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The Lancet. Global Health Jul 2023Malaria infections during pregnancy can cause adverse birth outcomes, yet many infections are undetected by microscopy. We aimed to describe the epidemiology of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Malaria infections during pregnancy can cause adverse birth outcomes, yet many infections are undetected by microscopy. We aimed to describe the epidemiology of submicroscopic malaria infections in pregnant women in Asia, the Americas, and Africa using aggregated and individual participant data (IPD).
METHODS
For this systematic review and meta-analysis, studies (published Jan 1, 1997 to Nov 10, 2021) with information on both microscopic and submicroscopic infections during pregnancy from Asia, the Americas, or Africa, identified in the Malaria-in-Pregnancy Library, were eligible. Studies (or subgroups or study groups) that selected participants on the basis of the presence of fever or a positive blood smear were excluded to avoid selection bias. We obtained IPD (when available) and aggregated data. Estimates of malaria transmission intensity and sulfadoxine-pyrimethamine resistance, matched by study location and year, were obtained using publicly available data. One-stage multivariable logit and multinomial models with random intercepts for study site were used in meta-analysis to assess prevalence of and risk factors for submicroscopic infections during pregnancy and at delivery. This study is registered with PROSPERO, number CRD42015027342.
FINDINGS
The search identified 87 eligible studies, 68 (78%) of which contributed to the analyses. Of these 68 studies, 45 (66%) studies contributed IPD (48 869 participants) and 23 (34%) studies contributed aggregated data (11 863 participants). During pregnancy, median prevalence estimates were 13·5% (range 0·0-55·9, 66 substudies) for submicroscopic and 8·0% (0·0-50·6, 66 substudies) for microscopic malaria. Among women with positive Plasmodium nucleic acid amplification tests (NAATs), the median proportion of submicroscopic infections was 58·7% (range 0·0-100); this proportion was highest in the Americas (73·3%, 0·0-100), followed by Asia (67·2%, 36·4-100) and Africa (56·5%, 20·5-97·7). In individual patient data analysis, compared with women with no malaria infections, those with submicroscopic infections were more likely to present with fever in Africa (adjusted odds ratio 1·32, 95% CI 1·02-1·72; p=0·038) but not in other regions. Among women with NAAT-positive infections in Asia and the Americas, Plasmodium vivax infections were more likely to be submicroscopic than Plasmodium falciparum infections (3·69, 2·45-5·54; p<0·0001). Risk factors for submicroscopic infections among women with NAAT-positive infections in Africa included older age (age ≥30 years), multigravidity, and no HIV infection.
INTERPRETATION
During pregnancy, submicroscopic infections are more common than microscopic infections and are associated with fever in Africa. Malaria control in pregnancy should target both microscopic and submicroscopic infections.
FUNDING
Bill & Melinda Gates Foundation through the Worldwide Antimalarial Resistance Network.
Topics: Female; Humans; Pregnancy; Adult; Prevalence; Malaria; Antimalarials; Malaria, Falciparum; Risk Factors
PubMed: 37276878
DOI: 10.1016/S2214-109X(23)00194-8 -
Clinical Endocrinology Aug 2021Acute suppurative thyroiditis (AST) is a rare but potentially fatal condition which can initially be difficult to distinguish from the more common subacute thyroiditis... (Review)
Review
OBJECTIVE
Acute suppurative thyroiditis (AST) is a rare but potentially fatal condition which can initially be difficult to distinguish from the more common subacute thyroiditis (SAT). We aim to update understanding of this medical emergency.
DESIGN
A systematic review over the past 20 years was performed on the epidemiology, clinical features, investigations, management and outcomes of AST. All full-text cases of microscopy or culture- proven AST in the English literature were included.
RESULTS
200 cases of AST have been described in 148 articles from January 2000 - January 2020. Bacterial AST is most common, often presenting with neck pain (89%) and fever (82%). Immunosuppression and pyriform sinus fistula are the most common causes, most often due to gram-positive aerobes. Transient hyperthyroidism is common (42%). Aspiration and antibiotics are becoming a more common treatment. Overall mortality was 7.8%. Tuberculous and fungal AST are less likely to present with fever and neck pain. Fungal AST is more common in immunosuppressed individuals (31%) and has a high overall mortality (33%). Tuberculous AST is more common in TB endemic areas.
CONCLUSION
The symptoms and signs of AST commonly overlap with SAT and initially can be hard to diagnose. AST can be rapidly morbid or even fatal. Clinicians need to consider AST when they assess patients with thyroiditis who are systemically unwell, have high fever, high white cell count and c-reactive protein, tender neck and abnormal neck imaging. An investigative and treatment strategy is described based on a systematic review of the literature.
Topics: Anti-Bacterial Agents; Diagnosis, Differential; Humans; Neck; Thyroiditis; Thyroiditis, Suppurative
PubMed: 33559162
DOI: 10.1111/cen.14440 -
Placenta Aug 2022Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has been implicated in the clinical pathology of... (Review)
Review
Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has been implicated in the clinical pathology of multiple organs and organ systems. Due to the novelty of the disease, there is a need to review emerging literature to understand the profile of SARS-CoV-2 in the placenta. This review sought to evaluate the literature on the mediators, mechanism of entry, pathogenesis, detection, and pathology of SARS-CoV-2 in the placenta. Systematic literature searches found 96 eligible studies. Our review revealed that SARS-CoV-2 canonical mediators, angiotensin-converting enzyme-2 (ACE2), and transmembrane serine protease-2 (TMPRSS2) are variably expressed in various placenta compartments, including the villous cytotrophoblasts, syncytiotrophoblasts (STBs), and extravillous trophoblasts (EVTs) throughout pregnancy. Placental SARS-CoV-2 and coronavirus-associated receptors and factors (SCARFs), including basigin (BSG/CD147), dipeptidyl peptidase-4 (DPP4/CD26), cathepsin B/L (CTL B/L), furin, interferon-induced transmembrane protein (IFITM1-3), and lymphocyte antigen 6E (LY6E) may increase or reduce the permissiveness of the placenta to SARS-CoV-2. EVTs express genes that code for proteins that may drive viral pathogenesis in the placenta. Viral RNA, proteins, and particles were detected primarily in the STBs by in situ hybridization, immunohistochemistry, electron microscopy, and polymerase chain reaction. Placental pathology in SARS-CoV-2-infected placentas included maternal and fetal vascular malperfusion and a generally nonspecific inflammatory-immune response. The localization of SARS-CoV-2 receptors, proteases, and genes involved in coding proteins that drive viral pathogenesis in the placenta predisposes the placenta to SARS-CoV-2 infection variably in all pregnancy trimesters, with antecedent placental pathology. There is a need for further studies to explicate the mechanism of entry and pathogenesis of SARS-CoV-2 in the placenta.
Topics: COVID-19; Female; Humans; Placenta; Pregnancy; Pregnancy Complications, Infectious; SARS-CoV-2; Trophoblasts
PubMed: 35872511
DOI: 10.1016/j.placenta.2022.07.007 -
Journal of Clinical Medicine Mar 2022Noninvasive imaging techniques have recently outlined precise microscopic features of acne elementary lesions and accurate quantifications for disease severity staging... (Review)
Review
Noninvasive imaging techniques have recently outlined precise microscopic features of acne elementary lesions and accurate quantifications for disease severity staging and therapeutical efficacy follow-up. The aim of this review is to systematically describe current applications of dermoscopy, reflectance confocal microscopy (RCM), and optical coherence tomography (OCT) in acne vulgaris assessment and management. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We included studies conducted on human subjects with elementary lesions of acne vulgaris, reporting assessment of the lesions with dermoscopy, RCM, and/or OCT. At present there are few large studies regarding acne and noninvasive imaging techniques, representing the main limitation of this review. Clinical examination represents the first line in acne diagnosis and treatment. However, dermoscopy, RCM, and OCT are further tools that can improve acne classification, monitoring of treatment, and pathophysiologic characterization. In the near future, dermoscopy, RCM, and OCT could become routinely used for the evaluation of acne vulgaris to provide a deeper knowledge of the disease and to guide the clinician in the prescription of tailored treatment protocols based on each patient's characteristics.
PubMed: 35407391
DOI: 10.3390/jcm11071783 -
Experimental Dermatology Jul 2023Common skin disorders such as acne vulgaris, rosacea and folliculitis are bothersome prevalent inflammatory diseases of hair follicles that can easily be investigated... (Review)
Review
Common skin disorders such as acne vulgaris, rosacea and folliculitis are bothersome prevalent inflammatory diseases of hair follicles that can easily be investigated bedside using optical coherence tomography (OCT) and reflectance confocal microscopy (RCM) with micrometre resolution, opening a novel era for high-resolution hair follicle diagnostics and quantitative treatment evaluation. EMBASE, PubMed and Web of Science were searched until 5 January 2023 to identify all studies imaging hair follicle characteristics by RCM and OCT for diagnosis and monitoring of treatment in hair follicle-based skin disorders. This study followed PRISMA guidelines. After inclusion of articles, methodological quality was assessed using the QUADAS-2 critical appraisal checklist. Thirty-nine in vivo studies (33 RCM and 12 OCT studies) were included. The studies focused on acne vulgaris, rosacea, alopecia areata, hidradenitis suppurativa, folliculitis, folliculitis decalvans, lichen planopilaris, discoid lupus erythemasus, frontal fibrosing alopecia and keratosis pilaris. Inter- and perifollicular morphology including number of demodex mites, hyperkeratinization, inflammation and vascular morphology could be assessed by RCM and OCT in all included skin disorders. Methodological study quality was low, and interstudy outcome variability was high. Quality assessment showed high or unclear risk of bias in 36 studies. Both RCM and OCT visualize quantitative features as size, shape, content and abnormalities of hair follicles, and have potential to support clinical diagnosis and evaluate treatment effects. However, larger studies with better methodological quality are needed to implement RCM and OCT directly into clinical practice.
Topics: Humans; Tomography, Optical Coherence; Hair; Folliculitis; Acne Vulgaris; Dermatitis; Rosacea; Hair Diseases; Alopecia Areata; Microscopy, Confocal
PubMed: 37140216
DOI: 10.1111/exd.14830 -
Clinical Microbiology and Infection :... Dec 2023Asymptomatic malaria infections are highly prevalent in endemic areas. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Asymptomatic malaria infections are highly prevalent in endemic areas.
OBJECTIVES
This systematic review aimed to estimate the pooled prevalence of malaria parasites in migrants screened in non-endemic areas.
DATA SOURCES
MEDLINE-Ovid, EMBASE, Web of Science, Global Health, Lilacs, Cochrane, and MedRxiv.
STUDY ELIGIBILITY CRITERIA
Cross-sectional studies and observational prospective or retrospective cohort studies conducted in Europe, USA, Canada, Australia, or New Zealand regardless of language or publication status. Studies should include prevalence data on malaria in migrants that were recruited through a systematic screening approach. We excluded studies where people were tested because of malaria symptoms.
PARTICIPANTS
Migrant individuals exposed to malaria infection ASSESSMENT OF RISK OF BIAS: A standardized and validated appraisal instrument was used for studies reporting prevalence data (Joanna Briggs Institute Manual for Evidence Synthesis).
METHODS OF DATA SYNTHESIS
Pooled estimates of the parasite prevalence by PCR, microscopy, and rapid diagnostic test (RDT) were calculated with a random-effects model. Heterogeneity was explored by stratification by age, region of origin, period of study, and quality of studies.
RESULTS
Of 1819 studies retrieved, 23 studies were included with in total 4203 participant PCR data, 3186 microscopy and 4698 RDT data, respectively. Migrants from sub-Saharan Africa had a malaria parasite prevalence of 8.3% (95% CI 5.1-12.2) by PCR, 4.3% (1.5-8.2) by RDT, and 3.1% (0.7-6.8) by microscopy. For migrants from Asia and Latin America, the prevalence with PCR was 0% (0.0-0.08) and 0.4% (0.0-1.8), respectively. Migrants from the Central African Region had the highest PCR prevalence (9.3% [6.0-13.0]), followed by West African migrants (2.0% [0.0-7.7]). Restricting the analysis to sub-Saharan Africa migrants arriving to the host country within the previous year, the PCR-based prevalence was 11.6% (6.9-17.4).
CONCLUSION
We provide estimates on the malaria parasite prevalence in migrants in non-endemic setting. Despite heterogeneity between settings, these findings can contribute to inform screening strategies and guidelines targeting malaria in migrants.
Topics: Animals; Humans; Parasites; Prevalence; Transients and Migrants; Cross-Sectional Studies; Prospective Studies; Retrospective Studies; Malaria; Asymptomatic Infections
PubMed: 37739263
DOI: 10.1016/j.cmi.2023.09.010 -
Plant Physiology and Biochemistry : PPB Nov 2023Microplastics (MPx) and nanoplastics (NPx) are increasingly accumulating in terrestrial ecosystems, heightening concerns about their potential adverse effects on human... (Review)
Review
Microplastics (MPx) and nanoplastics (NPx) are increasingly accumulating in terrestrial ecosystems, heightening concerns about their potential adverse effects on human health via the food chain. Techniques aimed at recovering the most challenging colloidal fractions of MPx and NPx, especially for analytical purposes, are limited. This systematic review emphasises the absence of a universal, efficient, and cost-effective analytical method as the primary hindrance to studying MPx and NPx in soil and plant samples. The study reveals that several methods, including density separation, organic matter removal, and filtration, are utilized to detect MPx or NPx in soil through vibrational spectroscopy and visual identification. Instruments such as Pyrolysis Gas Chromatography Mass Spectrometry (Py-GCMS), Transmission Electron Microscopy (TEM), Scanning Electron Microscopy (SEM), Fourier Transform Infrared (FTIR) Spectroscopy, and fluorescence microscopy are employed to identify MPx and NPx in plant tissue. In extraction procedures, organic solvents and sonication are used to isolate NPx from plant tissues, while Pyrolysis GC-MS quantifies the plastics. SEM and TEM serve to observe and characterize NPx within plant tissues. Additionally, FTIR and fluorescence microscopy are utilized to identify polymers of MPx and NPx based on their spectral characteristics and fluorescence signals. The findings from this review clarify the identification and quantification methods for MPx and NPx in soil and plant systems and provide a comprehensive methodology for assessing MPx/NPx in the environment.
Topics: Humans; Microplastics; Plastics; Soil; Ecosystem; Polymers; Water Pollutants, Chemical
PubMed: 37918078
DOI: 10.1016/j.plaphy.2023.108132 -
Journal of the European Academy of... Aug 2022Several skin diseases are characterized by epidermal alterations affecting epidermal thickness. Reference values of epidermal thickness in healthy humans and knowledge... (Meta-Analysis)
Meta-Analysis Review
Several skin diseases are characterized by epidermal alterations affecting epidermal thickness. Reference values of epidermal thickness in healthy humans and knowledge of possible differences regarding age, sex, skin phototype, and ethnic origin are essential in research and in clinical practice. The objectives of this systematic review were to provide epidermal thickness reference values for healthy human skin and describe possible effects of measurement methods, age, sex, ethnic origin, and skin phototype. A combined search in the databases Medline and Embase, and other sources were conducted. Searches covered a period from 1946 to 3 June 2020. Included studies were primarily observational and interventional studies providing means and spread values of epidermal thickness estimates in healthy humans, with clear reporting of skin area, age, and measurement method, and optional reporting of sex, ethnic origin, and skin phototype. Data were extracted per skin area and pooled in random-effects models. A total of 142 studies were included in the qualitative synthesis and 133 in the meta-analysis. Pooled epidermal thickness estimates were calculated for 37 skin areas. The lowest epidermal thickness of 31.2 (95% CI 27.8-34.6) μm was reported for the penis and the highest of 596.6 (95% CI 443.9-749.3) μm for the plantar aspect of the foot. Differences in epidermal thickness estimates obtained by histology, optical coherence tomography, and laser scanning microscopy were minor. High-frequency ultrasonography produces systematically higher values. The epidermis was thinner in aged skin. Differences between sexes and among ethnic origins were minor. Epidermal thickness reference values are provided for 37 skin areas. In conclusion, the epidermis tends to become thinner by ageing and does not seem to be influenced by sex. Histology, optical coherence tomography, and laser scanning microscopy might be used interchangeably to measure epidermal thickness, whereas high-frequency ultrasound should not be used.
Topics: Aged; Epidermal Cells; Epidermis; Humans; Male; Skin; Skin Aging; Tomography, Optical Coherence
PubMed: 35366353
DOI: 10.1111/jdv.18123 -
Journal of Fungi (Basel, Switzerland) Dec 2022Accurately diagnosing onychomycosis is vital, as therapy is time-consuming and accompanied by multiple adverse effects. Reflectance confocal microscopy (RCM), in... (Review)
Review
Accurately diagnosing onychomycosis is vital, as therapy is time-consuming and accompanied by multiple adverse effects. Reflectance confocal microscopy (RCM), in contrast to traditional mycological testing, is a noninvasive, point-of-care tool that can rapidly identify fungal lesions. This systematic review aims to understand the utility of RCM in evaluating onychomycosis and follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search of four databases was conducted. A total of five articles-three prospective cohort studies and two case reports-which reported RCM findings in nails clinically suspicious for onychomycosis were analyzed. Fungal hyphae or spores were visualized on RCM in 67 (81.7%) of the 82 mycologically confirmed cases of onychomycosis. Terms used to describe hyphae included bright, linear, lengthy, thready-like, branching and filamentous. Spores were described as bright, roundish structures with high reflection. The three cohort studies demonstrated RCM had a sensitivity of 52.9-91.7, a specificity of 57.58-90.2%, a positive predictive value of 61.1-88.6% and a negative predictive value of 68.0-90.5%. In conclusion, existing studies demonstrate how RCM can assist the diagnosis of onychomycosis at the bedside. Larger studies incorporating multiple testing modalities to confirm the diagnosis of onychomycosis are warranted to further explore the diagnostic utility of RCM.
PubMed: 36547605
DOI: 10.3390/jof8121272 -
Journal of Clinical Medicine Sep 2019Basal cell carcinoma (BCC) is the most common cancer worldwide and its incidence is constantly rising. Early diagnosis and treatment can significantly reduce patient... (Review)
Review
Basal cell carcinoma (BCC) is the most common cancer worldwide and its incidence is constantly rising. Early diagnosis and treatment can significantly reduce patient morbidity and healthcare costs. The value of reflectance confocal microscopy (RCM) in non-melanoma skin cancer diagnosis is still under debate. This systematic review and meta-analysis were conducted to assess the diagnostic accuracy of RCM in primary BCC. PubMed, Google Scholar, Scopus, and Web of Science databases were searched up to July 05, 2019, to collect articles concerning primary BCC diagnosis through RCM. The studies' methodological quality was assessed by the QUADAS-2 tool. The meta-analysis was conducted using Stata 13.0, RevMan 5.0, and MetaDisc 1.4 software. We included 15 studies totaling a number of 4163 lesions. The pooled sensitivity and specificity were 0.92 (95% CI, 0.87-0.95; I= 85.27%) and 0.93 (95% CI, 0.85-0.97; I= 94.61%), the pooled positive and negative likelihood ratios were 13.51 (95% CI, 5.8-31.37; I= 91.01%) and 0.08 (95% CI, 0.05-0.14; I= 84.83%), and the pooled diagnostic odds ratio was 160.31 (95% CI, 64.73-397.02; I=71%). Despite the heterogeneity and risk of bias, this study demonstrates that RCM, through its high sensitivity and specificity, may have a significant clinical impact on the diagnosis of primary BCC.
PubMed: 31540342
DOI: 10.3390/jcm8091462