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Frontiers in Immunology 2024Poisoning by widow-spider (genus ) bites occurs worldwide. The illness, termed latrodectism, can cause severe and persistent pain and can lead to muscle rigidity,...
Poisoning by widow-spider (genus ) bites occurs worldwide. The illness, termed latrodectism, can cause severe and persistent pain and can lead to muscle rigidity, respiratory complications, and cardiac problems. It is a global health challenge especially in developing countries. Equine serum-derived polyclonal anti-sera are commercially available as a medication for patients with latrodectism, but the use of sera imposes potential inherent risks related to its animal origin. The treatment may cause allergic reactions in humans (serum sickness), including anaphylactic shock. Furthermore, equine-derived antivenom is observed to have batch-to-batch variability and poor specificity, as it is always an undefined mix of antibodies. Because latrodectism can be extremely painful but is rarely fatal, the use of antivenom is controversial and only a small fraction of patients is treated. In this work, recombinant human antibodies were selected against alpha-latrotoxin of the European black widow () by phage display from a naïve antibody gene library. Alpha-Latrotoxin (α-LTX) binding scFv were recloned and produced as fully human IgG. A novel alamarBlue assay for venom neutralization was developed and used to select neutralizing IgGs. The human antibodies showed neutralization efficacy both as single antibodies and antibody combinations. This was also confirmed by electrophysiological measurements of neuronal activity in cell culture. The best neutralizing antibodies showed nanomolar affinities. Antibody MRU44-4-A1 showed outstanding neutralization efficacy and affinity to α-LTX. Interestingly, only two of the neutralizing antibodies showed cross-neutralization of the venom of the Southern black widow (). This was unexpected, because in the current literature the alpha-latrotoxins are described as highly conserved. The here-engineered antibodies are candidates for future development as potential therapeutics and diagnostic tools, as they for the first time would provide unlimited supply of a chemically completely defined drug of constant quality and efficacy, which is also made without the use of animals.
Topics: Humans; Animals; Black Widow Spider; Antibodies, Neutralizing; Spider Venoms; Antivenins; Single-Chain Antibodies; Spider Bites; Immunoglobulin G
PubMed: 38933276
DOI: 10.3389/fimmu.2024.1407398 -
International Journal of Environmental... May 2024We aim to investigate the relationships between the population characteristics of patients with Alzheimer's Disease (AD) and their Healthcare Utilization (HU) during the...
We aim to investigate the relationships between the population characteristics of patients with Alzheimer's Disease (AD) and their Healthcare Utilization (HU) during the COVID-19 pandemic. Electronic health records (EHRs) were utilized. The study sample comprised those with ICD-10 codes G30.0, G30.1, G30.8, and G30.9 between 1 January 2020 and 31 December 2021. Pearson's correlation and multiple regression were used. The analysis utilized 1537 patient records with an average age of 82.20 years (SD = 7.71); 62.3% were female. Patients had an average of 1.64 hospitalizations (SD = 1.18) with an average length of stay (ALOS) of 7.45 days (SD = 9.13). Discharge dispositions were primarily home (55.1%) and nursing facilities (32.4%). Among patients with multiple hospitalizations, a negative correlation was observed between age and both ALOS (r = -0.1264, = 0.0030) and number of hospitalizations (r = -0.1499, = 0.0004). Predictors of longer ALOS included male gender ( = 0.0227), divorced or widowed ( = 0.0056), and the use of Medicare Advantage and other private insurance ( = 0.0178). Male gender ( = 0.0050) and Black race ( = 0.0069) were associated with a higher hospitalization frequency. We recommend future studies including the co-morbidities of AD patients, larger samples, and longitudinal data.
Topics: Humans; COVID-19; Female; Male; Alzheimer Disease; Hospitalization; Aged; Aged, 80 and over; SARS-CoV-2; Electronic Health Records; Length of Stay; Pandemics; Data Analysis; United States; Secondary Data Analysis
PubMed: 38928949
DOI: 10.3390/ijerph21060703 -
Health Science Reports Jun 2024Marital status has been shown to be associated with mortality, but evidence in critically ill elder intensive care unit (ICU) patients with cerebrovascular diseases...
BACKGROUND AND AIMS
Marital status has been shown to be associated with mortality, but evidence in critically ill elder intensive care unit (ICU) patients with cerebrovascular diseases (CeVD) is limited. This study was to explore the correlation between marital status and the prognosis of patients with CeVD aged 65 years and over in the ICU.
METHODS
In the present study, 3564 patients were enrolled in the Medical Information Mart for Intensive Care IV database (version 2.2). Patients were divided into four groups based on marital status: married, single, divorced, and widowed. The primary outcome was all-cause mortality as patients were followed up for 3-, 6-, 9-, and 12-month. All-cause mortality risk for patients with different marital status was compared. Univariate and multivariable logistic regression analyses, survival curves and stratified analyses were performed to determine the correlation between marital status and mortality in critically ill patients with CeVD aged ≥65 years.
RESULTS
Of the patients, 51.2% (1825/3564) were married, followed by 23.8% (847/3564) were widowed, 18.2% (647/3564) were single, and 6.9% (245/3567) were divorced. Compared with the married, the unmarried had a higher proportion of female ( < 0.001), older ( < 0.001), and less proportion of mechanical ventilation ( = 0.045). Multivariate analyses showed that no differences were observed for mortality risk among different marital statuses ( > 0.05), while at late follow-up, widowed had a significance higher mortality risk than the married (9-month: odds ratio [OR]: 1.30, 95% confidence interval [CI]: 1.05-1.61, = 0.02; 12-month: OR: 1.38, 95% CI: 1.12-1.71, = 0.003). Stratified analyses indicated a stable correlation between marital status and 12-month mortality rate in sub-analysis for gender ( = 0.46) and age ( = 0.35).
CONCLUSION
Marital status is associated with long-term prognosis in older patients with CeVD admitted to ICU. Widowed people should receive more societal attention irrespective of sex or age.
PubMed: 38915359
DOI: 10.1002/hsr2.2177 -
Cureus May 2024Loneliness is often associated with behavioral, psychological, social, and mental and physical health aspects, while the relationship between trust and loneliness is...
INTRODUCTION
Loneliness is often associated with behavioral, psychological, social, and mental and physical health aspects, while the relationship between trust and loneliness is still challenging in terms of research. The present study aimed to investigate to what extent loneliness and trust interact and if there is any association between loneliness and routine events or behaviors that affect overall well-being.
METHODS
This cross-sectional sample of 120 participants, aged between 40 and 75 years, was collected from an urban Primary Health Care Unit, between May and July 2023, in a consecutive manner, after criteria application. The University of California, Los Angeles (UCLA) Loneliness Scale (Version 3) and the Personal Trust and Connections Scale (PerTC) were completed. Hierarchical multiple linear regression analysis in steps and multiple logistic regression analysis were performed.
RESULTS
The mean age of the participants was 59.8 years and the majority were females (73.3%). Only 10.8% were found to have no Behavioral Risk Factors (BRFs). A higher sense of loneliness was associated with being widowed/unmarried/divorced (unstandardized β=-4.10, p=0.045), not having children (β=-2.80, p=0.038), having more BRFs (β=2.03, p=0.032), or being in contact with fewer friends (β=-0.56, p<0.001). A higher sense of loneliness was related to lower levels of trust (β=-1.29, p=0.032). Lower odds of demonstrating high levels of loneliness were found among married individuals (odds ratio (OR): 0.38; 95% confidence interval (CI) 0.15, 0.95; p=0.039) and those who reported six or more routine contacts or meetings with friends (OR: 0.31; 95% CI 0.13, 0.74; p=0.008). A lower score on the total PerTC scale was related to higher odds of increased loneliness (OR: 2.78; 95%CI 1.01, 7.62; p=0.048).
CONCLUSION
Being married and coming in contact or meeting with more friends was associated with lower odds of reporting high feelings of loneliness, while lower trust was correlated with increased odds of loneliness. Also, persons with more BRFs were found to have a higher loneliness score. Given their inverse correlation, tools that measure levels of loneliness and trust, like the UCLA and PerTC scales, may be used within primary care consultation to offer new insights on health risk behaviors and their possible synergistic influences.
PubMed: 38910642
DOI: 10.7759/cureus.61019 -
Global Health Action Dec 2024Mauritius has implemented a range of stringent policies to control smoking and promote public health. Regular monitoring focuses on the prevalence of tobacco use, yet...
BACKGROUND
Mauritius has implemented a range of stringent policies to control smoking and promote public health. Regular monitoring focuses on the prevalence of tobacco use, yet there is a gap in understanding its socio-economic patterns.
OBJECTIVE
The aim of this study was to estimate the prevalence of tobacco smoking and to identify the social determinants associated with smoking among men in Mauritius in 2021.
METHODS
This is a cross-sectional population-based study conducted by the Ministry of Health and Wellness during 2021. In total, 3622 individuals participated (response rate of 84.1%), of which 1663 were men (45.9%). The study mainly focused on men given the low prevalence of smoking among women. Daily smoking was the outcome and a series of sociodemographic and socioeconomic factors were included as independent variables. Prevalence ratios (PR) and their 95% confidence intervals (95% CI) were estimated to fulfill the study objective.
RESULTS
The prevalence of smoking among men was 30.4%. People in the 25-34 age group (PR = 1.65; 95% CI: 1.12-2.41), those separated, divorced or widowed (PR = 1.57; 95% CI: 1.16-2.11), the ethnic groups Muslim-Mauritians (PR = 1.70; 95% CI: 1.00-2.89) and Creoles (PR = 1.97; 95% CI: 1.16-3.35), and those with secondary (PR = 1.29; 95% CI: 1.00-1.67) and primary education (PR = 1.47; 95% CI: 1.10-1.98) were statistically significantly associated with daily smoking.
CONCLUSIONS
Although a gradual decline in smoking prevalence was observed compared with the previous 2015 survey, the Ministry of Health and Wellness should persist in fortifying its anti-smoking measures and concentrate on crafting tailored interventions aimed at the vulnerable groups identified in this study.
Topics: Humans; Cross-Sectional Studies; Male; Adult; Mauritius; Prevalence; Middle Aged; Social Determinants of Health; Young Adult; Smoking; Socioeconomic Factors; Female; Adolescent; Sociodemographic Factors
PubMed: 38899339
DOI: 10.1080/16549716.2024.2367415 -
BioRxiv : the Preprint Server For... Jun 2024While there is extensive information about sperm nuclear basic proteins (SNBP) in vertebrates, there is very little information about Arthropoda by comparison. This...
While there is extensive information about sperm nuclear basic proteins (SNBP) in vertebrates, there is very little information about Arthropoda by comparison. This paper aims to contribute to filling this gap by analyzing these proteins in the sperm of the noble false widow spider (Order Araneae, Family Theridiidae). To this end, we have developed a protein extraction method that allows the extraction of cysteine-containing protamines suitable for the preparation and analysis of SNBPs from samples where the amount of starting tissue material is limited. We carried out top-down mass spectrometry sequencing and molecular phylogenetic analyses to characterize the protamines of and other spiders. We also used electron microscopy to analyze the chromatin organization of the sperm, and we found it to exhibit liquid-liquid phase spinodal decomposition during the late stages of spermiogenesis. These studies further our knowledge of the distribution of SNBPs within the animal kingdom and provide additional support for a proposed evolutionary origin of many protamines from a histone H1 (H5) replication-independent precursor.
PubMed: 38895387
DOI: 10.1101/2024.06.04.597381 -
JAMA Network Open Jun 2024Older adults are particularly vulnerable to loneliness and its physical and psychosocial sequelae, but scalable interventions are lacking, especially during disasters... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Older adults are particularly vulnerable to loneliness and its physical and psychosocial sequelae, but scalable interventions are lacking, especially during disasters such as pandemics.
OBJECTIVE
To compare the effects of layperson-delivered, telephone-based behavioral activation and mindfulness interventions vs telephone-based befriending on loneliness among at-risk older adults.
DESIGN, SETTING, AND PARTICIPANTS
This assessor-blinded, 3-arm randomized clinical trial screened Chinese older adults through household visits and community referrals from April 1, 2021, to April 30, 2023, in Hong Kong. Eligible participants (≥65 years of age) who were lonely, digitally excluded, living alone, and living below the poverty line and provided consent to participate were randomized into behavioral activation, mindfulness, and befriending groups. Assessments were conducted at baseline, 1 month, and 3 months.
INTERVENTION
As part of the Helping Alleviate Loneliness in Hong Kong Older Adults (HEAL-HOA) dual randomized clinical trial, 148 older laypersons were trained to deliver a twice-weekly 30-minute intervention via telephone for 4 weeks.
MAIN OUTCOMES AND MEASURES
The primary outcome was loneliness measured by the UCLA Loneliness Scale (range, 20-80) and the De Jong Gierveld Loneliness Scale (range, 0-6), with higher scores on both scales indicating greater loneliness. Secondary outcomes were depression, perceived stress, life satisfaction, psychological well-being, sleep quality, perceived social support, and social network.
RESULTS
A total of 1151 participants (mean [SD] age, 76.6 [7.8] years; 843 [73.2%] female) were randomized to the behavioral activation (n = 335), mindfulness (n = 460) or befriending (n = 356) group. Most were widowed or divorced (932 [81.0%]), had primary education or below (782 [67.9%]), and had 3 or more chronic diseases (505 [43.9%]). Following intention-to-treat principles, linear mixed-effects regression model analyses showed that loneliness measured by the UCLA Loneliness Scale was significantly reduced in the behavioral activation group (mean difference [MD], -1.96 [95% CI, -3.16 to -0.77] points; P < .001]) and in the mindfulness group (MD, -1.49 [95% CI, -2.60 to -0.37] points; P = .004) at 3 months compared with befriending. Loneliness measured by the De Jong Gierveld Loneliness Scale was not significantly reduced at 3 months in the behavioral activation group (MD, -0.06 [95% CI, -0.26 to 0.13] points; P > .99]) but was in the mindfulness group (MD, 0.22 [95% CI, 0.03 to 0.40] points; P = .01) at 3 months compared with befriending. In the behavioral activation and mindfulness groups, sleep quality improved compared with befriending, but perceived stress increased. Psychological well-being and perceived social support improved in the behavioral activation group. No statistically significant between-group differences were observed in depression, life satisfaction, or social network.
CONCLUSION AND RELEVANCE
In this randomized clinical trial, scalable psychosocial interventions delivered remotely by older laypersons appeared promising in reducing later life loneliness and addressing the pressing mental health challenges faced by aging populations and professional geriatric mental health workforce shortages. Further research should explore ways to maximize the clinical relevance and cost-effectiveness of these interventions.
TRIAL REGISTRATION
Chinese Clinical Trial Registry Identifier: ChiCTR2300072909.
Topics: Humans; COVID-19; Female; Aged; Male; Loneliness; Hong Kong; Telephone; Poverty; Mindfulness; SARS-CoV-2; Pandemics; Aged, 80 and over
PubMed: 38888923
DOI: 10.1001/jamanetworkopen.2024.16767 -
PloS One 2024Non-traumatic orthopedic conditions are pathological conditions involving musculoskeletal system that includes muscles, tendons, bone and joints and associated with...
Non-traumatic orthopedic conditions are pathological conditions involving musculoskeletal system that includes muscles, tendons, bone and joints and associated with frequent medical and surgical care and high treatment costs. There is paucity of information on the pattern of non-traumatic orthopedic conditions in low and middle income countries. The purpose of this study was to determine the epidemiology of non-traumatic orthopedic conditions among inpatients at the Kenyatta National Hospital in Kenya. This was a cross-sectional study with a sample of 175 charts reviewed. Approximately, 70.3% of the inpatients were aged between 25 to 64 years of age with the mean age of 39.97 years (STD 18.78). Ever married tended to be older 53.5 (95% CI: 46.8-60.2) years than other marital statuses. Approximately, 60.6% were males, 38.9% had comorbidities and 49.1% were casuals or unemployed. All inpatients were Kenyans with Nairobi County comprising 52.6% of all inpatients. Approximately, 77.7% were self-referrals. The commonest non-trauma orthopaedic conditions were infection and non-union (35.4%) and spinal degenerative diseases (20.60%) and the least was limb deformities (1.70%). Compared to females, males were 3.703 (p<0.001) times more likely to have infection and non-union. Patients with primary, secondary and tertiary education were 88.2% (p<0.001), 75.6% (p<0.001) and 68.1% (p = 0.016) less likely to have infection and non-union compared to those with no or preschool education. Widows were 8.500 (p = 0.028) times more likely to have spinal degenerative disease than married. Males were 70.8% (p = 0.031) less likely to have osteoarthritis than females. Inpatients with secondary education were 5.250 (p = 0.040) times more likely to have osteoarthritis than those with no or preschool education. In conclusion, majority of inpatients were young and middle aged adults. Infection and non-union and spinal degenerative diseases were the most common non-trauma orthopedic conditions. While males and those with low education were more likely to have infection and non-union, married were more likely to have spinal degenerative disease. Osteoarthritis was more likely among female admissions.
Topics: Humans; Kenya; Male; Female; Adult; Middle Aged; Cross-Sectional Studies; Inpatients; Tertiary Care Centers; Young Adult; Hospitals, Teaching; Adolescent; Aged; Musculoskeletal Diseases; Referral and Consultation
PubMed: 38885257
DOI: 10.1371/journal.pone.0303898 -
Cureus May 2024Multidrug-resistant tuberculosis (MDR-TB) patients experience disproportionately worse mental health, with implications for adherence, outcomes, and families....
BACKGROUND
Multidrug-resistant tuberculosis (MDR-TB) patients experience disproportionately worse mental health, with implications for adherence, outcomes, and families. Comprehensive assessments of comorbid depression/anxiety and related factors remain limited.
OBJECTIVE
This study aimed to assess the prevalence, predictors, and qualitative experiences of depression and anxiety in MDR-TB patients and household contacts.
METHODS
A sequential explanatory mixed methods study was conducted in Gujarat, India, with 403 smear-positive MDR-TB patients and 403 contacts. The quantitative phase administered structured questionnaires on sociodemographic factors, clinical history, depression/anxiety symptoms, and psychosocial stressors (like stigma and social support). Logistic regression models were used. The qualitative phase included in-depth interviews with 30 purposively sampled patients for thematic content analysis. Results were integrated to contextualize quantitative findings.
RESULTS
High rates of depression (37.5%, n = 151) and anxiety (45.2%, n = 182) were documented among the MDR-TB patients, significantly greater than household contacts (20.1%, n = 81 and 25.1%, n = 101, respectively). For depression, older age (adjusted odds ratio (AOR) 2.03, 95% CI 1.01-4.05), female gender (AOR 2.5, 95% CI 1.1-6.0), divorced/widowed status (AOR 3.8, 95% CI 1.1-8.0), financial constraints, substance abuse (AOR 1.7, 95% CI 1.1-2.7), greater disease severity (AOR 1.8, 95% CI 1.5-2.2), medication side effects (AOR 2.4, 95% CI 1.2-4.6), and perceived stigma (AOR 3.2, 95% CI 1.1-5.3) emerged as significant risk factors. For anxiety, significant predictors were less social support (AOR 0.81, 95% CI 0.71-0.86), higher perceived stigma (AOR 2.2, 95% CI 1.1-6.3), greater disease severity (AOR 2.6, 95% CI 1.3-4.0), and more medication side effects (AOR 3.3, 95% CI 1.1-5.5). Prominent themes included psychological impacts like depression and anxiety, experiences of stigma and caretaking challenges, and recommendations for comprehensive patient support services.
CONCLUSION
MDR-TB patients experience a substantially higher dual disease burden of depression and anxiety, elevating the risk for adverse outcomes and transmission. Improving psychosocial support is vital to patient-centric care pathways for vulnerable groups. Mixed methods provide comprehensive evidence to inform integrated physical and mental health services.
PubMed: 38883116
DOI: 10.7759/cureus.60412 -
Journal of Infection in Developing... May 2024Patients who recovered from the acute phase of COVID-19 experience several post-COVID-19 health and social problems. This study was therefore done to explore the living...
INTRODUCTION
Patients who recovered from the acute phase of COVID-19 experience several post-COVID-19 health and social problems. This study was therefore done to explore the living experiences and the various health problems experienced by people and their determinants during the post-recovery phase of COVID-19.
METHODOLOGY
This cross-sectional study was conducted in Mangalore in March 2022. Data were collected using a semi-structured questionnaire designed as a Google Doc. Post-COVID-19 conditions were defined as adverse health consequences returning, new, or persistent beyond 1 month after SARS-CoV-2 infection. The experiences in the post-recovery phase of COVID-19 were assessed based on a scoring system for the related items in the questionnaire.
RESULTS
Out of 235 participants, 204 (86.8%) reported post-COVID-19 health problems between 1 and 6 months following SARS-CoV-2 infection. The majority of them reported fatigue [114 (55.9%)]. Self-perceived health status and social relationships were significantly poorer among participants in the post-COVID-19 phase than before infection. In the multivariable analysis, unmarried/divorced/widow status, staying within city limits, and history of being admitted to the hospital due to various COVID-19-related emergencies were independently associated with the presence of post-COVID-19 conditions among the participants. The living experience in the post-recovery phase was positive only among 22 (9.4%) participants and was found to be significantly associated with the severe status of COVID-19 at the time of disease presentation.
CONCLUSIONS
Post-COVID-19 health problems were present among several participants. Those identified to be at risk of developing these conditions need to be periodically screened and managed with a multi-disciplinary care and rehabilitation program. There is also a need to address social problems and encourage positive living experiences among COVID-19 patients during the post-recovery phase of the disease.
Topics: Humans; COVID-19; India; Cross-Sectional Studies; Female; Male; Adult; Middle Aged; Surveys and Questionnaires; SARS-CoV-2; Young Adult; Health Status; Aged; Adolescent
PubMed: 38865406
DOI: 10.3855/jidc.17945