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El-Khoury R, Chemaitelly H, Alaama AS, Hermez JG, Nagelkerke N, Abu-Raddad LJ. Hepatitis C risk score as a tool to identify individuals with HCV infection: a demonstration and cross-sectional epidemiological study in Egypt. BMJ Open 2024; 14:e085506. [PMID: 38950989 DOI: 10.1136/bmjopen-2024-085506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
Abstract
OBJECTIVES Hepatitis C virus (HCV) infection poses a global health challenge. By the end of 2021, the WHO estimated that less than a quarter of global HCV infections had been diagnosed. There is a need for a public health tool that can facilitate the identification of people with HCV infection and link them to testing and treatment, and that can be customised for each country. METHODS We derived and validated a risk score to identify people with HCV in Egypt and demonstrated its utility. Using data from the 2008 and 2014 Egypt Demographic and Health Surveys, two risk scores were constructed through multivariable logistic regression analysis. A range of diagnostic metrics was then calculated to evaluate the performance of these scores. RESULTS The 2008 and 2014 risk scores exhibited similar dependencies on sex, age and type of place of residence. Both risk scores demonstrated high and similar areas under the curve of 0.77 (95% CI: 0.76 to 0.78) and 0.78 (95% CI: 0.77 to 0.80), respectively. For the 2008 risk score, sensitivity was 73.7% (95% CI: 71.5% to 75.9%), specificity was 68.5% (95% CI: 67.5% to 69.4%), positive predictive value (PPV) was 27.8% (95% CI: 26.4% to 29.2%) and negative predictive value (NPV) was 94.1% (95% CI: 93.5% to 94.6%). For the 2014 risk score, sensitivity was 64.0% (95% CI: 61.5% to 66.6%), specificity was 78.2% (95% CI: 77.5% to 78.9%), PPV was 22.2% (95% CI: 20.9% to 23.5%) and NPV was 95.7% (95% CI: 95.4% to 96.1%). Each score was validated by applying it to a different survey database than the one used to derive it. CONCLUSIONS Implementation of HCV risk scores is an effective strategy to identify carriers of HCV infection and to link them to testing and treatment at low cost to national programmes.
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Affiliation(s)
- Rayane El-Khoury
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York, USA
| | - Ahmed S Alaama
- Department of Communicable Diseases, World Health Organisation Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Joumana G Hermez
- Department of Communicable Diseases, World Health Organisation Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Nico Nagelkerke
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York, USA
- Department of Public Health, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
- College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar
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Prajapati H, Kumar V, Mittal G, Saxena Y. Pro- and anti-inflammatory cytokines signatures at different severity of dengue infection. J Family Med Prim Care 2024; 13:1975-1982. [PMID: 38948604 PMCID: PMC11213393 DOI: 10.4103/jfmpc.jfmpc_1576_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/28/2023] [Accepted: 12/31/2023] [Indexed: 07/02/2024] Open
Abstract
Context Dengue disease severity and progression are determined by the host immune response, with both pro- and anti-inflammatory cytokines are key mediators. Aims To study pro- and anti-inflammatory cytokines across dengue severity and as a biomarker for predicting severe dengue infection. Settings and Design Hospital-based cross-sectional study was conducted on 125 dengue-positive subjects across the 5-60 years age group of either gender in 2022. Methods and Materials Haematological parameters and blood samples were drawn to measure cytokines IL6, IL-10 and TNF alpha using the ELISA technique. Statistical Analysis One-way ANOVA and the Kruskal - Wallis test were used to compare the dependent variables across categories of the dengue spectrum. Receiver operating characteristic curve was drawn to calculate the predictability of the cytokines as a predictor of severe dengue. A P < 0.05 was considered significant. Results 34.4% of cases had severe dengue infection with 53.2% of severe cases reported in >40 years of age. Only IL-6 levels significantly increased (P < 0.01) across the spectrum of dengue infection across age groups >20 years with a consistent and significant fall in platelet levels (P < 0.01). The accuracy of IL-6 to predict severe dengue was 74.4% and platelet count was 16.2%. Conclusions Only IL-6 cytokine levels were significantly increased across the spectrum of dengue infection observed in age >20 years and can significantly predict the probability of severe dengue by 74% (sensitivity 81.4%). A significant decrease in platelet values is consistent with the severity but is not a good predictor for severe dengue infection.
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Affiliation(s)
- Himani Prajapati
- Department of Microbiology, Himalayan School of Bio-sciences, Swami Rama Himalayan University Jolly Grant, Dehradun, Uttarakhand, India
| | - Vivek Kumar
- Department of Microbiology, Himalayan School of Bio-sciences, Swami Rama Himalayan University Jolly Grant, Dehradun, Uttarakhand, India
| | - Garima Mittal
- Department of Microbiology, Swami Rama Himalayan University Jolly Grant, Dehradun, Uttarakhand, India
| | - Yogesh Saxena
- Department of Physiology, Swami Rama Himalayan University Jolly Grant, Dehradun, Uttarakhand, India
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Ebonyi AO, Okpokwu J, Rawizza H, Chebu P, Chaplin B, Hamel D, Oguche S, Agbaji OO, Sagay AS, Kanki PJ, Imade GE. Pretreatment and Acquired Drug Resistance in Children With Human Immunodeficiency Virus Type 1 in Jos, Nigeria. Open Forum Infect Dis 2024; 11:ofae092. [PMID: 38464491 PMCID: PMC10921386 DOI: 10.1093/ofid/ofae092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/15/2024] [Indexed: 03/12/2024] Open
Abstract
We determined pretreatment and acquired human immunodeficiency virus (HIV) drug resistance among children with HIV type 1 (HIV-1) in Jos, Nigeria. The majority (71%) of those who failed first-line antiretroviral therapy were on a nevirapine-containing regimen. The prevalence of pretreatment (48%) and acquired (76%) HIV drug resistance mutations was high in our study. Wider access to HIV drug resistance testing after treatment failure is necessary to optimize second-line treatment options among children with HIV in Nigeria.
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Affiliation(s)
- Augustine O Ebonyi
- Department of Paediatrics, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Jonathan Okpokwu
- AIDS Prevention Initiative in Nigeria–supported ISO 15189 Laboratory, Jos University Teaching Hospital, Jos, Nigeria
| | - Holly Rawizza
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Philippe Chebu
- APIN Public Health Initiatives, Plot 1551, Apo Resettlement, Apo District, Abuja, FCT, Nigeria
| | - Beth Chaplin
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Donald Hamel
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Stephen Oguche
- Department of Paediatrics, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Oche O Agbaji
- Department of Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Atiene S Sagay
- Department of Obstetrics and Gynaecology, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Phyllis J Kanki
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Godwin E Imade
- AIDS Prevention Initiative in Nigeria–supported ISO 15189 Laboratory, Jos University Teaching Hospital, Jos, Nigeria
- Department of Obstetrics and Gynaecology, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
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Guertin JR, Gilbert-Ouimet M, Dugas M, Carnovale V, Jalbert L, Svyntozelska O, Demers J, Matteau L, Bergeron F, LeBlanc A. Methods used to account for caregivers' sex and gender within studies examining the financial burden of caregivers of children and adolescents : Results from a scoping review. CLINICOECONOMICS AND OUTCOMES RESEARCH 2024; 16:35-53. [PMID: 38298908 PMCID: PMC10829241 DOI: 10.2147/ceor.s443077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024] Open
Abstract
Background Interest in the financial burden of informal caregivers has been growing. Unfortunately, it remains unclear which method(s) should be used when quantifying this burden. Purpose We conducted a scoping review aimed at identifying which methods have been used to conduct such work and quantified their performance. We were also interested in examining how sex and gender considerations were considered within selected studies. Data Sources Using a standardized approach, we identified studies published between 2012 and 2022 that aimed to document the financial burden of caregivers to child and adolescent patients. Our search strategy was applied to the MEDLINE, Embase, CINHAL, and Academic Search Premier databases. Study Selection Manuscript selection was performed by pairs of reviewers. Data Extraction Data extraction was performed by one reviewer with a second reviewer performing quality control. Results were reported using a narrative approach. Data Synthesis We identified 9801 unique citations, of which 200 were included in our review. Selected studies covered various disease area (eg, infection/parasitic diseases [n = 31, 16%]) and included quantitative (n = 180, 90%), qualitative (n = 4, 2%) and mixed study designs (n = 16, 8%). Most studies (n = 182, 91%) used questionnaires/surveys, either alone or in combination with other methods, to assess caregivers' financial burden. Less than half (n = 93, 47%) of studies reported on caregivers' sex and none reported on their gender. Conclusion We conducted an unrestricted review of published studies examining caregiver's financial burden which allowed us to identify general methodological trends observed in this literature. We believe this work may help improve future studies focusing on this important issue.
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Affiliation(s)
- Jason Robert Guertin
- Centre de recherche du Centre de recherche du CHU de Québec-Université Laval, Quebec City, Quebec, Canada
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- Centre de recherche en organogénèse expérimentale de l’Université Laval/LOEX, Quebec City, Quebec, Canada
| | - Mahée Gilbert-Ouimet
- Centre de recherche du Centre de recherche du CHU de Québec-Université Laval, Quebec City, Quebec, Canada
- Department of Health Sciences, Université du Québec À Rimouski, Levis, Quebec, Canada
| | - Michèle Dugas
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Valérie Carnovale
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Laura Jalbert
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Olha Svyntozelska
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Juliette Demers
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Léonie Matteau
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- Department of Health Sciences, Université du Québec À Rimouski, Levis, Quebec, Canada
| | - Frédéric Bergeron
- Bibliothèque-Direction des services-conseils, Université Laval, Quebec City, Quebec, Canada
| | - Annie LeBlanc
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
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Walter KS, Cohen T, Mathema B, Colijn C, Sobkowiak B, Comas I, Goig GA, Croda J, Andrews JR. Signatures of transmission in within-host M. tuberculosis variation. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.28.23300451. [PMID: 38234741 PMCID: PMC10793532 DOI: 10.1101/2023.12.28.23300451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Background Because M. tuberculosis evolves slowly, transmission clusters often contain multiple individuals with identical consensus genomes, making it difficult to reconstruct transmission chains. Finding additional sources of shared M. tuberculosis variation could help overcome this problem. Previous studies have reported M. tuberculosis diversity within infected individuals; however, whether within-host variation improves transmission inferences remains unclear. Methods To evaluate the transmission information present in within-host M. tuberculosis variation, we re-analyzed publicly available sequence data from three household transmission studies, using household membership as a proxy for transmission linkage between donor-recipient pairs. Findings We found moderate levels of minority variation present in M. tuberculosis sequence data from cultured isolates that varied significantly across studies (mean: 6, 7, and 170 minority variants above a 1% minor allele frequency threshold, outside of PE/PPE genes). Isolates from household members shared more minority variants than did isolates from unlinked individuals in the three studies (mean 98 shared minority variants vs. 10; 0.8 vs. 0.2, and 0.7 vs. 0.2, respectively). Shared within-host variation was significantly associated with household membership (OR: 1.51 [1.30,1.71], for one standard deviation increase in shared minority variants). Models that included shared within-host variation improved the accuracy of predicting household membership in all three studies as compared to models without within-host variation (AUC: 0.95 versus 0.92, 0.99 versus 0.95, and 0.93 versus 0.91). Interpretation Within-host M. tuberculosis variation persists through culture and could enhance the resolution of transmission inferences. The substantial differences in minority variation recovered across studies highlights the need to optimize approaches to recover and incorporate within-host variation into automated phylogenetic and transmission inference. Funding NIAID: 5K01AI173385.
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Affiliation(s)
| | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA
| | - Barun Mathema
- Department of Epidemiology, Columbia University Mailman School of Public Health; New York, United States
| | - Caroline Colijn
- Department of Mathematics, Simon Fraser University; Burnaby, Canada
| | - Benjamin Sobkowiak
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA
| | - Iñaki Comas
- Institute of Biomedicine of Valencia (CSIC), Valencia, Spain
| | - Galo A Goig
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Julio Croda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA
- Federal University of Mato Grosso do Sul - UFMS, Campo Grande, MS, Brazil
- Oswaldo Cruz Foundation Mato Grosso do Sul, Mato Grosso do Sul, Brazil
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Lopes-Luz L, Saavedra DP, Fogaça MBT, Bührer-Sékula S, Stefani MMDA. Challenges and advances in serological and molecular tests to aid leprosy diagnosis. Exp Biol Med (Maywood) 2023; 248:2083-2094. [PMID: 38059475 PMCID: PMC10800132 DOI: 10.1177/15353702231209422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
Leprosy is a neglected chronic infectious disease caused by obligate intracellular bacilli, Mycobacterium leprae and Mycobacterium lepromatosis. Despite multidrug therapy (MDT) success, leprosy accounts for more than 200,000 new cases yearly. Leprosy diagnosis remains based on the dermato-neurologic examination, but histopathology of skin biopsy and bacilloscopy of intradermal scraping are subsidiary diagnostic tests that require expertise and laboratory infrastructure. This minireview summarizes the state of the art of serologic tests to aid leprosy diagnosis, highlighting enzyme-linked immunosorbent assay (ELISA) and point-of-care tests (POCT) biotechnologies. Also, the impact of the postgenomic era on the description of new recombinantly expressed M. leprae-specific protein antigens, such as leprosy Infectious Disease Research Institute (IDRI) diagnostic (LID)-1 is summarized. Highly specific and sensitive molecular techniques to detect M. leprae DNA as the quantitative polymerase chain reaction (qPCR) and the loop-mediated isothermal amplification (LAMP) are briefly reviewed. Serology studies using phenolic glycolipid-I (PGL-I) semi-synthetic antigens, LID-1 fusion antigen, and the single fusion complex natural disaccharide-octyl (NDO)-LID show high sensitivity in multibacillary (MB) patients. However, serology is not applicable to paucibacillary patients, as they have weak humoral response and robust cell-mediated response, requiring tests for cellular biomarkers. Unlike ELISA-based tests, leprosy-specific POCT based on semi-synthetic PGL-I antigens and NDO-LID 1 antigen is easy to perform, cheaper, equipment-free, and can contribute to early diagnosis avoiding permanent incapacities and helping to interrupt M. leprae transmission. Besides its use to help diagnosis of household contacts or at-risk populations in endemic areas, potential applications of leprosy serology include monitoring MDT efficacy, identification of recent infection, especially in young children, as surrogate markers of disease progression to orient adult chemoprophylaxis and as a predictor of type 2 leprosy reactions. Advances in molecular biology techniques have reduced the complexity and execution time of qPCR confirming its utility to help diagnosis while leprosy-specific LAMP holds promise as an adjunct test to detect M. leprae DNA.
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Affiliation(s)
- Leonardo Lopes-Luz
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia 74605-050, Brasil
- Innovation Hub in Point of Care Technologies, UFG-Merck S/A. Alliance, Goiânia 74690-900, Brasil
| | - Djairo Pastor Saavedra
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia 74605-050, Brasil
- Innovation Hub in Point of Care Technologies, UFG-Merck S/A. Alliance, Goiânia 74690-900, Brasil
| | - Matheus Bernardes Torres Fogaça
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia 74605-050, Brasil
- Innovation Hub in Point of Care Technologies, UFG-Merck S/A. Alliance, Goiânia 74690-900, Brasil
| | - Samira Bührer-Sékula
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia 74605-050, Brasil
- Innovation Hub in Point of Care Technologies, UFG-Merck S/A. Alliance, Goiânia 74690-900, Brasil
| | - Mariane Martins de Araújo Stefani
- Laboratório de Desenvolvimento e Produção de Testes Rápidos, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia 74605-050, Brasil
- Innovation Hub in Point of Care Technologies, UFG-Merck S/A. Alliance, Goiânia 74690-900, Brasil
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Hoyer-Leitzel A, Iams S, Haslam-Hyde A, Zeeman M, Fefferman N. An immuno-epidemiological model for transient immune protection: A case study for viral respiratory infections. Infect Dis Model 2023; 8:855-864. [PMID: 37502609 PMCID: PMC10369473 DOI: 10.1016/j.idm.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/14/2023] [Accepted: 07/08/2023] [Indexed: 07/29/2023] Open
Abstract
The dynamics of infectious disease in a population critically involves both within-host pathogen replication and between host pathogen transmission. While modeling efforts have recently explored how within-host dynamics contribute to shaping population transmission, fewer have explored how ongoing circulation of an epidemic infectious disease can impact within-host immunological dynamics. We present a simple, influenza-inspired model that explores the potential for re-exposure during a single, ongoing outbreak to shape individual immune response and epidemiological potential in non-trivial ways. We show how even a simplified system can exhibit complex ongoing dynamics and sensitive thresholds in behavior. We also find epidemiological stochasticity likely plays a critical role in reinfection or in the maintenance of individual immunological protection over time.
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Affiliation(s)
- A. Hoyer-Leitzel
- Department of Mathematics and Statistics, Mount Holyoke College, 50 College St, South Hadley, MA, 01075, USA
| | - S.M. Iams
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, USA
| | - A.J. Haslam-Hyde
- Department of Mathematics and Statistics, Boston University, USA
| | - M.L. Zeeman
- Department of Mathematics, Bowdoin College, USA
| | - N.H. Fefferman
- Dept of Mathematics & Dept of Ecology and Evolutionary Biology & NIMBioS, University of Tennessee, Knoxville, USA
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Bugalia S, Tripathi JP. Assessing potential insights of an imperfect testing strategy: Parameter estimation and practical identifiability using early COVID-19 data in India. COMMUNICATIONS IN NONLINEAR SCIENCE & NUMERICAL SIMULATION 2023; 123:107280. [PMID: 37207195 PMCID: PMC10148719 DOI: 10.1016/j.cnsns.2023.107280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/27/2023] [Accepted: 04/25/2023] [Indexed: 05/21/2023]
Abstract
A deterministic model with testing of infected individuals has been proposed to investigate the potential consequences of the impact of testing strategy. The model exhibits global dynamics concerning the disease-free and a unique endemic equilibrium depending on the basic reproduction number when the recruitment of infected individuals is zero; otherwise, the model does not have a disease-free equilibrium, and disease never dies out in the community. Model parameters have been estimated using the maximum likelihood method with respect to the data of early COVID-19 outbreak in India. The practical identifiability analysis shows that the model parameters are estimated uniquely. The consequences of the testing rate for the weekly new cases of early COVID-19 data in India tell that if the testing rate is increased by 20% and 30% from its baseline value, the weekly new cases at the peak are decreased by 37.63% and 52.90%; and it also delayed the peak time by four and fourteen weeks, respectively. Similar findings are obtained for the testing efficacy that if it is increased by 12.67% from its baseline value, the weekly new cases at the peak are decreased by 59.05% and delayed the peak by 15 weeks. Therefore, a higher testing rate and efficacy reduce the disease burden by tumbling the new cases, representing a real scenario. It is also obtained that the testing rate and efficacy reduce the epidemic's severity by increasing the final size of the susceptible population. The testing rate is found more significant if testing efficacy is high. Global sensitivity analysis using partial rank correlation coefficients (PRCCs) and Latin hypercube sampling (LHS) determine the key parameters that must be targeted to worsen/contain the epidemic.
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Affiliation(s)
- Sarita Bugalia
- Department of Mathematics, Central University of Rajasthan, Bandar Sindri, Kishangarh 305817, Ajmer, Rajasthan, India
| | - Jai Prakash Tripathi
- Department of Mathematics, Central University of Rajasthan, Bandar Sindri, Kishangarh 305817, Ajmer, Rajasthan, India
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Machila N, Libonda L, Habineza P, Velu RM, Kamboyi HK, Ndhlovu J, Wamunyima I, Sinadambwe MM, Mudenda S, Zyambo C, Bumbangi FN. Prevalence and predictors of virological failure in pediatric patients on HAART in sub-Saharan Africa: a systematic review and meta-analysis. Pan Afr Med J 2023; 45:98. [PMID: 37692980 PMCID: PMC10491719 DOI: 10.11604/pamj.2023.45.98.37017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 06/08/2023] [Indexed: 09/12/2023] Open
Abstract
Antiretroviral treatment failure has emerged as a challenge in the management of pediatric human immunodeficiency virus (HIV) patients, especially in resource-limited countries despite accessibility to Highly Active Antiretroviral Therapy (HAART). A systematic review and meta-analysis was conducted to synthesize virological failure (VF) prevalence and ascertain its predictors in children in sub-Saharan Africa. An electronic database search strategy was conducted from January to September 2021 on PubMed, EMBASE, SCOPUS, HINARI, and CINAHL. Further, manual searching was conducted on non-indexed journals. Utilizing the JASP© version 0.17.2 (2023) statistical software, a meta-analysis of pooled prevalence of VF was estimated using the standardized mean differences. Further, selection models were used to assess the risk of bias and heterogeneity. The pooled odds ratios were estimated for the respective studies reporting on predictors of VF. The overall pooled estimate of the prevalence of VF in sub-Saharan Africa among the sampled population was 29% (95% CI: 27.0-32.0; p<0.001). Predictors of VF were drug resistance (OR: 1.68; 95% CI: 0.88-2.49; p < 0.001), poor adherence (OR: 5.35; 95% CI: 5.26-5.45; p < 0.001), nevirapine (NVP)-based regimen (OR: 5.11; 95% CI: 4.66-5.56; p < 0.001), non-usage of cotrimoxazole prophylaxis (OR: 4.30; 95% CI: 4.13-4.47; p < 0.001), higher viral load at the initiation of antiretroviral therapy (ART) (OR: 244.32; 95% CI: 244.2-244.47; p <0.001), exposure to the prevention of mother to child transmission (PMTCT) (OR: 8.02; 95%CI: 7.58-8.46; p < 0.001), increased age/older age (OR: 3.37; 95% CI: 2.70-4.04; p < 0.001), advanced World Health Organization (WHO) stage (OR: 6.57; 95% CI: 6.17-6.98; p < 0.001), not having both parents as primary caregivers (OR: 3.01; 95% CI: 2.50-3.53; p < 0.001), and tuberclosis (TB) treatment (OR: 4.22; 95% CI: 3.68-4.76; p <0.001). The mean VF prevalence documented is at variance with studies in other developing countries outside the sub-Saharan region. The high prevalence of HIV cases contrasting with the limited expertise in the management of pediatric ART patients could explain this variance.
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Affiliation(s)
- Nchimunya Machila
- Department of Disease Control and Prevention, School of Medicine, Eden University, Lusaka, Zambia
| | - Liyali Libonda
- Department of Disease Control and Prevention, School of Medicine, Eden University, Lusaka, Zambia
| | - Paul Habineza
- Department of Disease Control and Prevention, School of Medicine, Eden University, Lusaka, Zambia
| | | | - Harvey Kakoma Kamboyi
- Department of Disease Control and Prevention, School of Medicine, Eden University, Lusaka, Zambia
- Division of Infection and Immunity, International Institute for Zoonosis Control, Hokkaido University, Hokkaido, Japan
| | - Jacob Ndhlovu
- Department of Disease Control and Prevention, School of Medicine, Eden University, Lusaka, Zambia
| | - Inonge Wamunyima
- Department of Disease Control and Prevention, School of Medicine, Eden University, Lusaka, Zambia
| | | | - Steward Mudenda
- Department of Pharmacy, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Cosmas Zyambo
- Department of Community and Family Health, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Flavien Nsoni Bumbangi
- Department of Disease Control and Prevention, School of Medicine, Eden University, Lusaka, Zambia
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10
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Barata TY, Abiso G, Israel E, Molla S, Wolka E. Incidence of Mortality and Its Predictors Among Adult Human Immune Virus Infected Patients on Antiretroviral Therapy in Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia: A Retrospective Follow-Up Study. HIV AIDS (Auckl) 2023; 15:361-375. [PMID: 37359271 PMCID: PMC10289094 DOI: 10.2147/hiv.s401155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/21/2023] [Indexed: 06/28/2023] Open
Abstract
Background Although the goal of ART is to have better health, extend the life of the HIV-infected patient, and decrease HIV-related death, there is a continuation of HIV-related mortality with the use of ART. This study aimed to assess the incidence of mortality and its predictors among adult HIV/AIDS patients who were on ART follow-up at Wolaita Sodo Comprehensive specialized hospital in southern Ethiopia. Methods A retrospective follow-up study was conducted from May 1 to June 30, 2021 among adult HIV/AIDS patients with a total of 441 adult HIV/AIDS patients in this hospital included. Kaplan-Meier failure curve and Log rank test were fitted, and Cox-proportional hazards model was also used to identify the predictors of mortality. Both crude and adjusted hazard ratios (AHR) with their 95% confidence interval (CI) were calculated to show the strength of association. The proportional assumption was conducted by using a global test based on the Schoenfeld residuals. Results Incidence of the mortality rate was 5.61 (95% CI, 4.2-7.3) per 100 person-years observation. In the multivariable analysis, HIV/AIDS patients were widowed (aHR; 10.9 (95% CI, 3.13-37.99), poorly drug-adhered (aHR; 5.6 (95% CI, 2.4-13.2) and fair adhered (aHR; 3.53 (95% CI, 1.58-7.87), WHO clinical stage IV (aHR; 5.91, (95% CI, 1.41-24.71), history of substance use (aHR; 2.02 (95% CI, 1.01-4.06) and history of IV drug use (aHR; 2.26 (95% CI, 1.10-4.74) independently predicted the mortality of patients. Conclusion In this study, incidence of mortality was relatively high. The rate of mortality may be minimized by paying particular attention to individuals with widowing, substance use at the baseline, advanced clinical stage IV, history of IV drug use at the baseline, and those with adherence problems.
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Affiliation(s)
- Tagese Yakob Barata
- Department of Public Health Emergency, Institute of Bele Awassaa Health Office, Wolaita, Ethiopia
| | - Girumneh Abiso
- Department of Infection Prevention and Health Promotion, Institute of Sodo Town Health Office, Wolaita, Ethiopia
| | - Eskinder Israel
- Department of Reproductive Health, Institute of Public Health, Wolaita Sodo University, Wolaita, Ethiopia
| | - Simegn Molla
- Department of Epidemiology and Biostatistics, Institute of Public Health, Wolaita Sodo University, Wolaita, Ethiopia
| | - Eskinder Wolka
- Department of Epidemiology and Biostatistics, Institute of Public Health, Wolaita Sodo University, Wolaita, Ethiopia
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11
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Aguilar-Bretones M, Fouchier RA, Koopmans MP, van Nierop GP. Impact of antigenic evolution and original antigenic sin on SARS-CoV-2 immunity. J Clin Invest 2023; 133:e162192. [PMID: 36594464 PMCID: PMC9797340 DOI: 10.1172/jci162192] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and vaccinations targeting the spike protein (S) offer protective immunity against coronavirus disease 2019 (COVID-19). This immunity may further be shaped by cross-reactivity with common cold coronaviruses. Mutations arising in S that are associated with altered intrinsic virus properties and immune escape result in the continued circulation of SARS-CoV-2 variants. Potentially, vaccine updates will be required to protect against future variants of concern, as for influenza. To offer potent protection against future variants, these second-generation vaccines may need to redirect immunity to epitopes associated with immune escape and not merely boost immunity toward conserved domains in preimmune individuals. For influenza, efficacy of repeated vaccination is hampered by original antigenic sin, an attribute of immune memory that leads to greater induction of antibodies specific to the first-encountered variant of an immunogen compared with subsequent variants. In this Review, recent findings on original antigenic sin are discussed in the context of SARS-CoV-2 evolution. Unanswered questions and future directions are highlighted, with an emphasis on the impact on disease outcome and vaccine design.
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12
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Gunning CE, Rohani P, Mwananyanda L, Kwenda G, Mupila Z, Gill CJ. Young Zambian infants with symptomatic RSV and pertussis infections are frequently prescribed inappropriate antibiotics: a retrospective analysis. PeerJ 2023; 11:e15175. [PMID: 37193027 PMCID: PMC10183159 DOI: 10.7717/peerj.15175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 03/13/2023] [Indexed: 05/18/2023] Open
Abstract
Pediatric community-acquired pneumonia (CAP) remains a pressing global health concern, particularly in low-resource settings where diagnosis and treatment rely on empiric, symptoms-based guidelines such as the WHO's Integrated Management of Childhood Illness (IMCI). This study details the delivery of IMCI-based health care to 1,320 young infants and their mothers in a low-resource urban community in Lusaka, Zambia during 2015. Our Southern Africa Mother Infant Pertussis Study (SAMIPS) prospectively monitored a cohort of mother/infant pairs across infants' first four months of life, recording symptoms of respiratory infection and antibiotics prescriptions (predominantly penicillins), and tested nasopharyngeal (NP) samples for respiratory syncytial virus (RSV) and Bordetella pertussis. Our retrospective analysis of the SAMIPS cohort found that symptoms and antibiotics use were more common in infants (43% and 15.7%) than in mothers (16.6% and 8%), while RSV and B. pertussis were observed at similar rates in infants (2.7% and 32.5%) and mothers (2% and 35.5%), albeit frequently at very low levels. In infants, we observed strong associations between symptoms, pathogen detection, and antibiotics use. Critically, we demonstrate that non-macrolide antibiotics were commonly prescribed for pertussis infections, some of which persisted across many weeks. We speculate that improved diagnostic specificity and/or clinician education paired with timely, appropriate treatment of pertussis could substantially reduce the burden of this disease while reducing the off-target use of penicillins.
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Affiliation(s)
- Christian E. Gunning
- Odum School of Ecology, University of Georgia, Athens, GA, United States of America
| | - Pejman Rohani
- Odum School of Ecology, University of Georgia, Athens, GA, United States of America
- Center for the Ecology of Infectious Diseases; Department of Infectious Diseases, University of Georgia, Athens, GA, United States of America
- Department of Infectious Diseases, University of Georgia, Athens, GA, United States of America
| | - Lawrence Mwananyanda
- School of Public Health, Department of Global Health, Boston University, Boston, MA, United States of America
- Right to Care Zambia, Lusaka, Zambia
| | - Geoffrey Kwenda
- School of Health Sciences, Department of Biomedical Science, University of Zambia, Lusaka, Zambia
| | | | - Christopher J. Gill
- School of Public Health, Department of Global Health, Boston University, Boston, MA, United States of America
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13
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Berhanu K, Ayana D, Megersa B, Ashenafi H, Waktole H. Cryptosporidium in human-animal-environment interphase at Adama and Asella areas of Oromia regional state, Ethiopia. BMC Vet Res 2022; 18:402. [PMCID: PMC9661733 DOI: 10.1186/s12917-022-03497-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
In Ethiopia, several studies have reported the occurrence of Cryptosporidium infection in young calves, lambs, and HIV positive patients. However, research on cattle and sheep of all ages, as well as humans, has been limited.
Methods
A cross-sectional study was conducted to investigate the occurrence of Cryptosporidium in dairy cattle, sheep, humans, and manure samples. Dairy cattle and sheep were stratified according to their age groups and randomly sampled. Stool samples from volunteered dairy farm workers and rural household members were collected purposefully. A semi-structured questionnaire was also used to collect information about manure handling practices and socio-demographic variables. All collected samples were processed with the sugar floatation technique and the modified Ziehl–Neelsen staining method. Logistic regression was used to analyze the association of risk factors with the occurrence of Cryptosporidium in study subjects (p < 0.05).
Results
The overall prevalence of Cryptosporidium in dairy cattle, sheep, humans, and manure samples was 20.5%, 14%, 16%, and 13.20%, respectively. Cryptosporidium infection was significantly higher in dairy cattle aged 1–12 months and 13–36 months with odds of 3.48 and 3.07 times higher, respectively, compared to others. Similarly, its occurrence was 2.69 times higher in sheep aged 1–6 months than those above 6 months. And also, a higher average oocyst count (above 10 oocysts) per-field was observed in cattle aged 1–12 months, followed by sheep aged 1–6 months. Furthermore, the likelihood of infection was 13 times greater in farm workers compared to household members of smallholder farmers. In addition, the occurrence of oocysts was 22.8 times higher in manures from dairy cattle than that of sheep. About 16.8% of the study respondents had manure disposal pit, 98.1% of them used manure as fertilizer for crop and vegetable production without any treatment.
Conclusions
The study revealed the occurrence of Cryptosporidium infection in all age groups of dairy cattle and sheep, humans engaged in animal production. Occurrence of Cryptosporidium in manure suggests it potential contamination of environment and water sources.
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Survival rate and predictors of mortality among TB/HIV co-infected adult patients: retrospective cohort study. Sci Rep 2022; 12:18360. [PMID: 36319734 PMCID: PMC9626487 DOI: 10.1038/s41598-022-23316-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/29/2022] [Indexed: 12/31/2022] Open
Abstract
Nowadays, Tuberculosis remains the major cause of HIV-associated mortality, which accounts for 1 out of every 5 HIV-related mortality worldwide. This study aimed to determine the survival rate and predictors of mortality among TB/HIV co-infected patients. An institution-based retrospective cohort study was undertaken on adult TB/HIV co-infected individuals between 1st February 2014 and 30th January 2022 at Mettu Karl Referral Hospital. A Cox regression model was used to identify predictors of survival time to death among TB/HIV co-infected patients. This study comprised 402 TB and HIV co-infected adult patients. Among these, 84 (20.9%) died, and 318 (79.1%) were censored. The study subjects have been followed up for 6920 person-months with an overall median survival time of 17.6 months. The overall incidence rate was 12.1 per 1000 person months [95% CI: 9.77-14.98]. The results of a multivariable Cox regression analysis showed that being at an older age, urban residence, WHO clinical stage II & IV, CD4 count of ≥ 200 cells/mm3, bedridden functional status, using INH, and using CPT were associated with the survival time of TB and HIV co-infected patients at a significance level of alpha = 0.05. This retrospective study found that high mortality of TB/HIV co-infected patients occurred in the earlier months of treatment initiation. Close monitoring of patients with low CD4, who do not utilize CPT, who are in advanced WHO stages, and who have poor functional levels can help them improve their health and live longer.
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Ji S, Xiao S, Wang H, Lei H. Increasing contributions of airborne route in SARS-CoV-2 omicron variant transmission compared with the ancestral strain. BUILDING AND ENVIRONMENT 2022; 221:109328. [PMID: 35784591 PMCID: PMC9233747 DOI: 10.1016/j.buildenv.2022.109328] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/14/2022] [Accepted: 06/17/2022] [Indexed: 06/15/2023]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant has become the dominant lineage worldwide. Experimental studies have shown that SARS-CoV-2 Omicron variant is more stable on various environmental surfaces than the ancestral strains of SARS-CoV-2. However, the influences on the role of the contact route in SARS-CoV-2 transmission are still unknown. In this study, we built a Markov chain model to simulate the transmission of the Omicron and ancestral strains of SARS-CoV-2 within a household over a 1-day period from multiple pathways; that is, airborne, droplet, and contact routes. We assumed that there were two adults and one child in the household, and that one of the adults was infected with SARS-CoV-2. We assumed two scenarios. (1) Asymptomatic/presymptomatic infection, and (2) symptomatic infection. During asymptomatic/presymptomatic infection, the contact route contributing the most (37%-45%), followed by the airborne (34%-38%) and droplet routes (21%-28%). During symptomatic infection, the droplet route was the dominant pathway (48%-71%), followed by the contact route (25%-42%), with the airborne route playing a negligible role (<10%). Compared to the ancestral strain, although the contribution of the contact route increased in Omicron variant transmission, the increase was slight, from 25%-41% to 30%-45%. With the growing concern about the increase in the proportion of asymptomatic/presymptomatic infection in Omicron strain transmissions, the airborne route, rather than the fomite route, should be of focus. Our findings suggest the importance of ventilation in the SARS-CoV-2 Omicron variant prevention in building environment.
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Affiliation(s)
- Shuyi Ji
- School of Public Health, Zhejiang University, Hangzhou, 310058, PR China
| | - Shenglan Xiao
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107, PR China
| | - Huaibin Wang
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107, PR China
| | - Hao Lei
- School of Public Health, Zhejiang University, Hangzhou, 310058, PR China
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16
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Cardiac implantable electronic devices: an overview for primary care. Br J Gen Pract 2022; 72:402-404. [PMID: 35902258 PMCID: PMC9343029 DOI: 10.3399/bjgp22x720461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/09/2022] [Indexed: 10/31/2022] Open
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Lelisho ME, Teshale BM, Tareke SA, Hassen SS, Andargie SA, Merera AM, Awoke S. Modeling Survival Time to Death Among TB and HIV Co-infected Adult Patients: an Institution-Based Retrospective Cohort Study. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01348-w. [PMID: 35697902 DOI: 10.1007/s40615-022-01348-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/12/2022] [Accepted: 06/03/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tuberculosis is a serious health threat, particularly for people living with human immunodeficiency virus (HIV), and HIV-positive people are more likely than others to contract the disease. Globally, tuberculosis (TB) is one of the leading causes of death among people living with HIV. The purpose of the current study was to identify factors associated with survival rates of TB/HIV co-infected patients using survival models. METHODS A retrospective study was conducted on TB/HIV co-infected adult patients registered and under follow-up at Tepi General Hospital (TGH) and Mizan-Tepi University Teaching Hospital (MTUTH), southwest Ethiopia. All TB/HIV co-infection patients who were registered and under follow-up from 1st January 2015 through 1st January 2020 were considered. The global Schoenfeld test was used to test the proportional hazard (PH) assumption. Various accelerated failure time (AFT) models were compared to determine the best model for the time to death of TB/HIV co-infected patients' data set. Among the most commonly used accelerated failure time models (AFT models), the study used exponential, Weibull, log-logistic, and log-lognormal AFT models. AIC and BIC were used to compare the performance of fitted models. The data were analyzed with the statistical software R. RESULTS Of 363 TB/HIV co-infected patients followed for 60 months, 79 (21.8%) died, while the remaining 284 (78.2%) were censored. The overall median survival time was 15.6 months. The proportional hazard assumption was checked and it was violated. In comparison to other models, the lognormal AFT model performed better. The results of the multivariable lognormal AFT model showed that age, residence, substance use, educational status, clinical stages of the disease, cluster of differentiation 4 (CD4 count/mm3), functional status, cotrimoxazole prophylactic therapy use (CPT use), and INH were all found to be significant factors, while gender, illness other than TB, and disclosure of status were insignificant variables at 5% level of significance. CONCLUSION Current study results revealed that older age, substance use, advanced WHO clinical stages of the disease (stage IV), bedridden functional status, and CD4 less than 200 count/mm3 were significantly associated with shorter survival time to death of HIV/TB co-infected patients while having advanced educational status, being from urban residence, CPT use, and INH significantly increase the survival time to death of TB/HIV co-infected patients. Patients with TB/HIV co-infection should be given special attention based on these important factors to improve their health and prolong their lives. HIV-positive patients are more likely than others to contract the TB disease. The risk of death among TB/HIV co-infected patients was found to be high. Out of all patients, 79 (21.8%) died. Accelerated failure time models are good alternatives for scenario Cox proportional hazard assumptions not met.
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Affiliation(s)
- Mesfin Esayas Lelisho
- Department of Statistics, College of Natural and Computational Science, Mizan-Tepi University, Tepi, Ethiopia.
| | - Belete Mulatu Teshale
- Department of Statistics, College of Natural and Computational Science, Mizan-Tepi University, Tepi, Ethiopia
| | - Seid Ali Tareke
- Department of Statistics, College of Natural and Computational Science, Mizan-Tepi University, Tepi, Ethiopia
| | - Sali Suleman Hassen
- Department of Statistics, College of Natural and Computational Science, Mizan-Tepi University, Tepi, Ethiopia
| | - Solomon Abebaw Andargie
- Department of Statistics, College of Natural and Computational Science, Mizan-Tepi University, Tepi, Ethiopia
| | - Amanuel Mengistu Merera
- Department of Statistics, College of Natural and Computational Science, Mizan-Tepi University, Tepi, Ethiopia
| | - Sisay Awoke
- Department of Statistics, College of Natural and Computational Science, Addis Ababa University, Addis Ababa, Ethiopia
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18
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Addo MK, Aboagye RG, Tarkang EE. Factors influencing adherence to antiretroviral therapy among HIV/AIDS patients in the Ga West Municipality, Ghana. IJID REGIONS 2022; 3:218-225. [PMID: 35755462 PMCID: PMC9216268 DOI: 10.1016/j.ijregi.2022.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/23/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Antiretroviral therapy (ART) is used to suppress the HIV viral load but requires optimal adherence to be effective. This study examined the factors influencing ART adherence among HIV-positive clients in the Ga West Municipality, Ghana using the Health Belief Model (HBM). METHODS A facility-based cross-sectional design was adopted among 397 HIV clients aged 18 years and above. Data were collected using an interviewer-administered questionnaire and analysed using Stata version 16.0. Binary logistic regression was performed at the P < 0.05 level. RESULTS Adherence to ART was 44.6%. Clients who took less than 30 minutes to reach ART sites were 59% less likely to adhere to ART (odds ratio (OR) 0.41, 95% confidence interval (CI) 0.20-0.82). Clients who thought they lost income when they went to obtain their ART refill were more likely to adhere to ART (OR 1.71, 95% CI 1.04-2.83), as were those who developed side effects (OR 1.74, 95% CI 1.05-2.89) (perceived barriers). Clients who had confidence in their ability to take their medications (self-efficacy) (OR 1.86, 95% CI 1.05-3.31) and those who received reminders from health workers (cues to action) (OR 1.91, 95% CI 1.04-3.53) were more likely to adhere to ART. CONCLUSIONS Interventions should focus on increasing client confidence in adhering to ART. Providers should be empowered to provide reminders to patients.
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Affiliation(s)
- Mavis Kessewa Addo
- School of Public Health, University of Health and Allied Sciences, PMB 31 Ho, Volta Region, Ghana
| | - Richard Gyan Aboagye
- School of Public Health, University of Health and Allied Sciences, PMB 31 Ho, Volta Region, Ghana
| | - Elvis Enowbeyang Tarkang
- School of Public Health, University of Health and Allied Sciences, PMB 31 Ho, Volta Region, Ghana
- HIV/AIDS Prevention Research Network Cameroon PO Box 36 Kumba Southwest Region, Cameroon
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19
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Vahedi F, Ghasemi Y, Atapour A, Zomorodian K, Ranjbar M, Monabati A, Nezafat N, Savardashtaki A. B-Cell Epitope Mapping from Eight Antigens of Candida albicans to Design a Novel Diagnostic Kit: An Immunoinformatics Approach. Int J Pept Res Ther 2022; 28:110. [PMID: 35669279 PMCID: PMC9136830 DOI: 10.1007/s10989-022-10413-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 12/24/2022]
Abstract
Invasive candidiasis is an emerging fungal infection and a leading cause of morbidity in health care facilities. Despite advances in antifungal therapy, increased antifungal drug resistance in Candida albicans has enhanced patient fatality. The most common method for Candida albicans diagnosing is blood culture, which has low sensitivity. Therefore, there is an urgent need to establish a valid diagnostic method. Our study aimed to use the bioinformatics approach to design a diagnostic kit for detecting Candida albicans with high sensitivity and specificity. Eight antigenic proteins of Candida albicans (HYR1, HWP1, ECE1, ALS, EAP1, SAP1, BGL2, and MET6) were selected. Next, a construct containing different immunodominant B-cell epitopes was derived from the antigens and connected using a suitable linker. Different properties of the final construct, such as physicochemical properties, were evaluated. Moreover, the designed construct underwent 3D modeling, reverse translation, and codon optimization. The results confirmed that the designed construct could identify Candida albicans with high sensitivity and specificity in serum samples of patients with invasive candidiasis. However, experimental studies are needed for final confirmation.
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Affiliation(s)
- Farzaneh Vahedi
- Department of Medical Biotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Younes Ghasemi
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Atapour
- Department of Medical Biotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamiar Zomorodian
- Department of Parasitology & Mycology, School of Medicines, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Ranjbar
- Department of Medical Biotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Monabati
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Navid Nezafat
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Savardashtaki
- Department of Medical Biotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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20
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Wang C, Hesketh EL, Shamorkina TM, Li W, Franken PJ, Drabek D, van Haperen R, Townend S, van Kuppeveld FJM, Grosveld F, Ranson NA, Snijder J, de Groot RJ, Hurdiss DL, Bosch BJ. Antigenic structure of the human coronavirus OC43 spike reveals exposed and occluded neutralizing epitopes. Nat Commun 2022; 13:2921. [PMID: 35614127 PMCID: PMC9132891 DOI: 10.1038/s41467-022-30658-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 05/09/2022] [Indexed: 12/14/2022] Open
Abstract
Human coronavirus OC43 is a globally circulating common cold virus sustained by recurrent reinfections. How it persists in the population and defies existing herd immunity is unknown. Here we focus on viral glycoprotein S, the target for neutralizing antibodies, and provide an in-depth analysis of its antigenic structure. Neutralizing antibodies are directed to the sialoglycan-receptor binding site in S1A domain, but, remarkably, also to S1B. The latter block infection yet do not prevent sialoglycan binding. While two distinct neutralizing S1B epitopes are readily accessible in the prefusion S trimer, other sites are occluded such that their accessibility must be subject to conformational changes in S during cell-entry. While non-neutralizing antibodies were broadly reactive against a collection of natural OC43 variants, neutralizing antibodies generally displayed restricted binding breadth. Our data provide a structure-based understanding of protective immunity and adaptive evolution for this endemic coronavirus which emerged in humans long before SARS-CoV-2. Human coronavirus OC43 causes respiratory disease and is maintained in the human population through recurring infections. Here, by extensive structural analyses, the authors provide insights into the binding sites and breadth of neutralizing antibodies against this endemic coronavirus.
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Affiliation(s)
- Chunyan Wang
- Virology Section, Infectious Diseases and Immunology Division, Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Emma L Hesketh
- Astbury Centre Structural Molecular Biology, School Molecular and Cellular Biology, Faculty Biological Sciences, University of Leeds, Leeds, UK
| | - Tatiana M Shamorkina
- Biomolecular Mass Spectrometry & Proteomics, Bijvoet Center for Biomolecular Research, Department of Chemistry, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Wentao Li
- Virology Section, Infectious Diseases and Immunology Division, Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.,State Key Laboratory of Agricultural Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, P.R. China
| | - Peter J Franken
- Virology Section, Infectious Diseases and Immunology Division, Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Dubravka Drabek
- Department of Cell Biology, Erasmus Medical Center, Rotterdam, The Netherlands.,Harbour BioMed, Rotterdam, The Netherlands
| | - Rien van Haperen
- Department of Cell Biology, Erasmus Medical Center, Rotterdam, The Netherlands.,Harbour BioMed, Rotterdam, The Netherlands
| | - Sarah Townend
- Astbury Centre Structural Molecular Biology, School Molecular and Cellular Biology, Faculty Biological Sciences, University of Leeds, Leeds, UK
| | - Frank J M van Kuppeveld
- Virology Section, Infectious Diseases and Immunology Division, Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Frank Grosveld
- Department of Cell Biology, Erasmus Medical Center, Rotterdam, The Netherlands.,Harbour BioMed, Rotterdam, The Netherlands
| | - Neil A Ranson
- Astbury Centre Structural Molecular Biology, School Molecular and Cellular Biology, Faculty Biological Sciences, University of Leeds, Leeds, UK
| | - Joost Snijder
- Biomolecular Mass Spectrometry & Proteomics, Bijvoet Center for Biomolecular Research, Department of Chemistry, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Raoul J de Groot
- Virology Section, Infectious Diseases and Immunology Division, Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Daniel L Hurdiss
- Virology Section, Infectious Diseases and Immunology Division, Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.
| | - Berend-Jan Bosch
- Virology Section, Infectious Diseases and Immunology Division, Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.
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Siamisang K, Rankgoane-Pono G, Madisa TM, Mudiayi T, Tlhakanelo JT. Outcomes and predictors of tuberculosis mortality in Kweneng West District, Botswana: a retrospective cohort study. Pan Afr Med J 2022; 42:1. [PMID: 35685381 PMCID: PMC9142783 DOI: 10.11604/pamj.2022.42.1.32381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/13/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Botswana is among the countries with the highest tuberculosis (TB) notification rates in the world. However, there is paucity of data on the outcomes and predictors of TB mortality at district level in Botswana. This study was aimed at describing the TB outcomes and identifying the predictors of mortality in Kweneng West district, Botswana. METHODS this was a retrospective cohort study of TB outcomes in Kweneng West, from January 2008 to December 2016. All documented drug-sensitive TB (DS-TB) patients aged 16 years and above were included. The World Health Organization (WHO) definitions of treatment outcomes for DS-TB were used. Binary logistic regression was used to identify predictors of mortality. RESULTS there were 1475 TB notifications in the study period. The median age was 36 years and 41.5% were female. A total of 728 (49.4%) were HIV positive. Pulmonary TB (PTB) accounted for 87.3% of all cases. The overall treatment success rate (TSR) was 81.9% and the mortality rate was 9.4%. Compared to the 16-25 years age group, patients aged more than 65 years had the highest risk of mortality (AOR=9.63). Other significant predictors of mortality were male sex (AOR=1.63), no sputum microscopy (AOR=1.77), positive HIV (AOR=2.13) and unknown HIV status (AOR=4.47). Positive sputum microscopy (AOR=0.50) and extra-pulmonary TB (EPTB) (AOR=0.56) were associated with less mortality. CONCLUSION while Botswana has relatively good TB treatment success rates, the mortality rates are high. Public health interventions should target the identified risk factors of mortality.
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Affiliation(s)
- Keatlaretse Siamisang
- Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana,,Department of Health Services Management, Ministry of Health and Wellness, Gaborone, Botswana,Corresponding author: Keatlaretse Siamisang, Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana.
| | | | - Tumisang Malebo Madisa
- Department of Health Services Management, Ministry of Health and Wellness, Gaborone, Botswana
| | - Tantamika Mudiayi
- Department of Health Services Management, Ministry of Health and Wellness, Gaborone, Botswana
| | - John Thato Tlhakanelo
- Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana
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Dagnaw Tegegne K, Cherie N, Tadesse F, Tilahun L, Kassaw MW, Biset G. Incidence and Predictors of Opportunistic Infections Among Adult HIV Infected Patients on Anti-Retroviral Therapy at Dessie Comprehensive Specialized Hospital, Ethiopia: A Retrospective Follow-Up Study. HIV AIDS (Auckl) 2022; 14:195-206. [PMID: 35469324 PMCID: PMC9034843 DOI: 10.2147/hiv.s346182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/27/2022] [Indexed: 11/23/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Kirubel Dagnaw Tegegne
- Department of Comprehensive nursing, College of medicine and Health Science, Wollo University, Dessie, Ethiopia
- Correspondence: Kirubel Dagnaw Tegegne, Tel +251938405728, Email
| | - Nigus Cherie
- School of Public health, college of Medicine and Health science, Wollo University, Dessie, Ethiopia
| | - Fentaw Tadesse
- School of Public health, college of Medicine and Health science, Wollo University, Dessie, Ethiopia
| | - Lehulu Tilahun
- Department of Emergency Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Mesfine Wudu Kassaw
- School of nursing, college of health science, Woldia University, Woldia, Ethiopia
| | - Gebeyaw Biset
- Department of Pediatric Nursing, College of medicine and Health Science, Wollo University, Dessie, Ethiopia
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Shan D, Ning Z, Yu M, Zheng H, Yang J, Gong H, Li J, Liu H, Liu L, Wang V, Ran X, Han M, Zhang D. HIV incidence and risk factors among transgender women and cisgender men who have sex with men in two cities of China: a prospective cohort study. Infect Dis Poverty 2022; 11:26. [PMID: 35256001 PMCID: PMC8900389 DOI: 10.1186/s40249-022-00947-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/14/2022] [Indexed: 02/07/2023] Open
Abstract
Background HIV epidemic among men who have sex with men (MSM) remains a major public health concern in China. Despite a growing body of research on transgender women worldwide, little is known about Chinese transgender women within MSM. We sought to estimate HIV incidence and distinguish risk factors of HIV acquisition among them from that among cisgener (non-transgender) MSM (cis-MSM). Methods We conducted an open cohort study among Chinese MSM, including those who were identified as transgender in Shanghai and Tianjin. Participants were initially recruited by local community-based organizations from January to June, 2016, and were followed up approximately every 6 months until June 2018. At each visit, a structured questionnaire was used to gather information on demographics, sexual risk behaviors, and HIV status. HIV incidence was calculated as the number of seroconversions divided by total number of person-years of follow-up among HIV-negatives at baseline. Risk factors of HIV acquisition were assessed by univariate and multivariate Cox regression models with time-dependent variables. Results A total of 1056 participants contributed 1260.53 person-years (PYs) of follow-up, 33 HIV seroconversions occurred during the follow-up period, yielding an estimated HIV incidence of 2.62 (95% CI 1.80–3.68) per 100 PYs. HIV incidence among transgender women was 4.42 per 100 PYs, which was significantly higher than that of 1.35 per 100 PYs among cis-MSM, demonstrating a threefold higher odds of HIV infection than cis-MSM. For transgender women, those lived locally ≤ 2 years (adjusted hazard ratio [aHR] = 1.76, 95% CI 1.13–2.76) and unprotected anal sex last time (aHR = 4.22, 95% CI 1.82–9.79) were more likely to acquire HIV. For cis-MSM, factors associated with HIV acquisition were frequency of anal sex ≥ 3 times in past one month (aHR = 4.19, 95% CI 1.06–16.47) and unprotected anal sex last time (aHR = 5.33, 95% CI 1.52–18.73). Conclusions Compared to cis-MSM, transgender women were at higher risk of HIV acquisition, highlighting an urgent need of tailored prevention. Future HIV program should consider to include them to ensure that this population in China are not left behind. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40249-022-00947-3.
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Gizaw Z, Yalew AW, Bitew BD, Lee J, Bisesi M. Fecal indicator bacteria along multiple environmental exposure pathways (water, food, and soil) and intestinal parasites among children in the rural northwest Ethiopia. BMC Gastroenterol 2022; 22:84. [PMID: 35220951 PMCID: PMC8882269 DOI: 10.1186/s12876-022-02174-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 02/21/2022] [Indexed: 12/13/2022] Open
Abstract
Background Children in low-resource settings are exposed to multiple risk factors for enteropathogens. However, the probability of exposures may be different across exposure pathways. Accordingly, this study was conducted to assess environmental exposures of children to intestinal parasites in the east Dembiya district of Ethiopia.
Methods A cross-sectional study was conducted for 372 households with children aged 24–59 months. The potential for external exposure of children to intestinal parasites was assessed by determining the presence of fecal indicator organism (Escherichia coli (E. coli)) in drinking water at point of use, ready-to-eat foods, and courtyard soil from children’s outdoor play areas. For internal exposure assessment, ova of parasites in stool samples was detected using wet mount and Kato-Katz techniques to estimate exposure to intestinal parasites. The external and internal exposure assessments were also complemented using questionnaire and spot-check observations to assess behaviors that result in high risk of exposure. Individual and community-level predictors of intestinal parasites were identified using a multilevel logistic regression model. Statistically significant variables were identified on the basis of adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value < 0.05.
Results Ova of one or more intestinal parasites was detected among 178 (47.8%) (95% CI 42.8, 52.6%) of the children. The most common intestinal parasites were A. lumbricoides (20.7%) and S. mansoni (19.1%). Furthermore, E. coli was detected in 69.1% of drinking water samples at point of use, 67.5% of ready-to-eat food samples, and 83.1% of courtyard soil samples from children’s outdoor play areas. Exposure of children to intestinal parasites among children in the studied region was associated with poor hand hygiene of mothers (AOR 1.98, 95% CI (1.07, 3.66), poor hand hygiene of children (AOR 3.20, 95% CI (1.77, 5.77), mouthing of soil contaminated materials (AOR 2.31, 95% CI (1.26, 4.24), open defecation practices (AOR 2.22, 95% CI (1.20, 4.10), limited access to water (AOR 2.38, 95% CI (1.13, 5.01), water contamination (AOR 2.51, 95% CI (1.31, 4.80), food contamination (AOR 3.21, 95% CI (1.69, 6.09), and soil contamination (AOR 2.56, 95% CI (1.34, 4.90). Conclusion An extensive E. coli contamination of water, foods, and courtyard soil was found in the studied region and the potential sources of contamination were open defecation practices, unhygienic disposal of wastes, poor animal husbandry and keeping practices, and poor water and food safety measures at household level. Moreover, fecal contamination of water, foods, and soil linked to exposure of children to intestinal parasites in the studied region. Thus, it is critical to implement individual-level interventions (such as latrine utilization, hand hygiene promotion, food safety, home-based water treatment, and containment of domestic animals), plus community-level interventions (such as protecting water sources from contamination, source-based water treatment, and community-driven sanitation).
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MicroRNA let-7 and viral infections: focus on mechanisms of action. Cell Mol Biol Lett 2022; 27:14. [PMID: 35164678 PMCID: PMC8853298 DOI: 10.1186/s11658-022-00317-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/26/2022] [Indexed: 02/06/2023] Open
Abstract
MicroRNAs (miRNAs) are fundamental post-transcriptional modulators of several critical cellular processes, a number of which are involved in host defense mechanisms. In particular, miRNA let-7 functions as an essential regulator of the function and differentiation of both innate and adaptive immune cells. Let-7 is involved in several human diseases, including cancer and viral infections. Several viral infections have found ways to dysregulate the expression of miRNAs. Extracellular vesicles (EV) are membrane-bound lipid structures released from many types of human cells that can transport proteins, lipids, mRNAs, and miRNAs, including let-7. After their release, EVs are taken up by the recipient cells and their contents released into the cytoplasm. Let-7-loaded EVs have been suggested to affect cellular pathways and biological targets in the recipient cells, and can modulate viral replication, the host antiviral response, and the action of cancer-related viruses. In the present review, we summarize the available knowledge concerning the expression of let-7 family members, functions, target genes, and mechanistic involvement in viral pathogenesis and host defense. This may provide insight into the development of new therapeutic strategies to manage viral infections.
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Esmaeilnia M, Saffari M, Rashki S, Marzhoseyni Z, Khaledi A, Moosavi GA, Atoof F, Alani B. Molecular typing of clinical and environmental isolates of Klebsiella pneumoniae producing ESBLs by PFGE. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2022; 25:208-213. [PMID: 35655602 PMCID: PMC9124538 DOI: 10.22038/ijbms.2022.58445.12981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 01/11/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Klebsiella pneumoniae is the common cause of pneumonia in hospitalized patients, particularly in intensive care units (ICU). The infection can transfer by medical equipment such as mechanical ventilators. This study aimed to investigate the molecular typing of the extended-spectrum beta-lactamase-producing K. pneumoniae isolates recovered from Beheshti Hospital, Kashan, Iran. MATERIALS AND METHODS K. pneumoniae isolates producing ESBLs have been collected from the samples obtained from Shahid Beheshti hospital, Kashan, Iran. Antimicrobial susceptibility was determined using the Kirby Bauer disk diffusion method. The presence of ESBLs was evaluated using CLSI for ESBL screening by the double-disk diffusion method. Molecular typing was conducted by pulsed-field gel electrophoresis (PFGE). In total, 89 K. pneumoniae isolates were recovered, of which 47.1% were ESBL producers. RESULTS Results showed that all of the clinical and environmental isolates were resistant to ceftriaxone, meropenem, cefazolin, cefotaxime, cephalothin, and piperacillin-tazobactam. All isolates were grouped under four clusters (A-D). The major cluster was related to the C cluster with 22 isolates (19 clinical and 3 environmental). Seventy-two percent of isolates were from the ICU ward. There was no correlation between antibiotic resistance patterns and PFGE clusters (P=0.2). CONCLUSION We observed a common molecular signature among both clinical and environmental K. pneumoniae isolates, indicating a similar genotype and likely a common origin for ESBL producer isolates found in different hospital wards. Therefore, hospitals need to implement an effective infection control system to decrease the spreading of ESBL strains within the hospitals and subsequently the transmission of the infection to patients.
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Affiliation(s)
- Mohammad Esmaeilnia
- Department of Microbiology and Immunology, Faculty of Medicine, Kashan University of Medical Science, Kashan, Iran, Infectious Diseases Research Center, Kashan University of Medical Science, Kashan, Iran
| | - Mahmood Saffari
- Department of Microbiology and Immunology, Faculty of Medicine, Kashan University of Medical Science, Kashan, Iran, Infectious Diseases Research Center, Kashan University of Medical Science, Kashan, Iran
| | - Somaye Rashki
- Department of Microbiology and Immunology, Faculty of Medicine, Kashan University of Medical Science, Kashan, Iran, Infectious Diseases Research Center, Kashan University of Medical Science, Kashan, Iran
| | - Zeynab Marzhoseyni
- Department of Microbiology and Immunology, Faculty of Medicine, Kashan University of Medical Science, Kashan, Iran, Infectious Diseases Research Center, Kashan University of Medical Science, Kashan, Iran
| | - Azad Khaledi
- Department of Microbiology and Immunology, Faculty of Medicine, Kashan University of Medical Science, Kashan, Iran, Infectious Diseases Research Center, Kashan University of Medical Science, Kashan, Iran,Corresponding author: Azad Khaledi. Department of Microbiology and Immunology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran. Tel: +98-31-55443022;
| | - Gholam Abbas Moosavi
- Department of Vital Statistics and Epidemiology, School of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Fatemeh Atoof
- Department of Biostatistics, Health Faculty, Kashan University of Medical Sciences, Kashan, Iran
| | - Behrang Alani
- Department of Applied Cell Sciences, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
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Shifera N, Yosef T, Matiyas R, Kassie A, Assefa A, Molla A. Undernutrition and Associated Risk Factors among Adult HIV/AIDS Patients Attending Antiretroviral Therapy at Public Hospitals of Bench Sheko Zone, Southwest Ethiopia. J Int Assoc Provid AIDS Care 2022; 21:23259582221079154. [PMID: 35481790 PMCID: PMC9099061 DOI: 10.1177/23259582221079154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 11/16/2022] Open
Abstract
Even though there are advancements in the treatment of patients with HIV, many deaths are related to undernutrition. Despite this fact, the burden of undernutrition and associated factors among adults receiving ART is a significant shortcoming in the study area. A cross-sectional study was done in public hospitals of the Bench-Sheko zone. Face-to-face interviews were used to gather information. Odds ratio with a 95% confidence level was used to identify determinants of undernutrition. The proportion of undernutrition, normal, and overweight were 29.2%, 61.2%, and 9.6% respectively. Food insecurity, poor ART adherence, low CD4 count, and substance use were factors associated with under nutrition among HIV patients. Undernutrition was so high in comparison to other studies in Ethiopia; the local concerned bodies should focus on identified risk factors for improving HIV/AIDS treatment via health education, nutritional assistance and counseling.
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Affiliation(s)
- Nigusie Shifera
- Department of Epidemiology and Biostatics, School of Public Health, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Tewodros Yosef
- Department of Epidemiology and Biostatics, School of Public Health, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Rahel Matiyas
- Department of Psychology, Mizan-Tepi University, Mizzan, Ethiopia
| | - Ayechew Kassie
- Department of Nursing, Mizan-Tepi University, Mizzan, Ethiopia
| | - Ashenafi Assefa
- Department of Nursing, Mizan-Tepi University, Mizzan, Ethiopia
| | - Abebaw Molla
- Department of Nutrition, Mizan-Tepi University, Mizzan, Ethiopia
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Maleki B, Olfatifar M, Dodangeh S, Ahmadi N, Gorgipour M, Javanmard E. Subtype distribution of Blastocystis sp. isolated from humans in Iran: a systematic review and meta-analysis. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2022; 15:294-310. [PMID: 36762220 PMCID: PMC9876770 DOI: 10.22037/ghfbb.v15i4.2475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/13/2022] [Indexed: 02/11/2023]
Abstract
Aim This systematic review and meta-analysis evaluated the subtyped Blastocystis sp. isolated from humans in Iran. Background Blastocystis sp. is an anaerobic intestinal protozoan that infects humans as well as domestic and wild animals, i.e. mammals, amphibians, reptiles, and arthropods. Methods A comprehensive search for papers published before April 2022 was undertaken utilizing English and Persian databases. The following MeSH keywords were used in the electronic search: (Blastocystis sp.) AND (molecular OR subtype) AND (prevalence OR epidemiology) AND Iran. The quality of the included studies was evaluated. Thereafter, a random-effects meta-analysis was conducted to estimate the pooled prevalence and odds ratios regarding the included studies. Results A total of 32 studies comprised of five case-control studies and 27 cross-sectional studies met the eligibility criteria. The overall pooled prevalence of subtyped Blastocystis sp. in Iran was estimated to be 10% (95% confidence interval: 6 to 15%). Eight subtypes of Blastocystis sp. (ST1- ST7 and ST9) were identified in our study, of which ST3 was the most common subtype (0.04); 0.02-0.07). The difference in subtypes between two case and control groups in reported studies was not significant, but the odds ratio of infection by ST3 (0.98; 95% CI, 0.30 to 3.20) was higher in cases. Conclusion The current systematic review showed that with the exception of ST8 and ST12, all human Blastocystis sp. subtypes reported in the world are found in different parts of Iran.
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Affiliation(s)
- Bahman Maleki
- Department of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran Iran
| | - Meysam Olfatifar
- Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Samira Dodangeh
- Medical Microbiology Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Nayebali Ahmadi
- Proteomics Research Center, Department of Medical Lab Technology, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Gorgipour
- Department of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran Iran
| | - Ehsan Javanmard
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran Iran
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Das A, Lakhan T, Unisa S. Tuberculosis prevalence, knowledge of transmission and its association with vaccination of children. J Infect Prev 2021; 22:259-268. [PMID: 34880948 DOI: 10.1177/17571774211012777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background Understanding the perceptions of patients regarding tuberculosis (TB) will enable better design of a comprehensive, client-oriented program for the disease. Methods This study was conducted district-wise across India in 2015-2016 as part of the National Family Health Surveys (NFHS). Results We discovered that the prevalence of TB remains significantly high, with quite a high percentage of people being unaware of the exact cause of disease proliferation. The majority of people believed that touching or sharing utensils can be a source of TB. This perception affected the participants' responses about seeking diagnosis and treatment. However, it is a good sign that most people knew that TB is a curable disease that can be prevented to some extent if immunization with the Bacillus Calmette-Guérin (BCG) vaccine is done at the correct stage. So, a large section of the population had their children vaccinated. In addition, they would go for diagnosis if they had symptoms suggestive of the disease. Conclusion Findings from this study are indicative of the fact that a large population is aware that health facilities can make a significant contribution to the treatment of tuberculosis. There is a need to further investigate how this information could potentially be used to enhance early seeking of appropriate services among TB patients.
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Affiliation(s)
- Anisha Das
- Department of Statistics and Biostatistics, Florida State University, USA
| | - Tejal Lakhan
- Department of Bio-statistics and Demography, International Institute for Population Sciences, Mumbai, India
| | - Sayeed Unisa
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, India
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Causer L, Liu B, Watts C, McManus H, Donovan B, Ward J, Guy R. Hospitalisations for pelvic inflammatory disease in young Aboriginal women living in remote Australia: the role of chlamydia and gonorrhoea. Sex Transm Infect 2021; 98:445-447. [PMID: 34887352 DOI: 10.1136/sextrans-2021-055242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/21/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Aboriginal women living in remote Australia experience a high burden of both chlamydia and gonorrhoea infections and disproportionately high rates of pelvic inflammatory disease (PID). We estimated for the first time the fraction of PID attributable to these infections in young Aboriginal women living in these settings. METHODS Using published data from two large Australian studies (2002-2013; 2010-2014), we calculated the fraction of emergency department presentations and hospitalisations for PID attributable to chlamydia and/or gonorrhoea infection in Aboriginal women aged 16-29 years living in remote Australia. We used a Monte Carlo simulation to estimate the mean and 95% CIs for the assumed prevalence and population attributable fractions for PID for infection stratifications (chlamydia only, gonorrhoea only and dual infection) as well as for any infection (chlamydia and/or gonorrhoea). Additional outputs were calculated for chlamydia infection with/without gonorrhoea coinfection, and vice versa. RESULTS The prevalence of chlamydia only was 12.9% (95% CI: 11.6% to 14.2%), gonorrhoea only was 7.8% (95% CI: 6.6% to 8.9%) and dual infection was 6.5% (95% CI: 5.8% to 7.2%); rate ratios of PID were 1.9 (95% CI: 1.5 to 2.3), 5.2 (95% CI: 4.3 to 6.4) and 4.6 (95% CI: 3.8 to 5.5), respectively. The overall fraction of PID attributable to chlamydia and/or gonorrhoea was 40.2% (95% CI: 36.0% to 44.4%); any gonorrhoea was 33.4% (95% CI: 29.2% to 37.8%) and any chlamydia was 20.6% (95% CI: 16.9% to 24.6%). CONCLUSION Our study demonstrates the importance of calculating the fraction of PID related to chlamydia and gonorrhoea in the local context, demonstrating the major contribution gonorrhoea makes to PID hospitalisations among Australian Aboriginal women living in remote settings. To significantly and sustainably reduce the unacceptable rate of PID in this population, strategies are urgently needed to improve timely testing and treatment and recognition and management of PID in primary care.
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Affiliation(s)
- Louise Causer
- Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - Bette Liu
- School of Population Health, UNSW, Sydney, New South Wales, Australia
| | - Caroline Watts
- Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - Hamish McManus
- Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - Basil Donovan
- Kirby Institute, UNSW, Sydney, New South Wales, Australia.,Sydney Sexual Health Centre, Sydney, New South Wales, Australia
| | - James Ward
- Poche Centre for Indigenous Health, The University of Queensland-Saint Lucia Campus, Saint Lucia, Queensland, Australia
| | - Rebecca Guy
- Kirby Institute, UNSW, Sydney, New South Wales, Australia
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Chen W, Tseng CL. What are healthcare workers' preferences for hand hygiene interventions? A discrete choice experiment. BMJ Open 2021; 11:e052195. [PMID: 34732487 PMCID: PMC8572395 DOI: 10.1136/bmjopen-2021-052195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/20/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To understand the key attributes in designing effective interventions for improving healthcare workers' (HCWs') hand hygiene compliance and HCWs' preference for these attributes. DESIGN A discrete choice experiment (DCE) was conducted with five attributes extracted from the framework of Total Quality Management that can be applied in the design of hand hygiene interventions. They were hand hygiene monitoring, open discussion, message framing, resources accessibility and top management involvement. An addition attribute, peer hand hygiene performance, was considered as a contextual factor. Data were analysed by a conditional logit model to evaluate how these attributes impact HCWs' hand hygiene compliance. SETTING The DCE was conducted with participants from a university hospital in Taichung. PARTICIPANTS HCWs involved in daily patient-care activities (N=387). RESULTS To enhance their compliance, HCWs had strong and consistent preferences in having open discussion of hand hygiene problems ([Formula: see text], [Formula: see text]), easy access to hand hygiene resources ([Formula: see text], [Formula: see text]) and top management involvement ([Formula: see text], [Formula: see text]). For hand hygiene monitoring ([Formula: see text], [Formula: see text]), HCWs preferred to be monitored by infection control staff over their department head if their peer hand hygiene performance was low. On the other hand, when the peer performance was high, monitoring by their department head could improve their hand hygiene compliance. Similarly, how educational messages were framed impacted compliance and also depended on the peer hand hygiene performance. When the peer performance was low, HCWs were more likely to increase their compliance in reaction to loss-framed educational messages ([Formula: see text],[Formula: see text]). When the peer performance was high, gain-framed messages that focus on the benefit of compliance were more effective in inducing compliance. CONCLUSIONS Each intervention design has its unique impact on HCWs' hand hygiene compliant behaviour. The proposed approach can be used to evaluate HCWs' preference and compliance of an intervention before it is implemented.
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Affiliation(s)
- Wenlin Chen
- School of Management and Economics, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Chung-Li Tseng
- Business School, University of New South Wales, Sydney, New South Wales, Australia
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Goldenberg M, Wang H, Walker T, Kaffenberger BH. Clinical and immunologic differences in cellulitis vs. pseudocellulitis. Expert Rev Clin Immunol 2021; 17:1003-1013. [PMID: 34263717 DOI: 10.1080/1744666x.2021.1953982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: The immunologic mechanisms between cellulitis and pseudocellulitis differ greatly, even though their clinical presentations may overlap.Areas covered: This article discusses cellulitis and common entities within the pseudocellulitis spectrum including acute lymphedema, superficial venous thrombosis, allergic contact dermatitis, lipodermatosclerosis, stasis dermatitis, erythema nodosum, cutaneous gout, and bursitis. The literature search was conducted from PubMed search engine between March and May 2021.Expert commentary: While immunologic differences in cellulitis and the various entities of pseudocellulitis are clear, there is a practice gap in applying these differences to the clinic and hospital setting. Further, existing studies are weakened by the lack of a gold-standard diagnosis in this disease category. Additional work is necessary in developing a gold-standard for the diagnosis and secondly, to project these immunologic differences as biomarkers to differentiate sterile inflammation from a potential life threatening bacterial or fungal infection.
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Affiliation(s)
- Michael Goldenberg
- Division of Dermatology, Ohio State University College of Medicine, the Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Henry Wang
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Trent Walker
- Division of Dermatology, Ohio State University College of Medicine, the Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Benjamin H Kaffenberger
- Division of Dermatology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
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Matute T, Nuñez I, Rivera M, Reyes J, Blázquez-Sánchez P, Arce A, Brown AJ, Gandini C, Molloy J, Ramirez-Sarmiento CA, Federici F. Homebrew reagents for low cost RT-LAMP. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.05.08.21256891. [PMID: 34013302 PMCID: PMC8132288 DOI: 10.1101/2021.05.08.21256891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
RT-LAMP (reverse transcription - Loop-mediated isothermal amplification) has gained popularity for the detection of SARS-CoV-2. The high specificity, sensitivity, simple protocols and potential to deliver results without the use of expensive equipment has made it an attractive alternative to RT-PCR. However, the high cost per reaction, the centralized manufacturing of required reagents and their distribution under cold chain shipping limits RT-LAMP's applicability in low-income settings. The preparation of assays using homebrew enzymes and buffers has emerged worldwide as a response to these limitations and potential shortages. Here, we describe the production of Moloney murine leukemia virus (M-MLV) Reverse Transcriptase and BstLF DNA polymerase for the local implementation of RT-LAMP reactions at low cost. These reagents compared favorably to commercial kits and optimum concentrations were defined in order to reduce time to threshold, increase ON/OFF range and minimize enzyme quantities per reaction. As a validation, we tested the performance of these reagents in the detection of SARS-CoV-2 from RNA extracted from clinical nasopharyngeal samples, obtaining high agreement between RT-LAMP and RT-PCR clinical results. The in-house preparation of these reactions results in an order of magnitude reduction in costs, and thus we provide protocols and DNA to enable the replication of these tests at other locations. These results contribute to the global effort of developing open and low cost diagnostics that enable technological autonomy and distributed capacities in viral surveillance.
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Affiliation(s)
- Tamara Matute
- ANID – Millennium Science Initiative Program – Millennium Institute for Integrative Biology (iBio), Santiago, Chile
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Isaac Nuñez
- ANID – Millennium Science Initiative Program – Millennium Institute for Integrative Biology (iBio), Santiago, Chile
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Maira Rivera
- ANID – Millennium Science Initiative Program – Millennium Institute for Integrative Biology (iBio), Santiago, Chile
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javiera Reyes
- ANID – Millennium Science Initiative Program – Millennium Institute for Integrative Biology (iBio), Santiago, Chile
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paula Blázquez-Sánchez
- ANID – Millennium Science Initiative Program – Millennium Institute for Integrative Biology (iBio), Santiago, Chile
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Aníbal Arce
- ANID – Millennium Science Initiative Program – Millennium Institute for Integrative Biology (iBio), Santiago, Chile
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alexander J. Brown
- Department of Immunology and Genomic Medicine, National Jewish Health, Denver, CO, USA
- Department of Immunology & Microbiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Chiara Gandini
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Jennifer Molloy
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - César A. Ramirez-Sarmiento
- ANID – Millennium Science Initiative Program – Millennium Institute for Integrative Biology (iBio), Santiago, Chile
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fernán Federici
- ANID – Millennium Science Initiative Program – Millennium Institute for Integrative Biology (iBio), Santiago, Chile
- FONDAP Center for Genome Regulation. Departamento de Genética Molecular y Microbiología, Pontificia Universidad Católica de Chile, Santiago, 8331150, Chile
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
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Agegnehu CD, Alem AZ. Exploring spatial variation in BCG vaccination among children 0-35 months in Ethiopia: spatial analysis of Ethiopian Demographic and Health Survey 2016. BMJ Open 2021; 11:e043565. [PMID: 33910946 PMCID: PMC8094339 DOI: 10.1136/bmjopen-2020-043565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Tuberculosis is a major public health problem and is the second leading cause of death worldwide. BCG vaccination is a life-saving and important part of standard tuberculosis control measures, particularly in Ethiopia where tuberculosis is endemic. The End Tuberculosis Strategy targets of 2020 have not been achieved. Exploring spatial variations in BCG vaccination among children is vital to designing and monitoring effective intervention programmes. Therefore, this study aimed to explore the spatial variation in BCG vaccination among children in Ethiopia. DESIGN Cross-sectional study design. SETTING Ethiopia. PARTICIPANTS Children aged 0-35 months. PRIMARY OUTCOME BCG vaccination coverage. METHODS Data from the 2016 Ethiopian Demographic and Health Survey were used and a total of 4453 children aged 0-35 months were included. Spatial autocorrelation analysis, cluster and outlier analysis, hotspot analysis, spatial interpolation, and spatial scan statistics were carried out to identify geographical risk areas for BCG vaccine utilisation. ArcGIS V.10.6 and SaTScan V.9.6 statistical software were employed to explore spatial pattern and significant hotspot areas for BCG vaccination among children. RESULTS BCG vaccination was spatially clustered in Ethiopia at the regional level (Global Moran's I=0.516, p<0.001). A total of 51 most likely clusters of low BCG vaccination were identified in the Somali and Afar regions (log-likelihood ratio=136.58, p<0.001). Significant secondary clusters were also identified in North West Gambela, South Amhara, South West Addis Ababa, North East Southern Nations, Nationalities, and People's Region, and South West Oromia. CONCLUSION A low probability of receiving BCG vaccination was found among children in the Somali and Afar regions. Therefore, these areas should be given attention when designing effective immunisation strategies to improve BCG vaccination among children in order to reduce the burden of tuberculosis in Ethiopia.
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Affiliation(s)
- Chilot Desta Agegnehu
- School of Nursing, College of medicine and health scienes and comprehensive specailized hospital, Unievrsity of Gondar, Gondar, Ethiopia
| | - Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public health, Collge of medicine and health sciences, University of Gondar, Gondar, Ethiopia
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Ayana GM, Akalu TY, Ayele TA. Joint Modeling of Incidence of Tuberculosis and Change in Viral Load Over Time Among Adult HIV/AIDS Patients on Anti-Retroviral Therapy at Zewditu Memorial Hospital in Addis Ababa, Ethiopia. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:239-249. [PMID: 33688264 PMCID: PMC7935332 DOI: 10.2147/hiv.s291872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/29/2021] [Indexed: 11/23/2022]
Abstract
Background Globally, approximately 37.9 million people were living with HIV and one-third of these people are co-infected with tuberculosis (TB). However, little is known about predictors of tuberculosis incidence and its association with viral load. Thus, this study was aimed at assessing the incidence of tuberculosis and its predictors and its association with the longitudinal change in viral load over time among adult HIV/AIDS patients at Zewditu memorial hospital, Addis Ababa Ethiopia. Methods A retrospective follow-up study was conducted among 471 HIV patients. The proportional hazard assumption was checked for the survival sub-model and the longitudinal sub-model. Νormality assumption was checked. Then the joint model with time-dependent lagged parameterizations was fitted. The goodness of fit was checked using the Cox-Snell residual test and Akaike Information Criteria (AIC) was used for model selection. Finally, the hazard ratio with a 95% confidence interval (CI) with a corresponding P-value <0.05 was used. Results A total of 471 patients were followed for a minimum of 12 and a maximum of 48 months with a median follow-up time of 44 months [IQR (33, 46)]. The incidence rate was 3.08/1000 person-years (PY) with a 95% CI of [0.0023788, 0.003998). Age above 65 years adjusted hazard ratio (AHR) = 2.07, 95% CI: 1.06, 4.06), underweight at baseline (AHR = 2.29, 95% CI: 1.20, 4.35), past opportunistic infection (AHR = 2.98, CI: 1.23, 7.17) and 6th month lagged value of the viral load were significant predictors for being co-infected with TB. Conclusion The incidence of TB among HIV/AIDS patients in Zewditu memorial hospital was low. Older age, underweight at baseline, and past opportunistic infection were significant predictors of time to TB co-infection. Thus, addressing significant predictors and strengthening continuous follow-up are highly recommended in the study setting.
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Affiliation(s)
- Galana Mamo Ayana
- Department of Epidemiology and Biostatistics, School of Public Health, Haramaya University, Harar, Ethiopia
| | - Temesgen Yihunie Akalu
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Elsaid NMAB, Refaat AH, Fiala LA, Hamed ER. Delay in the diagnosis and management of tuberculosis among patients in the Suez Canal Area. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2019. [DOI: 10.4103/ejb.ejb_8_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mammas IN, Spandidos DA. Advancing challenges in Paediatric Virology: An interview with Professor Barbara A. Rath, Co-founder and Chair of the Vienna Vaccine Safety Initiative. Exp Ther Med 2019; 18:3231-3237. [PMID: 31588214 PMCID: PMC6766581 DOI: 10.3892/etm.2019.7948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 08/26/2019] [Indexed: 02/07/2023] Open
Abstract
The Vienna Vaccine Safety Initiative (ViVI) is an international, scientific, non-profit, research organization, which aims to promote research, clinical practice and communication on Paediatric Infectious Diseases (PID) in a globalized healthcare setting, to facilitate the implementation of high standards in vaccine safety and efficacy and to support international and interdisciplinary scientific collaboration. Professor Barbara A. Rath, Chair and Co-founder of the Vienna Vaccine Safety Initiative, advocates for the establishment of global research networks in the field of neonatal and paediatric viral infections. Viruses do not respect borders, and large datasets are required and joint action is necessary to further strengthen efforts towards viral diseases eradication and prevention. She encourages the paediatric community to embrace the new opportunities technology offers for healthcare and medical education. To date, the Vienna Vaccine Safety Initiative has developed a number of innovative mobile applications and diagnostic tools, such as the ‘VAccApp’, which helps parents understand which vaccines were administered to their children, the ‘ViVI Disease Severity Score’, which measures clinical severity in patients with acute respiratory infections and flu-like illnesses, the ‘VACC Tool’, which assesses patient's clinical presentation to a set of diagnostic algorithms for adverse events following immunization and the ‘ViVI Health Survey’, which enables children and young adults on the move to report health needs securely and confidentially. Professor Rath agrees that during this decade there is momentum in the field of Paediatric Virology, as new antivirals and vaccines emerge and are finally becoming available to children. In the future, ‘in-house’ specialists for Paediatric Virology could be helpful to provide quality of care and reduce antimicrobial resistance by providing individual as well as hospital-wide consultations and advice. She estimates that Paediatric Virology will eventually find its place in the context of PID and Vaccinology.
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Affiliation(s)
- Ioannis N Mammas
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece.,First Department of Paediatrics, University of Athens School of Medicine, 11527 Athens, Greece.,Paediatric Clinic, Aliveri, 34500 Island of Euboea, Greece
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
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Asres A, Jerene D, Deressa W. Delays to anti-tuberculosis treatment intiation among cases on directly observed treatment short course in districts of southwestern Ethiopia: a cross sectional study. BMC Infect Dis 2019; 19:481. [PMID: 31142288 PMCID: PMC6542087 DOI: 10.1186/s12879-019-4089-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 05/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Delayed tuberculosis (TB) diagnosis and treatment increase morbidity, mortality, expenditure, and transmission in the community. This study assessed patient and provider related delays to diagnosis and treatment of TB. METHODS A cross-sectional study was conducted among 735 new adult TB cases registered between January to December 2015 in 10 woredas equivalent to districts of southwestern Ethiopia. Data were collected through face-to-face interview of patients within the first 2 months of treatment initiation. Delay in days was tracked at three intervals: between onset of symptoms and self-presentation (Patient delay), Self-presentation to treatment initiation (Provider delay) and total delay. Days elapsed beyond median were used to define the delays. Bivariate and multiple logistic regression models were fit to identify predictors of delays and statistical significance was judged at p < 0.05. RESULT The median (inter-quartile range) of patient, provider and total delays were 25 (IQR;15-36), 22 (IQR:9-48) and 55 (IQR:32-100) days, respectively. More than half (54.6%) of the total delay was attributed to health system. Prior self-treatment [adjusted Odds Ratio (aOR)]: 1.72, 95% confidence interval [CI]:1.07-2.75), HIV co-infection (aOR:1.8, 95% CI: 1.05-3.10) and extra-pulmonary TB (aOR: 1.54,95% CI:1.03-2.29) were independently associated with increased odds of patient delay. On the other hand initial presentation to health posts or private clinics (aOR: 1.42, 95% CI: 1.01, 2.0) and patient delay (aOR: 1.81, 95% CI: 1.33-2.50) significantly predicted longer provider delay. Finally, having extra pulmonary TB (aOR: 1.6, 95% CI: 1.07-2.38), prior consultation of traditional healer (aOR: 3.72, 95% CI: 1.01-13.77) and use of holy water (aOR: 2.73, 95% CI: 1.11, 6.70) independently predicted longer total delay. CONCLUSION Tuberculosis patients waited too long time to initiate anti-TB treatment reflecting longer periods of morbidity and disease transmission. The delays are attributed to the patient, disease and health system related factors. Hence, improving community awareness, involving informal providers, health extension workers and TB treatment supporters can reduce the patient delay. Similarly, cough screening and improving diagnostic efficiencies of healthcare facilities should be in place to reduce the provider delays.
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Affiliation(s)
- Abyot Asres
- Department of Public Health, College of Health Sciences, Mizan Tepi University, Mizan Aman, Ethiopia. .,Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Degu Jerene
- Management Science for Health, Addis Ababa, Ethiopia
| | - Wakgari Deressa
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Abstract
OBJECTIVE Direct-acting antivirals have opened an opportunity for controlling hepatitis C virus (HCV) infection in Pakistan, where 10% of the global infection burden is found. We aimed to evaluate the implications of five treatment programme scenarios for HCV treatment as prevention (HCV-TasP) in Pakistan. DESIGN An age-structured mathematical model was used to evaluate programme impact using epidemiological and programme indicators. SETTING Total Pakistan population. PARTICIPANTS Total Pakistan HCV-infected population. INTERVENTIONS HCV treatment programme scenarios from 2018 up to 2030. RESULTS By 2030 across the five HCV-TasP scenarios, 0.6-7.3 million treatments were administered, treatment coverage reached between 3.7% and 98.7%, prevalence of chronic infection reached 2.4%-0.03%, incidence reduction ranged between 41% and 99%, program-attributed reduction in incidence rate ranged between 7.2% and 98.5% and number of averted infections ranged between 126 221 and 750 547. Annual incidence rate reduction in the first decade of the programme was around 6%-18%. Number of treatments needed to prevent one new infection ranged between 4.7-9.8, at a drug cost of about US$900. Cost of the programme by 2030, in the most ambitious elimination scenario, reached US$708 million. Stipulated WHO target for 2030 cannot be accomplished without scaling up treatment to 490 000 per year, and maintaining it for a decade. CONCLUSION HCV-TasP is a highly impactful and potent approach to control Pakistan's HCV epidemic and achieve elimination by 2030.
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Affiliation(s)
- Houssein H Ayoub
- Department of Mathematics, Statistics, and Physics, Qatar University, Doha, Qatar
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Doha, Qatar
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, USA
- College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar
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Tang SS, Biswas SK, Tan WS, Saha AK, Leo BF. Efficacy and potential of phage therapy against multidrug resistant Shigella spp. PeerJ 2019; 7:e6225. [PMID: 30984476 PMCID: PMC6452847 DOI: 10.7717/peerj.6225] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 12/04/2018] [Indexed: 12/21/2022] Open
Abstract
Shigella-infected bacillary dysentery or commonly known as Shigellosis is a leading cause of morbidity and mortality worldwide. The gradual emergence of multidrug resistant Shigella spp. has triggered the search for alternatives to conventional antibiotics. Phage therapy could be one such suitable alternative, given its proven long term safety profile as well as the rapid expansion of phage therapy research. To be successful, phage therapy will need an adequate regulatory framework, effective strategies, the proper selection of appropriate phages, early solutions to overcome phage therapy limitations, the implementation of safety protocols, and finally improved public awareness. To achieve all these criteria and successfully apply phage therapy against multidrug resistant shigellosis, a comprehensive study is required. In fact, a variety of phage-based approaches and products including single phages, phage cocktails, mutated phages, genetically engineered phages, and combinations of phages with antibiotics have already been carried out to test the applications of phage therapy against multidrug resistant Shigella. This review provides a broad survey of phage treatments from past to present, focusing on the history, applications, limitations and effective solutions related to, as well as the prospects for, the use of phage therapy against multidrug resistant Shigella spp. and other multidrug resistant bacterial pathogens.
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Affiliation(s)
- Swee-Seong Tang
- Division of Microbiology, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Sudhangshu Kumar Biswas
- Division of Microbiology, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
- Department of Genetic Engineering and Biotechnology, Islamic University Kushtia, Kushtia, Bangladesh
| | - Wen Siang Tan
- Department of Microbiology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Institute of Bioscience, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Ananda Kumar Saha
- Department of Zoology, Faculty of Life and Earth Sciences, University of Rajshahi, Rajshahi, Bangladesh
| | - Bey-Fen Leo
- Central Unit for Advanced Research Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Nanotechnology and Catalysis Research Centre (NANOCAT), University of Malaya, Kuala Lumpur, Malaysia
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Alemu T, Gutema H. Trend in magnitude of tuberculosis in Awi Zone, Northwest Ethiopia: a five-year tuberculosis surveillance data analysis. BMC Res Notes 2019; 12:209. [PMID: 30952210 PMCID: PMC6451271 DOI: 10.1186/s13104-019-4234-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/28/2019] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Ethiopia is among the 30 high tuberculosis (TB) burden countries with annual estimated TB incidence of 164/100,000 population and death rate of 28/100,000 population for 2017. We analyzed the trend in magnitude of tuberculosis in Awi Zone from July 08/2011 up to June 27/2016. RESULTS Tuberculosis surveillance data (2012 to 2016) was extracted from Awi Zonal Health Department Health Management Information System database and TB program unit and analyzed by Microsoft Excel 2007®. Epi-Info7 software was used for tuberculosis trend analysis using Chi square for trends. A total of 8193 new TB cases were included in the analysis, of which 18.7% were smear positive PTB cases, 28.5% smear negative PTB (PTB-) cases and 52.7% were extra pulmonary TB (EPTB) cases. All form TB prevalence rate was 213/100,000 population in 2012 and significantly decreased to 189 in 2016 (Trend χ2 = 11.97; P = 0.00054). Similarly, all form TB incidence rate was 167/100,000 population in 2012 and decreased to 122 in 2016 (Trend χ2 = 37.6; P = 0.000). Overall, the magnitude of tuberculosis had decreased over the periods reviewed. The proportion of EPTB is high. We recommend culture and chest X-ray diagnostic services expansion to capture EPTB and PTB- cases.
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Affiliation(s)
- Tefera Alemu
- Amhara Public Health Institute, Dessie, Ethiopia.
| | - Hordofa Gutema
- Department of Health Promotion and Behavioural Sciences, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Alema HB, Hailemariam SA, Misgina KH, Weldu MG, Gebregergis YS, Mekonen GK, Gebremedhin KA. Health care seeking delay among pulmonary tuberculosis patients in North West zone of Tigrai region, North Ethiopia. BMC Infect Dis 2019; 19:309. [PMID: 30953459 PMCID: PMC6451246 DOI: 10.1186/s12879-019-3893-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 03/10/2019] [Indexed: 11/18/2022] Open
Abstract
Background Tuberculosis (TB) is a major public health problem and it is among the top 10 causes of death worldwide. One of the challenges against attaining an effective TB control program is delay in seeking health care to diagnosis and treatment of TB patients. The aim of this study was to assess health care-seeking delay among pulmonary TB patients. Methods An institutional based cross-sectional study was conducted among new pulmonary tuberculosis (PTB) patients > 15 years of age who were enrolled in the intensive phase TB treatment from November 1, 2015 – January 30, 2016. Data were collected by an interviewer administered technique using a structured questionnaire. Health care seeking delay was categorized by using a median cutoff point of > 30 days as a prolonged health care seeking delay. Logistic regression analyses were employed to determine factors independently associated with the delays in health care seeking. Results A total of 422 PTB patients were included in this study. The median age of respondents was 37 years (interquartile range (IQR) =35–44). The median time of health care seeking delay was 30 days (IQR) = 21-60). Respondents occupation, knowledge about pulmonary tuberculosis, health facility visited first, seeking treatment from traditional or religious healers before visiting health facilities, reason for not seeking treatment early from health facilities, and reason for first consultation were found to be significantly associated with health care seeking delay. Conclusion The study showed the magnitude of health care seeking delay among pulmonary tuberculosis patient was very long and the factors associated with health care seeking delay were: occupation, knowledge status, health facility visited first and seeking treatment from religious or traditional healer before health facilities. To overcome delay of health care seeking among tuberculosis patients, efforts should required availing tuberculosis diagnostic and treatment services at the primary health care level.
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Affiliation(s)
| | | | - Kebede Haile Misgina
- Department of Public Health, College of Health Science, Aksum University, P.O.Box: 298, Axum, Ethiopia
| | - Meresa Gebremedhin Weldu
- Department of Public Health, College of Health Science, Aksum University, P.O.Box: 298, Axum, Ethiopia
| | - Yosef Sibhatu Gebregergis
- Department of Public Health, College of Health Science, Aksum University, P.O.Box: 298, Axum, Ethiopia
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Cissé AM, Laborde-Balen G, Kébé-Fall K, Dramé A, Diop H, Diop K, FatouNiasse-Traoré, Coulibaly M, Have NN, Vidal N, Thiam S, Wade AS, Peeters M, Taverne B, Msellati P, Touré-Kane C. High level of treatment failure and drug resistance to first-line antiretroviral therapies among HIV-infected children receiving decentralized care in Senegal. BMC Pediatr 2019; 19:47. [PMID: 30722780 PMCID: PMC6362577 DOI: 10.1186/s12887-019-1420-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/29/2019] [Indexed: 11/10/2022] Open
Abstract
Background In Senegal in 2015, an estimated 4800 children were living with HIV, with 1200 receiving ARV treatment, of whom half had follow-up care in decentralized sites outside Dakar. However, until now no studies have determined the efficacy of pediatric treatment in decentralized settings, even though the emergence of viral resistance, particularly among children in Africa, is a well-known phenomenon. This study aimed to assess the virological status of HIV-infected children in all decentralized facilities to help improve access to quality care. Methods A cross-sectional epidemiological and virological study was conducted in all of Senegal’s regions, except Dakar, between March and June 2015 and sought to include all HIV-infected children and adolescents (0–19 years), treated or not with ARVs. Socio-demographic and clinical data and a blood sample on blotting paper were collected for children from treatment sites. Samples were routed on public transportation, assisted by a network of community health workers. A viral load (VL) assay was performed for each child, followed by genotyping when it exceeded 1000 copies/mL (3 log10). Results Of the 851 identified children, 666 (78%) were enrolled in the study. Half of the children were girls, and the average age was 8 years (6 months–19 years). Most of the children (96.7%) were infected with HIV-1, and 90% were treated with ART, primarily with AZT + 3TC + NVP/EFV therapeutic regimen. The median duration of time on ART was 21 months (1–129). VL was measured for 2% of children before this study. Almost two-thirds (64%) of the children are experiencing virological failure. Among them, there was resistance to at least one drug for 86.5% of cases. Also, 25% children presented resistance to one drug and 40% to two out of three. For nearly one-third of the children presenting resistance, none of the three drugs of the treatment was active. Factors associated with virological failure were male sex, follow-up by a generalist rather than a specialist, and treatment interruptions. Conclusions We observed a high level of virological failure and a high percentage of viral resistance among children receiving health care in decentralized facilities in Senegal.
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Affiliation(s)
- Abdoul-Magib Cissé
- Service de pédiatrie Établissement Public de Santé (EPS) de Mbour, UFR Sciences de la Santé, Thiès University, Thiès, Senegal
| | - Gabrièle Laborde-Balen
- Expertise France, Paris, France.,ANRS-Senegal site, Dakar, Senegal.,Centre régional de recherche et de formation à la prise en charge clinique de Fann (CRCF), Dakar, Senegal
| | - Khady Kébé-Fall
- Bacteriology-Virology Laboratory, A. Le Dantec CHU, Cheikh Anta Diop University, Dakar, Senegal
| | - Aboubacry Dramé
- Bacteriology-Virology Laboratory, A. Le Dantec CHU, Cheikh Anta Diop University, Dakar, Senegal
| | - Halimatou Diop
- Bacteriology-Virology Laboratory, A. Le Dantec CHU, Cheikh Anta Diop University, Dakar, Senegal
| | - Karim Diop
- Expertise France, Paris, France.,Centre régional de recherche et de formation à la prise en charge clinique de Fann (CRCF), Dakar, Senegal.,Division de lutte contre le sidxa et les IST (DLSI), Ministry of Health and Social Action (MSAS), Dakar, Senegal
| | | | - Mohamed Coulibaly
- Division de lutte contre le sidxa et les IST (DLSI), Ministry of Health and Social Action (MSAS), Dakar, Senegal
| | - Ndeye-Ngone Have
- Réseau national des associations de personnes vivant avec le VIH au (RNP+), Dakar, Senegal
| | - Nicole Vidal
- Institut de Recherche pour le Développement (IRD), Montpellier, France
| | - Safiatou Thiam
- Conseil national de lutte contre le sida (CNLS), Dakar, Senegal
| | - Abdoulaye S Wade
- Division de lutte contre le sidxa et les IST (DLSI), Ministry of Health and Social Action (MSAS), Dakar, Senegal
| | - Martine Peeters
- Institut de Recherche pour le Développement (IRD), Montpellier, France
| | - Bernard Taverne
- Centre régional de recherche et de formation à la prise en charge clinique de Fann (CRCF), Dakar, Senegal.,Institut de Recherche pour le Développement (IRD), Montpellier, France
| | - Philippe Msellati
- Institut de Recherche pour le Développement (IRD), Montpellier, France. .,TransVIHMI, IRD, PACCI, 18 BP 1954, Abidjan 18, Abidjan, Côte d'Ivoire.
| | - Coumba Touré-Kane
- Bacteriology-Virology Laboratory, A. Le Dantec CHU, Cheikh Anta Diop University, Dakar, Senegal
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Ong KJ, Checchi M, Burns L, Pavitt C, Postma MJ, Jit M. Systematic review and evidence synthesis of non-cervical human papillomavirus-related disease health system costs and quality of life estimates. Sex Transm Infect 2018; 95:28-35. [PMID: 30674687 DOI: 10.1136/sextrans-2018-053606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/06/2018] [Accepted: 08/07/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Many economic evaluations of human papillomavirus vaccination should ideally consider multiple disease outcomes, including anogenital warts, respiratory papillomatosis and non-cervical cancers (eg, anal, oropharyngeal, penile, vulvar and vaginal cancers). However, published economic evaluations largely relied on estimates from single studies or informal rapid literature reviews. METHODS We conducted a systematic review of articles up to June 2016 to identify costs and utility estimates admissible for an economic evaluation from a single-payer healthcare provider's perspective. Meta-analyses were performed for studies that used same utility elicitation tools for similar diseases. Costs were adjusted to 2016/2017 US$. RESULTS Sixty-one papers (35 costs; 24 utilities; 2 costs and utilities) were selected from 10 742 initial records. Cost per case ranges were US$124-US$883 (anogenital warts), US$6912-US$52 579 (head and neck cancers), US$12 936-US$51 571 (anal cancer), US$17 524-34 258 (vaginal cancer), US$14 686-US$28 502 (vulvar cancer) and US$9975-US$27 629 (penile cancer). The total cost for 14 adult patients with recurrent respiratory papillomatosis was US$137 601 (one paper).Utility per warts episode ranged from 0.651 to 1 (12 papers, various utility elicitation methods), with pooled mean EQ-5D and EQ-VAS of 0.86 (95% CI 0.85 to 0.87) and 0.74 (95% CI 0.74 to 0.75), respectively. Fifteen papers reported utilities in head and neck cancers with range 0.29 (95% CI 0.0 to 0.76) to 0.94 (95% CI 0.3 to 1.0). Mean utility reported ranged from 0.5 (95% CI 0.4 to 0.61) to 0.65 (95% CI 0.45 to 0.75) (anal cancer), 0.59 (95% CI 0.54 to 0.64) (vaginal cancer), 0.65 (95% CI 0.60 to 0.70) (vulvar cancer) and 0.79 (95% CI 0.74 to 0.84) (penile cancer). CONCLUSIONS Differences in values reported from each paper reflect variations in cancer site, disease stages, study population, treatment modality/setting and utility elicitation methods used. As patient management changes over time, corresponding effects on both costs and utility need to be considered to ensure health economic assumptions are up-to-date and closely reflect the case mix of patients.
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Affiliation(s)
- Koh Jun Ong
- National Infection Service, Public Health England, London, UK
| | - Marta Checchi
- National Infection Service, Public Health England, London, UK
| | - Lorna Burns
- Faculty of Medicine and Dentistry, University of Plymouth, Devon, UK
| | | | - Maarten J Postma
- Department of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Health Sciences, University Medical Center Groningen, Groningen, The Netherlands.,Department of Economics, Econometrics & Finance, University of Groningen, Groningen, The Netherlands
| | - Mark Jit
- National Infection Service, Public Health England, London, UK .,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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45
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Abstract
BACKGROUND Data on pediatric HIV in Peru are limited. The National Institute of Child Health (Instituto Nacional de Salud del Niño: INSN) cares for the most HIV-infected children under the age of 18 years in the country. We describe the outcomes of children seen at INSN's HIV clinic over the 10 years when antiretroviral therapy and prevention of mother-to-child transmission (PMTCT) interventions became available in 2004. METHODS We conducted a retrospective review of INSN HIV clinic patients between 2003 and 2012. Deidentified data were collected and analyzed. RESULTS A total of 280 children were included: 50.0% (140/280) were male; 80.0% (224/280) lived in metropolitan Lima. Perinatal transmission was the mode of HIV infection in 91.4% (256/280) of children. Only 17% (32/191) of mothers were known to be HIV-infected at delivery; of these mothers, 41% (13/32) were receiving antiretroviral therapy at delivery, 72% (23/32) delivered by Cesarean section and 47% (15/32) of their infants received antiretroviral prophylaxis. Median age at HIV diagnosis for all children was 35.7 months (interquartile range 14.5-76.8 months), and 67% (143/213) had advanced disease (clinical stage C). After HIV diagnosis, the most frequent hospitalization discharge diagnoses were bacterial pneumonia, chronic malnutrition, diarrhea, anemia and tuberculosis. Twenty-four patients (8.6%) died at a median age of 77.4 months. CONCLUSIONS Most cases of pediatric HIV were acquired via perinatal transmission; few mothers were diagnosed before delivery; and among mothers with known HIV status, PMTCT was suboptimal even after national PMTCT policy was implemented. Most children were diagnosed with advanced disease. These findings underscore the need for improving early pediatric HIV diagnosis and treatment, as well as PMTCT strategies.
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46
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Hashim A, O’Sullivan M, Williams H, Verma S. Developing a community HCV service: project ITTREAT (integrated community-based test - stage - TREAT) service for people who inject drugs. Prim Health Care Res Dev 2018; 19:110-120. [PMID: 29199921 PMCID: PMC6452958 DOI: 10.1017/s1463423617000731] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 09/05/2017] [Accepted: 10/08/2017] [Indexed: 12/19/2022] Open
Abstract
Background and aims Majority of the individuals with hepatitis C virus (HCV) infection in England are people who inject drugs, a vulnerable and disenfranchised cohort with poor engagement with secondary care. Our aim is to describe our experiences in setting up a successful nurse led HCV service at a substance misuse service (SMS). METHODS We justify the need for a community HCV service and review the different community based models. Our experiences in engaging with stakeholders, obtaining funding, service set up, challenges faced and key recommendations are discussed. Finally, a summary of interim clinical outcomes is presented. RESULTS A successful community based "one-stop" nurse led HCV service was set up in Dec 2013 at a large SMS. It provides all aspects of care (blood borne virus screening, non-invasive assessment of hepatic fibrosis, Hepatology input, HCV treatment, peer mentor, social and psychiatrist support, and opiod substitution) at one site. Interim clinical data indicate high service uptake with HCV treatment outcomes comparable to secondary care. CONCLUSIONS The advent of direct acting antivirals provides a unique opportunity for HCV elimination in England by 2030. Our "one-stop" integrated and multidisciplinary community HCV model suggests that HCV care can be successfully delivered outside of a hospital setting and warrants national adoption.
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Affiliation(s)
- Ahmed Hashim
- Department of Medicine, Brighton and Sussex Medical School, Brighton, UK
- Department of Gastroenterology and Hepatology, Brighton and Sussex University Hospital, Brighton, UK
| | - Margaret O’Sullivan
- Department of Gastroenterology and Hepatology, Brighton and Sussex University Hospital, Brighton, UK
- Pavilions Drug & Alcohol Services, Richmond House, Brighton, UK
| | - Hugh Williams
- Pavilions Drug & Alcohol Services, Richmond House, Brighton, UK
- Surrey and Borders Partnership NHS foundation trust
| | - Sumita Verma
- Department of Medicine, Brighton and Sussex Medical School, Brighton, UK
- Department of Gastroenterology and Hepatology, Brighton and Sussex University Hospital, Brighton, UK
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47
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Hoyos-Bachiloglu R, Chou J, Sodroski CN, Beano A, Bainter W, Angelova M, Al Idrissi E, Habazi MK, Alghamdi HA, Almanjomi F, Al Shehri M, Elsidig N, Alaa Eldin M, Knipe DM, AlZahrani M, Geha RS. A digenic human immunodeficiency characterized by IFNAR1 and IFNGR2 mutations. J Clin Invest 2017; 127:4415-4420. [PMID: 29106381 DOI: 10.1172/jci93486] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 09/14/2017] [Indexed: 01/29/2023] Open
Abstract
Primary immunodeficiencies are often monogenic disorders characterized by vulnerability to specific infectious pathogens. Here, we performed whole-exome sequencing of a patient with disseminated Mycobacterium abscessus, Streptococcus viridians bacteremia, and cytomegalovirus (CMV) viremia and identified mutations in 2 genes that regulate distinct IFN pathways. The patient had a homozygous frameshift deletion in IFNGR2, which encodes the signal transducing chain of the IFN-γ receptor, that resulted in minimal protein expression and abolished downstream signaling. The patient also harbored a homozygous deletion in IFNAR1 (IFNAR1*557Gluext*46), which encodes the IFN-α receptor signaling subunit. The IFNAR1*557Gluext*46 resulted in replacement of the stop codon with 46 additional codons at the C-terminus. The level of IFNAR1*557Gluext*46 mutant protein expressed in patient fibroblasts was comparable to levels of WT IFNAR1 in control fibroblasts. IFN-α-induced signaling was impaired in the patient fibroblasts, as evidenced by decreased STAT1/STAT2 phosphorylation, nuclear translocation of STAT1, and expression of IFN-α-stimulated genes critical for CMV immunity. Pretreatment with IFN-α failed to suppress CMV protein expression in patient fibroblasts, whereas expression of WT IFNAR1 restored IFN-α-mediated suppression of CMV. This study identifies a human IFNAR1 mutation and describes a digenic immunodeficiency specific to type I and type II IFNs.
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Affiliation(s)
| | - Janet Chou
- Division of Immunology, Boston Children's Hospital and Department of Pediatrics, and
| | - Catherine N Sodroski
- Department of Microbiology and Immunobiology and Harvard Program in Virology, Harvard Medical School, Boston, Massachusetts, USA
| | - Abdallah Beano
- Division of Immunology, Boston Children's Hospital and Department of Pediatrics, and
| | - Wayne Bainter
- Division of Immunology, Boston Children's Hospital and Department of Pediatrics, and
| | - Magdalena Angelova
- Department of Microbiology and Immunobiology and Harvard Program in Virology, Harvard Medical School, Boston, Massachusetts, USA
| | - Eman Al Idrissi
- Department of Pediatrics, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Murad K Habazi
- Department of Pediatrics, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Fahd Almanjomi
- Department of Pediatrics, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohamed Al Shehri
- Department of Pediatrics, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Nagi Elsidig
- Department of Pediatrics, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Morsi Alaa Eldin
- Department of Pediatrics, King Fahad Medical City, Riyadh, Saudi Arabia
| | - David M Knipe
- Department of Microbiology and Immunobiology and Harvard Program in Virology, Harvard Medical School, Boston, Massachusetts, USA
| | - Mofareh AlZahrani
- Department of Pediatrics, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Raif S Geha
- Division of Immunology, Boston Children's Hospital and Department of Pediatrics, and
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48
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Morina N, Ewers SM, Passardi S, Schnyder U, Knaevelsrud C, Müller J, Bryant RA, Nickerson A, Schick M. Mental health assessments in refugees and asylum seekers: evaluation of a tablet-assisted screening software. Confl Health 2017; 11:18. [PMID: 29026438 PMCID: PMC5623980 DOI: 10.1186/s13031-017-0120-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 08/22/2017] [Indexed: 11/12/2022] Open
Abstract
Background Mental health problems resulting from persecution and forced migration are very common among refugees and asylum seekers and evolve into a major public health challenge in hosting societies. Language barriers often prevent timely access to appropriate health care, leading to chronic trajectories and abortive social integration. Tools for multilingual screening and assessment could be of great benefit for this particularly vulnerable population as well as for policy makers. This study aimed at testing the reliability, feasibility and usability of the Multi-Adaptive Psychological Screening Software (MAPSS), a newly developed Audio Computer-Assisted Self-Interview Software (ACASI) for touchscreen devices, for screening purposes in a clinical setting. Methods In a randomized cross-over design including both MAPSS and paper-pencil clinician-administered interviews, 30 treatment-seeking refugees completed clinical measures and a feasibility questionnaire to rate the user interface of MAPSS. Five professionals performed given tasks in MAPSS and completed usability questionnaires for the administration interface. Results Results showed no differences between the two assessment modalities with regard to symptom scores. The findings suggest good feasibility and usability of MAPSS in traumatized refugees. The administration via MAPSS was significantly shorter than the paper-pencil interview. Conclusion MAPSS may be a cost-effective, flexible and valid alternative to interpreter-based psychometric screening and assessment.
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Affiliation(s)
- Naser Morina
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Culmannstrasse 8, CH-8091 Zurich, Switzerland
| | - Simon M Ewers
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Culmannstrasse 8, CH-8091 Zurich, Switzerland
| | - Sandra Passardi
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Culmannstrasse 8, CH-8091 Zurich, Switzerland
| | - Ulrich Schnyder
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Culmannstrasse 8, CH-8091 Zurich, Switzerland
| | - Christine Knaevelsrud
- Department of Clinical Psychological Intervention, Freie Universität, Berlin, Germany
| | - Julia Müller
- Psychiatric Services Thurgau, CH-8596 Münsterlingen, Switzerland
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, N.S.W. 2052 Australia
| | - Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, N.S.W. 2052 Australia
| | - Matthis Schick
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Culmannstrasse 8, CH-8091 Zurich, Switzerland
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49
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Kerkhoff AD, Barr DA, Schutz C, Burton R, Nicol MP, Lawn SD, Meintjes G. Disseminated tuberculosis among hospitalised HIV patients in South Africa: a common condition that can be rapidly diagnosed using urine-based assays. Sci Rep 2017; 7:10931. [PMID: 28883510 PMCID: PMC5589905 DOI: 10.1038/s41598-017-09895-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/31/2017] [Indexed: 01/04/2023] Open
Abstract
HIV-associated disseminated TB (tuberculosis) has been under-recognised and poorly characterised. Blood culture is the gold-standard diagnostic test, but is expensive, slow, and may under-diagnose TB dissemination. In a cohort of hospitalised HIV patients, we aimed to report the prevalence of TB-blood-culture positivity, performance of rapid diagnostics as diagnostic surrogates, and better characterise the clinical phenotype of disseminated TB. HIV-inpatients were systematically investigated using sputum, urine and blood testing. Overall, 132/410 (32.2%) patients had confirmed TB; 41/132 (31.1%) had a positive TB blood culture, of these 9/41 (22.0%) died within 90-days. In contrast to sputum diagnostics, urine Xpert and urine-lipoarabinomannan (LAM) combined identified 88% of TB blood-culture-positive patients, including 9/9 who died within 90-days. For confirmed-TB patients, half the variation in major clinical variables was captured on two principle components (PCs). Urine Xpert, urine LAM and TB-blood-culture positive patients clustered similarly on these axes, distinctly from patients with localised disease. Total number of positive tests from urine Xpert, urine LAM and MTB-blood-culture correlated with PCs (p < 0.001 for both). PC1&PC2 independently predicted 90-day mortality (ORs 2.6, 95%CI = 1.3-6.4; and 2.4, 95%CI = 1.3-4.5, respectively). Rather than being a non-specific diagnosis, disseminated TB is a distinct, life-threatening condition, which can be diagnosed using rapid urine-based tests, and warrants specific interventional trials.
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Affiliation(s)
- Andrew D Kerkhoff
- Division of Infectious Disease, Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA.
| | - David A Barr
- Wellcome Trust Liverpool Glasgow Centre for Global Health Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,Wellcome Trust Centre for Infectious Diseases Research in Africa (CIDRI-Africa), Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Charlotte Schutz
- Wellcome Trust Centre for Infectious Diseases Research in Africa (CIDRI-Africa), Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Rosie Burton
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa.,Southern African Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
| | - Mark P Nicol
- Division of Medical Microbiology and Institute for Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Stephen D Lawn
- The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Graeme Meintjes
- Wellcome Trust Centre for Infectious Diseases Research in Africa (CIDRI-Africa), Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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50
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Van Ness SE, Chandra A, Sarkar S, Pleskunas J, Ellner JJ, Roy G, Lakshminarayanan S, Sahu S, Horsburgh CR, Jenkins HE, Hochberg NS. Predictors of delayed care seeking for tuberculosis in southern India: an observational study. BMC Infect Dis 2017; 17:567. [PMID: 28806911 PMCID: PMC5557420 DOI: 10.1186/s12879-017-2629-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/24/2017] [Indexed: 12/02/2022] Open
Abstract
Background Reducing delay to accessing care is necessary to reduce the Tuberculosis (TB) burden in high incidence countries such as India. This study aimed to identify factors associated with delays in seeking care for TB in Southern India. Methods We analyzed data from newly diagnosed, smear-positive, culture-confirmed, pulmonary TB patients in the Regional Prospective Observational Research for TB (RePORT) cohort in Puducherry and Tamil Nadu, India. Data were collected on demographic characteristics, symptom duration, and TB knowledge, among other factors. Delay was defined as cough ≥4 weeks before treatment initiation. Risky alcohol use was defined by the AUDIT-C score which incorporates information about regular alcohol use and binge drinking. TB knowledge was assessed by knowing transmission mode or potential curability. Results Of 501 TB patients, 369 (73.7%) subjects delayed seeking care. In multivariable analysis, risky alcohol use was significantly associated with delay (aOR 2.20, 95% CI: 1.31, 3.68). Delay was less likely in lower versus higher income groups (<3000 versus >10,000 rupees/month, aOR 0.31, 95% CI: 0.12, 0.78). TB knowledge was not significantly associated with delay. Conclusions Local TB programs should consider that risky alcohol users may delay seeking care for TB. Further studies will be needed to determine why patients with higher income delay in seeking care. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2629-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah E Van Ness
- Department of Biostatistics, Boston University, Crosstown Building, 801 Massachusetts Avenue, 3rd Floor, Boston, MA, 02118, USA.
| | - Ankit Chandra
- Department of Preventive and Social Medicine, JIPMER, Puducherry, India
| | - Sonali Sarkar
- Department of Preventive and Social Medicine, JIPMER, Puducherry, India
| | | | - Jerrold J Ellner
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA
| | - Gautam Roy
- Department of Preventive and Social Medicine, JIPMER, Puducherry, India
| | | | - Swaroop Sahu
- Department of Preventive and Social Medicine, JIPMER, Puducherry, India
| | - C Robert Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Helen E Jenkins
- Department of Biostatistics, Boston University, Crosstown Building, 801 Massachusetts Avenue, 3rd Floor, Boston, MA, 02118, USA
| | - Natasha S Hochberg
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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