Systematic review of Plasmodium falciparum and Plasmodium vivax polyclonal infections: Impact of prevalence, study population characteristics, and laboratory procedures

Multiple infections of genetically distinct clones of the same Plasmodium species are common in many malaria endemic settings. Mean multiplicity of infection (MOI) and the proportion of polyclonal infections are often reported as surrogate marker of transmission intensity, yet the relationship with traditional measures such as parasite prevalence is not well understood. We have searched Pubmed for articles on P. falciparum and P. vivax multiplicity, and compared the proportion of polyclonal infections and mean MOI to population prevalence. The impact of the genotyping method, number of genotyping markers, method for diagnosis (microscopy/RDT vs. PCR), presence of clinical symptoms, age, geographic region, and year of sample collection on multiplicity indices were assessed. For P. falciparum, 153 studies met inclusion criteria, yielding 275 individual data points and 33,526 genotyped individuals. The proportion of polyclonal infections ranged from 0–96%, and mean MOI from 1–6.1. For P. vivax, 54 studies met inclusion criteria, yielding 115 data points and 13,325 genotyped individuals. The proportion of polyclonal infections ranged from 0–100%, and mean MOI from 1–3.8. For both species, the proportion of polyclonal infections ranged from very low to close to 100% at low prevalence, while at high prevalence it was always high. Each percentage point increase in prevalence resulted in a 0.34% increase in the proportion of polyclonal P. falciparum infections (P<0.001), and a 0.78% increase in the proportion of polyclonal P. vivax infections (P<0.001). In multivariable analysis, higher prevalence, typing multiple markers, diagnosis of infections by PCR, and sampling in Africa were found to result in a higher proportion of P. falciparum polyclonal infections. For P. vivax, prevalence, year of study, typing multiple markers, and geographic region were significant predictors. In conclusion, polyclonal infections are frequently present in all settings, but the association between multiplicity and prevalence is weak.

Download Full-text

Systematic review of Plasmodium falciparum and Plasmodium vivax polyclonal infections: Impact of prevalence, study population characteristics, and laboratory procedures

10.1101/2021.03.18.436023 ◽

2021 ◽

Author(s):

Luis Lopez ◽

Cristian Koepfli

Keyword(s):

Clinical Symptoms ◽

Multivariable Analysis ◽

Surrogate Marker ◽

Geographic Region ◽

Population Characteristics ◽

Multiple Infections ◽

Inclusion Criteria ◽

Multiple Markers ◽

Data Points ◽

The Impact

AbstractMultiple infections of genetically distinct clones of the same Plasmodium species are common in many malaria endemic settings. Mean multiplicity of infection (MOI) and the proportion of polyclonal infections are often reported as surrogate marker of transmission intensity, yet the relationship with traditional measures such as parasite prevalence is not well understood. We have searched Pubmed for articles on P. falciparum and P. vivax multiplicity, and compared the proportion of polyclonal infections and mean MOI to population prevalence. The impact of the genotyping method, number of genotyping markers, method for diagnosis (microscopy/RDT vs. PCR), presence of clinical symptoms, age, geographic region, and year of sample collection on multiplicity indices were assessed. For P. falciparum, 153 studies met inclusion criteria, yielding 275 individual data points and 33526 genotyped individuals. The proportion of polyclonal infections ranged from 0-96%, and mean MOI from 1-6.1. For P. vivax, 54 studies met inclusion criteria, yielding 115 data points and 13325 genotyped individuals. The proportion of polyclonal infections ranged from 0-100%, and mean MOI from 1-3.8. For both species, the proportion of polyclonal infections ranged from very low to close to 100% at low prevalence, while at high prevalence it was always high. Each percentage point increase in prevalence resulted in a 0.34% increase in the proportion of polyclonal P. falciparum infections (P<0.001), and a 0.78% increase in the proportion of polyclonal P. vivax infections (P<0.001). In multivariable analysis, higher prevalence, typing multiple markers, diagnosis of infections by PCR, and sampling in Africa were found to result in a higher proportion of P. falciparum polyclonal infections. For P. vivax, prevalence, year of study, typing multiple markers, and geographic region were significant predictors. In conclusion, polyclonal infections are frequently present in all settings, but the association between multiplicity and prevalence is weak.

Download Full-text

Comparison of preoperative chemoradiation with radiation or chemotherapy alone in patients with non-metastatic, resectable retroperitoneal sarcoma

Journal of Radiotherapy in Practice ◽

10.1017/s1460396921000480 ◽

2021 ◽

pp. 1-6

Author(s):

Sung Jun Ma ◽

Brian Yu ◽

Lucas M. Serra ◽

Austin J. Bartl ◽

Oluwadamilola T. Oladeru ◽

...

Keyword(s):

Multivariable Analysis ◽

Preoperative Chemoradiation ◽

Retroperitoneal Sarcoma ◽

Rank Test ◽

Preoperative Radiation ◽

Inclusion Criteria ◽

Therapy Regimen ◽

Log Rank Test ◽

Kaplan Meier ◽

The Impact

Abstract Aim: Optimal preoperative therapy regimen in the treatment of resectable retroperitoneal sarcoma (RPS) remains unclear. This study compares the impact of preoperative radiation, chemoradiation and chemotherapy on overall survival (OS) in RPS patients. Materials and Methods: The National Cancer Database (NCDB) was queried for patients with non-metastatic, resectable RPS (2006–15). The primary endpoint was OS, evaluated by Kaplan–Meier method, log-rank test, Cox multivariable analysis and propensity score matching. Results: A total of 1,253 patients met the inclusion criteria, with 210 patients (17%) receiving chemoradiation, 850 patients (68%) receiving radiation and 193 patients (15%) receiving chemotherapy. On Cox multivariable analysis, when compared to preoperative chemoradiation, preoperative radiation was not associated with improved OS (hazards ratio [HR] 0·98, 95% CI 0·76–1·25, p = 0·84), while preoperative chemotherapy was associated with worse OS (HR 1·64, 95% CI 1·24–2·18, p < 0·001). Similar findings were observed in 199 and 128 matched pairs for preoperative radiation and chemotherapy, respectively, when compared to preoperative chemoradiation. Findings: Our study suggested an OS benefit in using preoperative chemoradiation compared to chemotherapy alone, but OS outcomes were comparable between preoperative chemoradiation and radiation alone.

Download Full-text

Impact of palliative care in patients with metastatic esophageal cancer declining chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.315 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 315-315

Author(s):

Nicholas Manguso ◽

Sungjin Kim ◽

Michelle Guan ◽

Veronica Placencio-Hickok ◽

Haesoo Kim ◽

...

Keyword(s):

Palliative Care ◽

Esophageal Cancer ◽

Multivariable Analysis ◽

Geographic Region ◽

Kaplan Meier ◽

Academic Center ◽

Significant Difference ◽

Comorbidity Index ◽

The Impact

315 Background: Palliative care has been associated with improved overall survival (OS), but limited data exist in metastatic esophageal cancer (mEC). We investigated the impact of palliative care in patients with mEC who declined chemotherapy (CTX). Methods: The National Cancer Database was used to identify patients between 2004-2015. Patients with M1 disease who declined CTX and had known palliative care status (surgery, radiotherapy [RT], pain management, or any combination of) were included. Cases with unknown CTX, RT, or nonprimary surgery status were excluded. Kaplan-Meier estimates of OS were calculated. Univariable and multivariable Cox regressions were performed. Results: Among 140,234 EC cases, we identified 1,493 patients who declined CTX and had complete data. Median age was 70 years, most (66.3%) had a Charlson Comorbidity Index (CCI) of 0, and 37.1% were treated at an academic center. Most (72.7%) did not receive palliative care. Median OS was 2.53 months (mos), with no statistically significant difference in median OS between those receiving palliative care (2.83 mos, 95% confidence interval [CI] 2.53-3.12) vs. no palliative care (2.37 mos, 2.2-2.56; p = 0.288). On univariable analysis, treatment at an academic center (hazard ratio [HR] 0.90, 0.80-1.00) and CCI ≥2 (HR 1.20, 1.00-1.42) were predictive of OS (p < 0.05). On multivariable analysis, male sex (HR 1.23, 1.08-1.40), South geographic region (HR 1.23, 1.04-1.46), CCI of 1 (HR 1.17, 1.03-1.32), higher grade (HR 1.21, 1.07-1.38), and higher T stage (HR 1.39, 1.12-1.73) were associated with poor OS (p < 0.05). Conclusions: Palliative care conferred a numerically higher, but not statistically significant difference in OS among patients with mEC declining CTX. Quality of life metrics, inpatient status, and subgroup analyses are important for examining the role of palliative care in mEC and future studies are warranted.

Download Full-text

Assessment of flow-mediated dilation in humans: a methodological and physiological guideline

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00471.2010 ◽

2011 ◽

Vol 300 (1) ◽

pp. H2-H12 ◽

Cited By ~ 768

Author(s):

Dick H. J. Thijssen ◽

Mark A. Black ◽

Kyra E. Pyke ◽

Jaume Padilla ◽

Greg Atkinson ◽

...

Keyword(s):

Clinical Symptoms ◽

Surrogate Marker ◽

Data Interpretation ◽

Evidence Base ◽

Early Event ◽

Flow Mediated Dilation ◽

Noninvasive Technique ◽

Measurement And Analysis ◽

The Impact

Endothelial dysfunction is now considered an important early event in the development of atherosclerosis, which precedes gross morphological signs and clinical symptoms. The assessment of flow-mediated dilation (FMD) was introduced almost 20 years ago as a noninvasive approach to examine vasodilator function in vivo. FMD is widely believed to reflect endothelium-dependent and largely nitric oxide-mediated arterial function and has been used as a surrogate marker of vascular health. This noninvasive technique has been used to compare groups of subjects and to evaluate the impact of interventions within individuals. Despite its widespread adoption, there is considerable variability between studies with respect to the protocols applied, methods of analysis, and interpretation of results. Moreover, differences in methodological approaches have important impacts on the response magnitude, can result in spurious data interpretation, and limit the comparability of outcomes between studies. This review results from a collegial discussion between physiologists with the purpose of developing considered guidelines. The contributors represent several distinct research groups that have independently worked to advance the evidence base for improvement of the technical approaches to FMD measurement and analysis. The outcome is a series of recommendations on the basis of review and critical appraisal of recent physiological studies, pertaining to the most appropriate methods to assess FMD in humans.

Download Full-text

The Effect of Anticoagulation and Antiplatelet Use in Trauma Patients on Mortality and Length of Stay

The American Surgeon ◽

10.1177/0003134821989043 ◽

2021 ◽

pp. 000313482198904

Author(s):

Nisha Narula ◽

Savas Tsikis ◽

Sayuri P. Jinadasa ◽

Charles S. Parsons ◽

Charles H. Cook ◽

...

Keyword(s):

Length Of Stay ◽

Injury Severity ◽

Trauma Registry ◽

Multivariable Analysis ◽

Trauma Patients ◽

Inclusion Criteria ◽

Hemorrhage Control ◽

Discharge Outcomes ◽

Control Procedures ◽

The Impact

Background Though many trauma patients are on anticoagulation or antiplatelet therapy (AAT), there are few generalizable data on the risks for these patients. The purpose of this study was to analyze the impact of anticoagulation (AC) and antiplatelet (AP) therapy on mortality and length of stay (LOS) in general trauma patients. Methods A retrospective review was performed of patients in the institutional trauma registry during 2019 to determine AAT use on admission and discharge. Outcomes were compared using standard statistics. Results Of 2261 patients who met the inclusion criteria, 2 were excluded due to an incomplete medication reconciliation, resulting in 2259 patients. Patients on AAT had a higher mortality (4.5% vs 2.1%). On multivariable analysis, preadmission AC (odds ratio OR, 3.325, P = .001), age (OR 1.040, P < .001), and injury severity score ((ISS) 1.094, P < .001) were associated with mortality. Anticoagulation use was also associated with longer LOS on multivariable analysis (OR: 1.626, P = .005). Antiplatelet use was not associated with higher mortality or longer LOS. More patients on AAT were unable to be discharged home. However, patients on AAT did not have a greater blood transfusion requirement or need more hemorrhage control procedures. Lastly, 23.7% of patients on preadmission AAT were not discharged on any AAT. Discussion These data demonstrate that patients on AC, but not AP, have greater mortality and longer hospital LOS. This may provide guidance for those being newly started on AAT. Further work to determine which patients benefit most from restarting AAT would lead to improvement in the care of trauma patients.

Download Full-text

APPLICATION OF PERMANENT PACEMAKERS AND OPTIMAL PROGRAMMATION IN HUE UNIVERSITY OF MEDICINE AND PHARMACY HOSPITAL

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2018.3.18 ◽

2018 ◽

pp. 114-121

Author(s):

Van Minh Huynh ◽

Anh Tien Hoang ◽

Khanh Hung Doan ◽

Vu Phong Nguyen ◽

Viet Lam Ngo ◽

...

Keyword(s):

Sick Sinus Syndrome ◽

Clinical Symptoms ◽

Jugular Vein ◽

Pacemaker Implantation ◽

Heart Association ◽

External Jugular Vein ◽

Permanent Pacemaker ◽

Male Gender ◽

Inclusion Criteria ◽

Underlying Diseases

Aim: To evaluate the application of permanent pacemaker and optimal programmation associated with Nora G. checklist in pacemaker implantation. Patients and methods: we analyse the 35 cases who were implanted the permanent pacemakers we analyse the 35 cases who were implanted the permanent pacemakers in 2017. For inclusion criteria, we used the recomendation of ACC/AHA/ HRS and Vietnam Heart Association. Apply the C arm fluoroscopy to perform the implantation of the permanent pacemaker. Most of patients were performed the subclavian vein and cephalic vein as the main way but some cases we choosed the external jugular vein as the alternative route. Results: male gender was 60%, mean age was 71.97±12.55. Mostly cardiac arrhythmia were sick sinus syndrome (42.86%), atrial fibrillation with slow rate response (17.14%), blocAVII nd degree Mobitz II (14.28%), bloc AV III rd (11.42%), the underlying diseases were arterial hypertension 42.86%, coronary disease (20%), diabetes mellitus (14.29%). The implanted pacemekers were predominantly one chamber VVIR type (47.5%). The complications was rare and there were a clear recovery of clinical symptoms and mortality death following the Nora checklist. Conclusion: VT technology is an integral part of the treatment of arrhythmias, especially the optimal combination of programming and the Nora checklist, which makes it more effective. Key words: permanent pacemaker, optimal programmation

Download Full-text

Graves' disease and radioiodine therapy

Nuklearmedizin ◽

10.3413/nukmed-0145 ◽

2008 ◽

Vol 47 (04) ◽

pp. 153-166 ◽

Cited By ~ 10

Author(s):

I. Weber ◽

W. Eschner ◽

F. Sudbrock ◽

M. Schmidt ◽

M. Dietlein ◽

...

Keyword(s):

Success Rate ◽

Thyroid Function ◽

Therapeutic Dose ◽

Radioiodine Therapy ◽

Antithyroid Drugs ◽

Graves Disease ◽

Inclusion Criteria ◽

End Point ◽

Point Measure ◽

The Impact

SummaryAim: This study was performed to analyse the impact of the choice of antithyroid drugs (ATD) on the outcome of ablative radioiodine therapy (RIT) in patients with Graves' disease. Patients, material, methods: A total of 571 consecutive patients were observed for 12 months after RIT between July 2001 and June 2004. Inclusion criteria were the confirmed diagnosis of Graves' disease, compensation of hyperthyroidism and withdrawal of ATD two days before preliminary radioiodine-testing and RIT. The intended dose of 250 Gy was calculated from the results of the radioiodine test and the therapeutically achieved dose was measured by serial uptake measurements. The end-point measure was thyroid function 12 months after RIT; success was defined as elimination of hyperthyroidism. The pretreatment ATD was retrospectively correlated with the results achieved. Results: Relief from hyperthyroidism was achieved in 96 % of patients. 472 patients were treated with carbimazole or methimazole (CMI) and 61 with propylthiouracil (PTU). 38 patients had no thyrostatic drugs (ND) prior to RIT. The success rate was equal in all groups (CMI 451/472; PTU 61/61; ND 37/38; p=0.22). Conclusion: Thyrostatic treatment with PTU achieves excellent results in ablative RIT, using an accurate dosimetric approach with an achieved post-therapeutic dose of more than 200 Gy.

Download Full-text

The impact of SPY angiography on intraoperative decision making and outcomes for post-mastectomy reconstruction

Journal of Cancer Science and Therapeutics ◽

10.36879/jcst.19.000109 ◽

2019 ◽

pp. 1-5

Keyword(s):

Decision Making ◽

Logistic Regression ◽

Skin Necrosis ◽

Regression Models ◽

Multivariable Analysis ◽

P Value ◽

Flap Necrosis ◽

Single Institution ◽

Logistic Regression Models ◽

The Impact

Objective: While the use of intraoperative laser angiography (SPY) is increasing in mastectomy patients, its impact in the operating room to change the type of reconstruction performed has not been well described. The purpose of this study is to investigate whether SPY angiography influences post-mastectomy reconstruction decisions and outcomes. Methods and materials: A retrospective analysis of mastectomy patients with reconstruction at a single institution was performed from 2015-2017.All patients underwent intraoperative SPY after mastectomy but prior to reconstruction. SPY results were defined as ‘good’, ‘questionable’, ‘bad’, or ‘had skin excised’. Complications within 60 days of surgery were compared between those whose SPY results did not change the type of reconstruction done versus those who did. Preoperative and intraoperative variables were entered into multivariable logistic regression models if significant at the univariate level. A p-value <0.05 was considered significant. Results: 267 mastectomies were identified, 42 underwent a change in the type of planned reconstruction due to intraoperative SPY results. Of the 42 breasts that underwent a change in reconstruction, 6 had a ‘good’ SPY result, 10 ‘questionable’, 25 ‘bad’, and 2 ‘had areas excised’ (p<0.01). After multivariable analysis, predictors of skin necrosis included patients with ‘questionable’ SPY results (p<0.01, OR: 8.1, 95%CI: 2.06 – 32.2) and smokers (p<0.01, OR:5.7, 95%CI: 1.5 – 21.2). Predictors of any complication included a change in reconstruction (p<0.05, OR:4.5, 95%CI: 1.4-14.9) and ‘questionable’ SPY result (p<0.01, OR: 4.4, 95%CI: 1.6-14.9). Conclusion: SPY angiography results strongly influence intraoperative surgical decisions regarding the type of reconstruction performed. Patients most at risk for flap necrosis and complication post-mastectomy are those with questionable SPY results.

Download Full-text

Psychological Distress and Post-Traumatic Symptomatology among Dental Healthcare Workers in Russia: Results of a Pilot Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020708 ◽

2021 ◽

Vol 18 (2) ◽

pp. 708 ◽

Cited By ~ 1

Author(s):

Maria Sarapultseva ◽

Alena Zolotareva ◽

Igor Kritsky ◽

Natal’ya Nasretdinova ◽

Alexey Sarapultsev

Keyword(s):

Psychological Distress ◽

Healthcare Workers ◽

Mental Health Problems ◽

Clinical Symptoms ◽

Stress Disorders ◽

Self Report ◽

Ptsd Symptoms ◽

Event Scale ◽

Post Traumatic ◽

The Impact

The spread of SARS-CoV-2 infection has increased the risk of mental health problems, including post-traumatic stress disorders (PTSD), and healthcare workers (HCWs) are at greater risk than other occupational groups. This observational cross-sectional study aimed to explore the symptoms of depression, anxiety, and PTSD among dental HCWs in Russia during the coronavirus disease 2019 (COVID-19) pandemic. The survey was carried out among 128 dental HCWs from three dental clinics of Ekaterinburg, Russia. The mean age of the sample was 38.6 years. Depression, anxiety, and stress were assessed using the Depression Anxiety and Stress Scale-21 (DASS-21); PTSD was assessed using the PTSD Symptom Scale-Self-Report (PSS-SR); subjective distress was assessed using the Impact of Event Scale-Revised (IES-R). The results indicated that 20.3–24.2% HCWs had mild to extremely severe symptoms of psychological distress, and 7.1–29.7% had clinical symptoms of PTSD. No differences between females and males were revealed. HCWs working directly with patients had significantly higher levels of PTSD symptoms and the risk of PTSD development compared to those working indirectly, whereas older HCWs had significantly higher levels of both psychological distress and PTSD symptoms compared to younger HCWs. Thus, dental HCWs are at high risk for psychological distress and PTSD symptoms during the COVID-19 pandemic.

Download Full-text

Physical activity in patients with rheumatoid arthritis - an agile lifelong behaviour: a qualitative meta-synthesis

RMD Open ◽

10.1136/rmdopen-2021-001635 ◽

2021 ◽

Vol 7 (2) ◽

pp. e001635

Author(s):

Emma Swärdh ◽

Christina Opava ◽

Nina Brodin

Keyword(s):

Rheumatoid Arthritis ◽

Physical Activity ◽

Web Of Science ◽

Body Awareness ◽

Main Theme ◽

Inclusion Criteria ◽

Online Databases ◽

Taking Action ◽

The Impact

BackgroundPhysical activity (PA) in rheumatoid arthritis (RA) is considered a cornerstone in the treatment. To highlight aspects involved in supporting a positive PA behaviour, it is important to understand the patients’ perceptions of the phenomenon.ObjectiveThe aim of this qualitative meta-synthesis was to explore and synthesise patient perceptions of PA in RA.MethodsA purposeful search was conducted across three online databases (PubMed, CINAHL and Web of Science). The methodological quality of the included studies was appraised, and data were extracted and analysed using an interpretive inductive thematic synthesis.ResultsFifteen studies met the inclusion criteria and were included. PA was identified as an agile lifelong behaviour, with one main theme: The disease as a persistent catalyst for or against PA illustrating how the constant presence of the disease itself underlies the entire process of a life with or without regular PA. Seven subthemes: ‘considering aggravated symptoms’, ‘acknowledging the impact on health’, ‘becoming empowered and taking action’, ‘keeping informed to increase awareness’, ‘creating body awareness’, ‘dealing with social support’ and ‘feeling satisfied with circumstances and achievements’ were interpreted as facilitators and/or challenges.ConclusionThis synthesis has identified PA as an agile lifelong behaviour in which the disease pervades all aspects of an individuals’ perception of PA. Placed in a theoretical context, our findings outline a model for tailoring PA support to the drivers and determinants of a certain individual, which will improve clinical practice for the benefit of both health professionals and patients with RA.

Download Full-text