Duration Of Infection Research Articles

Detection of Non-Alcoholic Fatty Liver Disease with Non-invasive Tools in Turkish People Living with HIV and with Apparently Normal Liver Function.

Non-alcoholic fatty liver disease (NAFLD) has become a significant cause of mortality and morbidity in people living with HIV. We aimed to investigate NAFLD presence by magnetic resonance imaging (MRI) methods, including MRI-derived proton density fat fraction (MRI-PDFF) and MRE, and ultrasound elastography among Turkish people living with HIV (PLWH), and identify factors correlated with fatty liver. We included 57 PLWH attending outpatient clinics on antiretroviral therapy (ART) for more than six months, without HBV/HCV co-infection, significant alcohol consumption, active opportunistic infection, previously diagnosed hepatobiliary disease, T2DM, and hyperlipidemia. We performed MRI, MRE, and US elastography on all participants. The mean age of the participants (M/F, 47/10) was 41.7± 12 years. The median duration of HIV infection was 3 (0.5-19 years) years. The mean MRI-PDFF was 4.4 ± 3.8 %, and 11 had fatty liver. The mean MRE value was 2.27 ± 0.6 kPa, inflammation was present in 16, and 4 participants had values consistent with fibrosis. The mean US elastography of the study population was 4.1±2.4 kPa. The mean right and left CCA intima-media of the study population was 0.65± 0.23 mm and 0.66± 0.25 mm; 16 had increased intima-media thickness. In patients with fatty liver, a significant positive correlation was present between MRE and CCA intima-media thickness (rs=0.82, p:0.006 for MRE-left CCA; r=0.68, p=0.042 for MRE-right CCA). We demonstrated that even a significant proportion of PLWH individuals with normal transaminase levels have fatty liver. Future prospective trials are warranted to understand and mitigate the risk factors, course of NAFLD, and accurate non-invasive tests, predicting fibrosis in people living with HIV.

High-risk human papillomavirus distribution in different cytological classification women

High-risk human papillomavirus (HR-HPV) infection is a major cause of infection-related cancer worldwide. 3101 HR-HPV-positive females were retrospectively analyzed and grouped using the cervical cytological screening (ThinPrep cytological test, TCT) evaluations combined with colposcopy. The HPV16 infection rate is the highest in all groups. HPV16 was the most frequent in each group, with significant differences between the four groups (χ2 = 23.41, P = 0.0001). The distribution of HPV16 and HPV33 correlated with the pathologic stage in each group. The mixed infection rate of mRNA testing differs significantly between groups (P < 0.01, χ2 = 17.44, P = 0.002). HR-HPV infection duration of less than six months accounted for 87.65%, 6 and 12 months of persistent infection (28.28%), and more than one year of continuous infection accounted for only 16.48%. The top three HPV types in a group with a duration of more than 12 months were HPV52 (3.03%), HPV16 (2.55%), and HPV39 (1.58%). The least clearance types were HPV39 (63.48%), 56 (69.54%), and 52 (71.44%) more than 12 months. This study revealed the region's primary pathogenic subtypes on different cervical lesions and provided the basis for diagnosing and treating HPV infection.

Immunomodulatory Effect of Infectious Disease of a Breastfed Child on the Cellular Composition of Breast Milk.

Recent studies suggest that the content of immune components in milk is influenced by the mother's health and also by the infant she feeds. We aimed to evaluate the effect of a child's respiratory tract infection on the cellular composition of breast milk (neutrophils, monocytes, eosinophils, lymphocytes, and their subpopulations). Twenty-six breastfeeding mothers whose children were hospitalized for respiratory tract infections were enrolled in the study. The control group consisted of 23 mothers of healthy children. Regarding the children, baseline laboratory blood tests were performed, and nasal swabs were taken for the presence of RS virus. In the next step, milk samples were collected from the mothers to assess the cellular composition of the milk, including neutrophils, monocytes, eosinophils, lymphocytes, and their subpopulations. Significantly higher percentages of T lymphocytes (helper and cytotoxic lymphocytes) were observed in the milk of the studied mothers. There was a significantly higher percentage of milk lymphocytes in the group of affected children with confirmed RSV etiology than in children with excluded RSV etiology. A significant positive correlation was observed between the duration of infection and the percentage of milk NK cells and between milk CD19 lymphocytes and the child's serum leukocytosis. This study may provide evidence of a link between cells in breast milk and disease in the breastfed infant. The severity of the infection, its duration, and the etiological agent of the infection may affect the cellular composition of milk.

Efficacy and safety of tixagevimab-cilgavimab versus SARS-CoV-2 breakthrough infection in the hematological conditions.

Managing SARS-CoV-2 infection in frail and immunosuppressed patients still represents an open challenge, but, starting from the phase 3 PROVENT study, prophylaxis with tixagevimab-cilgavimab has improved the approach in this category of patients, guaranteeing a better outcome and inferior mortality. Real-life data in a heterogeneous cohort are few. The aim of this study is to evaluate the benefit of prophylaxis with tixagevimab-cilgavimab in a cohort of 202 patients affected by different hematological diseases (lymphoproliferative, myeloproliferative, autoimmune, patients recently receiving a bone marrow transplant), active (with ongoing treatment), or in watch-and-wait strategy, followed in our center, during a median follow-up of 249 (45-325) days. An incidence of 44 breakthrough infections (21.8%) is reported, with no treatment-related adverse effects. Age ≥70years, ongoing treatment (above all with monoclonal antibodies), baseline lymphoproliferative disorders, and prior virus exposure are identified as risk factors related to subsequent infection (p<0.05). Moreover, the incidence is higher in low/nonresponse to prior vaccination (p=.002). Patients treated with tixagevimab-cilgavimab had a mild course of the infection and a reduction of the duration compared with preprophylaxis infection (11 vs. 15days, p<.001). The concurrent treatment with anti-CD20 monoclonal antibodies and B-non-Hodgkin lymphoma still confers a higher duration of infection despite prophylaxis. No deaths attributable to the infection occurred. Prophylaxis treatment seems to be a valid and safe strategy, although not preventing breakthrough infection, but the severe complications associated with the infection and the possible delays in administering lifesaving therapies from long positivity.

Using infection prevalence, seroprevalence and case report data to estimate chlamydial infection incidence

ObjectivesTo measure the effectiveness of chlamydia control strategies, we must estimate infection incidence over time. Available data, including survey-based infection prevalence and case reports, have limitations as proxies for infection...

CSF Inflammation Markers Associated with Asymptomatic Viral Escape in Cerebrospinal Fluid of HIV-Positive Individuals on Antiretroviral Therapy.

HIV establishes a viral reservoir in the CNS despite viral suppression in the blood on antiretroviral therapy (ART). In a minority of people with HIV (PWH), HIV RNA is detectable in CSF when HIV RNA in plasma is undetectable or HIV RNA levels are higher in CSF compared with plasma, an event termed CSF viral escape that can occur with or without neurological symptoms. Asymptomatic CSF viral escape occurs in 3-20% of PWH on ART, yet associated biomarkers are unclear. To identify biomarkers associated with asymptomatic CSF viral escape, we performed a matched group study of PWH on ART with vs. without CSF viral escape (n = 10 and n = 60, respectively, matched for age, duration of HIV infection, nadir CD4 count, and ART regimen) and 50 HIV-negative controls. PWH were on 3 or more ART drugs for >1 year, and the group with no CSF viral escape was suppressed below 50 copies/mL in plasma and CSF. Biomarkers of inflammation (IFN-γ, IL-1β, IL-6, IL-8, IL-15, IP-10, MCP-1, VEGF), cell adhesion (ICAM-1, VCAM-1), CNS injury (NFL), and glial activation (GFAP, YKL-40) were measured in paired plasma and CSF using the Meso Scale Discovery platform. PWH with vs. without CSF viral escape had more individuals (40%) with a plasma viral load (VL) > 50 copies/mL, higher CSF VL (median 156 vs. 40 copies/mL; p < 0.0001), lower CD4 count (318 vs. 512; p = 0.045), and higher CSF WBC (median [IQR] 4 [0-22] vs. 2 [0-4] cells/µL; p = 0.15) but similar proportions with HIV-associated neurocognitive disorders (HAND) (50% vs. 47%). CSF viral escape was associated with increased IL-1β, IFN-γ, IP-10, ICAM-1, and VCAM-1 in CSF but not plasma; IP-10 had the strongest association (p = 0.0008). CSF VL and WBC correlated with IFN-γ, IP-10, ICAM-1, and VCAM-1 (p < 0.05). Although markers of CNS injury showed no significant association with asymptomatic CSF viral escape, CSF YKL-40 correlated positively with CSF IL-1β (p = 0.003), IFN-γ (p = 0.0008), IP-10 (p < 0.0001), and NFL (p = 0.06) and negatively with neurocognitive T scores (p = 0.02). These findings identify CSF inflammation and glial activation markers that may serve as surrogate measures of HIV persistence in the CNS for future studies on therapeutics targeting the CNS reservoir.

Comparison of the computed tomography COVID-19 pneumonia severity scores in vaccinated and unvaccinated individuals without comorbidities

Aims: The aim of this study to investigate the effect of vaccines on pneumonia severity by comparing the computed tomography pneumonia scores of vaccinated and unvaccinated individuals with COVID-19 without known comorbidities. Methods: Between January 2020 and January 2022. A total of 270 patients, 133 vaccinated and 137 unvaccinated, with positive polymerase chain reaction test and without any significant co-morbidity were included in the study. Computed tomography pneumonia scores, demographic characteristics, and vaccination information were evaluated through the hospital’s electronic registry system. Results: Mean pneumonia scores of individuals vaccinated for 1 dose were higher than individuals vaccinated for 2 or more doses. The shortest duration of infection after vaccination was determined in the group with 1 dose of vaccine, and the longest in the group with 2 doses of vaccine. There was no significant difference between mean pneumonia scores of vaccinated and unvaccinated individuals (P &gt; 0.05). Pneumonia scores were found to be significantly lower in individuals over 70 years of age in vaccinated compared to unvaccinated individuals. A statistically significant positive correlation was found between the age of the patients and the pneumonia scores (Rho = 0.293). Conclusion: There is no significant difference in the pneumonia scores of vaccinated and unvaccinated Covid 19 pneumonia patients without comorbidities, except for patients over 70 years of age. There is a significant correlation between pneumonia score and age.

Quality of Life in HIV-Positive People in Poland Treated in the City of Bialystok: A Cross-Sectional Study.

The quality of life is one of the key factors in assessing the health status of HIV-positive individuals, with its improvement considered an important goal of treatment. Assessment of the quality of life helps accurately evaluate the impact of diseases and treatment on the patient's life. The aim of this study was to assess the quality of life of HIV-positive people in Poland using the example of patients treated in the Observation and Infection Clinic with the Subunit for HIV/AIDS Patients of the University Clinical Hospital in Bialystok, based on the evaluation of HIV-positive status acceptance in HIV patients as well as sociometric variables such as age, gender and marital status. A total of 147 patients participated in this study, including 104 men (70.7%) and 43 women (29.3%). This study was conducted between May 2019 and January 2020 in the Observation and Infection Clinic with the Subunit for HIV/AIDS Patients with the Consultation and Diagnostic Centre at the Teaching Hospital of the Medical University of Bialystok. This study used a diagnostic survey method with a modified questionnaire "Psychosocial Situation of People Living with HIV/AIDS in Poland" by Dr. Magdalena Ankiersztejn-Bartczak and the following standardised psychometric tools: the World Health Organization Quality of Life (WHOQOL-BREF), Short-Form Health Survey (SF-36), Acceptance of Illness Scale (AIS) and Satisfaction with Life Scale (SWLS). The majority of respondents (60%) reported no significant changes in their lives as a result of HIV infection. Gender was not a differentiating factor in the quality of life of people living with HIV. The variation in psychometric measures within the female and male groups was far greater than the difference between them. Marital status clearly differentiated the quality of life. The following conclusions were drawn from this study: The surveyed HIV patients presented a moderate level of quality of life, which was mainly determined by marital status. Higher quality of life was presented by married persons. Duration of infection was not correlated with quality of life. The level of acceptance of HIV infection was relatively high among respondents. A higher level of HIV acceptance was associated with a higher quality of life. The respondents presented a relatively poor level of satisfaction with life. Changing jobs, going on disability, relationship breakdown, not having a family of their own and losing friends were the key HIV-related changes in the lives of the respondents.

What do we mean by long COVID? A scoping review of the cognitive sequelae of SARS-CoV-2 infection.

Many COVID-19 patients report persistent symptoms, including cognitive disturbances. We performed a scoping review on this topic, focusing primarily on cognitive manifestations. Abstracts and full texts of studies published on PubMed (until May 2023) addressing cognitive involvement persisting after SARS-CoV-2 infection were reviewed, focusing on terms used to name the cognitive syndrome, reported symptoms, their onset time and duration, and testing batteries employed. Reported psychiatric symptoms, their assessment tools, and more general manifestations were also extracted. Among the 947 records identified, 180 studies were included. Only one third of them used a label to define the syndrome. A minority of studies included patients according to stringent temporal criteria of syndrome onset (34%), whereas more studies reported a minimum required symptom duration (77%). The most frequently reported cognitive symptoms were memory and attentional-executive disturbances, and among psychiatric complaints, the most frequent were anxiety symptoms, depression, and sleep disturbances. Most studies reported fatigue among general symptoms. Thirty-six studies employed cognitive measures: screening tests alone (n = 19), full neuropsychological batteries (n = 25), or both (n = 29); 30 studies performed psychiatric testing. Cognitive deficits were demonstrated in 39% of subjects, the most frequently affected domains being attention/executive functions (90%) and memory (67%). Currently, no agreement exists on a label for post-COVID-19 cognitive syndrome. The time of symptom onset after acute infection and symptom duration are still discussed. Memory and attention-executive complaints and deficits, together with fatigue, anxiety, and depression symptoms, are consistently reported, but the objective evaluation of these symptoms is not standardized.

Optimising the Delivery of RHDV to Rabbits for Biocontrol: An Experimental Evaluation of Two Novel Methods of Virus Delivery.

Rabbit haemorrhagic disease virus (RHDV) is established as a landscape-scale biocontrol that assists the management of invasive European rabbits and their impacts in both Australia and New Zealand. In addition to this, it is also available to land managers to augment rabbit control efforts at a local scale. However, current methods of deploying RHDV to rabbits that rely on the consumption of virus-treated baits can be problematic as rabbits are reluctant to consume bait when there is abundant, green, protein-rich feed available. We ran a suite of interrupted time-series experiments to compare the duration of infectivity of two conventional (carrot and oat baits) and two novel (meat bait and soil burrow spray) methods of deploying RHDV to rabbits. All methods effectively killed exposed rabbits. Soil burrow spray and carrot baits resulted in infection and mortality out to 5 days post their deployment in the field, and meat baits caused infection out to 10 days post their deployment. In contrast, oat baits continued to infect and kill exposed rabbits out to 20 days post deployment. Molecular assays demonstrated high viral loads in deployed baits beyond the duration for which they were infectious or lethal to rabbits. Based on our results, we suggest that the drying of meat baits may create a barrier to effective transmission of RHDV by adult flies within 10 days. We therefore hypothesise that fly larvae production and development on infected tissues is critical to prolonged viral transmission from meat baits, and similarly from carcasses of RHDV mortalities, via mechanical fly vectors. Our study demonstrates that meat baits and soil spray could provide additional virus deployment options that remove the need for rabbits to consume baits at times when they are reluctant to do so.

The Assessment of Immunological Status in Hemodialysis Patients Post COVID-19 Infection

Abstract Background Coronavirus disease 2019 (COVID-19) infection emerged in Wuhan, China in December 2019 and has spread rapidly worldwide. On March 11, 2020, WHO declared COVID-19 a pandemic. COVID-19 is a single-strain RNA virus that typically causes respiratory damage in humans and animals. Aim of the Work Detection of the level of immunoglobulin (IgG) antibodies against covid -19 virus to assess the immunological status of the patients post covid-19 infection and the risk of reinfection with covid -19 Patients and Methods This study is Cohort study, was carried out Hemodialysis unit in Nephrology department, Ain shams university Hospital and Ain shams specialized Hospital, on 60 of heamodialysis patients divided into these three groups; (Group 1): included 20 patients that have been infected with covid 19 and confirmed positive by PCR test, (Group 2): included 20 patients who were highly suspected infection with covid-19 by CT findings, (Group 3): included 20 patients with no history suggestive of covid-19 infection during the pandemic as acontrol study group. Results There is astrong significance between between patients in group A (who are confirmed positive covid 19 infection by pcr test) and group B (who are suspected covid infection by ct or symptoms and laboratory findings) and group C (who are not infected or have symptoms) as regard hospital admission and home isolation. There is a significance between patients in group A (who are confirmed positive covid 19 infection by pcr test) and group B (who are suspected covid infection by ct or symptoms and laboratory findings) and group C (who are not infected or have symptoms) as regard lymphocyte count during infection, and shows that there is no significance between the groups as regard (HB, MCV, MCH, MCHC, WBCS, Platelets). Significance positive Correlation of IgG Titer with age and there is a significance positive correlation of hospital admission duration with BMI in COVID suspected patients by CT (n = 20). There is a significance between duration of infection and IgG titre as patients who were 3 months from infection have strong significans more than who were 6 months or more from infection, and there is no significance between duration of infections and labs findings. There is significance between IgG titre and duration from infection in group A and group B if the duration of infection was less than 6 months or more than 6 months. Conclusion There was significance between patients in group A, group B and group C as regard IgG titer. There was significance negative Correlation of IgG Titer and hospital admission duration with lymphocytes count during infection and duration form infection respectively in COVID patients confirmed by PCR (n = 20). There was significance positive Correlation of IgG Titer with age and there was a significance positive correlation of hospital admission duration with BMI in COVID suspected patients by CT (n = 20).

Rheumatological and Immunological Manifestations among a Cohort of Human Immunodeficiency Virus Egyptian Patients

Abstract Background The human immunodeficiency virus (HIV) is a lentivirus (a subgroup of retrovirus) that is able to persist in the form of integrated proviruses in a predominantly CD4 T cell reservoir causing HIV infection and over time acquired immunodeficiency syndrome (AIDS). Objective Detection of frequency and pattern of rheumatological and immunological disorders in HIV infected Egyptian patients. Patients and Methods This study was observational cross sectional study conducted in tertiary hospital of infectious diseases in Giza, Egypt outpatient clinics and inpatient departments. It included one hundred human immune deficiency virus infected Egyptian patients diagnosed according to national AIDS program criteria having an immunological or a musculoskeletal disorder with age of ≥ 18 years. Results Results from our study which revealed a highly significant correlation between both CD4 count, HIV-PCR level and the incidence of oral ulcers. There was only a significant value between HIV-PCR level and the presence of myositis or thromboembolic manifestations. Within our 100 HIV positive patients the mean levels of ESR, CRP and SGOT levels were elevated. There was a weak inverse correlation between the CD4-positive lymphocyte count and ESR. There was a highly significant negative correlation between CD4 count and HIV infection duration ESR, CRP, urea, creatinine, blood urea level, SGOT, SGPT. Also, significant negative correlation between CD4 count and uric acid level. Moreover, there were a highly significant positive correlation between the HIVPCR level and ESR, CRP, serum creatinine level, SGOT and SGPT. There was a high significant negative correlation between the HIV-PCR level and hemoglobin level, platelets count and CD4 count. There was a significant negative correlation between HIV-PCR level and absolute lymphocyte count. Conclusion Rheumatologic manifestations are commonly occurring in HIV positive patients. Raynaud’s phenomenon, oral ulcers, and hepatosplenomegaly are significantly more prevalent in patients under non-HAART. ESR and CRP are significantly higher in patients not receiving HAART. Viral load is significantly higher in patients with non-specific antiviral treatment, while CD4 count is significantly lower in the same patient cohort. There is a significant relation between incidence of oral ulcers with lower CD4 count and higher viral load.

Helicobacter pylori intragastric colonization and migration: Endoscopic manifestations and potential mechanisms.

After being ingested and entering the human stomach, Helicobacter pylori (H. pylori) adopts several effective strategies to adhere to and colonize the gastric mucosa and move to different regions of the stomach to obtain more nutrients and escape from the harsher environments of the stomach, leading to acute infection and chronic gastritis, which is the basis of malignant gastric tumors. The endoscopic manifestations and pathological features of H. pylori infection are diverse and vary with the duration of infection. In this review, we describe the endoscopic manifestations of each stage of H. pylori gastritis and then reveal the potential mechanisms of bacterial intragastric colonization and migration from the perspective of endoscopists to provide direction for future research on the effective therapy and management of H. pylori infection.

Seroprevalence of anti-SARS-CoV-2 IgG antibodies in HIV-positive and HIV-negative patients in clinical settings in Douala, Cameroon.

The asymptomatic nature of COVID-19 coupled with differential testing are confounders in the assessment of SARS-CoV-2 incidence among people living with HIV (PLWH). As various comorbidities increase the risk of SARS-CoV-2 infection, it is crucial to assess the potential contribution of HIV to the risk of acquiring COVID-19. Our study aimed to compare the anti-SARS-CoV-2 IgG seroprevalence among people living with and without HIV. PLWH were enrolled in the HIV units of two health facilities in Douala, Cameroon. Participants were consecutively enrolled, among which 47 were people living with HIV and 31 were HIV-negative patients. SARS-CoV-2 antibody tests were performed on all participants. Overall, medical consultation was conducted. For HIV-positive participants only, viral load, antiretroviral regimen, duration of HIV infection, and duration of antiretroviral treatment were retrieved from medical records. We found an overall SARS-CoV-2 IgG seroprevalence of 42.31% within the study population, with a SARS-CoV-2 IgG seroprevalence of 44.6% for PLWH and 38.7% among those without HIV infection; no significant statistical difference was observed. Adjusting for sex, HIV status, and BCG vaccination, the odds of previous SARS-CoV-2 infection were higher among married persons in the study population. Sex, BCG vaccination, and HIV status were not found to be associated with SARS-CoV-2 IgG seropositivity. Our findings support the lack of association between HIV status and susceptibility to SARS-CoV-2 infection. The ARV regimen, suppressed viral load, and Tenofovir boasted ARV regimen might not affect the body's immune response after exposure to SARS-CoV-2 among PLWH. Thus, if HIV is well treated, the susceptibility to COVID-19 in PLWH would be like that of the general population.

Lessons learned from COVID-19 pandemic: outcomes after SARS-CoV-2 infection in hematopoietic cell transplant and cell therapy recipients

We investigated the outcomes after Coronavirus disease 2019 (COVID) in hematopoietic cell transplant (HCT) or chimeric antigen receptor-T cell (CART) therapy recipients in a single-centre study including all (n = 261)HCT/CART recipients (allogeneic-HCT 49%, autologous-HCT 40%, CART 11%). The median age was 60 (22-80) years. COVID severity was mild (74%), moderate (11%), and severe/critical (16%) with a mortality rate of 7% and a median duration of infection of 5.7 weeks. Significant predictors of COVID severe disease or mortality included concurrent infection (HR 14.9, 95% CI 2.2-5.6) and immunosuppressive therapy (OR 4.8, 95% CI 1.2-3.4).HCT/CART recipients have a higher risk of mortality with COVID and warrant vigilant interventions.

Frequency of Atypical Mutations in the Spike Glycoprotein in SARS-CoV-2 Circulating from July 2020 to July 2022 in Central Italy: A Refined Analysis by Next Generation Sequencing.

In this study, we provided a retrospective overview in order to better define SARS-CoV-2 variants circulating in Italy during the first two years of the pandemic, by characterizing the spike mutational profiles and their association with viral load (expressed as ct values), N-glycosylation pattern, hospitalization and vaccination. Next-generation sequencing (NGS) data were obtained from 607 individuals (among them, 298 vaccinated and/or 199 hospitalized). Different rates of hospitalization were observed over time and among variants of concern (VOCs), both in the overall population and in vaccinated individuals (Alpha: 40.7% and 31.3%, Beta: 0%, Gamma: 36.5% and 44.4%, Delta: 37.8% and 40.2% and Omicron: 11.2% and 7.1%, respectively, both p-values < 0.001). Approximately 32% of VOC-infected individuals showed at least one atypical major spike mutation (intra-prevalence > 90%), with a distribution differing among the strains (22.9% in Alpha, 14.3% in Beta, 41.8% in Gamma, 46.5% in Delta and 15.4% in Omicron, p-value < 0.001). Overall, significantly less atypical variability was observed in vaccinated individuals than unvaccinated individuals; nevertheless, vaccinated people who needed hospitalization showed an increase in atypical variability compared to vaccinated people that did not need hospitalization. Only 5/607 samples showed a different putative N-glycosylation pattern, four within the Delta VOC and one within the Omicron BA.2.52 sublineage. Interestingly, atypical minor mutations (intra-prevalence < 20%) were associated with higher Ct values and a longer duration of infection. Our study reports updated information on the temporal circulation of SARS-CoV-2 variants circulating in Central Italy and their association with hospitalization and vaccination. The results underline how SARS-CoV-2 has changed over time and how the vaccination strategy has contributed to reducing severity and hospitalization for this infection in Italy.

Prevalence, drivers and surveillance of antibiotic resistance and antibiotic use in rural China: Interdisciplinary study.

This study aimed to characterise antibiotic prescribing and dispensing patterns in rural health facilities in China and determine the community prevalence of antibiotic resistance. We investigated patterns and drivers of antibiotic use for common respiratory and urinary tract infections (RTI/UTI) in community settings, examined relationships between presenting symptoms, clinical diagnosis and microbiological results in rural outpatient clinics, and assessed potential for using patient records to monitor antibiotic use. This interdisciplinary mixed methods study included: (i) Observations and exit interviews in eight village clinics and township health centres and 15 retail pharmacies; (ii) Urine, throat swab and sputum samples from patients to identify potential pathogens and test susceptibility; (iii) 103 semi-structured interviews with doctors, patients, pharmacy workers and antibiotic-purchasing customers; (iv) Assessment of completeness and accuracy of electronic patient records through comparison with observational data. 87.9% of 1123 recruited clinic patients were prescribed antibiotics (of which 35.5% contained antibiotic combinations and >40% were for intravenous administration), most of whom had RTIs. Antibiotic prescribing for RTIs was not associated with presence of bacterial pathogens but was correlated with longer duration of infection (OR = 3.33) and presence of sore throat (OR = 1.64). Fever strongly predicted prescription of intravenous antibiotics (OR = 2.87). Resistance rates in bacterial pathogens isolated were low compared with national data. 25.8% of patients reported antibiotics use prior to their clinic visit, but only 56.2% of clinic patients and 53% of pharmacy customers could confirm their prescription or purchase included antibiotics. Diagnostic uncertainty, financial incentives, understanding of antibiotics as anti-inflammatory and limited doctor-patient communication were identified as key drivers of antibiotic use. Completion and accuracy of electronic patient records were highly variable. Prevalence of antibiotic resistance in this rural population is relatively low despite high levels of antibiotic prescribing and self-medication. More systematic use of e-records and in-service training could improve antibiotic surveillance and stewardship in rural facilities. Combining qualitative and observational anthropological methods and concepts with microbiological and epidemiological investigation of antibiotic resistance at both research design and analytic synthesis stages substantially increases the validity of research findings and their utility in informing future intervention development.

The Association of Cytomegalovirus and Allostatic Load by Country of Birth and Length of Time in the United States.

Cytomegalovirus (CMV) is a highly prevalent virus with a worldwide distribution. It typically remains dormant in most individuals until reactivation. Immunocompromised states are known to be potential causes for CMV reactivation. Current research has shown a link in the decline of immigrant health among those living in the US for an extended period, though the impact of CMV on this is not clear. This study investigated the association between country of birth, duration of US residency, allostatic load, and latent cytomegalovirus infection (CMV IgG) in a sample of US adults aged 20-49. The data utilized for our analysis was obtained from the National Health and Nutrition Examination Survey (NHANES) conducted between 2001 and 2004. Allostatic load, an index measuring the cumulative physiological strain on the body as it strives to regain stability in the presence of chronic stress, provided a valuable approach to assess stress within the context of CMV exposure. Logistic regression modeling was employed to estimate odds ratios and confidence intervals for the analysis. The chi-square test of association and Cramer's V statistic were used to assess the correlation among categorical variables, while Pearson's correlation coefficient was applied to evaluate the relationship between continuous variables. The results revealed that individuals born outside the US and those with less than 20 years of residency in the US exhibited significantly higher proportions of positive CMV IgG compared to individuals born in the US. Specifically, individuals born outside the US had more than triple the odds of CMV IgG when adjusting for the AL index (OR = 3.69, p-value = 0.0063). A similar trend was observed when examining AL risk based on the duration of US residency. Furthermore, age and sex were identified as significant predictors (p-value < 0.05) of AL risk, considering the individual's country of birth. In summary, the findings of this study significantly enhance our comprehension of the intricate interplay between cytomegalovirus (CMV) and allostatic load (AL). The investigation sheds light on how CMV and AL interact within specific demographic contexts, providing valuable insights into the underlying risk factors for CMV infection.

Efficacy and safety of selenium or vitamin E administration alone or in combination in ICU patients: A systematic review and meta-analysis

Micronutrient administration that contributes to antioxidant defense has been extensively studied in critically ill patients, but consensus remains elusive. Selenium and vitamin E are two important micronutrients that have synergistic antioxidant effects. This meta-analysis aimed to assess the effect of selenium or vitamin E administration alone and the combination of both on clinical outcomes in patients hospitalized in the ICU. After electronic searches on PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), SinoMed, VIP database and Wanfang data, initially 1767 papers were found, and 30 interventional studies were included in this analysis. We assessed the risk-difference between treatment and control (standard treatment) groups by pooling available data on length of stay (ICU length of stay and hospital length of stay), mortality (ICU mortality, hospital mortality, 28-day mortality, 6-month mortality and all-cause mortality), duration of mechanical ventilation, adverse events and new infections. By analyzing the included studies, we found no significant effect of selenium administration alone on mortality, mechanical ventilation duration, or adverse events in ICU patients. However, after excluding studies with high heterogeneity, the meta-analysis showed that selenium alone reduced the length of hospital stay (MD:-1.38; 95% CI:-2.52,-0.23; I-square: 0%). Vitamin E administration alone had no significant effect on mortality, duration of mechanical ventilation, or adverse events in ICU patients. However, after excluding studies with high heterogeneity, the meta-analysis showed that vitamin E alone could reduce the length of ICU stay (MD:-1.27; 95% CI:-1.86,-0.67; I-square: 16%). Combined administration of selenium and vitamin E had no significant effect on primary outcomes in ICU patients. Selenium administration alone may shorten the length of hospital stay, while vitamin E alone may reduce the length of ICU stay. The putative synergistic beneficial effect of combined administration of selenium and vitamin E in ICU patients has not been observed, but more clinical studies are pending to confirm it further.

Humoral immune responses associated with control of SARS-CoV-2 breakthrough infections in a vaccinated US military population.

COVID-19 vaccines have been critical for protection against severe disease following infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) but gaps remain in our understanding of the immune responses that contribute to controlling subclinical and mild infections. Vaccinated, active-duty US military service members were enrolled in a non-interventional, minimal-risk, observational study starting in May, 2021. Clinical data, serum, and saliva samples were collected from study participants and were used to characterise the humoral immune responses to vaccination and to assess its impact on clinical and subclinical infections, as well as virologic outcomes of breakthrough infections (BTI) including viral load and infection duration. The majority of VIRAMP participants had received the Pfizer COVID-19 vaccine and by January, 2022, N=149 had a BTI. The median BTI duration (PCR+ days) was 4 days and the interquartile range was 1-8 days. Participants that were nucleocapsid seropositive prior to their BTI had significantly higher levels of binding and functional antibodies to the spike protein, shorter median duration of infections, and lower median peak viral loads compared to seronegative participants. Furthermore, levels of neutralising antibody, ACE2 blocking activity, and spike-specific IgA measured prior to BTI also correlated with the duration of infection. We extended previous findings and demonstrate that a subset of vaccine-induced humoral immune responses, along with nucleocapsid serostatus are associated with control of SARS-CoV-2 breakthrough infections in the upper airways. This work was funded by the DoD Joint Program Executive Office for Chemical, Biological, Radiological and Nuclear Defense (JPEO-CBRND) in collaboration with the Defense Health Agency (DHA) COVID-19 funding initiative for the VIRAMP study.