured the diversity of the San Diego refugee community including East African (38%), Middle Eastern (35%), Afghan (17%), and Southeast Asian (11%) participants. Nearly two-thirds of respondents (65%) reported living in overcrowded conditions (> 1 individual per room) and 30% in severely crowded conditions (> 1.5 individuals per room). For each additional person per room, self-reported poor emotional health increased. Conversely, family size was associated with a lower likelihood of reporting poor emotional health. Crowded housing was significantly associated with a lower probability of accessing a COVID-19 diagnostic test, with every additional reported person per room there was approximately an 11% increase in the probability of having never accessed a COVID-19 testing. Access to affordable housing had the largest effect size and was associated with fewer people per room. Overcrowding housing is a structural burden that reduces COVID-19 risk mitigation behaviors. Improved access to affordable housing units or receiving vouchers could reduce overcrowded housing in vulnerable refugee communities.
Læs mere Tjek på PubMedLiwei Zheng, Lin Wang, Fengmin Lu
Journal of Medical Virology, 20.06.2023
Tilføjet 20.06.2023
Jingyuan Luo, Jialing Zhang, Hiu To Tang, Hoi Ki Wong, Aiping Lyu, Chun Hoi Cheung, Zhaoxiang Bian
Journal of Medical Virology, 20.06.2023
Tilføjet 20.06.2023
Zachary A. Yetmar, Joseph D. Yao, Raymund R. Razonable
Journal of Medical Virology, 20.06.2023
Tilføjet 20.06.2023
Infection, 20.06.2023
Tilføjet 20.06.2023
Abstract Purpose Antimicrobial resistance is a pressing issue in Ukraine, with healthcare-associated infections caused by multidrug-resistant organisms being a major concern. A recent prospective multicenter study revealed a staggering rate of 48.4% antimicrobial resistance to carbapenems among Enterobacterales causing a healthcare-associated infection. We conducted a systematic survey to investigate the incidence rate and incidence density of carbapenemase-producing Gram-negative bacteria (CPGN) among refugees and war-wounded Ukrainians in connection with the German health system. Methods From the onset of the war until November 2022, seven Ukrainian patients were admitted to our hospital. Upon admission, screening samples and samples from the focus of suspected infection were taken from all seven patients. The incidence rate and the incidence density of CPGN were calculated as a result of the microbiological findings. We sequenced all CPGN using Illumina technology. Results The incidence rate of CPGN at our hospital was 0.06 for 2021 and 0.18 for 2022. All seven Ukrainian patients were infected or colonized with at least one CPGN, including K. pneumoniae (14/25), P. aeruginosa (6/25), A. baumannii (1/25), Providencia stutartii (1/25), C. freundii (1/25), and E. coli (2/25). Genomic surveillance revealed that (i) most frequently detected carbapenemases among all sequenced isolates were blaNDM (17/25) and blaOXA-48 (6/25), (ii) most commonly observed plasmid replicons among the K. pneumoniae isolates recovered from Ukrainian patients were Col(pHAD28) (12/14), IncHI1B(pNDM-MAR) (9/14), IncFIB(pNDM-Mar) (12/14), and (iii) clonal relation between the pathogens of the Ukrainian isolates, but not for the isolates from our hospital surveillance system. Conclusion The rising prevalence of community-acquired colonization and infection with CPGN is having a direct effect on the infection prevention measures, such as higher number of isolations, reprocessing of patient rooms, additional microbiological testing and overall organization within hospitals.
Læs mere Tjek på PubMedMercedes, Rebecca A.; Kasbaum, Marie A.; George, Paul E.; Tumweheire, Enid G.; Scheurer, Michael E.; Nabukeera-Barungi, Nicolette
Journal of Acquired Immune Deficiency Syndromes, 20.06.2023
Tilføjet 20.06.2023
Background: Despite significant morbidity and mortality from human immunodeficiency virus (HIV) and severe acute malnutrition (SAM) among children in sub-Saharan Africa, research is lacking in these children. We describe the proportion of children living with HIV with SAM achieving recovery, the factors associated with recovery, and time to recovery in an outpatient therapeutic care (OTC) program. Setting and Methods: This is a retrospective observational study of children with SAM and HIV on antiretroviral therapy (6 months-15 years), enrolled in OTC from 2015-2017 at a pediatric HIV clinic in Kampala, Uganda. SAM diagnosis and recovery by 120 days after enrollment were determined per World Health Organization guidelines. Cox-proportional hazards models were used to determine predictors of recovery. Results: Data from 166 patients were analyzed (mean age 5.4 years, SD 4.7). Outcomes showed 36.1% recovered, 15.6% were lost to follow up, 2.4% died, and 45.8% failed. Average time to recovery was 59.9 days (SD 27.8). Patients 5 years or older were less likely to recover (CHR=0.33, 95% CI: 0.18-0.58). In multivariate analysis, febrile patients were less likely to recover (AHR=0.53, 95% CI: 0.12-0.65). Patients with CD4 count of 200 or less at enrollment were less likely to recover (CHR=0.46, 95% CI: 0.22-0.96). Conclusion: Despite treatment with antiretroviral therapy for children living with HIV, we observed poor rates of recovery from SAM, below the international target of >75%. Moreover, patients 5 years and older, fever, or low CD4 at diagnosis of SAM may require more intense therapy or closer monitoring than their counterparts. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedYue Ding, Cheng Bei, Qinghua Xue, Liangfei Niu, Jingfeng Tong, Yiwang Chen, Howard E. Takiff, Qian Gao, Bo YanaKey Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Shanghai Medical College, Shanghai Institute of Infectious Disease and Biosecurity and Shanghai Public Health Clinical Center, Fudan University, Shanghai, People's Republic of ChinabCenter for Tuberculosis Research, Shanghai Public Health Clinical Center, Fudan University, Shanghai, People's Republic of ChinacLaboratorio de Genética Molecular, CMBC, IVIC, Caracas, Venezuela, Sabine Ehrt
Infection and Immunity, 20.06.2023
Tilføjet 20.06.2023
Hayley M. Theriot, Priyangi A. Malaviarachchi, Madeleine G. Scott, Kenneth T. Appell, Srijon K. Banerjee, Roger D. PechousaDepartment of Microbiology and Immunology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USAbDepartment of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA, Igor E. Brodsky
Infection and Immunity, 20.06.2023
Tilføjet 20.06.2023
Sherry L. Kurtz, Lara R. Mittereder, Chelsea C. Lehman, Hamda Khan, Victoria A. Gould, Karen L. ElkinsaCenter for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA, Sabine Ehrt
Infection and Immunity, 20.06.2023
Tilføjet 20.06.2023
Tuyetnhu Pham, Yeqi Li, Wendy Watford, Xiaorong LinaDepartment of Plant Biology, University of Georgia, Athens, Georgia, USAbDepartment of Microbiology, University of Georgia, Athens, Georgia, USAcDepartment of Infectious Diseases, University of Georgia, Athens, Georgia, USA, Mairi C. Noverr
Infection and Immunity, 20.06.2023
Tilføjet 20.06.2023
Mackenzie E. Ryan, Prashant P. Damke, Carrie L. ShafferaDepartment of Microbiology, Immunology, and Molecular Genetics, University of Kentucky College of Medicine, Lexington, Kentucky, USAbDepartment of Veterinary Sciences, University of Kentucky College of Agriculture, Lexington, Kentucky, USAcDepartment of Pharmaceutical Sciences, University of Kentucky College of Pharmacy, Lexington, Kentucky, USAdMarkey Cancer Center, University of Kentucky College of Medicine, Lexington, Kentucky, USA, Anthony R. Richardson
Infection and Immunity, 20.06.2023
Tilføjet 20.06.2023
Journal of the American Medical Association, 20.06.2023
Tilføjet 20.06.2023
An animated discussion on a vaccination bill in the English Commons on April 19. brought out a speech by Sir William Priestley, an eminent London practitioner, who was formerly a professor in King’s College medical school; it contained a sharp arraignment of the enemies of vaccination. Among other points he stated that it is computed that at present about a third of all the children born in England and Wales were escaping vaccination, i. e., about 300,000 children, and in this connection they could not but recollect the serious object lesson recently presented by Gloucester. The discovery of glycerinated lymph was made in 1891, and yet it had never been adopted systematically in this country. It was most likely, if once adopted, to remove many of the objections and apprehensions of parents, which he had no doubt were very conscientious. It had been adopted in other countries where they had ministers of public health, and where a great deal more attention was paid to the question of public health than was the case in this country. The system had been carried out at Berlin, Paris, Geneva and other centers, and as yet there had been no misadventures. Admitting that harm was done by the practice of vaccination, it was not easy at any time to do a vast amount of good without some modicum of harm. All medical efforts were relative; if they were absolute no one would die. If they were to look into the history of many remedies they would find that misadventures came by their use. It was well known for instance, that no one could avail himself of the administration of chloroform to relieve pain without fear of misadventure. In regard to those domestic remedies, Epsom salts and castor oil, the effects had gone in some cases much farther than had been intended or expected. The great thing in the use of all remedies was to do the greatest amount of good with the least possible harm. It was entirely a question of proportion.…A distinguished scientific friend of his once said he always tried to teach his pupils to think to scale as well as work to scale; but these people who were always dwelling on the harm did not think to scale. They concentrated all their attention upon the mischief and they came signally to grief in their reasoning. Sir William Priestley then went on to express approval of the proposed domiciliary vaccination, although at the same time he hoped that stations would not be abolished altogether.
Læs mere Tjek på PubMedJournal of the American Medical Association, 20.06.2023
Tilføjet 20.06.2023
This Viewpoint discusses the proliferation of decentralized clinical trials during the COVID-19 pandemic and the need for rigorous studies to inform whether decentralized approaches promote or prevent access to clinical trials for people facing health disparities.
Læs mere Tjek på PubMedJournal of the American Medical Association, 20.06.2023
Tilføjet 20.06.2023
For patients with recurrent tonsillitis, tonsillectomies resulted in almost 50% fewer days of sore throats over 2 years compared with standard nonsurgical care, which included painkillers and antibiotics as needed, according to results from a randomized clinical trial that enrolled 453 adults across 27 UK hospitals.
Læs mere Tjek på PubMedJournal of the American Medical Association, 20.06.2023
Tilføjet 20.06.2023
This study used a population-based individual patient data set that included diagnoses of COVID-19 to determine whether there was a temporal association between COVID-19 and type 1 diabetes in children.
Læs mere Tjek på PubMedJournal of the American Medical Association, 20.06.2023
Tilføjet 20.06.2023
This study uses data collected by Australia’s vaccine safety surveillance system to examine the adverse event profile of the modified vaccinia Ankara–Bavarian Nordic vaccine.
Læs mere Tjek på PubMedAbi Manesh, Emily Devasagayam, Kundakarla Bhanuprasad, Lalee Varghese, Regi Kurien, Lisa M. Cherian, Divya Dayanand, Mithun M. George, Selwyn S. Kumar, Rajiv Karthik, Harshad Vanjare, Jayanthi Peter, Joy S. Michael, Meera Thomas, Binu S. Mathew, Prasanna Samuel, Pimnara Peerawaranun, Mavuto Mukaka, Vedantam Rupa, George M. Varghese
Clinical Microbiology and Infection, 20.06.2023
Tilføjet 20.06.2023
To evaluate the efficacy and safety of short-course intravenous amphotericin B followed by sustained release posaconazole tablets for diabetes or COVID-19 associated rhino-orbito-cerebral mucormycosis (ROCM).
Læs mere Tjek på PubMedJulie Boisard, Isabelle Florent
Trends in Parasitology, 20.06.2023
Tilføjet 20.06.2023
The apicomplexan parasite Porospora gigantea (Van Beneden, 1869) Schneider, 1875, is a marine septate intestinal eugregarine of Homarus gammarus, with a poorly known pathogenicity. Previously named Gregarina gigantea, it presents three outstanding characteristics according to the literature: (i) a gigantic size of its trophozoite stages with (ii) a remarkable gliding speed, which are the largest and the fastest recorded to date for any Apicomplexa, and (iii) an ability to accumulate as very specific cyst forms in the chitinous folds of the lobster rectum.
Læs mere Tjek på PubMedIvan T Lee, Catherine A Cosgrove, Patrick Moore, Claire Bethune, Rhiannon Nally, Marcin Bula, Philip A Kalra, Rebecca Clark, Paul I Dargan, Marta Boffito, Ray Sheridan, Ed Moran, Thomas C Darton, Fiona Burns, Dinesh Saralaya, Christopher J A Duncan, Patrick J Lillie, Alberto San Francisco Ramos, Eva P Galiza, Paul T Heath, Bethany Girard, Christy Parker, Dondi Rust, Shraddha Mehta, Elizabeth de Windt, Andrea Sutherland, Joanne E Tomassini, Frank J Dutko, Spyros Chalkias, Weiping Deng, Xing Chen, Jing Feng, LaRee Tracy, Honghong Zhou, Jacqueline M Miller, Rituparna Das, Study Investigators
Lancet Infectious Diseases, 20.06.2023
Tilføjet 20.06.2023
Omicron-containing booster vaccines generated superior immunogenicity against omicron BA.1 and comparable immunogenicity against the original strain with no new safety concerns. It remains important to continuously monitor the immune responses and real-world vaccine effectiveness as divergent SARS-CoV-2 variants emerge.
Læs mere Tjek på PubMedClinical Infectious Diseases, 20.06.2023
Tilføjet 20.06.2023
AbstractBackgroundThere is growing consensus that COVID-19 booster vaccines may be coadministered with other age-appropriate vaccines. Adding to the limited available data supporting coadministration, especially with adjuvanted vaccines, could enhance vaccine coverage in adults.MethodsIn this phase 3, randomized, open-label study, eligible adults aged ≥50 years were randomly assigned (1:1) to receive mRNA-1273 (50µg) booster vaccination and a first dose of recombinant zoster vaccine (RZV1) 2 weeks apart (Seq group) or concomitantly (Coad group). The second RZV dose (RZV2) was administered 2 months post- RZV1 in both groups. Primary objectives were noninferiority of anti-glycoprotein E and anti-Spike protein antibody responses in the Coad group compared to the Seq group. Safety and further immunogenicity assessments were secondary objectives.Results273 participants were randomized to the Seq group, 272 to the Coad group. Protocol-specified non-inferiority criteria were met. The adjusted geometric mean concentration ratio (Seq/Coad) was 1.01 (95% confidence interval [CI], 0.89–1.13) for anti-gE antibodies 1-month post-RZV2, and 1.09 (95% CI 0.90–1.32) for anti-Spike antibodies 1-month post-mRNA-1273 booster. No clinically relevant differences were observed in overall frequency, intensity, or duration of adverse events between the 2 study groups. Most solicited adverse events were mild/moderate in intensity, each with median duration ≤2.5 days. Administration site pain and myalgia were the most frequently reported in both groups.ConclusionsCoadministration of mRNA-1273 booster vaccine with RZV in adults aged ≥50 years was immunologically noninferior to sequential administration and had a safety and reactogenicity profile consistent with both vaccines administered sequentially (clinicaltrials.gov NCT05047770).
Læs mere Tjek på PubMedClinical Infectious Diseases, 20.06.2023
Tilføjet 20.06.2023
AbstractBackgroundDespite being the leading cause of mortality from bloodstream infections worldwide, little is known about regional variation in treatment practices for Staphylococcus aureus bacteremia (SAB). The aim of this study was to identify global variation in management, diagnostics, and definitions of SAB.MethodsDuring a 20-day period in 2022, physicians throughout the world were surveyed on SAB treatment practices. The survey was distributed through listservs, e-mails, and social media.ResultsIn total 2,031 physicians from 71 different countries on 6 continents (North America [701, 35%], Europe [573, 28%], Asia [409, 20%], Oceania [182, 9%], South America [124, 6%], and Africa [42, 2%]) completed the survey. Management-based responses differed significantly by continent for preferred treatment of methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) bacteremia, use of adjunctive rifampin for prosthetic material infection, and use of oral antibiotics (p
Læs mere Tjek på PubMedClinical Infectious Diseases, 20.06.2023
Tilføjet 20.06.2023
AbstractBackgroundAntimicrobial stewardship is an important topic in infectious diseases (ID) training, yet many ID fellowships lack formal training and little is known about fellows’ learning preferences.MethodsWe conducted 24 in-depth interviews with ID fellows across the United States during 2018 and 2019 to explore their experiences with and preferences for antimicrobial stewardship education during fellowship. Interviews were transcribed, de-identified, and analyzed to identify themes.ResultsFellows had variable exposure to antimicrobial stewardship before and during fellowship, which impacted their knowledge about and attitude toward stewardship as a career; however, all fellows expressed the importance of learning general stewardship principles during fellowship. Some fellows’ training included mandatory stewardship lectures and/or rotations, but most fellows felt their primary stewardship learning occurred through informal experiences in the clinical setting, such as holding the antimicrobial approval pager. Fellows expressed a preference for a standardized, structured curriculum that included in-person practical, interactive discussions with multidisciplinary faculty along with the opportunity to practice and apply their skills; however, they emphasized that time needed to be set aside for those educational activities. Although they wanted to learn the evidence and rationale for stewardship recommendations, they especially wanted training in and feedback on how to communicate stewardship recommendations to other health professionals, particularly in the setting of conflict.ConclusionsID fellows believe that standardized antimicrobial stewardship curricula should be included in their fellowship training, and they prefer structured, practical, and interactive learning experiences.
Læs mere Tjek på PubMedClinical Infectious Diseases, 20.06.2023
Tilføjet 20.06.2023
AbstractAntimicrobials are commonly prescribed and often misunderstood. With over 50% of hospitalized patients receiving an antimicrobial agent at any point in time, judicious and optimal use of these drugs is paramount to advancing patient care. This narrative will focus on myths relevant to nuanced consultation from infectious diseases specialists, particularly surrounding specific considerations for a variety of antibiotics.
Læs mere Tjek på PubMedJournal of Infectious Diseases, 20.06.2023
Tilføjet 20.06.2023
AbstractStaphylococcus aureus (S. aureus) is a major human pathogen associated with high mortality rates. The extensive use of antibiotics is associated with the rise of drug resistance, and exotoxins are not targeted by antibiotics. Therefore, monoclonal antibody (mAb) therapy has emerged as a promising solution to solve the clinical problems caused by refractory S. aureus. Recent research suggests that the synergistic effects of several cytotoxins, including bi-component toxins, are critical to the pathogenesis of S. aureus. By comparing the amino acid sequences, researchers found that α-toxin and bi-component toxins were found to have high homology. Therefore, we aimed to screen an antibody, designated as “all-in-one” mAb, that could neutralize both α-toxin and bi-component toxins through hybridoma fusion. We found that this mAb has a significant pharmacodynamic effect in vivo mouse models and in vitro experiments.
Læs mere Tjek på PubMedFEMS Microbiology Reviews, 20.06.2023
Tilføjet 20.06.2023
AbstractIn living cells the biochemical processes such as energy provision, molecule synthesis, gene expression and cell division take place in a confined space where the internal chemical and physical conditions are different from those in dilute solutions. The concentrations of specific molecules and the specific reactions and interactions vary for different types of cells, but a number of factors are universal and kept within limits, which we refer to as physicochemical homeostasis. For instance, the internal pH of many cell types is kept within the range of 7.0 to 7.5, the fraction of macromolecules occupies 15-20% of the cell volume (also know as macromolecular crowding) and the ionic strength is kept within limits to prevent salting-in or salting-out effects. In this article we summarize the generic physicochemical properties of the cytoplasm of bacteria, how they are connected to the energy status of the cell, and how they affect biological processes (Figure 1). We describe how the internal pH and proton motive force are regulated, how the internal ionic strength is kept within limits, what the impact of macromolecular crowding is on the function of enzymes and the interaction between molecules, how cells regulate their volume (and turgor), and how the cytoplasm is structured. Physicochemical homeostasis is best understood in Escherichia coli, but pioneering studies have also been performed in lactic acid bacteria.
Læs mere Tjek på PubMedGuillaume Favre, Emeline Maisonneuve, Léo Pomar, Charlotte Daire, Cécile Monod, Begoña Martinez de Tejada, Thibaud Quibel, Monya Todesco Bernasconi, Loïc Sentilhes, Caroline Blume, Andrea Papadia, Stephanie Sturm, Dirk Bassler, Claudia Grawe, Anda Petronela Radan, Marie-Claude Rossier, Jérôme Mathis, Romina Capoccia Brugger, Karine Lepigeon, Eva Gerbier, Marie Claude Addor, Ursula Winterfeld, David Baud, Alice Panchaud, COVI-PREG group
Clinical Microbiology and Infection, 20.06.2023
Tilføjet 20.06.2023
This study aimed to evaluate the risk of congenital malformation among pregnant women exposed to the mRNA COVID-19 vaccines during the first trimester of pregnancy, which is a developmental period where the fetus is at risk of teratogenicity.
Læs mere Tjek på PubMedBMC Infectious Diseases, 20.06.2023
Tilføjet 20.06.2023
Abstract Background A key factor driving the development and maintenance of antibacterial resistance (ABR) is individuals’ use of antibiotics (ABs) to treat illness. To better understand motivations and context for antibiotic use we use the concept of a patient treatment-seeking pathway: a treatment journey encompassing where patients go when they are unwell, what motivates their choices, and how they obtain antibiotics. This paper investigates patterns and determinants of patient treatment-seeking pathways, and how they intersect with AB use in East Africa, a region where ABR-attributable deaths are exceptionally high. Methods The Holistic Approach to Unravelling Antibacterial Resistance (HATUA) Consortium collected quantitative data from 6,827 adult outpatients presenting with urinary tract infection (UTI) symptoms in Kenya, Tanzania, and Uganda between February 2019- September 2020, and conducted qualitative in-depth patient interviews with a subset (n = 116). We described patterns of treatment-seeking visually using Sankey plots and explored explanations and motivations using mixed-methods. Using Bayesian hierarchical regression modelling, we investigated the associations between socio-demographic, economic, healthcare, and attitudinal factors and three factors related to ABR: self-treatment as a first step, having a multi-step treatment pathway, and consuming ABs. Results Although most patients (86%) sought help from medical facilities in the first instance, many (56%) described multi-step, repetitive treatment-seeking pathways, which further increased the likelihood of consuming ABs. Higher socio-economic status patients were more likely to consume ABs and have multi-step pathways. Reasons for choosing providers (e.g., cost, location, time) were conditioned by wider structural factors such as hybrid healthcare systems and AB availability. Conclusion There is likely to be a reinforcing cycle between complex, repetitive treatment pathways, AB consumption and ABR. A focus on individual antibiotic use as the key intervention point in this cycle ignores the contextual challenges patients face when treatment seeking, which include inadequate access to diagnostics, perceived inefficient public healthcare and ease of purchasing antibiotics without prescription. Pluralistic healthcare landscapes may promote more complex treatment seeking and therefore inappropriate AB use. We recommend further attention to healthcare system factors, focussing on medical facilities (e.g., accessible diagnostics, patient-doctor interactions, information flows), and community AB access points (e.g., drug sellers).
Læs mere Tjek på PubMedBMC Infectious Diseases, 20.06.2023
Tilføjet 20.06.2023
Abstract Background Rapid and accurate identification of carbapenemase-producing organism (CPO) intestinal carriers is essential for infection prevention and control. Molecular diagnostic methods can produce results in as little as 1 h, but require special instrumentation and are expensive. Therefore, it is urgent to find an alternative method. The broth enrichment-multiplex lateral flow immunochromatographic assay was recently reported, but using it to directly detect CPO intestinal carriers in rectal swabs still requires the evaluation of many samples. The aim of this study was to compare the performance of these two methods, and to explore the control measures of CPO infection. Methods Through CPO selective culture, PCR and DNA sequencing, 100 rectal swabs confirmed to be CPO-positive and 100 rectal swabs with negative results were collected continuously. After eluting the rectal swabs with saline, three aliquots were used: one for counting, one for detection by Xpert Carba-R, and one for culture in broth for 0 h, 1 h, 2 h, 3 h and 4 h, followed by NG-Test CARBA 5 assessment. The sensitivity and specificity of the NG-Test CARBA 5 method after different incubation times were calculated. The limit of detection (LoD) of this assay after 4 h broth incubation was estimated by examining the bacterial suspensions and simulated faecal suspensions prepared with CPOs producing different types of carbapenemases. Results Xpert Carba-R demonstrated a combined sensitivity of 99.0% and specificity of 98.0%. The sensitivity and specificity were higher than 90.0% for the different enzyme types. The specificities of five common carbapenemases detected by the broth enrichment NG-Test CARBA 5 combined method after different incubation times were 100%. The sensitivities increased with increasing incubation time. At 4 h, the Klebsiella pneumoniae carbapenemase (KPC), New Delhi metallo-beta-lactamase (NDM), imipenemase (IMP), Verona integron-encoded metallo-beta-lactamase (VIM), and oxacillinase (OXA) -48 detection sensitivities were 93.0%, 96.3%, 100%, 100% and 85.7%, respectively. The LoDs were between 102 and 104 CFU/mL for all five enzymes after 4 h of incubation. Conclusions This investigation highlighted that the broth enrichment-multiplex lateral flow immunochromatographic assay can be used as a new method for screening CPOs in rectal swabs.
Læs mere Tjek på PubMedBMC Infectious Diseases, 20.06.2023
Tilføjet 20.06.2023
Abstract Background Awake prone positioning has been widely used in non-intubated patients with acute hypoxic respiratory failure (AHRF) due to COVID-19, but the evidence is mostly from observational studies and low-quality randomized controlled trials (RCTs), with conflicting results from published studies. A systematic review of published high-quality RCTs to resolve the controversy over the efficacy and safety of awake prone positioning in non-intubated patients with AHRF due to COVID-19. Methods Candidate studies were identified through searches of PubMed, Web of Science, Cochrane, Embase, Scopus databases from December 1, 2019 to November 1, 2022. Literature screening, data extraction and risk of bias assessment were independently conducted by two researchers. Results Eight RCTs involving 2657 patients were included. Meta-analysis of fixed effects models showed that awake prone positioning did not increase mortality(OR = 0.88, 95%CI [0.72, 1.08]), length of stay in ICU (WMD = 1.14, 95%CI [-0.45, 2.72]), total length of stay (WMD = 0.11, 95%CI [-1.02, 1.23]), or incidence of adverse events (OR = 1.02, 95%CI [0.79, 1.31]) compared with usual care, but significantly reduced the intubation rate (OR = 0.72, 95%CI [0.60, 0.86]). Similar results were found in a subgroup analysis of patients who received only high flow nasal cannula (Mortality: OR = 0.86, 95%CI [0.70, 1.05]; Intubation rate: OR = 0.69, 95%CI [0.58, 0.83]). All eight RCTs had high quality of evidence, which ensured the reliability of the meta-analysis results. Conclusions Awake prone positioning is safe and feasible in non-intubated patients with AHRF caused by COVID-19, and can significantly reduce the intubation rate. More studies are needed to explore standardized implementation strategies for the awake prone positioning. Trial registration CRD42023394113.
Læs mere Tjek på PubMedMalaria Journal, 19.06.2023
Tilføjet 19.06.2023
Abstract Background Anopheles stephensi is an efficient vector of both Plasmodium falciparum and Plasmodium vivax in South Asia and the Middle East. The spread of An. stephensi to countries within the Horn of Africa threatens progress in malaria control in this region as well as the rest of sub-Saharan Africa. Methods The available malaria data and the timeline for the detection of An. stephensi was reviewed to analyse the role of An. stephensi in malaria transmission in Horn of Africa of the Eastern Mediterranean Region (EMR) in Djibouti, Somalia, Sudan and Yemen. Results Malaria incidence in Horn of Africa of EMR and Yemen, increased from 41.6 in 2015 to 61.5 cases per 1000 in 2020. The four countries from this region, Djibouti, Somalia, Sudan and Yemen had reported the detection of An. stephensi as of 2021. In Djibouti City, following its detection in 2012, the estimated incidence increased from 2.5 cases per 1000 in 2013 to 97.6 cases per 1000 in 2020. However, its contribution to malaria transmission in other major cities and in other countries, is unclear because of other factors, quality of the urban malaria data, human mobility, uncertainty about the actual arrival time of An. stephensi and poor entomological surveillance. Conclusions While An. stephensi may explain a resurgence of malaria in Djibouti, further investigations are needed to understand its interpretation trends in urban malaria across the greater region. More investment for multisectoral approach and integrated surveillance and control should target all vectors particularly malaria and dengue vectors to guide interventions in urban areas.
Læs mere Tjek på PubMedHasen, A. A., Seid, A. A., Mohammed, A. A.
BMJ Open, 19.06.2023
Tilføjet 19.06.2023
IntroductionCOVID-19 pandemic is a global health problem. In Africa, healthcare professionals face mental health problems due to COVID-19. But little was done on the prevalence of mental disorders among healthcare professionals during COVID-19 in Africa. This umbrella review of meta-analysis aimed to provide the pooled prevalence of anxiety, depression, stress, suicide, demoralisation and insomnia during COVID-19 pandemic in Africa. Methods and analysisWe will search the African Journals Online, MedRxiv, PubMed and Google Scholar to identify studies published from the occurrence of the pandemic to March 2023. Systematic review and meta-analysis studies assessing mental health problems among healthcare professionals in Africa will be considered. The outcomes of interest include prevalence of mental health problems on healthcare professionals following COVID-19. Two researchers will extract data and execute quality assessment independently. The Joanna Briggs Institute critical appraisal checklist will be used to assess the quality of studies. Stata V.16.0 software will be used for statistical analysis. The I² and Cochran’s Q-statistics will be used for analysis of heterogeneity. Publication bias will be examined by DOI plot and Luis Furuya Kanamori (LFK) index. Ethics and disseminationEthical approval and informed consent are not required as this is a literature review. The final results will be published in a peer-reviewed journal and presented at relevant conferences. PROSPERO registration numberCRD42022383939.
Læs mere Tjek på PubMed