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BMC Infectious Diseases, 27.04.2024
Tilføjet 27.04.2024
Abstract Background Patients infected with Acinetobacter baumannii (AB) bacteremia in hospital have high morbidity and mortality. We analyzed the clinical characteristics of pneumonia and nonpneumonia-related AB bloodstream infections (AB BSIs) and explored the possible independent risk factors for the incidence and prognosis of pneumonia-related AB BSIs. Methods A retrospective monocentric observational study was performed. All 117 episodes of hospital-acquired AB bacteremia sorted into groups of pneumonia-related AB BSIs (n = 45) and nonpneumonia-related AB BSIs (n = 72) were eligible. Univariate/multivariate logistic regression analysis was used to explore the independent risk factors. The primary outcome was the antibiotic susceptibility in vitro of pneumonia-related AB BSIs group. The secondary outcome was the independent risk factor for the pneumonia-related AB BSIs group. Results Among 117 patients with AB BSIs, the pneumonia-related group had a greater risk of multidrug resistant A. baumannii (MDRAB) infection (84.44%) and carbapenem-resistant A. baumannii (CRAB) infection (80%). Polymyxin, minocycline and amikacin had relatively high susceptibility rates (> 80%) in the nonpneumonia-related group. However, in the pneumonia-related group, only polymyxin had a drug susceptibility rate of over 80%. Univariate analysis showed that survival time (day), CRAB, MDRAB, length of hospital stay prior to culture, length of ICU stay prior to culture, immunocompromised status, antibiotics used prior to culture (n > = 3 types), endotracheal tube, fiberoptic bronchoscopy, PITT, SOFA and invasive interventions (n > = 3 types) were associated with pneumonia-related AB bacteremia. The multivariate logistic regression analysis revealed that recent surgery (within 1 mo) [P = 0.043; 0.306 (0.098–0.962)] and invasive interventions (n > = 3 types) [P = 0.021; 0.072 (0.008–0.671)] were independent risk factors related to pneumonia-related AB bacteremia. Multivariate logistic regression analysis revealed that length of ICU stay prior to culture [P = 0.009; 0.959 (0.930–0.990)] and recent surgery (within 1 mo) [P = 0.004; 0.260 (0.105–0.646)] were independent risk factors for mortality in patients with pneumonia-related AB bacteremia. The Kaplan‒Meier curve and the timing test showed that patients with pneumonia-related AB bacteremia had shorter survival time compared to those with nonpneumonia-related AB bacteremia. Conclusions Our study found that A. baumannii had a high rate of antibiotic resistance in vitro in the pneumonia-related bacteremia group, and was only sensitive to polymyxin. Recent surgery was a significantly independent predictor in patients with pneumonia-related AB bacteremia.
Læs mere Tjek på PubMedBMC Infectious Diseases, 27.04.2024
Tilføjet 27.04.2024
Abstract Introduction Carbapenemase-producing Enterobacterales (CPE) are an important public health threat, with costly operational and economic consequences for NHS Integrated Care Systems and NHS Trusts. UK Health Security Agency guidelines recommend that Trusts use locally developed risk assessments to accurately identify high-risk individuals for screening, and implement the most appropriate method of testing, but this presents many challenges. Methods A convenience sample of cross-specialty experts from across England met to discuss the barriers and practical solutions to implementing UK Health Security Agency framework into operational and clinical workflows. The group derived responses to six key questions that are frequently asked about screening for CPE. Key findings Four patient groups were identified for CPE screening: high-risk unplanned admissions, high-risk elective admissions, patients in high-risk units, and known positive contacts. Rapid molecular testing is a preferred screening method for some of these settings, offering faster turnaround times and more accurate results than culture-based testing. It is important to stimulate action now, as several lessons can be learnt from screening during the COVID-19 pandemic, as well as from CPE outbreaks. Conclusion Further decisive and instructive information is needed to establish CPE screening protocols based on local epidemiology and risk factors. Local management should continually evaluate local epidemiology, analysing data and undertaking frequent prevalence studies to understand risks, and prepare resources– such as upscaled screening– to prevent increasing prevalence, clusters or outbreaks. Rapid molecular-based methods will be a crucial part of these considerations, as they can reduce unnecessary isolation and opportunity costs.
Læs mere Tjek på PubMedBMC Infectious Diseases, 27.04.2024
Tilføjet 27.04.2024
Abstract Background Overuse of antibiotics is a key driver of antimicrobial resistance (AMR) world-wide. Malawi continues to report rising cases of AMR among both in-patients and out-patients. We investigated antibiotic use and resistance patterns among patients with suspected first line antibiotic treatment failure at Rumphi District Hospital, Malawi. Methods We used a cross-sectional study design in which records of patients data on culture and antimicrobial sensitivity tests were extracted, alongside treatment history from 2019 to March, 2023, retrospectively. We also included findings for point prevalence survey (PPS) conducted within four hospital wards in June, 2022 by a well-trained multi-disciplinary team from within the hospital. The data was analyzed for antibiotic use, characterization of pathogens and their susceptibility patterns using Microsoft excel and STATA-14 software. Results A total of 85 patients’ data records were reviewed on antibiotics resistance pattern in which 54 (63.5%) were females. Patient antibiotic history captured indicated Metronidazole (23%), Gentamycin (20%) and Doxycycline (23%) as the most frequently used antibiotics among clients referred for microbiological investigations. Among locally available antibiotics with over 50% sensitivity were Chloramphenicol (61%), ciprofloxacin (55%), and ceftriaxone (54%). Penicillins were among antibiotics with highest resistance: ampicillin (100%), amoxyclav (90%), Piperacilin-tazobactam (63%). The majority of patients came from STI clinic and presented with genital discharges 44% (n = 39). Over 80% of the isolated N. gonorrhoeae exhibited a reduced susceptibility to gentamycin. Prevalence of Methicillin resistant staphylococcus Aureus (MRSA) was 46% and were mostly isolated from wound pus. Among 80 data records of the patients reviewed during PPS, Ceftriaxone (54.3%) and Metronidazole (23.3%) emerged as the most frequently used antibiotics in the wards which were prescribed empirically without a microbiological indication. Conclusion In this study setting, we observed high use of watch antibiotics along with problem of multi-drug resistant infections in patients experiencing clinical failure in a variety of clinical syndromes. The findings underline the need to revamp diagnostic microbiology to increase the uptake of antimicrobial susceptibility testing to guide specific prescriptions of broad-spectrum antibiotics in the watch list.
Læs mere Tjek på PubMedBMC Infectious Diseases, 27.04.2024
Tilføjet 27.04.2024
Abstract Background Urinary tract infection (UTI) is a common cause of sepsis. Elderly patients with urosepsis in intensive care unit (ICU) have more severe conditions and higher mortality rates owing to factors such as advanced age, immunosenescence, and persistent host inflammatory responses. However, comprehensive studies on nomograms to predict the in-hospital mortality risk in elderly patients with urosepsis are lacking. This study aimed to construct a nomogram predictive model to accurately assess the prognosis of elderly patients with urosepsis and provide therapeutic recommendations. Methods Data of elderly patients with urosepsis were extracted from the Medical Information Mart for Intensive Care (MIMIC) IV 2.2 database. Patients were randomly divided into training and validation cohorts. A predictive nomogram model was constructed from the training set using logistic regression analysis, followed by internal validation and sensitivity analysis. Results This study included 1,251 patients. LASSO regression analysis revealed that the Glasgow Coma Scale (GCS) score, red cell distribution width (RDW), white blood count (WBC), and invasive ventilation were independent risk factors identified from a total of 43 variables studied. We then created and verified a nomogram. The area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA) of the nomogram were superior to those of the traditional SAPS-II, APACHE-II, and SOFA scoring systems. The Hosmer-Lemeshow test results and calibration curves suggested good nomogram calibration. The IDI and NRI values showed that our nomogram scoring tool performed better than the other scoring systems. The DCA curves showed good clinical applicability of the nomogram. Conclusions The nomogram constructed in this study is a convenient tool for accurately predicting in-hospital mortality in elderly patients with urosepsis in ICU. Improving the treatment strategies for factors related to the model could improve the in-hospital survival rates of these patients.
Læs mere Tjek på PubMedBMC Infectious Diseases, 27.04.2024
Tilføjet 27.04.2024
Abstract Objectives The increasing prevalence of severe Mycoplasma pneumoniae pneumonia (SMPP) poses a significant threat to the health of children. This study aimed to characterise and assess the outcomes in children with SMPP. Methods We retrospectively analysed children hospitalised for M. pneumoniae pneumonia (MPP) between January and December 2022. Retrospectively, demographic, clinical, underlying diseases, laboratory and radiological findings, and treatment outcomes were collected and analysed. Disease severity was defined as severe or general according to the Guideline for diagnosis and treatment of community-acquired pneumonia in children (2019 version). Results Over a 12-month observation period, 417 children with MPP were enrolled, 50.6% (211/417) of whom had SMPP, with the peak incidence observed in winter. Of the 211 children with SMPP, 210 were treated and discharged with improvement, while one child with congenital heart disease died of cardioembolic stroke. A significantly higher proportion of patients with SMPP had underlying diseases, extrapulmonary complications (myocardial and digestive system involvement), and bacterial co-infection. A total of 25 (12%) children with SMPP received mechanical ventilation. The median duration of mechanical ventilation was 3 days. All children were treated with macrolide antibiotic. A significantly higher proportion of patients with SMPP received antibiotic other than macrolides, methylprednisolone sodium succinate, intravenous immunoglobulin and anticoagulation, compared with patients with general MPP (GMPP). Children with SMPP had significantly higher levels of white blood cells, neutrophil percentage, C-reactive protein, procalcitonin, interferon-γ, interleukin (IL)-2, IL-5, IL-6, IL-8, IL-10 and significantly lower percentages of lymphocytes, monocytes, and natural killer cells, compared with GMPP group. Conclusion Our findings suggest that severely ill children have more pronounced inflammatory reaction and extrapulmonary complications. For effective management of children with SMPP, hormonal, prophylactic, anticoagulant therapy, as well as the use of antibiotics other than macrolides for bacterial co-infections, could be incorporated into treatment regimens.
Læs mere Tjek på PubMedVladislav Ilík, Erich M. Schwarz, Eva Nosková, Barbora Pafčo
Trends in Parasitology, 27.04.2024
Tilføjet 27.04.2024
Hookworms are parasites, closely related to the model nematode Caenorhabditis elegans, that are a major economic and health burden worldwide. Primarily three hookworm species (Necator americanus, Ancylostoma duodenale, and Ancylostoma ceylanicum) infect humans. Another 100 hookworm species from 19 genera infect primates, ruminants, and carnivores. Genetic data exist for only seven of these species. Genome sequences are available from only four of these species in two genera, leaving 96 others (particularly those parasitizing wildlife) without any genomic data. The most recent hookworm genomes were published 5 years ago, leaving the field in a dusk. However, assembling genomes from single hookworms may bring a new dawn. Here we summarize advances, challenges, and opportunities for studying these neglected but important parasitic nematodes.
Læs mere Tjek på PubMedSarah M. Short, Risa Pesapane
Trends in Parasitology, 27.04.2024
Tilføjet 27.04.2024
Blacklegged ticks (Ixodes scapularis) are responsible for transmission of the bacteria that cause Lyme disease – the most common tick-borne disease in temperate North America – as well as several other pathogens of medical and veterinary importance that are acquired during blood feeding. I. scapularis is a three-host tick with a wide host range, but its immature forms typically prefer small mammals or birds while adults prefer white-tailed deer. All three life stages bite humans and domestic animals.
Læs mere Tjek på PubMedXiaogang Wang, Jean C. Lee
Trends in Microbiology, 27.04.2024
Tilføjet 27.04.2024
Staphylococcus aureus is an important bacterial pathogen that causes a wide variety of human diseases in community and hospital settings. S. aureus employs a diverse array of virulence factors, both surface-associated and secreted, to promote colonization, infection, and immune evasion. Over the past decade, a growing body of research has shown that S. aureus generates extracellular membrane vesicles (MVs) that package a variety of bacterial components, many of which are virulence factors. In this review, we summarize recent advances in our understanding of S. aureus MVs and highlight their biogenesis, cargo, and potential role in the pathogenesis of staphylococcal infections. Lastly, we present some emerging questions in the field.
Læs mere Tjek på PubMedSarah Kimball, Marley Reynoso, Courtney McKnight, Don Des Jarlais
PLoS One Infectious Diseases, 27.04.2024
Tilføjet 27.04.2024
by Sarah Kimball, Marley Reynoso, Courtney McKnight, Don Des Jarlais Background The prevalence of hepatitis C virus (HCV) among people who inject drugs (PWID) is between 50–70%. Prior systematic reviews demonstrated that PWID have similar direct acting antiviral treatment outcomes compared to non-PWID; however, reviews have not examined treatment outcomes by housing status. Given the links between housing and health, identifying gaps in HCV treatment can guide future interventions. Methods We conducted a systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched six databases for articles from 2014 onward. Two reviewers conducted title/abstract screenings, full-text review, and data extraction. We extracted effect measures for treatment initiation, adherence, completion, success, and reinfection by housing status. Studies underwent quality and certainty assessments, and we performed meta-analyses as appropriate. Results Our search yielded 473 studies, eight of which met inclusion criteria. Only the treatment initiation outcome had sufficient measures for meta-analysis. Using a random-effects model, we found those with unstable housing had 0.40 (0.26, 0.62) times the odds of initiating treatment compared to those with stable housing. Other outcomes were not amenable for meta-analysis due to a limited number of studies or differing outcome definitions. Conclusions Among PWID, unstable housing appears to be a barrier to HCV treatment initiation; however, the existing data is limited for treatment initiation and the other outcomes we examined. There is a need for more informative studies to better understand HCV treatment among those with unstable housing. Specifically, future studies should better define housing status beyond a binary, static measure to capture the nuances and complexity of housing and its subsequent impact on HCV treatment. Additionally, researchers should meaningfully consider whether the outcome(s) of interest are being accurately measured for individuals experiencing unstable housing.
Læs mere Tjek på PubMedAleena Amjad Hafeeez, Karina Cavalcanti Bezerra, Zaharadeen Jimoh, Francesca B. Seal, Joan L. Robinson, Nahla A. Gomaa
PLoS One Infectious Diseases, 27.04.2024
Tilføjet 27.04.2024
by Aleena Amjad Hafeeez, Karina Cavalcanti Bezerra, Zaharadeen Jimoh, Francesca B. Seal, Joan L. Robinson, Nahla A. Gomaa Background There are no narrative or systematic reviews of hearing loss in patients with congenital syphilis. Objectives The aim of this study was to perform a scoping review to determine what is known about the incidence, characteristics, prognosis, and therapy of hearing loss in children or adults with presumed congenital syphilis. Eligibility criteria PROSPERO, OVID Medline, OVID EMBASE, Cochrane Library (CDSR and Central), Proquest Dissertations and Theses Global, and SCOPUS were searched from inception to March 31, 2023. Articles were included if patients with hearing loss were screened for CS, ii) patients with CS were screened for hearing loss, iii) they were case reports or case series that describe the characteristics of hearing loss, or iv) an intervention for hearing loss attributed to CS was studied. Sources of evidence Thirty-six articles met the inclusion criteria. Results Five studies reported an incidence of CS in 0.3% to 8% of children with hearing loss, but all had a high risk of bias. Seven reported that 0 to 19% of children with CS had hearing loss, but the only one with a control group showed comparable rates in cases and controls. There were 18 case reports/ case series (one of which also reported screening children with hearing loss for CS), reporting that the onset of hearing loss was usually first recognized during adolescence or adulthood. The 7 intervention studies were all uncontrolled and published in 1983 or earlier and reported variable results following treatment with penicillin, prednisone, and/or ACTH. Conclusions The current literature is not informative with regard to the incidence, characteristics, prognosis, and therapy of hearing loss in children or adults with presumed congenital syphilis.
Læs mere Tjek på PubMedLoraine Ledón-Llanes, Irazú Contreras-Yáñez, Guillermo Arturo Guaracha-Basáñez, Salvador Saúl Valverde-Hernández, Maximiliano Cuevas-Montoya, Ana Belén Ortiz-Haro, Virginia Pascual-Ramos
PLoS One Infectious Diseases, 27.04.2024
Tilføjet 27.04.2024
by Loraine Ledón-Llanes, Irazú Contreras-Yáñez, Guillermo Arturo Guaracha-Basáñez, Salvador Saúl Valverde-Hernández, Maximiliano Cuevas-Montoya, Ana Belén Ortiz-Haro, Virginia Pascual-Ramos Background Rheumatoid arthritis (RA) is one of the most prevalent rheumatic diseases that harms all aspects of patients’ lives, including sexual and reproductive health (SRH), often neglected in patients’ care. The study aimed to explore the sexual and reproductive experiences of Mexican outpatients with RA from a narrative perspective. Patients and methods From July 2020 to October 2021, 30 adult patients with RA from the Department of Immunology and Rheumatology outpatient clinic of a national referral center for rheumatic diseases had in-depth interviews audiotaped, transcribed, and analyzed using a thematic analysis approach. Results are presented in a descriptive and interpretative manner and integrated into a theoretical model for the topic understanding. Results Five intertwined major themes emerged: I) RA onset: Absence of SRH contents, II) Healthcare for RA: Emerging SRH contents, III) RA’s impact: Proliferation of SRH contents, IV) Coping with the process of living with RA: SRH-related strategies, and V) The impact of the COVID-19 pandemic on patients’ experiences: Increased SRH burden. SRH contents emerged through these major themes (but at RA onset), mostly when inquired and mainly when narrating the RA impact and coping. Patients identified that RA affected their couple dynamics, sexual function, and reproductive project. The SRH care was considered relevant but limited and focused on reproductive contents. It worsened during the COVID-19 pandemic. We proposed a theoretical model where patients’ SRH experiences are embedded across their RA biography and integrated with the RA impact and the copy with the disease process. These intertwined experiences were also evident during the COVID-19 pandemic, which challenged participants’ biopsychosocial resources. Conclusions The sexual and reproductive experiences narrated by the RA outpatients concerning their disease-related biography showed that even when the SRH appeared as not prioritized at the disease onset, it was widely expressed during the process of living and coping with the disease and was additionally affected by the COVID-19 pandemic.
Læs mere Tjek på PubMedNatalia Zeber-Lubecka, Maria Kulecka, Michalina Dabrowska, Katarzyna Baginska-Drabiuk, Maria Glowienka-Stodolak, Andrzej Nowakowski, Aneta Slabuszewska-Jozwiak, Bożena Bednorz, Ilona Jędrzejewska, Magdalena Piasecka, Jolanta Pawelec, Elzbieta Wojciechowska-Lampka, Jerzy Ostrowski
PLoS One Infectious Diseases, 27.04.2024
Tilføjet 27.04.2024
by Natalia Zeber-Lubecka, Maria Kulecka, Michalina Dabrowska, Katarzyna Baginska-Drabiuk, Maria Glowienka-Stodolak, Andrzej Nowakowski, Aneta Slabuszewska-Jozwiak, Bożena Bednorz, Ilona Jędrzejewska, Magdalena Piasecka, Jolanta Pawelec, Elzbieta Wojciechowska-Lampka, Jerzy Ostrowski High-risk Human Papillomavirus (HR-HPV) genotypes, specifically HPV16 and HPV18, pose a significant risk for the development of cervical intraepithelial neoplasia and cervical cancer. In the multifaceted cervical microenvironment, consisting of immune cells and diverse microbiota, Lactobacillus emerges as a pivotal factor, wielding significant influence in both stabilizing and disrupting the microbiome of the reproductive tract. To analyze the distinction between the cervical microbiota and Lactobacillus-dominant/non-dominant status of HR-HPV and non-infected healthy women, sixty-nine cervical swab samples were analyzed, included 44 with HR-HPV infection and healthy controls. All samples were recruited from Human Papillomavirus-based cervical cancer screening program and subjected to 16s rRNA sequencing analysis. Alpha and beta diversity analyses reveal no significant differences in the cervical microbiota of HR-HPV-infected women, including 16 and 18 HPV genotypes, and those with squamous intraepithelial lesion (SIL), compared to a control group. In this study we identified significantly lower abundance of Lactobacillus mucosae in women with HR-HPV infection compared to the control group. Furthermore, changes in bacterial diversity were noted in Lactobacillus non-dominant (LND) samples compared to Lactobacillus-dominant (LD) in both HR-HPV-infected and control groups. LND samples in HR-HPV-infected women exhibited a cervical dysbiotic state, characterized by Lactobacillus deficiency. In turn, the LD HR-HPV group showed an overrepresentation of Lactobacillus helveticus. In summary, our study highlighted the distinctive roles of L. mucosae and L. helveticus in HR-HPV infections, signaling a need for further research to demonstrate potential clinical implications of cervical microbiota dysbiosis.
Læs mere Tjek på PubMedNiels D. Martin, Laura L. Schott, Mary K. Miranowski, Amarsinh M. Desai, Cynthia C. Lowen, Zhun Cao, Krysmaru Araujo Torres
PLoS One Infectious Diseases, 27.04.2024
Tilføjet 27.04.2024
by Niels D. Martin, Laura L. Schott, Mary K. Miranowski, Amarsinh M. Desai, Cynthia C. Lowen, Zhun Cao, Krysmaru Araujo Torres Background Arginine-supplemented enteral immunonutrition has been designed to optimize outcomes in critical care patients. Existing formulas may be isocaloric and isoproteic, yet differ in L-arginine content, energy distribution, and in source and amount of many other specialized ingredients. The individual contributions of each may be difficult to pinpoint; however, all cumulate in the body’s response to illness and injury. The study objective was to compare health outcomes between different immunonutrition formulas. Methods Real-world data from October 2015 –February 2019 in the PINC AI™ Healthcare Database (formerly the Premier Healthcare Database) was reviewed for patients with an intensive care unit (ICU) stay and ≥3 days exclusive use of either higher L-arginine formula (HAF), or lower L-arginine formula (LAF). Multivariable generalized linear model regression was used to check associations between formulas and ICU length of stay. Results 3,284 patients (74.5% surgical) were included from 21 hospitals, with 2,525 receiving HAF and 759 LAF. Inpatient mortality (19.4%) and surgical site infections (6.2%) were similar across groups. Median hospital stay of 17 days (IQR: 16) did not differ by immunonutrition formula. Median ICU stay was shorter for patients receiving HAF compared to LAF (10 vs 12 days; P
Læs mere Tjek på PubMedOlatunji O. Adetokunboh, Elisha B. Are
PLoS One Infectious Diseases, 27.04.2024
Tilføjet 27.04.2024
by Olatunji O. Adetokunboh, Elisha B. Are Background Spatial analysis at different levels can help understand spatial variation of human immunodeficiency virus (HIV) infection, disease drivers, and targeted interventions. Combining spatial analysis and the evaluation of the determinants of the HIV burden in Southern African countries is essential for a better understanding of the disease dynamics in high-burden settings. Methods The study countries were selected based on the availability of demographic and health surveys (DHS) and corresponding geographic coordinates. We used multivariable regression to evaluate the determinants of HIV burden and assessed the presence and nature of HIV spatial autocorrelation in six Southern African countries. Results The overall prevalence of HIV for each country varied between 11.3% in Zambia and 22.4% in South Africa. The HIV prevalence rate was higher among female respondents in all six countries. There were reductions in prevalence estimates in most countries yearly from 2011 to 2020. The hotspot cluster findings show that the major cities in each country are the key sites of high HIV burden. Compared with female respondents, the odds of being HIV positive were lesser among the male respondents. The probability of HIV infection was higher among those who had sexually transmitted infections (STI) in the last 12 months, divorced and widowed individuals, and women aged 25 years and older. Conclusions Our research findings show that analysis of survey data could provide reasonable estimates of the wide-ranging spatial structure of the HIV epidemic in Southern African countries. Key determinants such as individuals who are divorced, middle-aged women, and people who recently treated STIs, should be the focus of HIV prevention and control interventions. The spatial distribution of high-burden areas for HIV in the selected countries was more pronounced in the major cities. Interventions should also be focused on locations identified as hotspot clusters.
Læs mere Tjek på PubMedMalaria Journal, 27.04.2024
Tilføjet 27.04.2024
Abstract Background Anopheles coluzzii is a primary vector of malaria found in West and Central Africa, but its presence has hitherto never been documented in Kenya. A thorough understanding of vector bionomics is important as it enables the implementation of targeted and effective vector control interventions. Malaria vector surveillance efforts in the country have tended to focus on historically known primary vectors. The current study sought to determine the taxonomic status of samples collected from five different malaria epidemiological zones in Kenya as well as describe the population genetic structure and insecticide resistance profiles in relation to other An. coluzzii populations. Methods Mosquitoes were sampled as larvae from Busia, Kwale, Turkana, Kirinyaga and Kiambu counties, representing the range of malaria endemicities in Kenya, in 2019 and 2021 and emergent adults analysed using Whole Genome Sequencing (WGS) data processed in accordance with the Anopheles gambiae 1000 Genomes Project phase 3. Where available, historical samples from the same sites were included for WGS. Comparisons were made with An. coluzzii cohorts from West and Central Africa. Results This study reports the detection of An. coluzzii for the first time in Kenya. The species was detected in Turkana County across all three time points from which samples were analyzed and its presence confirmed through taxonomic analysis. Additionally, there was a lack of strong population genetic differentiation between An. coluzzii from Kenya and those from the more northerly regions of West and Central Africa, suggesting they represent a connected extension to the known species range. Mutations associated with target-site resistance to DDT and pyrethroids and metabolic resistance to DDT were found at high frequencies up to 64%. The profile and frequencies of the variants observed were similar to An. coluzzii from West and Central Africa but the ace-1 mutation linked to organophosphate and carbamate resistance present in An. coluzzii from coastal West Africa was absent in Kenya. Conclusions These findings emphasize the need for the incorporation of genomics in comprehensive and routine vector surveillance to inform on the range of malaria vector species, and their insecticide resistance status to inform the choice of effective vector control approaches.
Læs mere Tjek på PubMedMalaria Journal, 27.04.2024
Tilføjet 27.04.2024
Abstract Background In Madagascar, the districts of Antsirabe II, Faratsiho and Antsiranana I have relatively low malaria incidence rates and have been selected by the National Malaria Control Programme for pilot elimination strategies. The districts have residual transmission despite increasing coverage and quality of malaria services. This study sought to identify priority subpopulations at highest risk for malaria and collect information on intervention preferences and methods that will inform subnational tailoring of malaria service delivery. Methods This mixed methods study employed (i) a quantitative malaria risk factor assessment in Antsirabe II and Faratsiho comprising a test-negative frequency matched case–control study and a qualitative risk factor assessment in Antsiranana I; and (ii) a qualitative formative assessment in all three districts. For the case–control study, a mixed effects logistic regression was used with age, sex and district included as fixed effects and health facility included as a random effect. The qualitative risk factor assessment used semi-structured interview guides and key informant interviews. For the qualitative formative assessment in the three districts, a summary report was generated following semi-structured interviews and focus group discussions with high-risk populations (HRPs) and stakeholders. Results In Antsirabe II and Faratsiho districts, rice agriculture workers, outdoor/manual workers, particularly miners, and those with jobs that required travel or overnight stays, especially itinerant vendors, had higher odds of malaria infection compared to other (non-rice) agricultural workers. In Antsiranana I, respondents identified non-rice farmers, mobile vendors, and students as HRPs. Risk factors among these groups included overnight stays and travel patterns combined with a lack of malaria prevention tools. HRPs reported treatment cost and distance to the health facility as barriers to care and expressed interest in presumptive treatment and involvement of gatekeepers or people who have influence over intervention access or participation. Conclusions The study results illustrate the value of in-depth assessments of risk behaviours, access to services and prevention tools, surveillance and prevention strategies, and the involvement of gatekeepers in shaping subnational tailoring to reach previously unreached populations and address residual transmission in elimination settings.
Læs mere Tjek på PubMedMalaria Journal, 27.04.2024
Tilføjet 27.04.2024
Abstract Background The increased availability and use of malaria rapid diagnostic test (RDT) by primary healthcare (PHC) workers has made universal diagnostic testing before malaria treatment more feasible. However, to meaningfully resolve the problem of over-treatment with artemisinin-based combination therapy and the heightened risk of selection pressure and drug resistance, there should be appropriate response (non-prescription of anti-malarial drugs) following a negative RDT result by PHC workers. This study explored the determinants of the use of RDT and anti-malarial drug prescription practices by PHC workers in Ebonyi state, Nigeria. Methods Between March 2 and 10, 2020, three focus group discussions were conducted in English with 23 purposively-selected consenting PHC workers involved in the diagnosis and treatment of malaria. Data was analysed thematically as informed by the method by Braun and Clarke. Results The determinants of the use of RDT for malaria diagnosis were systemic (RDT availability and patient load), provider related (confidence in RDT and the desire to make correct diagnosis, PHC worker’s knowledge and training, and fear to prick a patient), client related (fear of needle prick and refusal to receive RDT, and self-diagnosis of malaria, based on symptoms, and insistence on not receiving RDT), and RDT-related (the ease of conducting and interpreting RDT). The determinants of anti-malarial drug prescription practices were systemic (drug availability and cost) and drug related (effectiveness and side-effects of the drugs). The determinants of the prescription of anti-malarial drugs following negative RDT were provider related (the desire to make more money and limited confidence in RDT) and clients’ demand while unnecessary co-prescription of antibiotics with anti-malarial drugs following positive RDT was determined by the desire to make more money. Conclusions This evidence highlights many systemic, provider, client, and RDT/drug related determinants of PHC workers’ use of RDT and anti-malarial drug prescription practices that should provide tailored guidance for relevant health policy actions in Ebonyi state, Nigeria, and similar settings.
Læs mere Tjek på PubMedInfection, 27.04.2024
Tilføjet 27.04.2024
Abstract This case report highlights a case of a 65-year-old woman who presented to our clinic with suspicion of refractory scabies. She had undergone multiple treatments without improvement. However, the clinical condition was not scabies but rather Gianotti–Crosti Syndrome (GCS), leading to rapid clinical improvement and avoiding the need for further unnecessary tests and treatments. GCS is a postviral exanthem characterized by symmetrical, red papules on the extremities and buttocks, typically occurring in children but can also affect adults. It is crucial for every physician to distinguish it from other causes of rash, including scabies, to ensure an accurate diagnosis and appropriate management.
Læs mere Tjek på PubMedInfection, 27.04.2024
Tilføjet 27.04.2024
Abstract Nocardia is a genus of aerobic, Gram-positive bacteria known for their filamentous and branching morphology. N. brasiliensis is the most common species causing cutaneous nocardiosis. We present a 67-year-old woman who developed abscesseson the back of her right ankle after walking barefoot on soil. Cultures from the cutaneous lesions grew N. brasiliensis. Antibiotic therapy with trimethoprim-sulfamethoxazole given for a month provided near-complete resolution of her lesions.
Læs mere Tjek på PubMedInfection, 27.04.2024
Tilføjet 27.04.2024
Abstract Background Melioidosis is a bacterial infection associated with high mortality. The diagnostic approach to this rare disease in Europe is challenging, especially because pulmonary manifestation of melioidosis can mimic pulmonary tuberculosis (TB). Antibiotic therapy of melioidosis consists of an initial intensive phase of 2–8 weeks followed by an eradication therapy of 3–6 months. Case presentation We present the case of a 46-year-old female patient with pulmonary melioidosis in Germany. The patient showed chronic cough, a pulmonary mass and a cavitary lesion, which led to the initial suspicion of pulmonary TB. Melioidosis was considered due to a long-term stay in Thailand with recurrent exposure to rice fields. Results Microbiologic results were negative for TB. Histopathology of an endobronchial tumor showed marked chronic granulation tissue and fibrinous inflammation. Melioidosis was diagnosed via polymerase chain reaction by detection of Burkholderia pseudomallei/mallei target from mediastinal lymph-node tissue. Conclusion This case report emphasizes that melioidosis is an important differential diagnosis in patients with suspected pulmonary tuberculosis and recent travel to South-East Asia.
Læs mere Tjek på PubMedJournal of Infectious Diseases, 27.04.2024
Tilføjet 27.04.2024
Abstract We are currently witnessing the endemization of urogenital schistosomiasis in southern Europe. The incriminated parasite is a hybrid between a human parasite and a livestock parasite. Using an experimental evolutionary protocol, we created hybrid lines from pure strains of both parasite species. We showed that the host spectrum of the human parasite is enlarged to the livestock parasite after genomic introgression. We also evidenced that the tropism of the parasites within the host changes and that some hybrid lines are more virulent than the parental strains. These results engage a paradigm shift from human to zoonotic transmission of urogenital schistosomiasis.
Læs mere Tjek på PubMedJournal of Infectious Diseases, 27.04.2024
Tilføjet 27.04.2024
Summary Background The role of Gasdermin D (GSDMD) in bloodstream infection (BSI) diagnosis is unknown.Methods Serum GSDMD levels were measured in BSI patients. Endothelial cells and PBMCs were isolated, infected with bacteria/fungi, and intracellular/extracellular GSDMD concentrations were measured. An animal model was established to investigate the association between serum GSDMD levels and BSI incidence/progression.Results ROC curve analysis indicated that GSDMD could be a potential early diagnostic biomarker for BSI (AUC = 0.9885). Combining GSDMD with procalcitonin (PCT) improved the differential diagnosis of Gram-positive and Gram-negative bacteria (AUC = 0.6699, 66.15% specificity), and early diagnosis of Gram-positive bacteria (98.46% sensitivity), while PCT was not significantly elevated. The combined GSDMD and G-test had higher sensitivity (AUC = 0.7174) for differential diagnosis of bacterial and fungal infections, and early detection of fungal infections (98.44% sensitivity). In vitro and in vivo experiments confirmed that GSDMD levels increased significantly within 2 hours, peaked at 16 hours, and exhibited a time-dependent upward trend.Conclusions Serum GSDMD, alone or combined with other biomarkers, has potential for early diagnosis and differential diagnosis of BSI caused by various pathogens. This finding offers a new strategy for early detection and treatment of BSI.
Læs mere Tjek på PubMedXue NingLianmei LiJing LiuFang WangKun TanWenhui LiKai ZhouShujun JingAiwei LinJing BiShiyong ZhaoHuiling DengChunhui ZhuShanshan LvJuan LiJun LiangQing ZhaoYumin WangBiquan ChenLiang ZhuGuowu ShenJianlong LiuZhi LiJikui DengXin ZhaoMingfeng ShanYi WangShihua LiuTingting JiangXuexia ChenYufeng ZhangSha CaiLixue WangXudong LuJinghui JiangFang DongLan YeJing SunKaihu YaoYonghong YangGang Liua Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, People’s Republic of Chinab Department of Infectious and Digestive Diseases, Qinghai Province Women and Children's Hospital, Xining, People’s Republic of Chinac Department of Infectious Diseases, Hunan Children’s Hospital, Changsha, People’s Republic of Chinad Department of Infectious Diseases, Henan Children’s Hospital, (Children's Hospital Affiliated of Zhengzhou University, Zhengzhou Children's Hospital), Zhengzhou, People’s Republic of Chinae Department of Infectious Diseases, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of Chinaf Department of Infectious and Digestive Diseases, Children’s Hospital of Hebei Province, Shijiazhuang, People’s Republic of Chinag Department of Infectious Diseases, Children’s Hospital of Nanjing Medical University, Nanjing, People’s Republic of Chinah Department of Infectious Diseases, Dalian Children’s Hospital, Dalian, People’s Republic of Chinai Department of Infectious Diseases, Children’s Hospital Affiliated to Shandong University, Jinan, People’s Republic of Chinaj Jinan Children’s Hospital, Shandong University, Jinan, People’s Republic of Chinak Department of Infectious Diseases, Baoding Children’s Hospital, Baoding, People’s Republic of Chinal Department of Infectious Diseases, Hangzhou Children’s Hospital, Hangzhou, People’s Republic of Chinam Department of Infectious Diseases, Xian Children’s Hospital, Xian, People’s Republic of Chinan Department of Infectious Diseases, Children’s Hospital of Jiangxi Province, Nanchang, People’s Republic of Chinao Department of Infectious Diseases, Changchun Children’s Hospital, Changchun, People’s Republic of Chinap Department of Infectious Diseases, Urumqi Children’s Hospital, Urumqi, People’s Republic of Chinaq Department of Pediatric Intensive Care Unit, People’s Hospital of Liaocheng, Liaocheng, People’s Republic of Chinar Department of Infectious Diseases, Children’s Hospital of Shanxi Province, Taiyuan, People’s Republic of Chinas Department of Infectious Diseases, Maternal and Child Health Care Hospital of the Inner Mongolia autonomous region, Huhehaote, People’s Republic of Chinat Department of Infectious Diseases, Anhui Provincial Children’s Hospital, Hefei, People’s Republic of Chinau Department of clinical laboratory, Qinghai Province Women and Children's Hospital, Xining, People’s Republic of Chinav Department of clinic laboratory, Hunan Children’s Hospital, Changsha, People’s Republic of Chinaw Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, People’s Republic of China
Emerg Microbes Infect, 26.04.2024
Tilføjet 26.04.2024
International Journal for Parasitology, 26.04.2024
Tilføjet 26.04.2024
Publication date: Available online 25 April 2024 Source: International Journal for Parasitology Author(s): Robert Muriuki, Maingi Ndichu, Samuel Githigia, Nicholas Svitek
Læs mere Tjek på PubMedInternational Journal for Parasitology, 26.04.2024
Tilføjet 26.04.2024
Publication date: Available online 25 April 2024 Source: International Journal for Parasitology Author(s): C. Liang, L.T. Luong
Læs mere Tjek på PubMedInternational Journal for Parasitology, 26.04.2024
Tilføjet 26.04.2024
Publication date: Available online 25 April 2024 Source: International Journal for Parasitology Author(s): Maxime Delsart, Jean-Michel Reperant, Chantal Benoit, Edouard Boudin, Jean-François Da-Costa, Virginie Dorenlor, Florent Eono, Eric Eveno, Stéphane Kerpherique, Gilles Poulain, Marie Souquiere, Martine Thomas-Henaff, Françoise Pol, Barbara Dufour, Nicolas Rose, Christelle Fablet
Læs mere Tjek på PubMedImmunity, 26.04.2024
Tilføjet 26.04.2024
Publication date: Available online 25 April 2024 Source: Immunity Author(s): Rashmi Ray, Faez Amokrane Nait Mohamed, Daniel P. Maurer, Jiachen Huang, Berk A. Alpay, Larance Ronsard, Zhenfei Xie, Julianna Han, Monica Fernandez-Quintero, Quynh Anh Phan, Rebecca L. Ursin, Mya Vu, Kathrin H. Kirsch, Thavaleak Prum, Victoria C. Rosado, Thalia Bracamonte-Moreno, Vintus Okonkwo, Julia Bals, Caitlin McCarthy, Usha Nair
Læs mere Tjek på PubMedLili Wu, Hong Deng, Xiao Feng, Dongying Xie, Zhihui Li, Junfeng Chen, Zhishuo Mo, Qiyi Zhao, Zhaoxia Hu, Shuhong Yi, Shibo Meng, Jialei Wang, Xiaoyan Li, Bingliang Lin, Zhiliang Gao
Journal of Medical Virology, 26.04.2024
Tilføjet 26.04.2024
Isaac Quiros‐Fernandez, Sofia Libório‐Ramos, Lena Leifert, Bruno Schönfelder, Israel Vlodavsky, Angel Cid‐Arregui
Journal of Medical Virology, 26.04.2024
Tilføjet 26.04.2024
Friedman, M. R., Badri, S., Bowleg, L., Haberlen, S. A., Jones, D. L., Kempf, M.-C., Konkle-Parker, D., Kwait, J., Martinson, J., Mimiaga, M. J., Plankey, M. W., Stosor, V., Tsai, A. C., Turan, J. M., Ware, D., Wu, K.
BMJ Open, 26.04.2024
Tilføjet 26.04.2024
IntroductionThe increasing burden of non-communicable diseases, such as hypertension, diabetes and dyslipidaemia, presents key challenges to achieving optimal HIV care outcomes among ageing people living with HIV. These diseases are often comorbid and are exacerbated by psychosocial and structural inequities. This interaction among multiple health conditions and social factors is referred to as a syndemic. In the USA, there are substantial disparities by social position (ie, racial, ethnic and socioeconomic status) in the prevalence and/or control of non-communicable diseases and HIV. Intersecting stigmas, such as racism, classism and homophobia, may drive these health disparities by contributing to healthcare avoidance and by contributing to a psychosocial syndemic (stress, depression, violence victimisation and substance use), reducing success along the HIV and non-communicable disease continua of care. Our hypothesis is that marginalised populations experience disparities in non-communicable disease incidence, prevalence and control, mediated by intersectional stigma and the psychosocial syndemic. Methods and analysisCollecting data over a 4 year period, we will recruit sexual minority men (planned n=1800) enrolled in the MACS/WIHS Combined Cohort Study, a long-standing mixed-serostatus observational cohort in the USA, to investigate the following specific aims: (1) assess relationships between social position, intersectional stigma and the psychosocial syndemic among middle-aged and ageing sexual minority men, (2) assess relationships between social position and non-communicable disease incidence and prevalence and (3) assess relationships between social position and HIV and non-communicable disease continua of care outcomes, mediated by intersectional stigma and the psychosocial syndemic. Analyses will be conducted using generalised structural equation models using a cross-lagged panel model design. Ethics and disseminationThis protocol is approved as a single-IRB study (Advarra Institutional Review Board: Protocol 00068335). We will disseminate results via peer-reviewed academic journals, scientific conferences, a dedicated website, site community advisory boards and forums hosted at participating sites.
Læs mere Tjek på PubMedADEQUATE Paediatric Trial Group, Yau, Vitale, Vecchia, DAmbrosio, Bouwman, van Esschoten, Leus, de Pooter, Timbermont, Rodriguez Ruiz, Hommel, Tessonneau, Kohns Vasconcelos, Malhotra-Kumar, Allantaz, Vandepitte, Tissier, Cleuziat, Postma, van Asselt, van Dorst, van der Pol, Antonanzas, Rojas, Gonzales, Dawoud, Hawksworth, Lyttle, Heijerman, Clements, Prat Aymerich, Goossens, Bonten, Bielicki, Atkinson, van Werkhoven, Simitsopoulou, Pantzartzi, Zarras, Ftergioti, Kitsou, Karypiadou, Lampada, Charisi, Savvidou, Tsiatsiou, Chorafa, Michailidou, Roilides, Iosifidis, Stiegler, Junk, Kiesel, Belschner, Seyfried, Schmauder, Peter, Walter, Imort, Behret, Renk, Berger, Pfeiffer, Früh, Robinson, Marten, Werner, Gijon, Calderon, Machin, Cabello, Seoane, Mesa, Oviedo, Baron, Hernandez, Rojo, Gardiner, Capozzi, Ross, Hemeson, Nyirenda Nyangwa, Brock, Hultin, Hill, Severi Conti, Gualco, Vanoni
BMJ Open, 26.04.2024
Tilføjet 26.04.2024
IntroductionSyndromic panel assays, that is, using one test to simultaneously target multiple pathogens with overlapping signs and symptoms, have been integrated into routine paediatric care over the past decade, mainly for more severely ill and hospitalised patients. Their wider availability and short turnaround times open the possibility to apply them to non-hospitalised patients as well. In this context, it is important to trial how clinicians make use of pathogen detection data and if their early availability influences management decisions, particularly antibiotic use and hospitalisation. Methods and analysisAdvanced Diagnostics for Enhanced QUality of Antibiotic prescription in respiratory Tract infections in Emergency rooms is an individually randomised, controlled, open-label effectiveness trial comparing the impact of a respiratory pathogen panel assay (BIOFIRE Respiratory Panel 2.1plus) used as a rapid syndromic test on nasopharyngeal swabs in addition to the standard of care versus standard of care alone. The trial will 1:1 randomise 520 participants under the age of 18 at 7 paediatric emergency departments in 5 European countries. Inclusion criteria for the trial consist of two sets, with the first describing respiratory tract infections in paediatric patients and the second describing the situation of potential management uncertainty in which test results may immediately affect management decisions. Enrolment started in July 2021 and is expected to be completed in early 2024. We will perform a two-sample t-test assuming a pooled variance estimate to compare the log-transformed mean time on antibiotic treatment (in hours) and number of days alive out of the hospital within 14 days after study enrolment between the control and intervention arms. Ethics and disseminationThe trial protocol and materials were approved by research ethics committees in all participating countries. The respiratory pathogen panel assay is CE marked (assessed to meet European regulations) and FDA (United States Food and Drug Administration) cleared for diagnostic use. Participants and caregivers provide informed consent prior to study procedures commencing. The trial results will be published in peer-reviewed journals and at national and international conferences. Key messages will also be disseminated via press and social media where appropriate. Trial registration number NCT04781530.
Læs mere Tjek på PubMedMpirirwe, R., Segawa, I., Ojiambo, K. O., Kamacooko, O., Nangendo, J., Semitala, F. C., Kyambadde, P., Kalyango, J. N., Kiragga, A., Karamagi, C., Katahoire, A., Kamya, M., Mujugira, A.
BMJ Open, 26.04.2024
Tilføjet 26.04.2024
ObjectiveTo evaluate oral pre-exposure prophylaxis (PrEP) uptake, retention and adherence among female sex workers (FSWs) receiving care through community and facility delivery models in sub-Saharan Africa (SSA). DesignSystematic review and meta-analysis. Data sourcesWe searched online databases (PubMed, MEDLINE, SCOPUS, EMBASE, Google Scholar, Cochrane Database of Systematic Reviews and Web of Science) between January 2012 and 3 April 2022. Eligibility criteria for studiesRandomised controlled trials, cohort studies, cross-sectional studies and quasi-experimental studies with PrEP uptake, adherence and retention outcomes among FSWs in SSA. Data extraction and synthesisSeven coders extracted data. The framework of the Cochrane Consumers and Communication Review Group guided data synthesis. The Risk of Bias In Non-Randomized Studies of Interventions tool was used to evaluate the risk of bias. Meta-analysis was conducted using a random-effects model. A narrative synthesis was performed to analyse the primary outcomes of PrEP uptake, adherence and retention. ResultsOf 8538 records evaluated, 23 studies with 40 669 FSWs were included in this analysis. The pooled proportion of FSWs initiating PrEP was 70% (95% CI: 56% to 85%) in studies that reported on facility-based models and 49% (95% CI: 10% to 87%) in community-based models. At 6 months, the pooled proportion of FSWs retained was 66% (95% CI: 15% to 100%) for facility-based models and 83% (95% CI: 75% to 91%) for community-based models. Factors associated with increased PrEP uptake were visiting a sex worker programme (adjusted OR (aOR) 2.92; 95% CI: 1.91 to 4.46), having ≥10 clients per day (aOR 1.71; 95% CI: 1.06 to 2.76) and lack of access to free healthcare in government-run health clinics (relative risk: 1.16; 95% CI: 1.06 to 1.26). ConclusionsA hybrid approach incorporating both facility-based strategies for increasing uptake and community-based strategies for improving retention and adherence may effectively improve PrEP coverage among FSWs. PROSPERO registration numberCRD42020219363.
Læs mere Tjek på PubMedSchöbi, N., Sanchez, C., Welzel, T., Bamford, A., Webb, K., Rojo, P., Tremoulet, A., Atkinson, A., Schlapbach, L. J., Bielicki, J. A., The Swissped-RECOVERY trial group, Andre, Bailey, Blanchard-Rohner, Buettcher, Grazioli, Koehler, Perez, Trück, Vanoni, Zimmermann
BMJ Open, 26.04.2024
Tilføjet 26.04.2024
ObjectivesIn trials of acute severe infections or inflammations frequent administration of non-randomised treatment (ie, intercurrent event) in response to clinical events is expected. These events may affect the interpretation of trial findings. Swissped-RECOVERY was set up as one of the first randomised controlled trials worldwide, investigating the comparative effectiveness of anti-inflammatory treatment with intravenous methylprednisolone or intravenous immunoglobulins in children and adolescents with Paediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS). We present one approach towards improving the interpretation of non-randomised treatment in a randomised controlled trial. DesignThis is a pre-planned ancillary analysis of the Swissped-RECOVERY trial, a randomised multicentre open-label two-arm trial. Setting10 Swiss paediatric hospitals (secondary and tertiary care) participated. ParticipantsPaediatric patients hospitalised with PIMS-TS. InterventionsAll patient-first intercurrent events, if applicable, were presented to an independent adjudication committee consisting of four international paediatric COVID-19 experts to provide independent clinical adjudication to a set of standardised questions relating to whether additional non-randomised treatments were clinically indicated and disease classification at the time of the intercurrent event. ResultsOf 41 treatments in 75 participants (24/41 (59%) and 17/41 (41%) in the intravenous methylprednisolone and immunoglobulin arms of the trial, respectively), two-thirds were considered indicated. The most common treatment (oral glucocorticoids, 14/41, 35%) was mostly considered not indicated (11/14, 79%), although in line with local guidelines. Intercurrent events among patients with Shock-like PIMS-TS at baseline were mostly considered indicated. A significant proportion of patients with undifferentiated PIMS-TS at baseline were not attributed to the same group at the time of the intercurrent event (6/12 unchanged, 4/12 Kawasaki disease-like, 2/12 Shock-like). ConclusionThe masked adjudication of intercurrent events contributes to the interpretation of results in open-label trials and should be incorporated in the future. Trial registration numbersSNCTP000004720 and NCT 04826588.
Læs mere Tjek på PubMedMarx, T., Moore, L., Talbot, D., Guertin, J. R., Lachapelle, P., Blais, S., Singbo, N., Simonyan, D., Lavallee, J., Zada, N., Shahrigharahkoshan, S., Huard, B., Olivier, P., Mallet, M., Letourneau, M., Lafreniere, M., Archambault, P., Berthelot, S., For the Network of Canadian Emergency Researchers
BMJ Open, 26.04.2024
Tilføjet 26.04.2024
ObjectiveTo compare health outcomes and costs given in the emergency department (ED) and walk-in clinics for ambulatory children presenting with acute respiratory diseases. DesignA retrospective cohort study. SettingThis study was conducted from April 2016 to March 2017 in one ED and one walk-in clinic. The ED is a paediatric tertiary care centre, and the clinic has access to lab tests and X-rays. ParticipantsInclusion criteria were children: (1) aged from 2 to 17 years old and (2) discharged home with a diagnosis of upper respiratory tract infection (URTI), pneumonia or acute asthma. Main outcome measuresThe primary outcome measure was the proportion of patients returning to any ED or clinic within 3 and 7 days of the index visit. The secondary outcome measures were the mean cost of care estimated using time-driven activity-based costing and the incidence of antibiotic prescription for URTI patients. ResultsWe included 532 children seen in the ED and 201 seen in the walk-in clinic. The incidence of return visits at 3 and 7 days was 20.7% and 27.3% in the ED vs 6.5% and 11.4% in the clinic (adjusted relative risk at 3 days (aRR) (95% CI) 3.17 (1.77 to 5.66) and aRR at 7 days 2.24 (1.46 to 3.44)). The mean cost (95% CI) of care (CAD) at the index visit was $C96.68 (92.62 to 100.74) in the ED vs $C48.82 (45.47 to 52.16) in the clinic (mean difference (95% CI): 46.15 (41.29 to 51.02)). Antibiotic prescription for URTI was less common in the ED than in the clinic (1.5% vs 16.4%; aRR 0.10 (95% CI 0.03 to 0.32)). ConclusionsThe incidence of return visits and cost of care were significantly higher in the ED, while antibiotic use for URTI was more frequent in the walk-in clinic. These data may help determine which setting offers the highest value to ambulatory children with acute respiratory conditions.
Læs mere Tjek på PubMedIroh Tam, P.-Y., Twabi, H. H., Gondwe, M., O'Byrne, T., Lufesi, N., Desmond, N.
BMJ Open, 26.04.2024
Tilføjet 26.04.2024
ObjectivesWe aimed to assess the prevalence, presentation and referral patterns of children with acute illness attending primary health centres (PHCs) in a low-resource setting. Design, setting and participantsWe conducted a secondary analysis of ASPIRE. Children presenting at eight PHCs in urban Blantyre district in southern Malawi with both recorded clinician and mHealth (non-clinician) triage data were included, and patient records from different data collection points along the patient healthcare seeking pathway were consolidated and analysed. ResultsBetween April 2017 and September 2018, a total of 204 924 children were triaged, of whom 155 931 had both recorded clinician and mHealth triage data. The most common presenting symptoms at PHCs were fever (0.3%), cough (0.2%) and difficulty breathing (0.2%). The most common signs associated with referral for under-5 children were trauma (26.7%) and temperature (7.4%). The proportion of emergency and priority clinician triage were highest among young infants
Læs mere Tjek på PubMedAmbrosio, L., Faulkner, J., Morris, J. H., Stuart, B., Lambrick, D., Compton, E., Portillo, M. C.
BMJ Open, 26.04.2024
Tilføjet 26.04.2024
ObjectiveTo understand the physical activity and mental health of individuals living with long-term conditions during the COVID-19 pandemic. DesignA sequential explanatory mixed-methods study with two phases: phase 1: quantitative survey and phase 2: qualitative follow-up interviews. SettingFor the quantitative phase, an online survey was launched in March 2021, using Microsoft Forms. For the qualitative phase, in-depth semistructured interviews were conducted via online. Participants368 adults over 18 years old living in the UK with at least one long-term condition completed the survey. Interviews were conducted in a subsample of participants from the previous quantitative phase, with 26 people. Data were analysed using thematic analysis. ResultsResponses from the survey showed that people with one long-term condition were significantly more physically active and spent less time sitting, than those with two or more conditions, presenting with significantly higher well-being (p
Læs mere Tjek på PubMedHagel, S., Brillinger, N., Decker, S., Deja, M., Ertmer, C., Fiedler, S., Franken, P., Heim, M., Weigand, M. A., Zarbock, A., Pletz, M. W., SepNet Critical Care Trials Group, Ehler, Bloos, Bauer, Brenner, Meybohm, Kluge, Vogt, Lahmer, Fortenbach, John, Berger, Ling, Dutzmann, Nierhaus, Güldner, Bach, Nierhaus, Jung, Bruno, Zoller, Frank, Müller, Bercker, Feussner, Groesdonk, Putensen, Münster, Rosenberger, Häberle, Frey, Wischermann, Otto, Lindner, Heyckendorf, Reuchsel, Reichmann, Weis
BMJ Open, 26.04.2024
Tilføjet 26.04.2024
IntroductionHerpes simplex virus (HSV) is frequently detected in the respiratory tract of mechanically ventilated patients and is associated with a worse outcome. The aim of this study is to determine whether antiviral therapy in HSV-positive patients improves outcome. Methods and analysisProspective, multicentre, open-label, randomised, controlled trial in parallel-group design. Adult, mechanically ventilated patients with pneumonia and HSV type 1 detected in bronchoalveolar lavage (≥105 copies/mL) are eligible for participation and will be randomly allocated (1:1) to receive acyclovir (10 mg/kg body weight every 8 hours) for 10 days (or until discharge from the intensive care unit if earlier) or no intervention (control group). The primary outcome is mortality measured at day 30 after randomisation (primary endpoint) and will be analysed with Cox mixed-effects model. Secondary endpoints include ventilator-free and vasopressor-free days up to day 30. A total of 710 patients will be included in the trial. Ethics and disseminationThe trial was approved by the responsible ethics committee and by Germany’s Federal Institute for Drugs and Medical Devices. The clinical trial application was submitted under the new Clinical Trials Regulation through CTIS (The Clinical Trials Information System). In this process, only one ethics committee, whose name is unknown to the applicant, and Germany’s Federal Institute for Drugs and Medical Devices are involved throughout the entire approval process. Results will be published in a journal indexed in MEDLINE and CTIS. With publication, de-identified, individual participant data will be made available to researchers. Trial registration number NCT06134492.
Læs mere Tjek på PubMedBergmann, J., Egger, M., Müller, F., Jahn, K.
BMJ Open, 26.04.2024
Tilføjet 26.04.2024
IntroductionCritical illness polyneuropathy and myopathy (CIP/CIM) are frequent complications in the intensive care unit (ICU) with major consequences for the progress and outcome of subjects. CIP/CIM delays the weaning process, prolongs the hospital stay and increases the mortality rate. Additionally, it may have long-term consequences beyond the hospitalisation phase with prolonged disability. Even though there is growing interest in CIP/CIM, research about the clinical and post-clinical course as well as the middle-term and long-term outcomes of subjects with CIP/CIM is scarce. A large prospective study of critically ill subjects is needed with accurate diagnosis during the acute stage and comprehensive assessment during long-term follow-up. Methods and analysisThis prospective observational cohort study aims to compare the clinical and post-clinical course of chronically critically ill subjects with and without the diagnosis of CIP/CIM and to determine predictors for the middle-term and long-term outcomes of subjects with CIP/CIM. In addition, the influence of the preclinical health status and the preclinical frailty on the long-term outcome of subjects with CIP/CIM will be investigated. This single-centre study will include 250 critically ill patients who were invasively ventilated for at least 5 days at the ICU and show reduced motor strength. At five study visits at admission and discharge to neurological rehabilitation, and 12, 18 and 24 months after disease onset, a comprehensive test battery will be applied including assessments of functioning and impairment, independence, health-related quality of life, activity and participation, cognition, gait and balance, fatigue, mental health and frailty. Secondary objectives are the documentation of therapy goals, therapy content and achieved milestones during the rehabilitation, to evaluate the clinimetric properties of the Mini-BESTest in critically ill patients, and to evaluate the time course and outcome of subjects with CIP/CIM after SARS-CoV-2 infection. Ethics and disseminationThe study was approved by the ethical committee of the Ludwig-Maximilians University Munich. Participants will be included in the study after having signed informed consent. Results will be published in scientific, peer-reviewed journals and at national and international conferences. Trial registration numberGerman Clinical Trial Register (DRKS00021753).
Læs mere Tjek på PubMedBMC Infectious Diseases, 26.04.2024
Tilføjet 26.04.2024
Abstract Background In regions endemic for tuberculosis and brucellosis, distinguishing between tuberculous meningitis (TBM) and brucella meningitis (BM) poses a substantial challenge. This study investigates the clinical and paraclinical characteristics of patients with TBM and BM. Methods Adult patients diagnosed with either TBM or BM who were admitted to two referral hospitals between March 2015 and October 2022, were included, and the characteristics of the patients were analyzed. Results Seventy patients formed the study group, 28 with TBM and 42 with BM, were included. TBM patients had a 2.06-fold (95% CI: 1.26 to 3.37, P-value: 0.003) higher risk of altered consciousness and a 4.80-fold (95% CI: 1.98 to 11.61, P-value:
Læs mere Tjek på PubMedBMC Infectious Diseases, 26.04.2024
Tilføjet 26.04.2024
Abstract The present study aimed to explore the pathogenic spectrum and risk factors of peritoneal dialysis-associated peritonitis (Peritoneal dialysis associated peritonitis, PDAP) in Yongzhou, Hunan, China. The clinical and epidemiological data on regular peritoneal dialysis (Peritoneal dialysis, PD) between January 2016 and December 2020 in Yongzhou were collected for retrospective analysis. The related factors of peritonitis were evaluated by single-factor analysis, while risk factors of refractory PDAP were evaluated by multivariate logistic regression analysis.172/331 172 (51.9%) patients developed peritonitis. The risk factors of PDAP in PD patients included high C-reactive protein (C-reactive protein, CRP), low albumin(Albumin, ALB), low hemoglobin (Hemoglobin, Hb), low educational level (junior high school or lower), preference of spicy food, irregular diet, low annual household income, unfavorable fluid exchange conditions, unstable employment (including working as a farmer), and unfavorable humidity conditions (P
Læs mere Tjek på PubMedWeiyi Tan, Hai Nian, Lam-Son Phan Tran, Jing Jin, Tengxiang Lian
Trends in Microbiology, 26.04.2024
Tilføjet 26.04.2024
The crucial role of rhizosphere microbes in plant growth and their resilience to environmental stresses underscores the intricate communication between microbes and plants. Plants are equipped with a diverse set of signaling molecules that facilitate communication across different biological kingdoms, although our comprehension of these mechanisms is still evolving. Small peptides produced by plants (SPPs) and microbes (SPMs) play a pivotal role in intracellular signaling and are essential in orchestrating various plant development stages. In this review, we posit that SPPs and SPMs serve as crucial signaling agents for the bidirectional cross-kingdom communication between plants and rhizosphere microbes. We explore several potential mechanistic pathways through which this communication occurs. Additionally, we propose that leveraging small peptides, inspired by plant–rhizosphere microbe interactions, represents an innovative approach in the field of holobiont engineering.
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