Poliovirus excretion among children with primary immune deficiency in Pakistan: a pilot surveillance study protocol

IntroductionChildren with primary immunodeficiency disorders (PID) are more susceptible to developing viral infections and are at a substantially increased risk of developing paralytic poliomyelitis. Such children, if given oral polio vaccines tend to excrete poliovirus chronically that may lead to the propagation of highly divergent vaccine-derived poliovirus (VDPV). Consequently, they may act as a reservoir for the community by introducing an altered virus potentially imposing a risk to global polio eradication. However, the risks of chronic and prolonged excretion are not well characterised in the study context. This study seeks to establish a pilot surveillance system for successful identification and monitoring of VDPV excretion among children with PID. It will assess whether the Jeffrey Modell warning signs of PID can be used as an appropriate screening tool for PID in Pakistan.Methods and analysisIn this pilot surveillance, recruitment of PID cases is currently done at participating hospitals in Pakistan. Potential children are screened and tested against the Jeffrey Modell Foundation (JMF) warning signs for immunodeficiency and their stool is collected to test for poliovirus excretion. Cases excreting poliovirus are followed until the two consecutive negative stool samples are obtained over a period of 6 months. The data will be analysed to calculate hospital-based proportions of total Immunodeficiency-related vaccine-derived poliovirus (iVDPV) cases over a 2-year period and to determine the sensitivity and specificity of the JMF signs.Ethics and disseminationThis protocol was reviewed and approved by the WHO (WHO Reference-2018/811124-0), Aga Khan University (AKU ERC-2018-0380-1029) and National Bioethics Committee (Ref No. 4-87 NBC-308-Y2). The results will be published in an open access peer-reviewed scientific journal and presented to the iVDPV Working Group members, policy-makers, paediatric consultants and fellow researchers with the same domain interest. It may be presented in scientific conferences and seminars in the form of oral or poster presentations.

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Immunological Aspects Related to Viral Infections in Severe Asthma and the Role of Omalizumab

Biomedicines ◽

10.3390/biomedicines9040348 ◽

2021 ◽

Vol 9 (4) ◽

pp. 348

Author(s):

Francesco Menzella ◽

Giulia Ghidoni ◽

Carla Galeone ◽

Silvia Capobelli ◽

Chiara Scelfo ◽

...

Keyword(s):

Innate Immunity ◽

Severe Asthma ◽

Viral Infections ◽

Respiratory Infections ◽

Antiviral Effect ◽

Point Of View ◽

Type I ◽

Effector Cells ◽

Viral Spread ◽

Increased Risk

Viral respiratory infections are recognized risk factors for the loss of control of allergic asthma and the induction of exacerbations, both in adults and children. Severe asthma is more susceptible to virus-induced asthma exacerbations, especially in the presence of high IgE levels. In the course of immune responses to viruses, an initial activation of innate immunity typically occurs and the production of type I and III interferons is essential in the control of viral spread. However, the Th2 inflammatory environment still appears to be protective against viral infections in general and in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections as well. As for now, literature data, although extremely limited and preliminary, show that severe asthma patients treated with biologics don’t have an increased risk of SARS-CoV-2 infection or progression to severe forms compared to the non-asthmatic population. Omalizumab, an anti-IgE monoclonal antibody, exerts a profound cellular effect, which can stabilize the effector cells, and is becoming much more efficient from the point of view of innate immunity in contrasting respiratory viral infections. In addition to the antiviral effect, clinical efficacy and safety of this biological allow a great improvement in the management of asthma.

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Ketogenic Diet as a Preventive and Supportive Care for COVID-19 Patients

Nutrients ◽

10.3390/nu13031004 ◽

2021 ◽

Vol 13 (3) ◽

pp. 1004

Author(s):

Elena Gangitano ◽

Rossella Tozzi ◽

Orietta Gandini ◽

Mikiko Watanabe ◽

Sabrina Basciani ◽

...

Keyword(s):

Ketogenic Diet ◽

Systemic Inflammation ◽

Viral Infections ◽

Invasive Mechanical Ventilation ◽

Preventive Measure ◽

Respiratory Compromise ◽

Obese People ◽

Increased Risk ◽

Severely Obese ◽

Respiratory Conditions

Severe obesity is associated with an increased risk of admission to intensive care units and need for invasive mechanical ventilation in patients with COVID-19. The association of obesity and COVID-19 prognosis may be related to many different factors, such as chronic systemic inflammation, the predisposition to severe respiratory conditions and viral infections. The ketogenic diet is an approach that can be extremely effective in reducing body weight and visceral fat in the short term, preserving the lean mass and reducing systemic inflammation. Therefore, it is a precious preventive measure for severely obese people and may be considered as an adjuvant therapy for patients with respiratory compromise.

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Immunometabolic Status of COVID-19 Cancer Patients

Physiological Reviews ◽

10.1152/physrev.00018.2020 ◽

2020 ◽

Vol 100 (4) ◽

pp. 1839-1850

Author(s):

A. Sica ◽

M. P. Colombo ◽

A. Trama ◽

L. Horn ◽

M. C. Garassino ◽

...

Keyword(s):

Cancer Patients ◽

Cancer Progression ◽

Macrophage Activation ◽

Viral Infections ◽

Immune Cell ◽

Case Series ◽

The United States ◽

Alternative Activation ◽

Nad Metabolism ◽

Increased Risk

Cancer patients appear to be more likely to be diagnosed with coronavirus disease 2019 (COVID-19). This is supported by the understanding of immunometabolic pathways that intersect patients with infection and cancer. However, data derived by case series and retrospective studies do not offer a coherent interpretation, since data from China suggest an increased risk of COVID-19, while data from the United States and Italy show a prevalence of COVID-19 in cancer patients comparable with the general population. Noteworthy, cancer and COVID-19 exploit distinct patterns of macrophage activation that promote disease progression in the most severe forms. In particular, the alternative activation of M2-polarized macrophages plays a crucial role in cancer progression. In contrast, the macrophage-activation syndrome appears as the source of M1-related cytokine storm in severe COVID-19 disease, thus indicating macrophages as a source of distinct inflammatory states in the two diseases, nonetheless as a common therapeutic target. New evidence indicates that NAMPT/NAD metabolism can direct both innate immune cell effector functions and the homeostatic robustness, in both cancer and infection. Moreover, a bidirectional relationship exists between the metabolism of NAD and the protective role that angiotensin converting enzyme 2, the COVID-19 receptor, can play against hyperinflammation. Within this immunometabolic framework, the review considers possible interference mechanisms that viral infections and tumors elicit on therapies and provides an overview for the management of patients with cancer affected by COVID-19, particularly for the balance of risk and benefit when planning normally routine cancer treatments and follow-up appointments.

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Mannan-Binding Lectin Levels and Activity Are Not Altered in Atopic Dermatitis Patients with a History of Eczema Herpeticum

Dermatology Research and Practice ◽

10.1155/2011/769890 ◽

2011 ◽

Vol 2011 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Kemp W. Bundy ◽

Laura Y. McGirt ◽

Lora G. Bankova ◽

Andreas Wollenberg ◽

Lisa A. Beck ◽

...

Keyword(s):

Atopic Dermatitis ◽

Functional Activity ◽

Viral Infections ◽

Serum Levels ◽

Small Samples ◽

Eczema Herpeticum ◽

Increased Risk ◽

History Of ◽

Mannan Binding Lectin ◽

Binding Lectin

Background. Eczema herpeticum (EH) is a potentially serious, systemic complication in subjects with atopic dermatitis (AD) caused by herpes simplex virus (HSV). The innate immune dysregulation that predisposes these subjects to cutaneous viral infections is not well understood. We tested the hypothesis that defects in mannan-binding lectin (MBL) may be associated with an increased risk of EH.Methods. We evaluated serum MBL levels and functional activity in 13 AD subjects with a history of EH (EH+) and 21 AD subjects with no history of EH (EH−). MBL levels were detected by enzyme immunoassay. MBL pathway functional activity was evaluated by determining MBL C4b deposition capacity.Results. We found no statistical difference in MBL serum levels or function between EH+ and EH− groups.Conclusion. Considering the limitations of this study (e.g., small samples size) our findings suggest that MBL defects do not play a role in EH.

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The Danish implementation study on response to pregnancy complications, MAMAACT

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1070 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

S Villadsen ◽

H Johnsen ◽

T D Rasmussen ◽

J Sørensen ◽

U Christensen ◽

...

Keyword(s):

Pregnant Women ◽

Pregnancy Complications ◽

Smart Phone ◽

Target Group ◽

Warning Signs ◽

Perinatal Health ◽

Vulnerable Groups ◽

Contributing Factors ◽

Increased Risk ◽

Ward Level

Abstract Differential incidence and severity of pregnancy complications are likely important contributing factors to the increased risk of poor pregnancy outcomes among ethnic minority women in Europe. To address this issue, the MAMAACT trial has been developed based on a thorough mixed methods needs assessment and co-creation process, feasibility tested, now implemented in a nationwide complex intervention. The overall aim of the Danish MAMAACT trial is to reduce ethnic and social disparity in stillbirth and newborns' health by improved management of pregnancy complications. The overall target group is all pregnant women, and the specific target group is women of non-Western origin. The hypothesis of MAMAACT is that improved communication between pregnant women and midwives regarding body symptoms that need prompt reaction will improve perinatal health among these vulnerable groups. The intervention consists of postgraduate training of midwives in intercultural communication and a smart phone application and a leaflet, both in six different languages. The app and leaflet target the women and explain the most serious warning signs of pregnancy complications and how to respond to them. MAMAACT is implemented and evaluated in a randomized controlled cluster trial and 10 maternity wards consist the intervention groups, while nine maternity wards are the control groups. The evaluation is a mixed method evaluation focusing on understanding the mechanisms of change, how context at both maternity ward level as well as in the everyday life of women affects the implementation, and finally if effects on health literacy of the women and perinatal health of the children can be documented.

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COVID-19 Mortality is Associated with Impaired Innate Immunity in Pre-existing Health Conditions

10.1101/2021.05.31.446476 ◽

2021 ◽

Author(s):

Matthew E Lee ◽

Yung Chang ◽

Navid Ahmadinejad ◽

Crista E Johnson-Agbakwu ◽

Celeste Bailey ◽

...

Keyword(s):

Risk Factors ◽

Innate Immunity ◽

Viral Infections ◽

Enrichment Analysis ◽

Gene Set Enrichment Analysis ◽

Therapeutic Interventions ◽

Health Conditions ◽

Molecular Abnormalities ◽

Hazard Ratios ◽

Increased Risk

Background: COVID-19 poses a life-threatening endangerment to individuals with chronic diseases. However, not all comorbidities affect COVID-19 prognosis equally. Some increase the risk of COVID-19 related death by more than six folds while others show little to no impact. To prevent severe outcomes, it is critical that we comprehend pre-existing molecular abnormalities in common health conditions that predispose patients to poor prognoses. In this study, we aim to discover some of these molecular risk factors by associating gene expression dysregulations in common health conditions with COVID-19 mortality rates in different cohorts. Methods: We focused on fourteen pre-existing health conditions, for which age-and-sex-adjusted hazard ratios of COVID-19 mortality have been documented. For each health condition, we analyzed existing transcriptomics data to identify differentially expressed genes (DEGs) between affected individuals and unaffected individuals. We then tested if fold changes of any DEG in these pre-existing conditions were correlated with hazard ratios of COVID-19 mortality to discover molecular risk factors. We performed gene set enrichment analysis to identify functional groups overrepresented in these risk factor genes and examined their relationships with the COVID-19 disease pathway. Results: We found that upregulated expression of 70 genes and downregulated expression of 181 genes in pre-existing health conditions were correlated with increased risk of COVID-19 related death. These genes were significantly enriched with endoplasmic reticulum (ER) function, proinflammatory reaction, and interferon production that participate in viral transcription and immune responses to viral infections. Conclusions: Impaired innate immunity in pre-existing health conditions are associated with increased hazard of COVID-19 mortality. The discovered molecular risk factors are potential prognostic biomarkers and targets for therapeutic interventions.

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Airway Management in the Emergency Department During Coronavirus Disease (COVID-19)

Acta medica Lituanica ◽

10.15388/amed.2020.27.2.1 ◽

2020 ◽

Vol 28 (2) ◽

pp. 5-11

Author(s):

Sohil Pothiawala

Keyword(s):

Emergency Department ◽

Airway Management ◽

Viral Infections ◽

Transmission Risk ◽

National Guidelines ◽

Hospital Policy ◽

Resource Limited ◽

Increased Risk ◽

Emerging Viral Diseases ◽

Evidence Based Guidelines

Front-line health-care workers in the Emergency Department (ED) are at an increased risk of infection during the airway management of patients with known or suspected Emerging Viral Diseases (EVD) like Coronavirus Disease 2019 (COVID-19). The primary route for transmission of the virus from an infected patient to the ED staff is due to aerosolized droplets, and the transmission risk is high despite wearing adequate Personal Protective Equipment (PPE). There are limited evidence-based guidelines for airway management during these viral infections, especially with a focus on the principles of airway management in a busy, fast-paced ED. This article provides an overview of the principles of airway management in suspected or confirmed EVD patients, including COVID-19, particularly in the context of ED, and also considering strategies in resource limited setting. These principles should be adapted to suit your local department and hospital policy on airway management as well as national guidelines.

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Infection, inflammation and thrombosis: a review of potential mechanisms mediating arterial thrombosis associated with influenza and severe acute respiratory syndrome coronavirus 2

Biological Chemistry ◽

10.1515/hsz-2021-0348 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Stefan Veizades ◽

Alexandria Tso ◽

Patricia K. Nguyen

Keyword(s):

Myocardial Infarction ◽

Severe Acute Respiratory Syndrome ◽

Arterial Thrombosis ◽

Viral Infections ◽

Respiratory Viruses ◽

Causal Connection ◽

Immune Systems ◽

Clinical Observations ◽

Increased Risk ◽

Time Of Infection

Abstract Thrombosis has long been reported as a potentially deadly complication of respiratory viral infections and has recently received much attention during the global coronavirus disease 2019 pandemic. Increased risk of myocardial infarction has been reported during active infections with respiratory viruses, including influenza and severe acute respiratory syndrome coronavirus 2, which persists even after the virus has cleared. These clinical observations suggest an ongoing interaction between these respiratory viruses with the host’s coagulation and immune systems that is initiated at the time of infection but may continue long after the virus has been cleared. In this review, we discuss the epidemiology of viral-associated myocardial infarction, highlight recent clinical studies supporting a causal connection, and detail how the virus’ interaction with the host’s coagulation and immune systems can potentially mediate arterial thrombosis.

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1700. A Rare Case of Candida glabrata Hemorrhagic Cystitis with Empagliflozin Use

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1564 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S622-S623

Author(s):

Ly Tran ◽

Mathew Thomas ◽

Jeremy Harvey ◽

Rahul Sampath ◽

Richard Rose

Keyword(s):

Candida Glabrata ◽

Viral Infections ◽

Hemorrhagic Cystitis ◽

Bladder Wall ◽

Sglt2 Inhibitor ◽

Symptomatic Improvement ◽

Immunocompetent Host ◽

Predisposing Factor ◽

Increased Risk ◽

Urinary Glucose

Abstract Background Hemorrhagic cystitis is an inflammatory condition of the bladder, infrequently seen after cancer chemotherapy, pelvic radiation, and viral infections in immunocompromised hosts. Methods We report a case of biopsy-proven Candida glabrata hemorrhagic cystitis in an immunocompetent host associated with empagliflozin use. Empagliflozin is a sodium-glucose co-transporter 2 (SGLT2) inhibitor, that increases urinary glucose excretion, and is associated with an increased risk of urogenital mycotic infections Results A 71-year-old man with a history type 2 diabetes, neurogenic bladder status post transurethral resection of the prostate, developed symptoms of pelvic pain and gross hematuria 3 months after the initiation of empagliflozin. The patient received multiple courses of empirical antibiotic therapy without any relief. Six months into the illness, the patient had significant weight loss, fatigue, progressive renal failure, and continued hematuria. Empagliflozin was self-discontinued by the patient secondary to a perceived relation between symptom onset and medication use. Urine cultures were negative. A CT scan showed mucosal thickening of the bladder wall with hydronephrosis. Cystoscopy was consistent with hemorrhagic cystitis. A bladder biopsy was negative for malignancy, stain and PCR negative for fungi, but culture positive for C. glabrata susceptible to Fluconazole. Mycobacterial stains, cultures, and PCR were negative. The patient was treated with Fluconazole for 4 weeks and experienced symptomatic improvement and resolution of hematuria one week into the therapy. Conclusion This is the first reported case of C. glabrata hemorrhagic cystitis in an immunocompetent host associated with empagliflozin. Invasive candida infections in the genitourinary system are rare in immunocompetent patients. We believe that empagliflozin-induced glycosuria may have been a predisposing factor. Disclosures All authors: No reported disclosures.

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Contextual Factors Influencing the MAMAACT Intervention: A Qualitative Study of Non-Western Immigrant Women’s Response to Potential Pregnancy Complications in Everyday Life

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17031040 ◽

2020 ◽

Vol 17 (3) ◽

pp. 1040

Author(s):

Helle Johnsen ◽

Ulla Christensen ◽

Mette Juhl ◽

Sarah Fredsted Villadsen

Keyword(s):

Everyday Life ◽

Maternity Care ◽

Pregnancy Complications ◽

Immigrant Women ◽

Warning Signs ◽

Delayed Response ◽

Full Potential ◽

Care Providers ◽

Sources Of Knowledge ◽

Increased Risk

In western countries, immigrant women have an increased risk of negative birth outcomes. Immigrant women’s and maternity care system’s delayed response to pregnancy complications contribute to ethnic inequities in reproductive health. The MAMAACT intervention was developed to improve midwives’ and women’s response to pregnancy complications in Denmark. The study examines the context of the implementation of the MAMAACT intervention and investigates how the intended intervention mechanisms regarding response to pregnancy complications were affected by barriers in non-Western immigrant women’s everyday life situations. Twenty-one interviews with non-Western immigrant women were undertaken. Systematic text condensation and the situational-adaptation framework by Alonzo were used to analyze data. Four main categories were identified: ‘Sources of knowledge during pregnancy’, ‘Containment of pregnancy warning signs’, ‘Barriers during the onset of acute illness’ and ‘Previous situations with maternity care providers’. Attention to potential pregnancy complications may conflict with immigrant women’s everyday life situations and result in the containment of symptoms as well as causing delays in seeking medical assistance. It is probable that barriers in women’s everyday life will impact the intended intervention mechanisms and thus the full potential of the intervention may not be reached.

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