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Viruses May 2024HIV case finding is an essential component for ending AIDS, but there is limited evidence on the effectiveness of such a strategy in the pediatric population. We sought...
Strategic HIV Case Findings among Infants at Different Entry Points of Health Facilities in Cameroon: Optimizing the Elimination of Mother-To-Child Transmission in Low- and- Middle-Income Countries.
BACKGROUND
HIV case finding is an essential component for ending AIDS, but there is limited evidence on the effectiveness of such a strategy in the pediatric population. We sought to determine HIV positivity rates among children according to entry points in Cameroon.
METHODS
A facility-based survey was conducted from January 2015 to December 2019 among mother-child couples at various entry points of health facilities in six regions of Cameroon. A questionnaire was administered to parents/guardians. Children were tested by polymerase chain reaction (PCR). Positivity rates were compared between entry points. Associations were quantified using the unadjusted positivity ratio (PR) for univariate analyses and the adjusted positivity ratio (aPR) for multiple Poisson regression analyses with 95% confidence intervals (CIs). -values < 0.05 were considered significant.
RESULTS
Overall, 24,097 children were enrolled. Among them, 75.91% were tested through the HIV prevention of mother-to-child transmission (PMTCT) program, followed by outpatient (13.27%) and immunization (6.27%) services. In total, PMTCT, immunization, and outpatient services accounted for 95.39% of children. The overall positivity was 5.71%, with significant differences ( < 0.001) between entry points. Univariate analysis showed that inpatient service (PR = 1.45; 95% CI: [1.08, 1.94]; = 0.014), infant welfare (PR = 0.43; 95% CI: [0.28, 0.66]; < 0.001), immunization (PR = 0.56; 95% CI: [0.45, 0.70]; < 0.001), and PMTCT (PR = 0.41; 95% CI: [0.37, 0.46]; < 0.001) were associated with HIV transmission. After adjusting for other covariates, only PMTCT was associated with transmission (aPR = 0.66; 95% CI: [0.51, 0.86]; = 0.002).
CONCLUSIONS
While PMTCT accounts for most tested children, high HIV positivity rates were found among children presenting at inpatient, nutrition, and outpatient services and HIV care units. Thus, systematic HIV testing should be proposed for all sick children presenting at the hospital who have escaped the PMTCT cascade.
Topics: Humans; Cameroon; Infectious Disease Transmission, Vertical; HIV Infections; Female; Infant; Male; Health Facilities; Surveys and Questionnaires; Pregnancy; Child, Preschool; Infant, Newborn; Adult; Developing Countries; Mothers
PubMed: 38793633
DOI: 10.3390/v16050752 -
Respiratory Research May 2024Large-scale estimates of bronchopulmonary dysplasia (BPD) are warranted for adequate prevention and treatment. However, systematic approaches to ascertain rates of BPD... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Large-scale estimates of bronchopulmonary dysplasia (BPD) are warranted for adequate prevention and treatment. However, systematic approaches to ascertain rates of BPD are lacking.
OBJECTIVE
To conduct a systematic review and meta-analysis to assess the prevalence of BPD in very low birth weight (≤ 1,500 g) or very low gestational age (< 32 weeks) neonates.
DATA SOURCES
A search of MEDLINE from January 1990 until September 2019 using search terms related to BPD and prevalence was performed.
STUDY SELECTION
Randomized controlled trials and observational studies evaluating rates of BPD in very low birth weight or very low gestational age infants were eligible. Included studies defined BPD as positive pressure ventilation or oxygen requirement at 28 days (BPD28) or at 36 weeks postmenstrual age (BPD36).
DATA EXTRACTION AND SYNTHESIS
Two reviewers independently conducted all stages of the review. Random-effects meta-analysis was used to calculate the pooled prevalence. Subgroup analyses included gestational age group, birth weight group, setting, study period, continent, and gross domestic product. Sensitivity analyses were performed to reduce study heterogeneity.
MAIN OUTCOMES AND MEASURES
Prevalence of BPD defined as BPD28, BPD36, and by subgroups.
RESULTS
A total of 105 articles or databases and 780,936 patients were included in this review. The pooled prevalence was 35% (95% CI, 28-42%) for BPD28 (n = 26 datasets, 132,247 neonates), and 21% (95% CI, 19-24%) for BPD36 (n = 70 studies, 672,769 neonates). In subgroup meta-analyses, birth weight category, gestational age category, and continent were strong drivers of the pooled prevalence of BPD.
CONCLUSIONS AND RELEVANCE
This study provides a global estimation of BPD prevalence in very low birth weight/low gestation neonates.
Topics: Humans; Bronchopulmonary Dysplasia; Infant, Newborn; Infant, Very Low Birth Weight; Prevalence; Randomized Controlled Trials as Topic; Observational Studies as Topic
PubMed: 38790002
DOI: 10.1186/s12931-024-02850-x -
Journal of Fungi (Basel, Switzerland) May 2024The United Arab Emirates has very little data on the incidence or prevalence of fungal diseases. Using total and underlying disease risk populations and likely affected...
The United Arab Emirates has very little data on the incidence or prevalence of fungal diseases. Using total and underlying disease risk populations and likely affected proportions, we have modelled the burden of fungal disease for the first time. The most prevalent serious fungal conditions are recurrent vulvovaginitis (~190,000 affected) and fungal asthma (~34,000 affected). Given the UAE's low prevalence of HIV, we estimate an at-risk population of 204 with respect to serious fungal infections with cryptococcal meningitis estimated at 2 cases annually, 15 cases of pneumonia (PCP) annually, and 20 cases of esophageal candidiasis in the HIV population. PCP incidence in non-HIV patients is estimated at 150 cases annually. Likewise, with the same low prevalence of tuberculosis in the country, we estimate a total chronic pulmonary aspergillosis prevalence of 1002 cases. The estimated annual incidence of invasive aspergillosis is 505 patients, based on local data on rates of malignancy, solid organ transplantation, and chronic obstructive pulmonary disease (5.9 per 100,000). Based on the 2022 annual report of the UAE's national surveillance database, candidaemia annual incidence is 1090 (11.8/100,000), of which 49.2% occurs in intensive care. Fungal diseases affect ~228,695 (2.46%) of the population in the UAE.
PubMed: 38786708
DOI: 10.3390/jof10050353 -
Journal of Education and Health... 2024The maintenance of oral hygiene and subsequent health related issues in visually handicapped children is a challenging task. Hence, tools must be used to ensure good...
BACKGROUND
The maintenance of oral hygiene and subsequent health related issues in visually handicapped children is a challenging task. Hence, tools must be used to ensure good oral health in these children. The study aimed to analyze the effectiveness of preventive programs on oral health using specialized audio and tactile aids in visually impaired school children.
MATERIALS AND METHODS
100 visually handicapped children were selected for the study. They were divided into two groups: Group A (Training using Braille) and Group B (training by means of audio aids). Children were trained using appropriate tools and oral health was assessed using Plaque and Gingival bleeding indices.
STATISTICAL ANALYSIS
Independent 'T-test' was used for comparing mean ± SD values.
RESULTS
Statistically significant improvements in both plaque and gingival bleeding indices were obtained on follow-up observations at 3 and 6 months.
CONCLUSION
The use of specialized tactile and audio tools significantly improved the oral health status of visually impaired school children.
PubMed: 38784276
DOI: 10.4103/jehp.jehp_641_23 -
International Journal of Surgery Case... Jun 2024Gastrointestinal stromal tumors (GISTs) represent a unique subset of neoplasms within the digestive tract. They can manifest in various organs throughout the digestive...
INTRODUCTION
Gastrointestinal stromal tumors (GISTs) represent a unique subset of neoplasms within the digestive tract. They can manifest in various organs throughout the digestive tract, ranging from the oral cavity to the anus, with a predilection for the stomach and small intestine. A distinct subtype of GISTs, known as Extra-gastrointestinal stromal tumors (EGISTs), originate outside the typical GIST organs such as the mesentery, retroperitoneum, and occasionally the omentum. EGISTs are relatively rare, accounting for <5 % of all GIST cases.
PRESENTATION OF CASE
We present the case of a 30-year-old female patient who presented with an upper abdominal mass associated with anorexia, fever, and weakness. Radiographic imaging revealed a cystic mass beneath the left hypochondrium. Exploratory laparoscopy confirmed the presence of an isolated mass adherent to the gastrocolic ligament and greater omentum. Histopathological examination confirmed GIST, characterized by spindle-shaped cells with DOG1 and CD117/C-kit expression. The patient underwent successful tumor resection and was discharged home with postoperative imatinib therapy. Follow-up at 14 months showed no recurrence.
DISCUSSION
The rarity of Gastrointestinal Stromal Tumors (GISTs) in the Greater Omentum highlights diagnostic challenges and underscores the need for further research. Immunohistochemical analysis aids in diagnosis, with Ki-67 staining indicating a high-risk classification. Surgery remains the primary treatment, with potential adjuvant therapy utilizing Imatinib mesylate.
CONCLUSION
Our case underscores the rare occurrence of GIST in the Greater Omentum. Despite their infrequency, EGISTs should be considered in intra-abdominal masses, emphasizing accurate diagnosis for appropriate management and the need for further research.
PubMed: 38781841
DOI: 10.1016/j.ijscr.2024.109793 -
JAMA Network Open May 2024SARS-CoV-2 viral load (VL) in the nasopharynx is difficult to quantify and standardize across settings, but it may inform transmission potential and disease severity.
IMPORTANCE
SARS-CoV-2 viral load (VL) in the nasopharynx is difficult to quantify and standardize across settings, but it may inform transmission potential and disease severity.
OBJECTIVE
To characterize VL at COVID-19 diagnosis among previously uninfected and unvaccinated individuals by evaluating the association of demographic and clinical characteristics, viral variant, and trial with VL, as well as the ability of VL to predict severe disease.
DESIGN, SETTING, AND PARTICIPANTS
This secondary cross-protocol analysis used individual-level data from placebo recipients from 4 harmonized, phase 3 COVID-19 vaccine efficacy trials sponsored by Moderna, AstraZeneca, Janssen, and Novavax. Participants were SARS-CoV-2 negative at baseline and acquired COVID-19 during the blinded phase of the trials. The setting included the US, Brazil, South Africa, Colombia, Argentina, Peru, Chile, and Mexico; start dates were July 27, 2020, to December 27, 2020; data cutoff dates were March 26, 2021, to July 30, 2021. Statistical analysis was performed from November 2022 to June 2023.
MAIN OUTCOMES AND MEASURES
Linear regression was used to assess the association of demographic and clinical characteristics, viral variant, and trial with polymerase chain reaction-measured log10 VL in nasal and/or nasopharyngeal swabs taken at the time of COVID-19 diagnosis.
RESULTS
Among 1667 participants studied (886 [53.1%] male; 995 [59.7%] enrolled in the US; mean [SD] age, 46.7 [14.7] years; 204 [12.2%] aged 65 years or older; 196 [11.8%] American Indian or Alaska Native, 150 [9%] Black or African American, 1112 [66.7%] White; 762 [45.7%] Hispanic or Latino), median (IQR) log10 VL at diagnosis was 6.18 (4.66-7.12) log10 copies/mL. Participant characteristics and viral variant explained only 5.9% of the variability in VL. The independent factor with the highest observed differences was trial: Janssen participants had 0.54 log10 copies/mL lower mean VL vs Moderna participants (95% CI, 0.20 to 0.87 log10 copies/mL lower). In the Janssen study, which captured the largest number of COVID-19 events and variants and used the most intensive post-COVID surveillance, neither VL at diagnosis nor averaged over days 1 to 28 post diagnosis was associated with COVID-19 severity.
CONCLUSIONS AND RELEVANCE
In this study of placebo recipients from 4 randomized phase 3 trials, high variability was observed in SARS-CoV-2 VL at the time of COVID-19 diagnosis, and only a fraction was explained by individual participant characteristics or viral variant. These results suggest challenges for future studies of interventions seeking to influence VL and elevates the importance of standardized methods for specimen collection and viral load quantitation.
Topics: Humans; COVID-19; Nasopharynx; Viral Load; Male; SARS-CoV-2; Female; Adult; Middle Aged; COVID-19 Vaccines; Randomized Controlled Trials as Topic; United States; Aged
PubMed: 38780941
DOI: 10.1001/jamanetworkopen.2024.12835 -
BMC Pediatrics May 2024Genetic disorders significantly affect patients in neonatal intensive care units, where establishing a diagnosis can be challenging through routine tests and... (Observational Study)
Observational Study
BACKGROUND
Genetic disorders significantly affect patients in neonatal intensive care units, where establishing a diagnosis can be challenging through routine tests and supplementary examinations. Whole-exome sequencing offers a molecular-based approach for diagnosing genetic disorders. This study aimed to assess the importance of whole-exome sequencing for neonates in intensive care through a retrospective observational study within a Chinese cohort.
METHODS
We gathered data from neonatal patients at Tianjin Children's Hospital between January 2018 and April 2021. These patients presented with acute illnesses and were suspected of having genetic disorders, which were investigated using whole-exome sequencing. Our retrospective analysis covered clinical data, genetic findings, and the correlation between phenotypes and genetic variations.
RESULTS
The study included 121 neonates. Disorders affected multiple organs or systems, predominantly the metabolic, neurological, and endocrine systems. The detection rate for whole-exome sequencing was 52.9% (64 out of 121 patients), identifying 84 pathogenic or likely pathogenic genetic variants in 64 neonates. These included 13 copy number variations and 71 single-nucleotide variants. The most frequent inheritance pattern was autosomal recessive (57.8%, 37 out of 64), followed by autosomal dominant (29.7%, 19 out of 64). In total, 40 diseases were identified through whole-exome sequencing.
CONCLUSION
This study underscores the value and clinical utility of whole-exome sequencing as a primary diagnostic tool for neonates in intensive care units with suspected genetic disorders. Whole-exome sequencing not only aids in diagnosis but also offers significant benefits to patients and their families by providing clarity in uncertain diagnostic situations.
Topics: Humans; Exome Sequencing; Infant, Newborn; Intensive Care Units, Neonatal; Retrospective Studies; Male; Female; China; Genetic Diseases, Inborn; DNA Copy Number Variations; Genetic Testing; East Asian People
PubMed: 38778310
DOI: 10.1186/s12887-024-04820-0 -
Nature Communications May 2024
PubMed: 38778041
DOI: 10.1038/s41467-024-48645-y -
JCI Insight Apr 2024Children with perinatally acquired HIV (PHIV) have special vaccination needs, as they make suboptimal immune responses. Here, we evaluated safety and immunogenicity of 2...
Children with perinatally acquired HIV (PHIV) have special vaccination needs, as they make suboptimal immune responses. Here, we evaluated safety and immunogenicity of 2 doses of 4-component group B meningococcal vaccine in antiretroviral therapy-treated children with PHIV and healthy controls (HCs). Assessments included the standard human serum bactericidal antibody (hSBA) assay and measurement of IgG titers against capsular group B Neisseria meningitidis antigens (fHbp, NHBA, NadA). The B cell compartment and vaccine-induced antigen-specific (fHbp+) B cells were investigated by flow cytometry, and gene expression was investigated by multiplexed real-time PCR. A good safety and immunogenicity profile was shown in both groups; however, PHIV demonstrated a reduced immunogenicity compared with HCs. Additionally, PHIV showed a reduced frequency of fHbp+ and an altered B cell subset distribution, with higher fHbp+ frequency in activated memory and tissue-like memory B cells. Gene expression analyses on these cells revealed distinct mechanisms between PHIV and HC seroconverters. Overall, these data suggest that PHIV presents a diverse immune signature following vaccination. The impact of such perturbation on long-term maintenance of vaccine-induced immunity should be further evaluated in vulnerable populations, such as people with PHIV.
Topics: Humans; HIV Infections; Male; Female; Child; Meningococcal Vaccines; Child, Preschool; Meningococcal Infections; Antibodies, Bacterial; B-Lymphocytes; Infectious Disease Transmission, Vertical; Immunogenicity, Vaccine; Immunoglobulin G
PubMed: 38775152
DOI: 10.1172/jci.insight.177182