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Kepha S, Mazigo HD, Odiere MR, Mcharo C, Safari T, Gichuki PM, Omondi W, Wakesho F, Krolewiecki A, Pullan RL, Mwandawiro CS, Oswald WE, Halliday KE. Exploring factors associated with Trichuris trichiura infection in school children in a high-transmission setting in Kenya. IJID Reg 2024; 11:100352. [PMID: 38634069 PMCID: PMC11021359 DOI: 10.1016/j.ijregi.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 04/19/2024]
Abstract
Objectives Kenya has implemented a national school-based deworming program, which has led to substantial decline in the prevalence of soil-transmitted helminths (STHs), although some pockets of infections remain. To effectively design an STH control program that leads to significant reductions of Trichuris trichiura, there is a need to understand the drivers of persistent infection despite ongoing treatment programs. Methods This study was conducted between July and September 2019 at the south coast of Kenya, using a two-stage sampling design. First, a school-based cross-sectional survey was conducted in 2265 randomly selected school children from selected schools in areas known to be endemic for T. trichiura. After this, we conducted a nested case-control study wherein all children positive for T. trichiura (142) were matched to 148 negative controls based on age and village. A household survey was then conducted with all household members of cases and controls. In addition, a subsample of 116 children found to be infected with T. trichiura were followed up to assess the efficacy of albendazole at day 21 post-treatment. The predictors of presence of T. trichiura were investigated through multilevel logistic regression, considering clustering of infection. Results Overall, 34.4% of the children were infected with at least one STH species; T. trichiura was the most common (28.3%), 89.1% of those with T. trichiura had light-intensity infections. The prevalence of T. trichiura was significantly higher in male children and was positively associated with younger age and number of people infected with T. trichiura in a household. The parasitological cure rate and egg reduction rate of T. trichiura were 35% and 51%, respectively. Other STHs identified were hookworm (9.6%) and Ascaris lumbricoides (5.7%). Conclusions T. trichiura remains a significant public health challenge in the study area with albendazole treatment efficacy against the parasite, remaining lower than the World Health Organization-recommended thresholds. Because of the observed focal transmission of T. trichiura in the current area, control efforts tailored to local conditions and targeting lower implementation units should be used to achieve optimal results on transmission.
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Affiliation(s)
- Stella Kepha
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Humphrey D. Mazigo
- Department of Medical Parasitology and Entomology, School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, United Republic of Tanzania
| | - Maurice R. Odiere
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Carlos Mcharo
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Th'uva Safari
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Paul M. Gichuki
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Wykcliff Omondi
- Division of Vector Borne and Neglected Tropical Diseases, Ministry of Health, Nairobi, Kenya
| | - Florence Wakesho
- Division of Vector Borne and Neglected Tropical Diseases, Ministry of Health, Nairobi, Kenya
| | - Alejandro Krolewiecki
- Universidad Nacional de Salta, Instituto de Investigaciones de Enfermedades Tropicales/CONICET, Oran, Salta, Argentina
| | - Rachel L. Pullan
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Charles S. Mwandawiro
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - William E. Oswald
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Katherine E. Halliday
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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2
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Nieves E, Cimino R, Krolewiecki A, Juarez M, Lanusse C, Alvarez L, Ceballos L. Albendazole metabolites excretion in human saliva as a biomarker to assess treatment compliance in mass drug administration (MDA) anthelmintic programs. Sci Rep 2024; 14:6271. [PMID: 38491091 PMCID: PMC10943003 DOI: 10.1038/s41598-024-56804-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/11/2024] [Indexed: 03/18/2024] Open
Abstract
Soil-transmitted-helminth (STH) infections continue to be a persistent global public health problem. Control strategies for STH have been based on the use of mass drug administration (MDA). Coverage and compliance assessment is critical to understanding the true effectiveness of albendazole (ABZ) in those MDA programs. The aims of this work were to characterize the pattern of albendazole and metabolites excretion in human saliva, and to develop a saliva-based biomarker (HPLC drug/metabolite detection) useful to accurately estimate the coverage/compliance in MDA campaigns. The study subjects were 12 healthy volunteers treated with a single oral dose of ABZ (400 mg). Saliva and blood (dried blood spot, DBS) samples were taken previously and between 2 and 72 h post-treatment. The samples were analyzed by HPLC with UV detection, C18 reversed-phase column. ABZ sulphoxide was the main analyte recovered up to 72 h p.t. in blood and saliva. The concentration profiles measured in the blood (DBS samples) were higher (P < 0.05) than those in saliva, however, this ABZ-metabolite was recovered longer in saliva. The in vivo measurement of drugs/metabolites in saliva samples from ABZ-treated volunteers offers strong scientific evidence to support the use of saliva as a valid biological sample for assessing compliance in MDA programs.
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Affiliation(s)
- E Nieves
- Facultad Regional Orán, Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Salta, Argentina
| | - R Cimino
- Facultad Regional Orán, Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Salta, Argentina
| | - A Krolewiecki
- Facultad Regional Orán, Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Salta, Argentina
| | - M Juarez
- Facultad Regional Orán, Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Orán, Salta, Argentina
| | - C Lanusse
- Laboratorio de Farmacología, Centro de Investigación Veterinaria de Tandil (CIVETAN), UNCPBA-CICPBA-CONICET, Tandil, Buenos Aires, Argentina
- Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Tandil, Buenos Aires, Argentina
| | - L Alvarez
- Laboratorio de Farmacología, Centro de Investigación Veterinaria de Tandil (CIVETAN), UNCPBA-CICPBA-CONICET, Tandil, Buenos Aires, Argentina
- Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Tandil, Buenos Aires, Argentina
| | - L Ceballos
- Laboratorio de Farmacología, Centro de Investigación Veterinaria de Tandil (CIVETAN), UNCPBA-CICPBA-CONICET, Tandil, Buenos Aires, Argentina.
- Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Tandil, Buenos Aires, Argentina.
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3
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Krolewiecki A, Enbiale W, Gandasegui J, van Lieshout L, Kepha S, Messa Junior A, Bengtson M, Gelaye W, Escola V, Martinez-Valladares M, Cambra-Pellejà M, Algorta J, Martí-Soler H, Fleitas P, Ballester MR, Doyle SR, Williams NA, Legarda A, Mandomando I, Mwandawiro C, Muñoz J. An adaptive phase II/III safety and efficacy randomized controlled trial of single day or three-day fixed-dose albendazole-ivermectin co-formulation versus albendazole for the treatment of Trichuris trichiura and other STH infections. ALIVE trial protocol. Gates Open Res 2022; 6:62. [PMID: 36540062 PMCID: PMC9714317 DOI: 10.12688/gatesopenres.13615.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Soil-transmitted helminths (STH) are targeted for control through mass drug-administration campaigns to prevent morbidity affecting at-risk groups in endemic regions. Although broadly successful, the use of albendazole and mebendazole achieved variable progress, with deficiencies against Trichuris trichiura and a predictable low efficacy against Strongyloides stercoralis. Novel drug combinations offer a potential solution, providing they can be delivered safely and maintain efficacy against all STH species. Here we present the protocol of a clinical trial to evaluate a fixed-dose combination (FDC) tablet containing albendazole and ivermectin that will be compared against albendazole against STH . Methods: An adaptive phase II/III randomized controlled trial will be undertaken in STH endemic sites in Ethiopia, Kenya and Mozambique to evaluate an oral FDC of 400 mg albendazole and either 9- or 18 mg ivermectin. FDC will be administered as a single dose or single doses over three-consecutive days and assessed against a single dose of 400 mg albendazole. In the phase II trial, 126 T. trichiura-infected children weighting 15 to 45 kg will be treated in a dose-escalation manner to determine safety objectives. In the phase III trial, 1097 participants aged 5 to 18 years old infected with T. trichiura, hookworm and S. stercoralis will be recruited to determine safety and efficacy. The trial will be open-label with blinded outcome assessors. Cure rate measured 21-days after-treatment in duplicate Kato-Katz is the primary efficacy outcome. Secondary objectives include efficacy evaluation by quantitative polymerase chain reaction (PCR) as an outcome measurement, description of pharmacokinetic parameters, palatability and acceptability evaluations, and monitoring of anthelmintic resistance. Conclusions: This trial with registrational goals seeks to evaluate an innovative fixed-dose combination of albendazole and ivermectin co-formulated tablets, with the goal of providing an anthelmintic regimen with improved efficacy and spectrum of coverage against STH. ClinicalTrials.gov registration: NCT05124691 (18/11/2021).
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Affiliation(s)
- Alejandro Krolewiecki
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Oran, Salta, 4530, Argentina
| | - Wendemagegn Enbiale
- College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia.,Department of Dermatology,, Amsterdam Institute for Infection and Immunity, Academic Medical Centre, Amsterdam, The Netherlands
| | - Javier Gandasegui
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Lisette van Lieshout
- Department of Parasitology, Centre of Infectious Diseases, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Stella Kepha
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | | | - Michel Bengtson
- Department of Parasitology, Centre of Infectious Diseases, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Woyneshet Gelaye
- College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Valdemiro Escola
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - María Martinez-Valladares
- Instituto de Ganadería de Montaña, CSIC-Universidad de León, Grulleros, León, Spain.,Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad de León, Campus de Vegazana, León, Spain
| | - María Cambra-Pellejà
- Instituto de Ganadería de Montaña, CSIC-Universidad de León, Grulleros, León, Spain.,Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad de León, Campus de Vegazana, León, Spain
| | | | - Helena Martí-Soler
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Pedro Fleitas
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Oran, Salta, 4530, Argentina
| | - Maria Rosa Ballester
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain.,Faculty of Health Sciences Blanquerna,, University Ramon Llull, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | | | - Nana Aba Williams
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Almudena Legarda
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Inácio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Charles Mwandawiro
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - José Muñoz
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
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4
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Algorta J, Krolewiecki A, Pinto F, Gold S, Muñoz J. Pharmacokinetic Characterization and Comparative Bioavailability of an Innovative Orodispersible Fixed-Dose Combination of Ivermectin and Albendazole: A Single Dose, Open Label, Sequence Randomized, Crossover Clinical Trial in Healthy Volunteers. Front Pharmacol 2022; 13:914886. [PMID: 35910353 PMCID: PMC9329971 DOI: 10.3389/fphar.2022.914886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Soil-transmitted helminths are intestinal worm diseases transmitted through the soil. Available treatments are albendazole and/or ivermectin. The co-administration of existing drugs is an appropriate strategy. A fixed-dose combination adds practical advantages mainly considering mass drug administration. The aim is to characterize pharmacokinetics and to evaluate the comparative bioavailability of an innovative fixed-dose combination of ivermectin/albendazole 18/400 mg compared with the marketed references. Seventy-eight healthy volunteers were included in this laboratory-blinded, randomized, three-treatment, three-period crossover study. Each subject received a single dose of ivermectin/albendazole 18/400 mg (1 tablet); ivermectin 3 mg (6 tablets); and albendazole 400 mg (1 tablet). Serial blood samples for the pharmacokinetic analysis were obtained pre-dose and up to 72 h post-dose. Plasma concentrations of ivermectin H2B1a, ivermectin H2B1b, albendazole, and albendazole sulfoxide were analyzed by LC-MS/MS. Pharmacokinetic parameters were estimated by a non-compartmental analysis and bioavailability compared through a bioequivalence analysis. Safety and tolerability were assessed throughout the study. Main pharmacokinetic parameters of the fixed combination were estimated for both, ivermectin [Cmax (mean, confidence interval): 86.40 (30.42–39.23) ng/ml; AUC0-72 (mean, CI): 1,040 (530–1,678) ng·h/mL; tmax (median, min., and max.); 4.50 (2.50–5.50)] and albendazole [Cmax (mean, CI): 22.27 (1.89–111.78) ng/ml; AUC0-72 (mean, CI): 94.65 (11.65–507.78) ng·h/mL; tmax (median, min., and max.): 2.50 (1.00–12.00) h]. The 90% confidence interval of the geometric mean ratios demonstrated the bioequivalence in the case of ivermectin (Cmax: 110.68%–120.49%; AUC0-72: 110.46%–119.60%) but not in the case of albendazole (Cmax: 53.10%–70.34%; AUC0-72: 61.13%–76.54%). The pharmacokinetic profile of a new fixed-dose combination of ivermectin and albendazole was characterized. The bioequivalence versus the reference ivermectin was demonstrated, though bioequivalence versus albendazole was not shown. The three medications analyzed were well tolerated. The results allow the advancement to the next phase of the clinical program to demonstrate efficacy and safety in patients affected by soil-transmitted helminths.Clinical Trial Registration:https://www.clinicaltrialsregister.eu/ctr-search/search/, identifier Nr. 2020-003438-19
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Affiliation(s)
- Jaime Algorta
- Laboratorios Liconsa, Departamento Médico, Barcelona, Spain
- *Correspondence: Jaime Algorta, , Orcid.org/0000-0002-7042-5675
| | - Alejandro Krolewiecki
- Instituto de Investigaciones de Enfermedades Tropicales (IIET-CONICET), Sede Regional Orán, Universidad Nacional de Salta, Orán, Argentina
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Filipe Pinto
- BlueClinical Phase 1, Hospital de Prelada, Porto, Portugal
| | - Silvia Gold
- Fundación Mundo Sano, Buenos Aires, Argentina
| | - Jose Muñoz
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic-University of Barcelona, Barcelona, Spain
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5
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Camprubí D, Almuedo-Riera A, Martí-Soler H, Soriano A, Hurtado JC, Subirà C, Grau-Pujol B, Krolewiecki A, Muñoz J. Correction: Lack of efficacy of standard doses of ivermectin in severe COVID-19 patients. PLoS One 2022; 17:e0268667. [PMID: 35551297 PMCID: PMC9098077 DOI: 10.1371/journal.pone.0268667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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6
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Mayer MA, Krolewiecki A, Ferrero A, Bocchio M, Barbero J, Miguel M, Paladini A, Delgado C, Ojeda JR, Elorza C, Bertone A, Fleitas PE, Vera G, Kohan MR. Safety and Efficacy of a MEURI Program for the Use of High Dose Ivermectin in COVID-19 Patients. Front Public Health 2022; 10:813378. [PMID: 35273939 PMCID: PMC8902036 DOI: 10.3389/fpubh.2022.813378] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/31/2022] [Indexed: 12/13/2022] Open
Abstract
Background In the absence of antiviral alternatives, interventions under research for COVID-19 might be offered following guidelines from WHO for monitored emergency use of unregistered and experimental interventions (MEURI). Ivermectin is among several drugs explored for its role against SARS-CoV-2, with a well-known safety profile but conflicting data regarding clinical utility for COVID-19. The aim of this report is to inform on the results of a MEURI Program of high-dose ivermectin in COVID-19 carried out by the Ministry of Health of the Province of La Pampa, Argentina. Methods COVID-19 subjects, within 5 days of symptoms onset were invited to participate in the program, which consisted in the administration of ivermectin 0.6 mg/kg/day for 5 days plus standard of care. Active pharmacosurveillance was performed for 21 days, and hepatic laboratory assessments were performed in a subset of patients. Frequency of Intensive Care Unit (ICU) admission and COVID-19-related mortality of subjects in the ivermectin intention to treat group were compared with that observed in inhabitants of the same province during the same period not participating in the program. Results From 21,232 subjects with COVID-19, 3,266 were offered and agreed to participate in the ivermectin program and 17,966 did not and were considered as controls. A total of 567 participants reported 819 adverse events (AEs); 3.13% discontinued ivermectin due to adverse events. ICU admission was significantly lower in the ivermectin group compared to controls among participants ≥40 year-old (1.2 vs. 2.0%, odds ratio 0.608; p = 0.024). Similarly, mortality was lower in the ivermectin group in the full group analysis (1.5 vs. 2.1%, odds ratio 0.720; p = 0.029), as well as in subjects ≥ 40 year- old (2.7 vs. 4.1%, odds ratio 0.655; p = 0.005). Conclusions This report highlights the safety and possible efficacy of high dose ivermectin as a potentially useful intervention deserving public health-based consideration for COVID-19 patients.
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Affiliation(s)
- Marcos Alejandro Mayer
- Ministerio de Salud de la Provincia de La Pampa, Santa Rosa, Argentina.,Fundación Centro de Salud e Investigaciones Médicas, Santa Rosa, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Alejandro Krolewiecki
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.,Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Sede Regional Orán, Salta, Argentina
| | - Alejandro Ferrero
- Ministerio de Salud de la Provincia de La Pampa, Santa Rosa, Argentina
| | - Marcelo Bocchio
- Ministerio de Salud de la Provincia de La Pampa, Santa Rosa, Argentina
| | - Juan Barbero
- Ministerio de Salud de la Provincia de La Pampa, Santa Rosa, Argentina
| | - Marcos Miguel
- Ministerio de Salud de la Provincia de La Pampa, Santa Rosa, Argentina
| | - Ariel Paladini
- Ministerio de Salud de la Provincia de La Pampa, Santa Rosa, Argentina
| | - Carlos Delgado
- Ministerio de Salud de la Provincia de La Pampa, Santa Rosa, Argentina
| | - Juan Ramón Ojeda
- Ministerio de Salud de la Provincia de La Pampa, Santa Rosa, Argentina
| | - Claudia Elorza
- Ministerio de Salud de la Provincia de La Pampa, Santa Rosa, Argentina
| | - Ana Bertone
- Ministerio de Salud de la Provincia de La Pampa, Santa Rosa, Argentina
| | - Pedro Emanuel Fleitas
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.,Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta, Sede Regional Orán, Salta, Argentina
| | - Gustavo Vera
- Ministerio de Salud de la Provincia de La Pampa, Santa Rosa, Argentina
| | - Mario Rubén Kohan
- Ministerio de Salud de la Provincia de La Pampa, Santa Rosa, Argentina
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7
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Segatori VI, Garona J, Caligiuri LG, Bizzotto J, Lavignolle R, Toro A, Sanchis P, Spitzer E, Krolewiecki A, Gueron G, Alonso DF. Effect of Ivermectin and Atorvastatin on Nuclear Localization of Importin Alpha and Drug Target Expression Profiling in Host Cells from Nasopharyngeal Swabs of SARS-CoV-2- Positive Patients. Viruses 2021; 13:2084. [PMID: 34696514 PMCID: PMC8537229 DOI: 10.3390/v13102084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/01/2021] [Accepted: 10/11/2021] [Indexed: 01/07/2023] Open
Abstract
Nuclear transport and vesicle trafficking are key cellular functions involved in the pathogenesis of RNA viruses. Among other pleiotropic effects on virus-infected host cells, ivermectin (IVM) inhibits nuclear transport mechanisms mediated by importins and atorvastatin (ATV) affects actin cytoskeleton-dependent trafficking controlled by Rho GTPases signaling. In this work, we first analyzed the response to infection in nasopharyngeal swabs from SARS-CoV-2-positive and -negative patients by assessing the gene expression of the respective host cell drug targets importins and Rho GTPases. COVID-19 patients showed alterations in KPNA3, KPNA5, KPNA7, KPNB1, RHOA, and CDC42 expression compared with non-COVID-19 patients. An in vitro model of infection with Poly(I:C), a synthetic analog of viral double-stranded RNA, triggered NF-κB activation, an effect that was halted by IVM and ATV treatment. Importin and Rho GTPases gene expression was also impaired by these drugs. Furthermore, through confocal microscopy, we analyzed the effects of IVM and ATV on nuclear to cytoplasmic importin α distribution, alone or in combination. Results showed a significant inhibition of importin α nuclear accumulation under IVM and ATV treatments. These findings confirm transcriptional alterations in importins and Rho GTPases upon SARS-CoV-2 infection and point to IVM and ATV as valid drugs to impair nuclear localization of importin α when used at clinically-relevant concentrations.
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Affiliation(s)
- Valeria Inés Segatori
- Centro de Oncología Molecular y Traslacional y Plataforma de Servicios Biotecnológicos, Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, Bernal B1876BXD, Argentina; (V.I.S.); (J.G.); (L.G.C.)
| | - Juan Garona
- Centro de Oncología Molecular y Traslacional y Plataforma de Servicios Biotecnológicos, Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, Bernal B1876BXD, Argentina; (V.I.S.); (J.G.); (L.G.C.)
- Centro de Medicina Traslacional, Hospital El Cruce, Florencio Varela B1888AAE, Argentina
| | - Lorena Grisel Caligiuri
- Centro de Oncología Molecular y Traslacional y Plataforma de Servicios Biotecnológicos, Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, Bernal B1876BXD, Argentina; (V.I.S.); (J.G.); (L.G.C.)
| | - Juan Bizzotto
- Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Biológica, Intendente Guiraldes 2160, Buenos Aires C1428EGA, Argentina; (J.B.); (R.L.); (A.T.); (P.S.)
- CONICET—Universidad de Buenos Aires, Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales, Buenos Aires C1428EGA, Argentina
| | - Rosario Lavignolle
- Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Biológica, Intendente Guiraldes 2160, Buenos Aires C1428EGA, Argentina; (J.B.); (R.L.); (A.T.); (P.S.)
- CONICET—Universidad de Buenos Aires, Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales, Buenos Aires C1428EGA, Argentina
| | - Ayelén Toro
- Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Biológica, Intendente Guiraldes 2160, Buenos Aires C1428EGA, Argentina; (J.B.); (R.L.); (A.T.); (P.S.)
- CONICET—Universidad de Buenos Aires, Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales, Buenos Aires C1428EGA, Argentina
| | - Pablo Sanchis
- Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Biológica, Intendente Guiraldes 2160, Buenos Aires C1428EGA, Argentina; (J.B.); (R.L.); (A.T.); (P.S.)
- CONICET—Universidad de Buenos Aires, Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales, Buenos Aires C1428EGA, Argentina
| | - Eduardo Spitzer
- Laboratorio Elea-Phoenix, Los Polvorines B1613AUE, Argentina;
| | - Alejandro Krolewiecki
- Instituto de Investigaciones de Enfermedades Tropicales (IIET-CONICET), Sede Regional Orán, Universidad Nacional de Salta, Orán A4530ANQ, Argentina;
| | - Geraldine Gueron
- Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Biológica, Intendente Guiraldes 2160, Buenos Aires C1428EGA, Argentina; (J.B.); (R.L.); (A.T.); (P.S.)
- CONICET—Universidad de Buenos Aires, Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales, Buenos Aires C1428EGA, Argentina
| | - Daniel Fernando Alonso
- Centro de Oncología Molecular y Traslacional y Plataforma de Servicios Biotecnológicos, Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, Bernal B1876BXD, Argentina; (V.I.S.); (J.G.); (L.G.C.)
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8
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Krolewiecki A, Lifschitz A, Moragas M, Travacio M, Valentini R, Alonso DF, Solari R, Tinelli MA, Cimino RO, Álvarez L, Fleitas PE, Ceballos L, Golemba M, Fernández F, de Oliveira DF, Astudillo G, Baeck I, Farina J, Cardama GA, Mangano A, Spitzer E, Gold S, Lanusse C. Corrigendum to Antiviral effect of high-dose ivermectin in adults with COVID-19: A proof-of-concept randomized trial [EClinicalMedicine 37 (2021) 100,959]". EClinicalMedicine 2021; 39:101119. [PMID: 34462733 PMCID: PMC8387727 DOI: 10.1016/j.eclinm.2021.101119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
[This corrects the article DOI: 10.1016/j.eclinm.2021.100959.].
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Affiliation(s)
- Alejandro Krolewiecki
- Instituto de Investigaciones de Enfermedades Tropicales (IIET-CONICET), Sede Regional Orán, Universidad Nacional de Salta, Argentina
- Corresponding author at: Instituto de Investigaciones de Enfermedades Tropicales. UNSa. Alvarado 751 (4530), Orán, Argentina.
| | - Adrián Lifschitz
- Laboratorio de Farmacología, Centro de Investigación Veterinaria de Tandil (CIVETAN), CONICET-CICPBA-UNCPBA, Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina
| | - Matías Moragas
- Unidad de Virología y Epidemiología Molecular, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan"-CONICET, Ciudad de Buenos Aires, Argentina
| | - Marina Travacio
- Cátedra de Química General e Inorgánica, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Valentini
- Departamento de Medicina. Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Daniel F. Alonso
- Centro de Oncología Molecular y Traslacional (COMTra) y Plataforma de Servicios Biotecnológicos, Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, Buenos Aires, Argentina
| | - Rubén Solari
- Hospital Francisco J. Muñiz, Buenos Aires, Argentina
| | | | - Rubén O. Cimino
- Instituto de Investigaciones de Enfermedades Tropicales (IIET-CONICET), Sede Regional Orán, Universidad Nacional de Salta, Argentina
| | - Luis Álvarez
- Laboratorio de Farmacología, Centro de Investigación Veterinaria de Tandil (CIVETAN), CONICET-CICPBA-UNCPBA, Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina
| | - Pedro E. Fleitas
- Instituto de Investigaciones de Enfermedades Tropicales (IIET-CONICET), Sede Regional Orán, Universidad Nacional de Salta, Argentina
| | - Laura Ceballos
- Laboratorio de Farmacología, Centro de Investigación Veterinaria de Tandil (CIVETAN), CONICET-CICPBA-UNCPBA, Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina
| | - Marcelo Golemba
- Unidad de Virología y Epidemiología Molecular, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan"-CONICET, Ciudad de Buenos Aires, Argentina
| | - Florencia Fernández
- Unidad de Virología y Epidemiología Molecular, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan"-CONICET, Ciudad de Buenos Aires, Argentina
| | - Diego Fernández de Oliveira
- Departamento de Medicina. Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | | | - Inés Baeck
- Departamento de Medicina. Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Javier Farina
- Servicio de Infectología. Hospital Cuenca Alta, Cañuelas, Argentina
| | - Georgina A. Cardama
- Centro de Oncología Molecular y Traslacional (COMTra) y Plataforma de Servicios Biotecnológicos, Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, Buenos Aires, Argentina
| | - Andrea Mangano
- Unidad de Virología y Epidemiología Molecular, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan"-CONICET, Ciudad de Buenos Aires, Argentina
| | | | - Silvia Gold
- Fundación Mundo Sano, Buenos Aires, Argentina
| | - Carlos Lanusse
- Laboratorio de Farmacología, Centro de Investigación Veterinaria de Tandil (CIVETAN), CONICET-CICPBA-UNCPBA, Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina
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9
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Krolewiecki A, Lifschitz A, Moragas M, Travacio M, Valentini R, Alonso DF, Solari R, Tinelli MA, Cimino RO, Álvarez L, Fleitas PE, Ceballos L, Golemba M, Fernández F, Fernández de Oliveira D, Astudillo G, Baeck I, Farina J, Cardama GA, Mangano A, Spitzer E, Gold S, Lanusse C. Antiviral effect of high-dose ivermectin in adults with COVID-19: A proof-of-concept randomized trial. EClinicalMedicine 2021; 37:100959. [PMID: 34189446 PMCID: PMC8225706 DOI: 10.1016/j.eclinm.2021.100959] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There are limited antiviral options for the treatment of patients with COVID-19. Ivermectin (IVM), a macrocyclic lactone with a wide anti-parasitary spectrum, has shown potent activity against SARS-CoV-2 in vitro. This study aimed at assessing the antiviral effect of IVM on viral load of respiratory secretions and its relationship with drug concentrations in plasma. METHODS Proof-of-concept, pilot, randomized, controlled, outcome-assessor blinded trial to evaluate antiviral activity of high-dose IVM in 45 COVID-19 hospitalized patients randomized in a 2:1 ratio to standard of care plus oral IVM at 0·6 mg/kg/day for 5 days versus standard of care in 4 hospitals in Argentina. Eligible patients were adults with RT-PCR confirmed SARS-CoV-2 infection within 5 days of symptoms onset. The primary endpoint was the difference in viral load in respiratory secretions between baseline and day-5, by quantitative RT-PCR. Concentrations of IVM in plasma were measured. Study registered at ClinicalTrials.gov: NCT04381884. FINDINGS 45 participants were recruited (30 to IVM and 15 controls) between May 18 and September 9, 2020. There was no difference in viral load reduction between groups but a significant difference was found in patients with higher median plasma IVM levels (72% IQR 59-77) versus untreated controls (42% IQR 31-73) (p = 0·004). Mean ivermectin plasma concentration levels correlated with viral decay rate (r: 0·47, p = 0·02). Adverse events were similar between groups. No differences in clinical evolution at day-7 and day-30 between groups were observed. INTERPRETATION A concentration dependent antiviral activity of oral high-dose IVM was identified at a dosing regimen that was well tolerated. Large trials with clinical endpoints are necessary to determine the clinical utility of IVM in COVID-19. FUNDING This work was supported by grant IP-COVID-19-625, Agencia Nacional de Promoción de la Investigación, el Desarrollo Tecnológico y la Innovación, Argentina and Laboratorio ELEA/Phoenix, Argentina.
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Affiliation(s)
- Alejandro Krolewiecki
- Instituto de Investigaciones de Enfermedades Tropicales (IIET-CONICET), Sede Regional Orán, Universidad Nacional de Salta, Alvarado 751 (4530), Orán, Argentina
- Corresponding author.
| | - Adrián Lifschitz
- Laboratorio de Farmacología, CONICET-CICPBA-UNCPBA, Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires, Centro de Investigación Veterinaria de Tandil (CIVETAN), Tandil, Argentina
| | - Matías Moragas
- Unidad de Virología y Epidemiología Molecular, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan"-CONICET, Ciudad de Buenos Aires, Argentina
| | - Marina Travacio
- Cátedra de Química General e Inorgánica, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Valentini
- Departamento de Medicina, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Daniel F. Alonso
- Centro de Oncología Molecular y Traslacional (COMTra) y Plataforma de Servicios Biotecnológicos, Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, Buenos Aires, Argentina
| | - Rubén Solari
- Hospital Francisco J. Muñiz, Buenos Aires, Argentina
| | | | - Rubén O. Cimino
- Instituto de Investigaciones de Enfermedades Tropicales (IIET-CONICET), Sede Regional Orán, Universidad Nacional de Salta, Alvarado 751 (4530), Orán, Argentina
| | - Luis Álvarez
- Laboratorio de Farmacología, CONICET-CICPBA-UNCPBA, Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires, Centro de Investigación Veterinaria de Tandil (CIVETAN), Tandil, Argentina
| | - Pedro E. Fleitas
- Instituto de Investigaciones de Enfermedades Tropicales (IIET-CONICET), Sede Regional Orán, Universidad Nacional de Salta, Alvarado 751 (4530), Orán, Argentina
| | - Laura Ceballos
- Laboratorio de Farmacología, CONICET-CICPBA-UNCPBA, Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires, Centro de Investigación Veterinaria de Tandil (CIVETAN), Tandil, Argentina
| | - Marcelo Golemba
- Unidad de Virología y Epidemiología Molecular, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan"-CONICET, Ciudad de Buenos Aires, Argentina
| | - Florencia Fernández
- Unidad de Virología y Epidemiología Molecular, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan"-CONICET, Ciudad de Buenos Aires, Argentina
| | - Diego Fernández de Oliveira
- Departamento de Medicina, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | | | - Inés Baeck
- Departamento de Medicina, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Javier Farina
- Servicio de Infectología, Hospital Cuenca Alta, Cañuelas, Argentina
| | - Georgina A. Cardama
- Centro de Oncología Molecular y Traslacional (COMTra) y Plataforma de Servicios Biotecnológicos, Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, Buenos Aires, Argentina
| | - Andrea Mangano
- Unidad de Virología y Epidemiología Molecular, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan"-CONICET, Ciudad de Buenos Aires, Argentina
| | | | - Silvia Gold
- Fundación Mundo Sano, Buenos Aires, Argentina
| | - Carlos Lanusse
- Laboratorio de Farmacología, CONICET-CICPBA-UNCPBA, Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires, Centro de Investigación Veterinaria de Tandil (CIVETAN), Tandil, Argentina
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10
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Matamoros G, Sánchez A, Gabrie JA, Juárez M, Ceballos L, Escalada A, Rodríguez C, Martí-Soler H, Rueda MM, Canales M, Lanusse C, Cajal P, Álvarez L, Cimino RO, Krolewiecki A. Efficacy and safety of albendazole and high-dose ivermectin co-administration in school-aged children infected with Trichuris trichiura in Honduras: A Randomized Controlled Trial. Clin Infect Dis 2021; 73:1203-1210. [PMID: 33906234 DOI: 10.1093/cid/ciab365] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The efficacy of currently available anthelminthics against Trichuris trichiura infections is significatively lower than for other soil-transmitted helminths (STH). The combination of ivermectin (IVM) and albendazole (ALB) has shown significant improvements in efficacy. METHODS Safety and efficacy randomized controlled clinical trial comparing 3 experimental regimens against ALB monotherapy for the treatment of T. trichiura infections in northern Honduras. Infected children were randomized to one of the following treatments: (Arm 1) single-dose ALB 400 mg; (Arm 2) single-dose ALB 400 mg/IVM 600 μg/kg; (Arm 3) ALB 400 mg for 3 consecutive days; or (Arm 4) ALB 400 mg/IVM 600 μg/kg for 3 consecutive days. Efficacy was measured through egg reduction rate (ERR) and cure rate (CR), both assessed 14-21 days after treatment using the Kato-Katz method. Safety was evaluated by analyzing the frequency and severity of adverse events. RESULTS A total of 176 children were randomized to one of the 4 treatment arms, 117 completed treatment and follow-up. The ERR for Arms 1 to 4 were: 47.7%, 96.7%, 72.1% and 100%, respectively; with p-values <0.001 between IVM groups and ALB only arms. The CRs were 4.2%, 88.6%, 33.3% and 100%, respectively. A total of 48 (85.4% mild) AEs were reported in 36 children. CONCLUSIONS The combined use of ALB and high-dose IVM is a highly effective and well tolerated treatment for the treatment of T. trichiura infections offering a significantly improved treatment for the control of this infection.
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Affiliation(s)
- Gabriela Matamoros
- Instituto de Investigaciones en Microbiología, Universidad Nacional Autónoma de Honduras.,Faculty of Applied Health Sciences, Brock University, Ontario. Canada
| | - Ana Sánchez
- Instituto de Investigaciones en Microbiología, Universidad Nacional Autónoma de Honduras.,Faculty of Applied Health Sciences, Brock University, Ontario. Canada
| | | | - Marisa Juárez
- Instituto de Investigaciones de Enfermedades Tropicales (IIET-CONICET), Sede Regional Orán, Universidad Nacional de Salta, Argentina
| | - Laura Ceballos
- Laboratorio de Farmacología, Centro de Investigación Veterinaria de Tandil (CIVETAN), UNCPBA-CICPBA-CONICET, Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina
| | - Andrés Escalada
- Instituto de Investigaciones de Enfermedades Tropicales (IIET-CONICET), Sede Regional Orán, Universidad Nacional de Salta, Argentina
| | - Carol Rodríguez
- Escuela de Microbiología, Universidad Nacional Autónoma de Honduras
| | | | | | - Maritza Canales
- Escuela de Microbiología, Universidad Nacional Autónoma de Honduras
| | - Carlos Lanusse
- Laboratorio de Farmacología, Centro de Investigación Veterinaria de Tandil (CIVETAN), UNCPBA-CICPBA-CONICET, Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina
| | - Pamela Cajal
- Instituto de Investigaciones de Enfermedades Tropicales (IIET-CONICET), Sede Regional Orán, Universidad Nacional de Salta, Argentina
| | - Luis Álvarez
- Laboratorio de Farmacología, Centro de Investigación Veterinaria de Tandil (CIVETAN), UNCPBA-CICPBA-CONICET, Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina
| | - Rubén O Cimino
- Instituto de Investigaciones de Enfermedades Tropicales (IIET-CONICET), Sede Regional Orán, Universidad Nacional de Salta, Argentina
| | - Alejandro Krolewiecki
- Instituto de Investigaciones de Enfermedades Tropicales (IIET-CONICET), Sede Regional Orán, Universidad Nacional de Salta, Argentina.,Laboratorio de Farmacología, Centro de Investigación Veterinaria de Tandil (CIVETAN), UNCPBA-CICPBA-CONICET, Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina
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11
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Camprubí D, Almuedo-Riera A, Martí-Soler H, Soriano A, Hurtado JC, Subirà C, Grau-Pujol B, Krolewiecki A, Muñoz J. Lack of efficacy of standard doses of ivermectin in severe COVID-19 patients. PLoS One 2020; 15:e0242184. [PMID: 33175880 PMCID: PMC7657540 DOI: 10.1371/journal.pone.0242184] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/28/2020] [Indexed: 12/15/2022] Open
Abstract
Ivermectin has recently shown efficacy against SARS-CoV-2 in-vitro. We retrospectively reviewed severe COVID-19 patients receiving standard doses of ivermectin and we compared clinical and microbiological outcomes with a similar group of patients not receiving ivermectin. No differences were found between groups. We recommend the evaluation of high-doses of ivermectin in randomized trials against SARS-CoV-2.
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Affiliation(s)
- Daniel Camprubí
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Alex Almuedo-Riera
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Helena Martí-Soler
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Alex Soriano
- Infectious Diseases Department, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Juan Carlos Hurtado
- Microbiology Department, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Carme Subirà
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Berta Grau-Pujol
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Alejandro Krolewiecki
- Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta/CONICET, Orán, Argentina
| | - Jose Muñoz
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- * E-mail:
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12
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Mejia R, Damania A, Jeun R, Bryan PE, Vargas P, Juarez M, Cajal PS, Nasser J, Krolewiecki A, Lefoulon E, Long C, Drake E, Cimino RO, Slatko B. Impact of intestinal parasites on microbiota and cobalamin gene sequences: a pilot study. Parasit Vectors 2020; 13:200. [PMID: 32306993 PMCID: PMC7168842 DOI: 10.1186/s13071-020-04073-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/10/2020] [Indexed: 01/10/2023] Open
Abstract
Background Approximately 30% of children worldwide are infected with gastrointestinal parasites. Depending on the species, parasites can disrupt intestinal bacterial microbiota affecting essential vitamin biosynthesis. Methods Stool samples were collected from 37 asymptomatic children from a previous cross-sectional Argentinian study. A multi-parallel real-time quantitative PCR was implemented for Ascaris lumbricoides, Ancylostoma duodenale, Necator americanus, Strongyloides stercoralis, Trichuris trichiura, Cryptosporidium spp., Entamoeba histolytica and Giardia duodenalis. In addition, whole-genome sequencing analysis was conducted for bacterial microbiota on all samples and analyzed using Livermore Metagenomic Analysis Toolkit and DIAMOND software. Separate analyses were carried out for uninfected, Giardia-only, Giardia + helminth co-infections, and helminth-only groups. Results For Giardia-only infected children compared to uninfected children, DNA sequencing data showed a decrease in microbiota biodiversity that correlated with increasing Giardia burden and was statistically significant using Shannonʼs alpha diversity (Giardia-only > 1 fg/µl 2.346; non-infected group 3.253, P = 0.0317). An increase in diversity was observed for helminth-only infections with a decrease in diversity for Giardia + helminth co-infections (P = 0.00178). In Giardia-only infections, microbiome taxonomy changed from Firmicutes towards increasing proportions of Prevotella, with the degree of change related to the intensity of infection compared to uninfected (P = 0.0317). The abundance of Prevotella bacteria was decreased in the helminths-only group but increased for Giardia + helminth co-infections (P = 0.0262). Metagenomic analysis determined cobalamin synthesis was decreased in the Giardia > 1 fg/µl group compared to both the Giardia < 1 fg/µl and the uninfected group (P = 0.0369). Giardia + helminth group also had a decrease in cobalamin CbiM genes from helminth-only infections (P = 0.000754). Conclusion The study results may provide evidence for an effect of parasitic infections enabling the permissive growth of anaerobic bacteria such as Prevotella, suggesting an altered capacity of vitamin B12 (cobalamin) biosynthesis and potential impact on growth and development in children .
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Affiliation(s)
- Rojelio Mejia
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA. .,Universidad Nacional de Salta, Salta, Argentina.
| | - Ashish Damania
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Rebecca Jeun
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Patricia E Bryan
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | | | | | | | | | | | | | - Evan Drake
- New England Biolabs, Inc, Ipswich, MA, USA
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13
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Navarro M, Camprubí D, Requena-Méndez A, Buonfrate D, Giorli G, Kamgno J, Gardon J, Boussinesq M, Muñoz J, Krolewiecki A. Safety of high-dose ivermectin: a systematic review and meta-analysis. J Antimicrob Chemother 2020; 75:827-834. [PMID: 31960060 DOI: 10.1093/jac/dkz524] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/17/2019] [Accepted: 11/26/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Ivermectin is a key anthelmintic for the control of neglected tropical diseases. The main indications for population-level control with ivermectin through mass drug administration are onchocerciasis and lymphatic filariasis; however, there is interest in using higher, fixed-dose regimens for the control of scabies, soil-transmitted helminths and malaria. Safety data for these higher-dose regimens are needed. METHODS A systematic literature review and meta-analysis on the safety and doses of ivermectin was conducted. Eligible studies reported patient-level data and, for the meta-analysis, clinical trials reporting data on doses ≥200 and ≥400 μg/kg were included. Incidence ratios were used to compare adverse events by severity and organ system affected. RESULTS The systematic search identified six studies for inclusion, revealing no differences in the number of individuals experiencing adverse events. A descriptive analysis of these clinical trials for a variety of indications showed no difference in the severity of the adverse events between standard (up to 400 μg/kg) and higher doses of ivermectin. Organ system involvement only showed an increase in ocular events in the higher-dose group in one trial for the treatment of onchocerciasis, all of them transient and mild to moderate in intensity. CONCLUSIONS Although within this review the safety of high-dose ivermectin appears to be comparable to standard doses, there are not enough data to support a recommendation for its use in higher-than-approved doses. Ocular adverse events, despite being transient, are of concern in onchocerciasis patients. These data can inform programme managers and guide operational research activities as new approaches for the use of ivermectin are evaluated.
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Affiliation(s)
- Miriam Navarro
- Department of Public Health, Science History and Gynecology, Universidad Miguel Hernández de Elche, Alicante, Spain
| | - Daniel Camprubí
- Barcelona Institute for Global Health (ISGlobal) Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Ana Requena-Méndez
- Barcelona Institute for Global Health (ISGlobal) Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Dora Buonfrate
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Giovanni Giorli
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Joseph Kamgno
- Centre de Recherche sur les Filarioses et autres Maladies tropicales, Yaounde, Cameroon
| | - Jacques Gardon
- Institut de Recherche pour le Développement, Montpellier, France
| | | | - Jose Muñoz
- Barcelona Institute for Global Health (ISGlobal) Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Alejandro Krolewiecki
- Barcelona Institute for Global Health (ISGlobal) Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Instituto de Investigaciones de Enfermedades Tropicales Universidad Nacional de Salta/CONICET, Orán, Argentina
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14
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Abstract
Most of the 30 to 100 million people infected with Strongyloides stercoralis have subclinical (or asymptomatic) infections. These infections are commonly chronic and longstanding. A change in immune status can increase parasite numbers, leading to hyperinfection syndrome, dissemination, and death if unrecognized. The use of corticosteroids and HTLV-1 infection are most commonly associated with the hyperinfection syndrome. Strongyloides adult parasites reside in the small intestine and induce immune responses that are like other nematodes. Definitive diagnosis of S stercoralis infection is based on stool examinations for larvae. S stercoralis remains largely neglected.
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Affiliation(s)
- Alejandro Krolewiecki
- Institute for Tropical Diseases Research, Universidad Nacional de Salta/CONICET, Alvarado 751, Oran 4530, Salta, Argentina
| | - Thomas B Nutman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Building 4 - Room B1-03, 4 Center Drive, Bethesda, MD 20892-0425, USA.
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15
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Freeman MC, Akogun O, Belizario V, Brooker SJ, Gyorkos TW, Imtiaz R, Krolewiecki A, Lee S, Matendechero SH, Pullan RL, Utzinger J. Challenges and opportunities for control and elimination of soil-transmitted helminth infection beyond 2020. PLoS Negl Trop Dis 2019; 13:e0007201. [PMID: 30973872 PMCID: PMC6459486 DOI: 10.1371/journal.pntd.0007201] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Matthew C. Freeman
- Department of Environmental Health, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | | | - Vicente Belizario
- College of Public Health, University of the Philippines Manila, Manila, the Philippines
| | - Simon J. Brooker
- Global Health, Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Theresa W. Gyorkos
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Rubina Imtiaz
- Children Without Worms, The Task Force for Global Health, Decatur, Georgia, United States of America
| | - Alejandro Krolewiecki
- Instituto de Investigaciones en Enfermedades Tropicales, Universidad Nacional de Salta, Oran, Argentina
| | - Seung Lee
- Save the Children, Washington, DC, United States of America
| | | | - Rachel L. Pullan
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Becker SL, Liwanag HJ, Snyder JS, Akogun O, Belizario. V, Freeman MC, Gyorkos TW, Imtiaz R, Keiser J, Krolewiecki A, Levecke B, Mwandawiro C, Pullan RL, Addiss DG, Utzinger J. Toward the 2020 goal of soil-transmitted helminthiasis control and elimination. PLoS Negl Trop Dis 2018; 12:e0006606. [PMID: 30106975 PMCID: PMC6091919 DOI: 10.1371/journal.pntd.0006606] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Sören L. Becker
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany
| | - Harvy Joy Liwanag
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Ateneo School of Medicine and Public Health, Ateneo de Manila University, Metro Manila, the Philippines
| | - Jedidiah S. Snyder
- Children Without Worms, The Task Force for Global Health, Decatur, Georgia, United States of America
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Oladele Akogun
- Soil-Transmitted Helminthiasis Advisory Committee, Decatur, Georgia, United States of America
- Modibbo Adama University of Technology, Yola, Nigeria
| | - Vicente Belizario.
- Soil-Transmitted Helminthiasis Advisory Committee, Decatur, Georgia, United States of America
- College of Public Health, University of the Philippines, Manila, the Philippines
| | - Matthew C. Freeman
- Soil-Transmitted Helminthiasis Advisory Committee, Decatur, Georgia, United States of America
- Department of Environmental Health, Emory University, Atlanta, Georgia, United States of America
| | - Theresa W. Gyorkos
- Soil-Transmitted Helminthiasis Advisory Committee, Decatur, Georgia, United States of America
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Rubina Imtiaz
- Children Without Worms, The Task Force for Global Health, Decatur, Georgia, United States of America
- Soil-Transmitted Helminthiasis Advisory Committee, Decatur, Georgia, United States of America
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Alejandro Krolewiecki
- Soil-Transmitted Helminthiasis Advisory Committee, Decatur, Georgia, United States of America
- Instituto de Investigaciones en Enfermedades Tropicales, Universidad Nacional de Salta, Oran, Argentina
| | - Bruno Levecke
- Department of Virology, Parasitology, and Immunology, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Charles Mwandawiro
- Soil-Transmitted Helminthiasis Advisory Committee, Decatur, Georgia, United States of America
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Rachel L. Pullan
- Soil-Transmitted Helminthiasis Advisory Committee, Decatur, Georgia, United States of America
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David G. Addiss
- Children Without Worms, The Task Force for Global Health, Decatur, Georgia, United States of America
- Soil-Transmitted Helminthiasis Advisory Committee, Decatur, Georgia, United States of America
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Soil-Transmitted Helminthiasis Advisory Committee, Decatur, Georgia, United States of America
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Lodh N, Caro R, Sofer S, Scott A, Krolewiecki A, Shiff C. Diagnosis of Strongyloides stercoralis: Detection of parasite-derived DNA in urine. Acta Trop 2016; 163:9-13. [PMID: 27456935 DOI: 10.1016/j.actatropica.2016.07.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/11/2016] [Accepted: 07/21/2016] [Indexed: 01/08/2023]
Abstract
Detecting infections of Strongyloides stercoralis is arduous and has low sensitivity. Clinically this is a major problem because chronic infections may disseminate in the host and lead to a life threatening condition. Epidemiologically, S. stercoralis is often missed in surveys as it is difficult to identify by standard stool examination procedures. We present, for the first time, evidence that the infection can be detected in filtered urine samples collected and processed in the field and subsequently assayed for the presence of parasite DNA. Urine specimens (∼40mL) were collected from 125 test and control individuals living in rural and peri-urban regions of Northern Argentina. From the same individuals, fresh stool specimens were processed using three different copropological methods. Urine specimens were filtered in the field through a 12.5cm Whatman No. 3 filter. The filters were dried and packed individually in sealable plastic bags with desiccant and shipped to a laboratory where DNA was recovered from the filter and PCR-amplified with primers specific to a dispersed repetitive sequence. Prevalence of S. stercoralis infection by stool culture and direct examination was 35/125 (28%), In contrast, PCR-based detection of parasite-specific trans-renal DNA in urine indicated that 56/125 (44.8%) carried the parasite. Of the patients that tested positive for urine-based parasite DNA, approximately half also tested positive in their stool specimens. There were 6.4% of cases where parasite larvae were seen in the stool but no DNA was amplified from the urine. As proof of principle, DNA amplification from urine residue reveals significantly more cases of S. stercoralis infection than the current standard stool examination techniques. Additional work is required to establish the relative utility, sensitivity and specificity of urine-based analysis compared to parasitological and nucleic acid detection from stool for clinical and epidemiological detection for S. stercoralis infection.
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Cimino RO, Jeun R, Juarez M, Cajal PS, Vargas P, Echazú A, Bryan PE, Nasser J, Krolewiecki A, Mejia R. Identification of human intestinal parasites affecting an asymptomatic peri-urban Argentinian population using multi-parallel quantitative real-time polymerase chain reaction. Parasit Vectors 2015; 8:380. [PMID: 26183074 PMCID: PMC4504406 DOI: 10.1186/s13071-015-0994-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 07/07/2015] [Indexed: 11/29/2022] Open
Abstract
Background In resource-limited countries, stool microscopy is the diagnostic test of choice for intestinal parasites (soil-transmitted helminths and/or intestinal protozoa). However, sensitivity and specificity is low. Improved diagnosis of intestinal parasites is especially important for accurate measurements of prevalence and intensity of infections in endemic areas. Methods The study was carried out in Orán, Argentina. A total of 99 stool samples from a local surveillance campaign were analyzed by concentration microscopy and McMaster egg counting technique compared to the analysis by multi-parallel quantitative real-time polymerase chain reaction (qPCR). This study compared the performance of qPCR assay and stool microscopy for 8 common intestinal parasites that infect humans including the helminths Ascaris lumbricoides, Ancylostoma duodenale, Necator americanus, Strongyloides stercoralis, Trichuris trichiura, and the protozoa Giardia lamblia, Cryptosporidium parvum/hominis, and Entamoeba histolytica, and investigated the prevalence of polyparasitism in an endemic area. Results qPCR showed higher detection rates for all parasites as compared to stool microscopy except T. trichiura. Species-specific primers and probes were able to distinguish between A. duodenale (19.1 %) and N. americanus (36.4 %) infections. There were 48.6 % of subjects co-infected with both hookworms, and a significant increase in hookworm DNA for A. duodenale versus N. americanus (119.6 fg/μL: 0.63 fg/μL, P < 0.001) respectively. qPCR outperformed microscopy by the largest margin in G. lamblia infections (63.6 % versus 8.1 %, P < 0.05). Polyparasitism was detected more often by qPCR compared to microscopy (64.7 % versus 24.2 %, P < 0.05). Conclusions Multi-parallel qPCR is a quantitative molecular diagnostic method for common intestinal parasites in an endemic area that has improved diagnostic accuracy compared to stool microscopy. This first time use of multi-parallel qPCR in Argentina has demonstrated the high prevalence of intestinal parasites in a peri-urban area. These results will contribute to more accurate epidemiological survey, refined treatment strategies on a public scale, and better health outcomes in endemic settings.
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Affiliation(s)
- Rubén O Cimino
- Instituto de Investigaciones en Enfermedades Tropicales - Universidad Nacional de Salta/CONICET, Oran, Argentina. .,Cátedra de Química Biológica, Facultad de Ciencias Naturales, Universidad Nacional de Salta, Oran, Argentina.
| | - Rebecca Jeun
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Marisa Juarez
- Instituto de Investigaciones en Enfermedades Tropicales - Universidad Nacional de Salta/CONICET, Oran, Argentina. .,Fundación Mundo Sano, Buenos Aires, Argentina.
| | - Pamela S Cajal
- Instituto de Investigaciones en Enfermedades Tropicales - Universidad Nacional de Salta/CONICET, Oran, Argentina.
| | - Paola Vargas
- Instituto de Investigaciones en Enfermedades Tropicales - Universidad Nacional de Salta/CONICET, Oran, Argentina.
| | - Adriana Echazú
- Instituto de Investigaciones en Enfermedades Tropicales - Universidad Nacional de Salta/CONICET, Oran, Argentina.
| | - Patricia E Bryan
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Julio Nasser
- Instituto de Investigaciones en Enfermedades Tropicales - Universidad Nacional de Salta/CONICET, Oran, Argentina. .,Cátedra de Química Biológica, Facultad de Ciencias Naturales, Universidad Nacional de Salta, Oran, Argentina.
| | - Alejandro Krolewiecki
- Instituto de Investigaciones en Enfermedades Tropicales - Universidad Nacional de Salta/CONICET, Oran, Argentina.
| | - Rojelio Mejia
- Cátedra de Química Biológica, Facultad de Ciencias Naturales, Universidad Nacional de Salta, Oran, Argentina. .,National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA.
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Mejia R, Vargas P, Jeun R, Krolewiecki A, Juarez M, Cajal P, Nasser J, Hotez P, Cimino R. 1789Multi-parallel quantitative real-time PCR surveillance of gastrointestinal parasites in a symptomatic rural Argentinian population: initial results of the Latin American Multicenter Parasite Study (LAMPS). Open Forum Infect Dis 2014. [PMCID: PMC5781524 DOI: 10.1093/ofid/ofu051.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rojelio Mejia
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX
| | - Paola Vargas
- Universidad Nacional de Salta, Argentina, Salta, Argentina
| | - Rebecca Jeun
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX
| | | | - Marisa Juarez
- Universidad Nacional de Salta, Argentina, Salta, Argentina
| | - Pamela Cajal
- Universidad Nacional de Salta, Argentina, Salta, Argentina
| | - Julio Nasser
- Universidad Nacional de Salta, Argentina, Salta, Argentina
| | - Peter Hotez
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX
| | - Rubén Cimino
- Universidad Nacional de Salta, Argentina, Salta, Argentina
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Barda B, Cajal P, Villagran E, Cimino R, Juarez M, Krolewiecki A, Rinaldi L, Cringoli G, Burioni R, Albonico M. Mini-FLOTAC, Kato-Katz and McMaster: three methods, one goal; highlights from north Argentina. Parasit Vectors 2014; 7:271. [PMID: 24929554 PMCID: PMC4074144 DOI: 10.1186/1756-3305-7-271] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 05/26/2014] [Indexed: 01/01/2023] Open
Abstract
Background Copro-parasitological diagnosis is still a challenge in management of helminth infections at individual and community levels in resource-limited settings. The aim of our study was to compare the performance of three quantitative techniques: Kato-Katz, McMaster and Mini-FLOTAC methids. The study was carried out in Oran, Northern Argentina. Methods 200 schoolchildren were enrolled to provide a single stool sample, which was tested for helminth infections with Kato-Katz, McMaster and Mini-FLOTAC methods. The Mini-FLOTAC was performed with two flotation solutions (FS2 saturated saline and FS7 zinc sulphate). Preparation and reading time for each of the three methods was calculated both when processing single and multiple samples. Results Out of 193 schoolchildren examined, 40% were positive for any helminth infection by any method; the most prevalent was Hymenolepis nana (23%) followed by Ascaris lumbricoides (17%) and a third group of less prevalent helminths: Enterobius vermicularis, Trichuris trichiura and hookworms (11% all together). Mini-FLOTAC FS2 was more sensitive than FS7 for H. nana (93% vs 78%) and for other helminths (85% vs 80%), whereas FS7 was more sensitive for A. lumbricoides (87% vs 61%). Kato-Katz method was more sensitive than McMaster method for A. lumbricoides (84% vs 48%) and for other helminths (48% vs 43%) except for H. nana (49% vs 61%). As for egg counts, Mini-FLOTAC FS2 reported 904 eggs per gram of faeces (EPG) for H. nana (vs 457 with McMaster and 111 with Kato-Katz) and 1177 EPG for A. lumbricoides (vs 1315 with Kato-Katz and 995 with McMaster); FS2 detected the highest EPG for both H.nana and A.lumbricoides (904 vs 568 and 1177 vs 643 respectively), the differences were not statistically significant. The technique feasibility was calculated: Kato-Katz mean time was 48 minutes/sample, Mini-FLOTAC 13 minutes/sample and McMaster 7 minutes/sample. However, especially for Kato-Katz and Mini-FLOTAC, the mean time (min/sample) decreased significantly when processing multiple samples. Conclusions Mini-FLOTAC is a promising technique for helminth diagnosis, it is more sensitive than Kato-Katz and McMaster for H. nana and as sensitive as Kato-Katz and more sensitive than McMaster for A. lumbricoides identification. Egg counts differences although relevant, did not reach statistical significance.
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Affiliation(s)
- Beatrice Barda
- Laboratory of Microbiology San Raffaele Hospital, Milan, Italy.
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Lammie PJ, Moss DM, Brook Goodhew E, Hamlin K, Krolewiecki A, West SK, Priest JW. Development of a new platform for neglected tropical disease surveillance. Int J Parasitol 2012; 42:797-800. [PMID: 22846784 DOI: 10.1016/j.ijpara.2012.07.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 07/11/2012] [Accepted: 07/12/2012] [Indexed: 12/11/2022]
Abstract
An expanded global focus on the control and elimination of neglected tropical diseases (NTDs) has called attention to the need to develop and validate surveillance strategies that are cost effective and can be integrated across diseases. Here, we describe a multiplex tool for the sensitive detection of antibody responses to NTDs as well as vaccine preventable diseases, malaria, and waterborne and zoonotic infections. The assay platform is robust, can be performed with either serum or dried blood spots and can be adapted to local epidemiological conditions and public health priorities. Multiplex assays open the door to conducting routine serosurveillance for NTDs through demographic health surveillance or malaria indicator surveys.
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Affiliation(s)
- Patrick J Lammie
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
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Azzoni L, Foulkes AS, Liu Y, Li X, Johnson M, Smith C, Kamarulzaman AB, Montaner J, Mounzer K, Saag M, Cahn P, Cesar C, Krolewiecki A, Sanne I, Montaner LJ. Prioritizing CD4 count monitoring in response to ART in resource-constrained settings: a retrospective application of prediction-based classification. PLoS Med 2012; 9:e1001207. [PMID: 22529752 PMCID: PMC3328436 DOI: 10.1371/journal.pmed.1001207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 03/09/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Global programs of anti-HIV treatment depend on sustained laboratory capacity to assess treatment initiation thresholds and treatment response over time. Currently, there is no valid alternative to CD4 count testing for monitoring immunologic responses to treatment, but laboratory cost and capacity limit access to CD4 testing in resource-constrained settings. Thus, methods to prioritize patients for CD4 count testing could improve treatment monitoring by optimizing resource allocation. METHODS AND FINDINGS Using a prospective cohort of HIV-infected patients (n=1,956) monitored upon antiretroviral therapy initiation in seven clinical sites with distinct geographical and socio-economic settings, we retrospectively apply a novel prediction-based classification (PBC) modeling method. The model uses repeatedly measured biomarkers (white blood cell count and lymphocyte percent) to predict CD4(+) T cell outcome through first-stage modeling and subsequent classification based on clinically relevant thresholds (CD4(+) T cell count of 200 or 350 cells/µl). The algorithm correctly classified 90% (cross-validation estimate=91.5%, standard deviation [SD]=4.5%) of CD4 count measurements <200 cells/µl in the first year of follow-up; if laboratory testing is applied only to patients predicted to be below the 200-cells/µl threshold, we estimate a potential savings of 54.3% (SD=4.2%) in CD4 testing capacity. A capacity savings of 34% (SD=3.9%) is predicted using a CD4 threshold of 350 cells/µl. Similar results were obtained over the 3 y of follow-up available (n=619). Limitations include a need for future economic healthcare outcome analysis, a need for assessment of extensibility beyond the 3-y observation time, and the need to assign a false positive threshold. CONCLUSIONS Our results support the use of PBC modeling as a triage point at the laboratory, lessening the need for laboratory-based CD4(+) T cell count testing; implementation of this tool could help optimize the use of laboratory resources, directing CD4 testing towards higher-risk patients. However, further prospective studies and economic analyses are needed to demonstrate that the PBC model can be effectively applied in clinical settings. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Livio Azzoni
- Wistar Institute, Philadelphia, Pennsylvania, United States of America
| | - Andrea S. Foulkes
- University of Massachusetts, Amherst, Massachusetts, United States of America
| | - Yan Liu
- University of Massachusetts, Amherst, Massachusetts, United States of America
| | - Xiaohong Li
- BG Medicine, Waltham, Massachusetts, United States of America
| | | | | | | | - Julio Montaner
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Karam Mounzer
- Philadelphia FIGHT, Philadelphia, Pennsylvania, United States of America
| | - Michael Saag
- University of Alabama, Tuscaloosa, Alabama, United States of America
| | - Pedro Cahn
- Fundación Huésped, Buenos Aires, Argentina
| | | | | | - Ian Sanne
- University of the Witwatersrand, Johannesburg, South Africa
| | - Luis J. Montaner
- Wistar Institute, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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Laufer N, Abusamra L, Bolcic F, Gun A, Rolón M, Pérez H, Krolewiecki A, Salomón H, Quarleri J, Cahn P. No reduction of HCV viral load in HIV patients co-infected with HCV genotype 1 during a 30days course of nitazoxanide monotherapy. Antiviral Res 2011; 92:497-9. [DOI: 10.1016/j.antiviral.2011.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 09/01/2011] [Accepted: 10/05/2011] [Indexed: 11/24/2022]
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Cahn P, Montaner J, Junod P, Patterson P, Krolewiecki A, Andrade-Villanueva J, Cassetti I, Sierra-Madero J, Casiró AD, Bortolozzi R, Lupo SH, Longo N, Rampakakis E, Ackad N, Sampalis JS. Pilot, randomized study assessing safety, tolerability and efficacy of simplified LPV/r maintenance therapy in HIV patients on the 1 PI-based regimen. PLoS One 2011; 6:e23726. [PMID: 21886816 PMCID: PMC3158782 DOI: 10.1371/journal.pone.0023726] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 07/25/2011] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES To compare the efficacy and safety of an individualized treatment-simplification strategy consisting of switching from a highly-active anti-retroviral treatment (HAART) with a ritonavir-boosted protease inhibitor (PI/r) and 2 nucleoside reverse-transcriptase inhibitors (NRTIs) to lopinavir/ritonavir (LPV/r) monotherapy, with intensification by 2 NRTIs if necessary, to that of continuing their HAART. METHODS This is a one-year, randomized, open-label, multi-center study in virologically-suppressed HIV-1-infected adults on their first PI/r-containing treatment, randomized to either LPV/r-monotherapy or continue their current treatment. Treatment efficacy was determined by plasma HIV-1 RNA viral load (VL), time-to-virologic rebound, patient-reported outcomes (PROs) and CD4+T-cell-count changes. Safety was assessed with the incidence of treatment-emergent adverse events (AE). RESULTS Forty-one patients were randomized to LPV/r and 39 to continue their HAART. No statistically-significant differences between the two study groups in demographics and baseline characteristics were observed. At day-360, 71(39:LPV/r;32:HAART) patients completed treatment, while 9(2:LPV/r;7:HAART) discontinued. In a Last Observation Carried Forward Intent-to-Treat analysis, 40(98%) patients on LPV/r and 37(95%) on HAART had VL<200 copies/mL (P = 0.61). Time-to-virologic rebound, changes in PROs, CD4+ T-cell-count and VL from baseline, also exhibited no statistically-significant between-group differences. Most frequent AEs were diarrhea (19%), headache (18%) and influenza (16%). Four (10%) patients on LPV/r were intensified with 2 NRTIs, all regaining virologic control. Eight serious AEs were reported by 5(2:LPV/r;3:HAART) patients. CONCLUSION At day-360, virologic efficacy and safety of LPV/r appears comparable to that of a PI+2NRTIs HAART. These results suggest that our individualized, simplified maintenance strategy with LPV/r-monotherapy and protocol-mandated NRTI re-introduction upon viral rebound, in virologically-suppressed patients merits further prospective long-term evaluation. TRIAL REGISTRATION ClinicalTrials.gov NCT00159224.
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Affiliation(s)
- Pedro Cahn
- Fundacion Huesped, Buenos Aires, Argentina
| | | | - Patrice Junod
- Clinique Médicale du Quartier Latin, Montréal, Canada
| | | | | | - Jaime Andrade-Villanueva
- Antiguo Hospital Civil de Guadalajara “Fray Antonio Alcalde”, CUCS, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | | | | | | | - Raul Bortolozzi
- División Estudios Clínicos, Centro Diagnóstico Médico de Alta Complejidad S.A. (CIBIC), Santa Fé, Argentina
| | | | | | | | | | - John S. Sampalis
- JSS Medical Research, Westmount, Canada
- McGill University, Montréal, Canada
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Socías ME, Sued O, Laufer N, Lázaro ME, Mingrone H, Pryluka D, Remondegui C, Figueroa MI, Cesar C, Gun A, Turk G, Bouzas MB, Kavasery R, Krolewiecki A, Pérez H, Salomón H, Cahn P. Acute retroviral syndrome and high baseline viral load are predictors of rapid HIV progression among untreated Argentinean seroconverters. J Int AIDS Soc 2011; 14:40. [PMID: 21831310 PMCID: PMC3179691 DOI: 10.1186/1758-2652-14-40] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 08/10/2011] [Indexed: 12/12/2022] Open
Abstract
Background Diagnosis of primary HIV infection (PHI) has important clinical and public health implications. HAART initiation at this stage remains controversial. Methods Our objective was to identify predictors of disease progression among Argentinean seroconverters during the first year of infection, within a multicentre registry of PHI-patients diagnosed between 1997 and 2008. Cox regression was used to analyze predictors of progression (LT-CD4 < 350 cells/mm3, B, C events or death) at 12 months among untreated patients. Results Among 134 subjects, 74% presented with acute retroviral syndrome (ARS). Seven opportunistic infections (one death), nine B events, and 10 non-AIDS defining serious events were observed. Among the 92 untreated patients, 24 (26%) progressed at 12 months versus three (7%) in the treated group (p = 0.01). The 12-month progression rate among untreated patients with ARS was 34% (95% CI 22.5-46.3) versus 13% (95% CI 1.1-24.7) in asymptomatic patients (p = 0.04). In univariate analysis, ARS, baseline LT-CD4 < 350 cells/mm3, and baseline and six-month viral load (VL) > 100,000 copies/mL were associated with progression. In multivariate analysis, only ARS and baseline VL > 100,000 copies/mL remained independently associated; HR: 8.44 (95% CI 0.97-73.42) and 9.44 (95% CI 1.38-64.68), respectively. Conclusions In Argentina, PHI is associated with significant morbidity. HAART should be considered in PHI patients with ARS and high baseline VL to prevent disease progression.
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Fink VI, Shepherd BE, Cesar C, Krolewiecki A, Wehbe F, Cortés CP, Crabtree-Ramírez B, Padgett D, Shafaee M, Schechter M, Gotuzzo E, Bacon M, McGowan C, Cahn P, Masys D. Cancer in HIV-infected persons from the Caribbean, Central and South America. J Acquir Immune Defic Syndr 2011; 56:467-73. [PMID: 21239992 PMCID: PMC3293455 DOI: 10.1097/qai.0b013e31820bb1c3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND HIV-infected individuals have heightened cancer risk. With the advent of highly active antiretroviral therapy (HAART), the frequency of some AIDS-defining cancers (ADC) has decreased although certain non-AIDS-defining cancers (NADC) are becoming more frequent. Cancers among HIV-infected individuals in Latin American and the Caribbean have not yet been carefully studied. METHODS Cancer cases among the Caribbean, Central and South American network for HIV Research (CCASAnet) cohort were identified reviewing clinical records and pre-existing databases. RESULTS There were 406 cancers reported: 331 ADC (224 Kaposi sarcomas and 98 non Hodgkin lymphomas). Most frequent NADC (n = 75) were Hodgkin lymphoma and skin cancers. Seventy-three percent of NADC and 45% of ADC were diagnosed >1 year after HIV diagnosis. Fifty-six percent of ADC occurred before HAART start. Median time from HAART start until cancer diagnosis was 2.5 years for NADC and 0.5 years for ADC (P = <0.001). Within 3372 HAART starters, 158 were diagnosed with 165 cancers (82.4% ADC); 85 cases were previous to or concomitant with HAART initiation. Incidence of cancer after HAART initiation in 8080 person-years of follow-up was 7.2 per 1000 person-years (95% confidence interval = 5.5 to 9.3) for ADC and 2.7 (95% confidence interval = 1.8 to 4.1) for NADC; incidence was higher in the first 2 months, particularly for ADC (47.6). A pre-HAART ADC was a predictor of mortality after adjusting for age, sex, and CD4 at HAART initiation. CONCLUSIONS ADC were the most frequent cancers in this region and were often diagnosed close to HIV diagnosis and HAART start. Incidence of cancer was highest around HAART initiation.
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Affiliation(s)
- Valeria I Fink
- Huésped, Investigaciones Clínicas, Buenos Aires, Argentina.
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Gil J, Cimino R, López Quiroga I, Cajal S, Acosta N, Juarez M, Zacca R, Orellana V, Krolewiecki A, Diosque P, Nasser J. [Reactivity of GST-SAPA antigen of Trypanosoma cruzi against sera from patients with Chagas disease and leishmaniasis]. Medicina (B Aires) 2011; 71:113-119. [PMID: 21550926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Serologic diagnosis of Trypanosoma cruzi infection is important due to the limited sensitivity of direct parasitologic methods for diagnosis in the indeterminate and chronic phases of disease. SAPA antigen has been used in several studies and has been shown to be a good marker for use in the diagnosis of T. cruzi infection. Chagas disease and leishmaniasis are endemic in northern Salta with overlapping zones of transmission, which frequently leads to T. cruzi-Leishmania spp. mixed infections. Diagnosis is complicated by the fact that there is significant cross-reactivity when non-specific antigens are used. We evaluated the reactivity of GST-SAPA antigen in the ELISA test (ELISA-SAPA) against sera from persons infected with T. cruzi (n = 154), leishmaniasis (n = 66), mixed infections (29), and healthy controls (n = 28) using commercial ELISA and IHA kits as reference tests. For ELISA-SAPA the sensitivity, specificity and kappa index were calculated for detection of T. cruzi infection. Among sera from patients infected with leishmaniasis, 30.5% of co-infections were detected. ELISA-SAPA sensitivity was 97.1% (confidence interval 95%: 94.5-99.9), specificity was 100% (confidence interval 95%: 99.4-100), and kappa index was 96% (confidence interval 95%: 93-99%), for detection of T. cruzi infection. Sensitivity, specificity and kappa indices have shown a high efficiency of ELISA-SAPA.
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Affiliation(s)
- José Gil
- Laboratorio de Química Biológica y Biología Molecular, Facultad de Ciencias Naturales, Universidad Nacional de Salta (LQByBM).
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Dilernia DA, Mónaco DC, Krolewiecki A, César C, Cahn P, Salomón H. [The importance of early diagnosis for the survival of HIV positive patients]. Medicina (B Aires) 2010; 70:453-456. [PMID: 20920966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
In Argentina, HIV diagnosis is reached by voluntary testing or symptom-based case findings. However, because of the high proportion of infected individuals unaware of their serologic status new strategies are required. In this article we show how a mathematic model predicts the impact of expanding HIV testing in Argentina. The model is based on time-dependent Markov matrixes and applies parameters-dependent transition-probabilities obtained from both national and international cohort studies. Outputs include time on clinical stages and therapy regime, CD4-count, viral-load, infection-state and age; mortality rates and proportion of unidentified infection at a population-level. Simulations were performed for current testing strategy and for a theoretical scenario with earlier diagnosis. We show how our prediction suggests that diagnosis before onset of symptoms would increase life expectancy by 10.7 years. Also, we show how a reduction of time to diagnosis to 5 or less years from infection would reduce mortality rates in the first year of HAART from 7.6% to 2.1%, the proportion of unrecognized infection from 43.2% to 23.8% and the proportion of individuals with unaware infection needing treatment from 12% to 0.2%. Based on this prediction we stress the importance of implementing health policies aimed at detecting HIV infection in early stages in Argentina.
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Affiliation(s)
- Darío A Dilernia
- Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
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Sued O, Lattner J, Gun A, Patterson P, Abusamra L, Cesar C, Fink V, Krolewiecki A, Cahn P. Use of darunavir and enfuvirtide in a pregnant woman. Int J STD AIDS 2008; 19:866-7. [DOI: 10.1258/ijsa.2008.008075] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 41-year-old pregnant woman with multiple virological failures started darunavir, enfuvirtide, zidovudine and lamivudine at week 28 of pregnancy. During week 38, the patient had a viral load <400 copies/mL and a CD4 count of 180 cells/mm3 (13%). The child was found to be in good health, with negative HIV-polymerase chain reactions at birth, at two and at six months.
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Affiliation(s)
- O Sued
- Fundación Huèsped, Area de Investigaciones Clinicas, CP1202 Buenos Aires
| | - J Lattner
- Hospital Fernández, Servicio de Infectologia, CP1425 Buenos Aires, Argentina
| | - A Gun
- Fundación Huèsped, Area de Investigaciones Clinicas, CP1202 Buenos Aires
| | - P Patterson
- Fundación Huèsped, Area de Investigaciones Clinicas, CP1202 Buenos Aires
| | - L Abusamra
- Fundación Huèsped, Area de Investigaciones Clinicas, CP1202 Buenos Aires
| | - C Cesar
- Fundación Huèsped, Area de Investigaciones Clinicas, CP1202 Buenos Aires
| | - V Fink
- Fundación Huèsped, Area de Investigaciones Clinicas, CP1202 Buenos Aires
| | - A Krolewiecki
- Fundación Huèsped, Area de Investigaciones Clinicas, CP1202 Buenos Aires
| | - P Cahn
- Fundación Huèsped, Area de Investigaciones Clinicas, CP1202 Buenos Aires
- Hospital Fernández, Servicio de Infectologia, CP1425 Buenos Aires, Argentina
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30
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Belloso W, Ivalo S, Benetucci J, Pugliese D, Garone D, Cahn P, Krolewiecki A, Casiro A, Cassetti I, Bologna R, Duran A, Toibaro J, Rieger A, Vago B, Clumeck N, Kabeya K, Cooper C, Dufresne S, Lalonde R, Walmsley S, Gerstoft J, Mathiesen L, Nielsen H, Obel N, Pedersen C, Lazzarin A, Castagna A, Bruun JN, Gatell JM, Arnaiz J, Blaxhult A, Flamholc L, Gisslén M, Vernazza P, Bingham J, Peters B, Gazzard B, Nelson M, Johnson M, Youle M, Weber J, Scullard G, Brar I, Bouzi V, Brutus A, Jayaweera DT, Mogyoros M, Rodwick BM, Stein D, Wiznia A, Schwartz R, Vandenberg-Wolf MG, Tedaldi E, Dragsted UB, Gerstoft J, Youle M, Fox Z, Losso M, Benetucci J, Jayaweera DT, Rieger A, Bruun JN, Castagna A, Gazzard B, Walmsley S, Hill A, Lundgren JD. A Randomized Trial to Evaluate Lopinavir/Ritonavir versus Saquinavir/Ritonavir in HIV-1-Infected Patients: The Maxcmin2 Trial. Antivir Ther 2005. [DOI: 10.1177/135965350501000608] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To assess the rate of protocol-defined treatment failure and safety of lopinavir/ritonavir (LPV/r) and saquinavir/ritonavir (SAQ/r). Design Open-label, prospective, randomized (1:1), international multi-centre trial. Methods Adult HIV-1-infected patients were assigned LPV/r 400/100 mg twice daily or SAQ/r 1000/100 mg twice daily with two or more nucleoside reverse transcriptase inhibitors (NRTIs)/non-NRTIs. All patients, whether on or off the assigned treatment, were followed for 48 weeks. Results Of 339 randomized patients, 324 initiated assigned treatment (intention-to-treat/exposed [ITT/e] population). At 48 weeks, treatment failure occurred in 29/163 (18%) and 53/161 (33%) of patients in the LPV/r and SAQ/r arms, respectively (ITT/e, P=0.002, log rank test). In an analysis that also considered those patients who discontinued treatment as having failed treatment (ITT/e/discontinuation=failure), 40/161 (25%) LPV/r-treated individuals versus 63/161 (39%) SAQ/R-treated individuals failed treatment ( P=0.005, log rank test). Discontinuation of the assigned treatment occurred in 23/163 (14%) patients in the LPV/r-treated group, compared with 48/161 (30%) in the SAQ/r-treated group (ITT/e; P=0.001). The primary reasons for premature discontinuation were non-fatal adverse events (LPV/r: 12/163; SAQ/r: 21/161) and patients’ choice (LPV/r: 7/163; SAQ/r: 8/161). In the on-treatment analysis of time to treatment failure, no difference was observed between the two arms ( P=0.27, log rank test). Conclusion LPV/r had better antiretroviral effects compared with SAQ/r at the doses and in the formulations studied. This may have been a result of patients’ preferences and ability to adhere to assigned therapy, rather than a result of differences in the intrinsic potency of the study protease inhibitors.
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Affiliation(s)
| | | | - S Ivalo
- Hospital Italiano de Buenos Aires
| | | | | | | | | | | | | | | | | | | | | | - A Rieger
- University of Vienna Medical School, AKH
| | - B Vago
- University of Vienna Medical School, AKH
| | | | | | | | | | | | | | | | | | | | - N Obel
- Aarhus University Hospital
| | | | | | | | | | | | | | | | | | - M Gisslén
- Sahlgrenska University Hospital/Östra
| | | | | | | | - B Gazzard
- Chelsea and Westminster Healthcare Trust
| | - M Nelson
- Chelsea and Westminster Healthcare Trust
| | | | | | | | | | - I Brar
- Henry Ford Hospital Center
| | - V Bouzi
- Brookdale University Hospital
| | | | | | | | | | | | | | | | | | | | | | | | - Mike Youle
- Royal Free Hospital, London, United Kingdom
| | - Zoe Fox
- Hvidovre University Hospital, Copenhagen, Denmark
| | | | | | | | - Armin Rieger
- University of Vienna Medical School - AKH, Vienna, Austria
| | | | | | - Brian Gazzard
- Chelsea and Westminster Healthcare Trust, London, United Kingdom
| | - Sharon Walmsley
- Toronto Hospital, University Health Network, Toronto, Canada
| | - Andrew Hill
- University of Liverpool, Liverpool, United Kingdom
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Badía X, Podzamczer D, Moral I, Roset M, Arnaiz JA, Loncà M, Casiró A, Rosón B, Gatell JM, Grinberg N, Puentes T, Furst MJL, Julio Méndez S, Lupo S, Suárez C, Agostini M, Cassetti I, Bologna R, Salud H, Cahn P, Patterson P, Krolewiecki A, David DO, Luna N, Cruceta A, Pich J, Varea S, Carné X, Mallolas J, Clotet B, Romeu J, Cruz L, Arrizabalaga J, Iribarren JA, Rodríguez F, Von Wichmann MA, Jimeno B, Pulido F, Rubio R, Flores J, González-Lahoz J, Rodríguez-Rosado R, Núñez M. Health-Related Quality of Life in HIV Patients Switching to Twice-Daily Indinavir/Ritonavir Regimen or Continuing with Three-Times-Daily Indinavir-Based Therapy. Antivir Ther 2004. [DOI: 10.1177/135965350400900615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To evaluate health-related quality of life (HRQoL) changes in patients treated with indinavir three-times daily after switching to a twice-daily indinavir/ritonavir regimen or continuing with the same regimen. Methods Patients on HAART including indinavir three-times-daily with undetectable viral load were randomly assigned to continue with this therapy or to change to a twice-daily indinavir/ritonavir (800/100 mg) regimen. The Medical Outcomes Study HIV Health Survey (MOS-HIV) questionnaire was used as the HRQoL measure. Results A total of 118 patients participated in the study, of which 59 (50%) were randomly assigned to continue with the three-times-daily regimen. Patients had a mean age of 39 years and 80% of them were male. At baseline, subjects included in the three-times-daily group presented a significantly greater number of symptoms than subjects in the twice-daily group, but no statistically significant differences were observed in MOS-HIV scores between the groups. In the intention-to-treat (ITT) analysis, a reduction in HRQoL scores was observed in both groups, which was greater in the twice-daily group. In the per protocol analysis, reduction of HRQoL was minimal. Conclusions A HRQoL deterioration, greater in the twice-daily group, was observed in this study in the ITT analysis, while HRQoL remained stable in both groups in patients who continued with and tolerated the allocated regimen.
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Affiliation(s)
| | - Xavier Badía
- Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- HO Statistics & Modelling, Health Outcomes Research Group, Barcelona, Spain
| | | | - Irene Moral
- HO Statistics & Modelling, Health Outcomes Research Group, Barcelona, Spain
| | - Montse Roset
- HO Statistics & Modelling, Health Outcomes Research Group, Barcelona, Spain
| | | | | | | | - Beatriz Rosón
- Hospital Universitario de Bellvitge, Barcelona, Spain
| | | | - N Grinberg
- Hospital Alvarez, Buenos Aires, Argentina
| | | | | | | | - S Lupo
- Centro Caici, Rosario, Argentina
| | - C Suárez
- Centro Caici, Rosario, Argentina
| | | | | | | | | | - P Cahn
- Fundación Huésped, Buenos Aires, Argentina
| | | | | | - DO David
- Hospital Rawson, Córdoba, Argentina
| | - N Luna
- Hospital Rawson, Córdoba, Argentina
| | | | - J Pich
- Hospital Clinic, Barcelona, Spain
| | - S Varea
- Hospital Clinic, Barcelona, Spain
| | - X Carné
- Hospital Clinic, Barcelona, Spain
| | | | - B Clotet
- Hospital Germans Trias i Pujol, Badalona, Spain
| | - J Romeu
- Hospital Germans Trias i Pujol, Badalona, Spain
| | - L Cruz
- Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - JA Iribarren
- Hospital Ntra Sra de Aranzazu, San Sebastián, Spain
| | - F Rodríguez
- Hospital Ntra Sra de Aranzazu, San Sebastián, Spain
| | | | - B Jimeno
- Hospital Ntra Sra de Aranzazu, San Sebastián, Spain
| | - F Pulido
- Hospital 12 de Octubre, Madrid, Spain
| | - R Rubio
- Hospital 12 de Octubre, Madrid, Spain
| | - J Flores
- Hospital Arnau de Vilanova, Valencia, Spain
| | | | | | - M Núñez
- Hospital Carlos III, Madrid, Spain
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van Leth F, Conway B, Laplumé H, Martin D, Fisher M, Jelaska A, Wit FW, Lange JMA, Laplumé H, Lasala MB, Losso MH, Bogdanowicz E, Lattes R, Krolewiecki A, Zala C, Orcese C, Terlizzi S, Duran A, Ebensrteijn J, Bloch M, Russell O, Russell DB, Roth NR, Eu B, Austin D, Gowers A, Quan D, Demonty J, Peleman R, Vandercam B, Vogelaers D, van der Gucht B, van Wanzeele F, Moutschen MM, Badaro R, Grinsztejn B, Schechter M, Uip D, Netto EN, Coelho SS, Badaró F, Pilotto JH, Schubach A, Barros ML, Leite OHM, Kiffer CRV, Wunsch CT, Nunes D, Catalani A, de Cassia Alves LR, Dossin TJ, D'Alló de Oliveira MT, Martini S, Conway B, de Wet JJ, Montaner JSG, Murphy C, Woodfall B, Sestak P, Phillips P, Montessori V, Harris M, Tesiorowski A, Willoughby B, Voigt R, Farley J, Reynolds R, Devlaming S, Livrozet JM, Rozenbaum W, Sereni D, Valantin MA, Lascoux C, Milpied B, Brunet C, Billaud E, Huart A, Reliquet V, Charonnat MF, Sicot M, Esnault JL, Slama L, Staszewski S, Bickel M, Lazanas MK, Stavrianeas N, Mangafas N, Zagoreos I, Kourkounti S, Paparizos V, Botsi C, Clarke S, Brannigan E, Boyle N, Chiriani A, Leoncini F, Montella F, Francesco L, Ambu S, Farese A, Gargiulo M, Di Sora F, Lavria F, Folgori F, Beniowski M, Boron Kaczmarska A, Halota W, Prokopowicz D, Bander DB, Leszuzyszyn-Pynka MLP, Wnuk AW, Bakowska E, Pulik P, Flisiak R, Wiercinska-Drapalo A, Mularska E, Witor A, Antunes F, Sarmento RSE, Doroana M, Horta AA, Vasconcelos O, Andrews SM, Huisamen CB, Johnson D, Martin O, Bekker LG, Maartens G, Wilson D, Visagie CJ, David NJ, Rattley M, Nettleship E, Martin DJ, Keyser V, Moraites TM, Moorhouse MA, Pitt JA, Orrell CJ, Bester C, Parboosing R, Moodley P, Gathiram V, Woolf D, Bernasconi E, Magenta L, Cardiello P, Kroon E, Ungsedhapand C, Fisher M, Wilkins EGL, Stockwell E, Day J, Daintith RS, Perry N, Timaeus C, Intosh-Roffet JM, Powell A, Youle M, Tyrer M, Madge S, Drinkwater A, Cuthbertson Z, Carroll A, Becker S, Katner H, Rimland D, Saag MS, Thompson M, Witt M, Aguilar MM, LaVoy A, Illeman M, Guerrero M, Gatell J, Belsey E, Hirschel B, Potarca A, Cronenberg M, Kreekel L, Meester R, Khodabaks J, Botma HJ, Esrhir N, Farida I, Feenstra M, Jansen K, Klotz A, Mulder M, Ruiter G, Bass CB, Pluymers E, de Vlegelaer E, Leeneman (VCL) R, Carlier H, van Steenberge E, Hall D. Quality of Life in Patients Treated with First-Line Antiretroviral Therapy Containing Nevirapine And/Or Efavirenz. Antivir Ther 2004. [DOI: 10.1177/135965350400900512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To assess whether differences in safety profiles between nevirapine (NVP) and efavirenz (EFV), as observed in the 2NN study, translated into differences in ‘health related quality of life’ (HRQoL). Design A sub-study of the 2NN study, with antiretro-viral-naive patients randomly allocated to NVP (once or twice daily), EFV or NVP+EFV, in addition to stavudine and lamivudine. Methods Comparing differences in changes of HRQoL over 48 weeks as measured with the Medical Outcomes Study HIV Health Survey (MOS-HIV) questionnaire, using analysis of variance. Results The 2NN study enrolled 1216 patients. No validated questionnaires were available for 244 patients, and 55 patients had no HRQoL data at all, leaving 917 patients eligible for this sub-study. A total of 471 (51%) had HRQoL measurements both at baseline and week 48. The majority (69%) of patients without HRQoL measurements did, however, complete the study. The change in the physical health score (PHS) was 3.9 for NVP, 3.4 for EFV and 2.4 for NVP+EFV ( P=0.712). For the mental health score (MHS) these values were 6.1, 7.0 and 3.9, respectively ( P=0.098). A baseline plasma HIV-1 RNA concentration (pVL) ≥100 000 copies/ml and a decline in pVL (per log10) were independently associated with an increase of PHS. An increase of MHS was only associated with pVL decline. Patients experiencing an adverse event during follow-up had a comparable change in PHS but a significantly smaller change in MHS, compared with those without an adverse event. Conclusions First-line ART containing NVP and/or EFV leads to an improvement in HRQoL. The gain in HRQoL was similar for NVP and EFV, but slightly lower for the combination of these drugs.
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Affiliation(s)
| | - Frank van Leth
- International Antiviral Therapy Evaluation Center (IATEC); Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Brian Conway
- University of British Columbia, Vancouver, BC, Canada
| | - Hector Laplumé
- Hospital Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Des Martin
- Toga Laboratories, Edenvale, South Africa
| | - Martin Fisher
- Brighton and Sussex University Hospitals, Brighton, UK
| | - Ante Jelaska
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Conn., USA
| | - Ferdinand W Wit
- International Antiviral Therapy Evaluation Center (IATEC); Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Joep MA Lange
- International Antiviral Therapy Evaluation Center (IATEC); Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Prata A, Silva-Vergara ML, Costa L, Rocha A, Krolewiecki A, Silva JC, de Paula EV, Pimenta Junior FG, Giraldo LER. Efficacy of azithromycin in the treatment of cutaneous leishmaniasis. Rev Soc Bras Med Trop 2003; 36:65-9. [PMID: 12715065 DOI: 10.1590/s0037-86822003000100010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The present open pilot study was conducted to assess the efficacy of azithromycin for the treatment of patients with cutaneous leishmaniasis in Ara ua and Varzelândia, MG. Twenty-four patients with less of six months of disease evolution were treated after clinical examination, Montenegro test and a biopsy. The treatment schemes consisted of oral doses of 500 mg per day for 3, 5 and 10 days and of 1000 mg for two days. A clinical control was performed monthly and treatment cycles were repeated when necessary until full reepithelialization of the lesions. On the occasion of the final evaluation, 20 patients had completed the study and 17 of them (85%) were cured. The time to obtain a cure was 60 days ifor 6 (30%) patients, 90 days for 7 (35%), and 120 for 4 (20%). The three patients with treatment failure received a pentavalent antimonial for 20 days. No adverse reactions to the medication were observed and a 14 month follow-up did not show recurrence in any patient. These results suggest that azithromycin can be a good therapeutic option for the treatment of cutaneous leishmaniasis caused by Leishmania Viannia brasiliensis.
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Affiliation(s)
- Aluízio Prata
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina do Triângulo Mineiro, Uberaba, MG, Brasil
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Abstract
Azithromycin, an azalide antibiotic of the macrolide family, concentrates in the tissues and especially in macrophages. Because Leishmania parasites reside in these cells, we tested this antibiotic for a possible antileishmanial activity in vitro and in vivo. Azithromycin decreased the Leishmania major promastigote count in cell-free cultures at log phase approximately 50-fold. In macrophage cultures infected with L. major amastigotes, azithromycin caused a significant decrease in parasite levels with an ED50 of 12 microg/ml. The activity in vivo was evaluated after infection of the footpads of susceptible BALB/cByJ mice and resistant C57BL/6J mice with L. major. Treatment of BALB/cByJ mice with azithromycin, 100 to 200 mg/kg/d, resulted in a significant decrease in lesion size and in the number of parasites per lesion, whereas no effect was seen in the treated C57BL/6J mice. Azithromycin has activity against L. major in vitro and in vivo. Given the severity of the disease and the limitations of the available therapeutic agents, azithromycin may have a significant role in the treatment of this group of diseases.
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Affiliation(s)
- Alejandro Krolewiecki
- Department of Microbiology and Immunology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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35
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Zala C, Ochoa C, Krolewiecki A, Patterson P, Cahn P, Crawford RI, Montaner JS. Highly active antiretroviral therapy does not protect against Kaposi's sarcoma in HIV-infected individuals. AIDS 2000; 14:2217-8. [PMID: 11061672 DOI: 10.1097/00002030-200009290-00027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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