Infections
24 Sep Herpes Zoster/Shingles Vaccine Not Found Cost Effective In Patients Under 60
Posted at 19:57h
in Author Interviews, Cleveland Clinic, Cost of Health Care, Herpes Viruses, Vaccine Studies
MedicalResearch.com Interview with:
Phuc Le, Ph.D., M.P.H.
Center for Value-Based Care Research, Medicine Institute
Cleveland, OH
Medical Research: What is the background for this study? What are the main findings?
Dr. Phuc Le: The live attenuated herpes zoster vaccine is approved by the FDA for persons aged 50 years and above. However, the Advisory Committee on Immunization Practices recommends it for only persons aged 60 years and older. Therefore, we aimed to analyze the vaccine’s cost-effectiveness among persons aged 50-59 years to see if ACIP’s recommendation is reasonable. We found that the vaccine is not cost-effective among people at aged 50 years, having an incremental costs of $323,000 per QALY gained, which is 3 times more than a commonly accepted threshold ($100,000/QALY).
24 Sep Death Rate of HIV-Infected Youth Increased Thirty Fold
MedicalResearch.com Interview with: Gayatri Mirani MD and Tulane University School of Medicine New Orleans, Louisiana Paige L. Williams, PhD Department of Biostatistics Harvard T. H. Chan School of Public Health Boston, MA 02115 Medical Research: What is the background for this study Response: Combination antiretroviral therapy (cART) has resulted in a dramatic decrease in HIV-related opportunistic infections and deaths in US youth, but both continue to occur. IMPAACT P1074, a long-term US-based prospective multicenter cohort study funded through NIH was conducted from April 2008 to June 2014. We reviewed complications and mortality rates in HIV-infected US youth enrolled in this study. Comparisons were made with a previous observational cohort study, P219C. While P219C was conducted from 2000 to 2007, we restricted our analysis to 2004-2007 in order to evaluate changes over the past decade. A total of 1201 HIV-infected youth were enrolled in the IMPAACT P1074 study, with most (1040, or 90%) infected with HIV at birth. The overall study population was 52% female, 58% black non-Hispanic and 28% Hispanic. Their mean age at the first chart abstraction was 17.4 (±5.4 Std. Dev.) years. The majority were on cART, had a stable CD4 count (baseline mean > 500 cells/mm3) and a suppressed viral load over a median follow-up of 3.7 years. The P219C group was younger, with a mean age of 11.9 (±5.0 Std. Dev.) years at the start of the 2004-2007 follow-up period.20 Sep High Dose Flu Vaccine In Elderly Reduced Overall Health Care Costs
Posted at 22:26h
in Author Interviews, Cost of Health Care, Flu - Influenza, Geriatrics, Lancet, Vaccine Studies
MedicalResearch.com Interview with:
Dr Ayman Chit PhD
Sanofi Pasteur
Swiftwater, PA 18370
Medical Research: What is the background for this study? What are the main findings?
Dr. Chit: Our analysis used data from a large-scale, multi-center efficacy trial, in which a higher-dose split-virus inactivated influenza vaccine (IIV-HD, Fluzone® High-Dose vaccine, Sanofi Pasteur) was compared to a standard-dose split-virus inactivated influenza vaccine (IIV-SD, Fluzone vaccine, Sanofi Pasteur) in persons 65 years of age and older. These data were supplemented with US healthcare cost data.
In the efficacy trial, a total of 31,989 adults 65 years of age and older were randomly assigned in a 1:1 ratio to receive either IIV-HD or IIV-SD and followed for six to eight months post-vaccination for the occurrence of influenza, serious adverse events, and medical encounters. Healthcare utilization (HCU) data were captured for all participants through a surveillance program that covered each influenza season, including the following events occurring within 30 days after any respiratory illness: use of prescription and non-prescription medications (limited to antipyretics/analgesics/non-steroidal anti-inflammatory drugs, antivirals and antibiotics), emergency room visits, non-routine or urgent care visits, and hospitalizations. In addition, all hospitalizations were captured for participants for the entire duration of the study.
The primary results from the efficacy trial were published in The New England Journal of Medicine, which reported that IIV-HD was 24.2% (95% confidence interval [CI], 9.7% to 36.5%) more effective in preventing laboratory-confirmed influenza-like illness compared to IIV-SD.1 In the current supplemental analysis of the trial, we used US healthcare cost data to evaluate economic impacts of using IIV-HD compared to IIV-SD within the efficacy trial participants. In this analysis, total healthcare payer costs (the combined costs of study vaccine, prescription drugs, emergency room visits, non-routine and urgent-care visits, and hospital admissions) were about $116 less per person.
- DiazGranados et al, NEJM, 2014;14;371(7):635-45
18 Sep Investigating cellular HIV resistance to understand “Elite controllers”?
MedicalResearch.com Interview with: Yong-Hui Zheng, Ph.D. Associate Professor Biomedical Physical Science Building Department of Microbiology and Molecular Genetics Michigan State University East Lansing, MI 48824-4320 Medical Research: What is the background for this study? What are the main findings? Dr. Zheng: Although HIV-1 has caused one of the most devastating pandemics by inducing AIDS, this virus failed to...
16 Sep Dilute White Vinegar Disrupts Bacterial Biofilms
MedicalResearch.com Interview with:
Dr Mark Webber PhD, MSc, BSc
Senior Research Fellow
School of Immunity and Infection
University of Birmingham and the National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre (SRMRC)
Medical Research: What is the background for this study? What are the main findings?
Dr. Webber: Infection is a major problem for patients who suffer burn injuries and these are vary hard to treat with traditional antibiotics which struggle to effectively reach the wound and kill the bugs. One alternative which has been used in the Queen Elizabeth Hospital in Birmingham for some time is the use of acetic acid, basically vinegar. Acetic acid has long been known to be a useful antimicrobial but clinicians in Birmingham have found it to be effective in treating wounds infected, particularly with Pseudomonas. There is though very little science about what concentration of acetic acid would work best and how it kills bugs. We have shown the acetic acid works well against lots of different bugs and at much lower concentrations than are used in practice. Importantly we showed that the acetic acid works well against bugs stuck to a surface - in what's known as a 'Biofilm'. Biofilms are typically highly drug resistant.
15 Sep Risk Factors For MRSA Infections After Discharge Identified
MedicalResearch.com Interview with: Dr. Lauren Epstein M.D., M.S. Division of Healthcare Quality Promotion Epidemic Intelligence Service Centers for Disease Control and Prevention Atlanta, GA, USA Medical Research: What is the background for this study? What are the main findings? Dr. Epstein: Nearly 80% of methicillin resistant Staphylococcus aureus (MRSA) infections occurs outside of the hospitals and mostly among individuals with a recent hospitalization. However, risk factors for MRSA infections among patients recently discharged from an acute care hospital have not been well explored. The goal of this study was to identify modifiable risk factors associated with MRSA infections among recently discharged patients to target future prevention efforts. We found that patients with a history of MRSA colonization, chronic wounds, invasive devices at discharge such as central lines and surgical drains, and those discharged from a hospital to a nursing home are at increased risk of invasive MRSA infections within 12 weeks after hospital discharge. Medical Research: What should clinicians and patients take away from your report? Dr. Epstein: MRSA infections are a significant public health concern and patients remain at risk for MRSA infections following acute care hospitalizations, especially in the 3 months following discharge from an acute care facility. Patients with a prior history of MRSA colonization are at increased risk for MRSA infections following an acute care hospitalization. In addition, patients who have an invasive device (such as a central line or surgical drain) or a chronic wound at the time of discharge from a hospitalization are at increased risk of MRSA infection following discharge. Finally, patients who are discharged to a long term care facility, regardless of other risk factors, are at increased risk of MRSA infection.11 Sep Elders Also Benefit When Young Adults Get Flu Vaccine
MedicalResearch.com Interview with:
Dr. Glen Taksler, PhD
Medicine Institute
Cleveland Clinic Main Campus
Medical Research: What is the background for this study? What are the main findings?
Dr. Taksler: Although young, healthy adults who develop influenza are usually able to recover, they may spread the flu to other people in the community who have a higher risk of hospitalization or other serious complications. These higher-risk people have a limited ability to protect themselves from influenza, because flu vaccines are less effective in the elderly and in people with weakened immune systems.
To better understand whether young, healthy adults could help the community-at-large by getting a flu vaccine, we looked at data on more than 3 million Medicare beneficiaries across 8 influenza seasons.
We found that the elderly had 21% lower odds of developing influenza if they lived in areas where more nonelderly adults (people aged 18-64 years old) got a flu vaccine.
Importantly, we found these benefits even in elderly adults who obtained an influenza vaccine, perhaps because flu vaccines are less effective in the elderly. This means that elderly adults who were proactive to try to prevent influenza still benefited from communitywide vaccination.
10 Sep HIV Self-Testing Found Safe and Acceptable in Community Setting
MedicalResearch.com Interview with: Augustine T. Choko MSc Malawi–Liverpool–Wellcome Trust Clinical Research Programme Blantyre, Malawi Medical Research: What is the background for this study? Response: Despite rapid scale up of HIV testing in the sub Saharan African region, half of people living with HIV are unware of their status. We investigated a novel approach of HIV self testing as an additional strategy to existing HIV testing options. Medical Research: What are the main findings? Response: Population uptake of HIV self testing was high at the first offer and remained high at the second offer 12 months later. The approach saw high numbers of adolescents and men testing. Community participants with 8% illiterate were able to do the test and correctly interpret it on their own with minimal training. People who self-tested positive were able to link into the clinic for antiretroviral therapy eligibility assessment.10 Sep HIV Meds Given to HIV Negative MSM Reduced New Infections Over 80%
MedicalResearch.com Interview with:
Professor Sheena McCormack
Clinical Epidemiology
Medical Research Council Clinical Trials Unit
University College London
Medical Research: What is the background for this study? What are the main findings?
Prof. McCormack: PROUD is the first study of pre-exposure prophylaxis (PrEP) to prevent HIV carried out in the UK. The results show that PrEP could play a major role in reducing the number of new infections among men who have sex with men who are at risk of catching HIV.
Pre-exposure prophylaxis (PrEP) is a HIV prevention strategy that involves HIV-negative people taking some of the drugs we use for treatment of HIV to reduce the risk of becoming infected. The PROUD study (www.proud.mrc.ac.uk) looked at whether offering daily PrEP to men who have sex with men was an effective way to prevent HIV infection. The results show that pre-exposure prophylaxis is highly protective, reducing the risk of infection for this group by 86%.
The drug used in the trial – the antiretroviral Truvada – was already known to reduce the incidence of HIV infection compared to placebo (a dummy pill). The PROUD study was designed to see how good Truvada would be found as pre-exposure prophylaxis in a real world situation when participants knew they were taking an active drug. It aimed to address outstanding questions such as whether taking PrEP would change sexual risk behaviour – for example increasing the number of partners they did not use condoms with and increasing the rate of other sexually transmitted infections (STIs) – and whether or not it would be cost-effective to make it available on the NHS.
09 Sep Norovirus Highly Prevalent In and Transmitted By Raw Oysters
MedicalResearch.com Interview with: Yongjie Wang PhD College of Food Science and Technology Shanghai Ocean University Laboratory of Quality and Safety Risk Assessment for Aquatic Products on Storage & Preservation Ministry of Agriculture Shanghai China Medical Research: What is the background for this study? Dr Wang: Norovirus (NoVs) are recognized as the most important food-borne viruses. They cause acute gastroenteritis in humans and infect people of all ages across the world. In our previous study, we found that approximate 90% of human norovirus sequences were discovered in the coastal regions in China, which likely result from the consumption of NoV-contaminated oysters. Oysters are well recognized as the main vectors of environmentally transmitted noroviruses, and disease outbreaks linked to oyster consumption have been commonly observed. In order to gain a better understanding of how noroviruses are transmitted via oysters in the environment, we examined the genetic variants associated with oyster-related NoV outbreaks. Medical Research: What are the main findings? Dr Wang: A high degree of genetic diversity was observed for oyster-related noroviruses, and almost all the human norovirus genotypes were found in oyster-related norovirus sequences. These sequences were widely but unevenly distributed geographically, and most of them were detected in coastal regions. A higher frequency of GI strains was found in oyster-related than in human-related NoV sequences, while the yearly distributions of oyster-related sequences and human outbreak sequences were similar, indicating that oysters may act as a reservoir of noroviruses in the environment.08 Sep Benefits of Iron Supplementation During Pregnancy Outweighed Malaria Risks
MedicalResearch.com Interview with:
Dr. Martin N. Mwangi
Researcher
Division of Human Nutrition,
Nutrition and Health over the lifecourse
International Nutrition Unit
Wageningen University
The Netherlands
Medical Research: What is the background for this study?
Dr. Mwangi : Anemia in pregnancy is a moderate or severe health problem in more than 80 percent of countries worldwide, but particularly in Africa, where it affects 57 percent of pregnant women. Iron deficiency is the most common cause, but iron supplementation during pregnancy has uncertain health benefits. There is some evidence to suggest that iron supplementation may increase the risk of infectious diseases, including malaria.
Our main objective was to measure the effect of antenatal iron supplementation on maternal Plasmodium infection risk, maternal iron status, and neonatal outcomes. We randomly assigned 470 pregnant Kenyan women living in a malaria endemic area to daily supplementation with 60 mg of iron (n = 237 women) or placebo (n = 233) until 1 month postpartum. All women received 5.7 mg iron/day through flour fortification during intervention and usual intermittent preventive treatment against malaria.
Medical Research: What are the main findings?
Dr. Mwangi : Overall, we found no effect of daily iron supplementation during pregnancy on risk of maternal Plasmodium infection. Iron supplementation resulted in an increased birth weight [5.3 ounces], gestational duration, and neonatal length; enhanced maternal and infant iron stores at 1 month after birth; and a decreased risk of low birth weight (by 58 percent) and prematurity. The effect on birth weight was influenced by initial maternal iron status. Correction of maternal iron deficiency led to an increase in birth weight by [8.4 ounces].
08 Sep Molecular Test For C. difficile Leads To Overdiagnosis
MedicalResearch.com Interview with:
Christopher R. Polage, M. D.
Associate Professor of Pathology and Infectious Diseases
University of California, Davis School of Medicine
Medical Director, Microbiology Laboratory and SARC
UC Davis Health System
Medical Research: What is the background for this study?
Dr. Polage: Clostridium difficile is a frequent cause of diarrhea and infection in U.S. hospitals but common diagnostic tests often disagree about which patients are infected or need treatment. We compared clinical symptoms and outcomes in hospitalized patients with different C. difficile test results to determine which type of test (molecular or PCR test versus toxin test) was the better predictor of need for treatment and disease.
Medical Research: What are the main findings?
Dr. Polage: Twice as many patients were positive by the molecular test versus the conventional toxin test. However, patients with a positive molecular test only had a shorter duration of symptoms than patients with toxins, and outcomes that were similar to patients withoutC. difficile by all test methods. Virtually all traditional complications of C. difficile infection occurred in patients with a positive toxin test; none occurred in patients with a positive molecular test only, despite little or no treatment.
02 Sep Poor Patients Receiving Care Through Ryan White Programs Achieve Better HIV Control
MedicalResearch.com Interview with:
Dr. John Weiser MD MPH
Medical epidemiologist
Division of HIV/AIDS Prevention
CDC
Medical Research: What is the background for this study? What are the main findings?
Dr. Weiser: Ryan White was an Indiana teenager diagnosed with AIDS in the late 1980s. As a result of fear and stigma, he was barred from school and went on to become a national advocate for HIV education and acceptance. This year marks the 25th anniversary of his death and passage of the Ryan White CARE Act creating The Ryan White HIV/AIDS Program (RWHAP) which provides funding for healthcare facilities to deliver needed medical care and support services for hundreds of thousands of poor, uninsured, and underinsured Americans. While increased access to Medicaid and private insurance under the Affordable Care Act will provide coverage for medical care, it might not provide coverage for support services so it is likely that the RWHAP will continue to play a key role in providing these crucial services.
Overall, 34.4 percent of facilities received Ryan White HIV/AIDS Program funding and 72.8 percent of patients received care at RWHAP-funded facilities. Many of the patients at Ryan White HIV/AIDS Program -funded facilities had multiple social determinants of poor health, with patients at RWHAP-funded facilities more likely to be ages 18 to 29; female; black or Hispanic; have less than a high school education; income at or below the poverty level; and lack health care coverage.
Despite the greater likelihood of poverty, unstable housing and lack of health care coverage, nearly 75 percent of patients receiving care at RWHAP-funded facilities achieved viral suppression. The percentage of ART (antiretroviral therapy) prescribing was similar for patients at RWHAP-funded compared with non-funded facilities. Patients at RWHAP-funded facilities were less likely to be virally suppressed. However, individuals at or below the poverty level and those ages 30 to 39 who received care at a RWHAP-funded facility compared with those who received care at a non-RWHAP-funded facility were more likely to achieve viral suppression.
01 Sep Recent Spike in Plague Cases in Western US
[caption id="attachment_17159" align="alignleft" width="300"]
The White-Throated Wood Rat, is a proven carrier of plague vector fleas.[/caption]
Medical Research: What is the background for this study? What are the main findings?
Response: Plague, a bacterial disease that is endemic to the Western United States, is most famous for the destruction it caused during the Middle Ages when it killed over half the population of Europe. Today, plague still infects people around the world and there are a handful of cases each year here in the U.S. However, this year where there are normally 3-7 cases, there have been 12 cases since the beginning of April.
Medical Research: What should clinicians and patients take away from your report?
Response: One of the main reasons CDC issued our report on this year’s plague cases was because we want to remind clinicians and their patients that plague should be considered as a diagnosis if the symptoms, travel history, and exposure fit. Most cases occur between late spring and early fall, so there might still be more cases this year. It’s good to be aware of three things: where cases occur, how the disease is spread, and how to prevent it.
- Most cases occur in the Western United States, and so far this year the cases have been from Arizona (two), California (one), Colorado (four), Georgia (one, but exposed in California), New Mexico (two), Oregon (one), and Utah (one).
- Plague is spread when fleas become infected by feeding on rodents, such as chipmunks, prairie dogs, ground squirrels, mice, and other mammals that are infected with the plague bacterium Yersinia pestis. Fleas then spread the plague bacteria to humans and other mammals during their next feeding.
- Most important, CDC recommends that people who live in or travel to the Western United States wear long pants when possible and use insect repellent on clothing and skin when outside. People also should avoid direct contact with ill or dead animals and never feed squirrels, chipmunks, or otherwild rodents. In addition, pet owners should regularly use flea control products on their pets and consult a veterinarian if their pet is ill. Rodent habitat can be reduced around the home by removing brush, clutter, and potential rodent food sources such as garbage or pet food. If you have any symptoms of plague, please see a clinician and let them know where you’ve traveled and if you’ve had contact with rodents.
01 Sep Arterial Catheters Remain Source of Hospital Associated Infections
Posted at 12:02h
in Author Interviews, Critical Care - Intensive Care - ICUs, Infections, Outcomes & Safety
MedicalResearch.com Interview with:
Leonard Mermel, DO, ScM, AM (Hon), FSHEA, FIDSA, FACP
Professor of Medicine, Warren Alpert Medical School of Brown University
Medical Director, Dept. of Epidemiology & Infection Control, Rhode Island Hospital
Adjunct Clinical Professor, University of Rhode Island College of Pharmacy
Medical Research: What is the background for this study? What are the main findings?
Dr. Mermel: Arterial catheters are an under recognized source of hospital-associated bloodstream infection. As a result, arterial catheter infection prevention strategies are less well studied than with central lines. We did a national survey and our findings reaffirmed the fact that physicians using these catheters underestimate the risk of infection. Additionally and not surprisingly, infection prevention strategies are variable particularly concerning barrier precautions at insertion.
Medical Research: What should clinicians and patients take away from your report?
Dr. Mermel: Arterial catheters can cause catheter-related bloodstream infections. These devices should be aseptically inserted and managed post-insertion and removed as soon as no longer required for patient care. We are also in need of better studies to clearly delineate the ideal infection prevention strategies with these catheters based on our understanding of the pathogenesis of such infections.
31 Aug ID Badges and Lanyards Appear To Have Low Risk of Viral Spread In Hospitals
MedicalResearch.com Interview with:
Daryl R. Cheng, MBBS
Monash Children's Hospital
Victoria, Australia
Medical Research: What is the background for this study? What are the main findings?
Response: Inanimate objects worn and used by health care workers (HCW), such as neckties and stethoscopes, have been shown to be reservoirs for potential pathogens. Of particular concern in the pediatric setting are identity (ID) badges and lanyards.
Many pediatric health care workers use them not only for
identification but also as a distraction tool during examination or procedures. Children have an increased tendency to place these items in their mouth as health care workers lean over to examine or care for them, therefore completing the chain of transmission for a potential nosocomial infection.
Whilst previous studies have demonstrated that ID badges and lanyards worn by health care workers may harbor pathogenic bacteria , there is paucity of comparative data suggesting that ID badges may be similarly contaminated with viral pathogens.
However, given the higher incidence of viral infections in pediatrics up to 50% of preterm infants screened during their hospital stay y had viruses detected in their nasopharynx, further evaluation of the viral burden and potential for nosocomial transmission of prevalent viruses are of both clinical and economic significance.
27 Aug Lice in Many States May Be Resistant To Common Treatments
MedicalResearch.com Interview with:
Kyong Sup Yoon, Ph.D.
Assistant Professor
Department of Biological Sciences and Environmental Sciences Program
Southern Illinois University-Edwardsville
Edwardsville, IL 62026
Medical Research: What is the background for this study? What are the main findings?
Response: Dr. John Clark (Professor, University of Massachusetts-Amherst) and I have been studying this matter for 15 years. The goal of our current study is to determine resistance (knockdown resistance or kdr conferred by 3 point mutations in voltage gated sodium channel alpha subunit gene) frequencies in US head louse populations collected from 48 contiguous states. We were able to analyze 109 populations from 30 states and found 100% kdr frequencies in 104 populations. Hopefully, we can achieve our original goal in near future and publish it.
Medical Research: What should clinicians and patients take away from your report?
Response: We need to implement practical resistance management. Now, for the first time since introduction of pyrethroids, we have different compounds already available or will be (hopefully) available in near future. We suggest to use mixture strategies to minimize development of resistance to any new products.
25 Aug Study Finds Poor Adherence To Guidelines For Skin and Soft Tissue Infections
MedicalResearch.com Interview with:
John P. Haran MD
Assistant Professor of Emergency Medicine
University of Massachusetts Medical School, Worcester, MA
Medical Research: What is the background for this study? What are the main findings?
Dr. Haran: The Infectious Disease Society of America (IDSA) publishes evidence based guidelines for the treatment of skin and soft tissue infections, however, how closely clinicians follow these guidelines is unknown. Observation units have been increasingly used over the past decade in emergency medicine for short-term care of patients for many medical conditions including skin infections. These units offer a great alternative to hospitalization especially for older adults. We set out to describe the treatment patterns used in the observation unit of an academic institute and compare them to the IDSA guidelines. We found that physicians had poor adherence to these guidelines. Additionally, we discovered that older adults were at increased risk of being over-treated while women were at increased risk for being under-treated. These age and gender biases are not new to medicine and emergency departments should standardize antibiotic treatments to reduce treatment bias.
22 Aug Spinach Bleach Contours May Prevent Adequate Decontamination
MedicalResearch.com Interview with:
Nichola Kinsinger, Ph.D
Postdoctoral Researcher, Chemical & Environmental Engineering
University of California, Riverside
USDA National Institute for Food and Agricultural Postdoctoral Fellow
DoD Office of Naval Research National Defense Science and Engineering Graduate Research Fellow, EIT (Chemical Engineering)
Medical Research: What is the background for this study? What are the main findings?
Dr. Kinsinger: Outbreaks observed in produce are becoming increasing common possibly due to contaminated irrigation waters or contaminated waters used during processing. In 2006 California had spinach-borne E. coli outbreak that impacted 26 states and 200 confirmed sickened. Leafy greens account for 20% of the outbreaks alone and are of increased concern since they are frequently consumed raw. These outbreaks drew our attention over the past few years and we started applying methods originally developed for studying bacterial adhesion on engineered surfaces to the issue of food safety. Although food safety is a new area of study for our lab, the project is based upon the concept of pathogen adhesion transport which has been the focus of my advisor’s lab for many years previously. Rather than the previous scenario looking at pathogen interaction with engineered or mineral surfaces, we are looking at a spinach leaf instead.
We are using a parallel plate flow chamber system developed by Professor Sharon Walker to evaluate the real time attachment and detachment of the pathogens to the spinach epicuticle layer (surface layer of the leaf) in realistic water chemistries and flow conditions. Subsequently we can evaluate the efficacy of the rinsing process to kill the bacteria that may remain on the leaf. Initially we were finding that at low concentrations of bleach, bacteria will detach from the leaf surface allowing for potential cross-contamination later in the process. However above 500ppb we observed 100% of the attached bacterial cells are killed.
So how in commercial rinsing operations that use bleach concentration ranging from 50-200ppm result in outbreaks? Through this study we analyzed the topography of the leaf and modeled the concentration gradient across the surface of a leaf based on commercial rinsing practices. We found that even at high bleach concentrations within rinse water result in low bleach concentrations at the leaf surface on the order of 5-1000 ppb bleach, which in our study has shown to that the bacteria can survive when attached to the leaf and/or detach causing concern for cross-contamination. In this case the very disinfection processes intended to clean, remove, and prevent contamination was found to be a potential pathway to amplifying foodborne outbreaks.
22 Aug Novel DNA Vaccine Provides Protection Against MERS Virus
MedicalResearch.com Interview with:
David B. Weiner, Ph.D.
Professor, Department of Pathology and Laboratory Medicine
Chair, Gene Therapy and Vaccine Program, CAMB
Co-Leader Tumor Virology Program, Abramson Cancer Program
University of Pennsylvania, Perelman School of Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Weiner: MERS, like the Severe Acute Respiratory Syndrome (SARS), is characterized by high fever and severe cough from pneumonia. MERS is caused by an emerging human coronavirus, which is distinct from the SARS coronavirus. Since its identification in 2012, MERS has been linked to over 1,300 infections and close to 400 deaths. It has occurred in the Arabian Peninsula, Europe, and in the US and in Asia. It can be spread in a hospital setting.
Scientists now report that a novel synthetic DNA vaccine can, for the first time, induce protective immunity against the Middle EastRespiratory Syndrome (MERS) coronavirus in animal species. Researchers from the Perelman School of Medicine at the University of Pennsylvania. The NIH, the Public Health agency of Canada, and from a leading company in the development of synthetic DNA vaccine technology, Inovio described the results in a paper published their work in Science Translational Medicine (STM) this week. The experimental, preventive vaccine, given six weeks before exposure to the MERS virus, fully protects rhesus macaques from disease. The vaccine also generated potentially protective antibodies in blood drawn from camels, the purported source of MERS transmission in the Middle East.
19 Aug Routine Urinalysis Tests Can Lead To Overtreating Asymptomatic Patients
MedicalResearch.com Interview with:
Jerome A. Leis, MD MSc FRCPC
Division of Infectious Diseases
Sunnybrook Health Sciences Centre
Physician Lead, Antimicrobial Stewardship Team
Faculty Quality Improvement Advisor, Centre for QuIPS
Assistant Professor, Department of Medicine
University of Toronto
Sunnybrook Health Sciences Centre
Toronto, Ontario
Medical Research: What is the background for this study? What are the main findings?
Dr. Leis: We know that urinary tract infections are frequently diagnosed among general medicine patients who lack symptoms of this infection. We wondered whether urinalysis ordering practices in the Emergency Department influence diagnosis and treatment for urinary tract infection among these asymptomatic patients. We found that over half of patients admitted to the general medicine service underwent a urinalysis in the Emergency Department of which over 80% lacked a clinical indication for this test. Urinalysis results among these asymptomatic patients did influence diagnosis as patients with incidental positive results were more likely to undergo urine cultures and treatment with antibiotics for urinary tract infection. The study suggests that unnecessary urinalysis ordering contributes to over-diagnosis and treatment of urinary tract infection among patients admitted to general medicine service.
16 Aug Steroids May Improve Outcomes For Community-Acquired Pneumonia
MedicalResearch.com Interview with:
Reed A.C. Siemieniuk, MD
Department of Clinical Epidemiology & Biostatistics
Ontario Canada
Medical Research: What is the background for this study? What are the main findings?
Dr. Siemieniuk: Local and cytokine-mediated systematic inflammatory responses help clear bacterial pathogens in community-acquired pneumonia (CAP), but often they can also cause harm. Pneumonia is the most common cause of the acute respiratory distress syndrome (ARDS), an often fatal inflammatory complication. Two randomized trials were published earlier this year, each of which suggested the possibility of benefit from adjunctive corticosteroid therapy. We decided to perform a systematic review and meta-analysis, taking all available data into consideration.
Corticosteroids may be effective for reducing the incidence of ARDS by 6%, the need for mechanical ventilation by 5%, and mortality by 3% (all moderate confidence). They also reduce time to clinical stability and time to discharge by approximately 1 day (high confidence).
15 Aug MMR Vaccination May Not Be Reliable in HIV+ Children
MedicalResearch.com Interview with:
George K Siberry, MD, MPH, Medical Officer
Maternal and Pediatric Infectious Disease (MPID) Branch
Eunice Kennedy Shriver National Institute of Child Health and Human Development
National Institutes of Health
Bethesda, MD
Medical Research: What is the background for this study?
Dr. Siberry: Vaccines may not work as reliably in children with HIV infection, especially when their HIV is not under effective treatment. Today, most children in the United States who were born with HIV infection are receiving effective HIV treatment and have reached school age or even young adulthood. However, many received their childhood vaccines before they got started on their HIV treatment (because modern HIV treatments weren’t available when they were very young or their HIV infection was diagnosed late). So we wanted to see if these older children still had immunity from the vaccines they received when they were much younger.
Medical Research: What are the main findings?
Dr. Siberry: We looked specifically at whether older children with HIV since birth were protected against measles, mumps, and rubella, the three viral infections covered by the measles-mumps-rubella (or MMR) vaccine. We found that 1/3 up to almost 1/2 of these children were not protected against these viruses, even though nearly all of the children had received at least 2 MMR doses, as recommended. And even if their HIV was currently under excellent control. When we analyzed factors that were linked to being protected, we found that one of the most important factors was whether you got your MMR vaccine doses after you got on good treatment for your HIV infection. For instance, over 85% of children who had gotten at least 2 MMR vaccine doses after being on effective HIV treatment were protected against measles compared to less than half of those who didn’t get both of their MMR vaccine doses while on effective HIV treatment.
14 Aug Compromised Antimicrobial Response Tied to Infections in Diabetes
MedicalResearch.com Interview with:
Wesley M. Williams, PhD
Cell molecular biologist
Department of Biological Sciences
Case Western Reserve University School of Dental Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Williams: Individuals with uncontrolled blood sugar levels frequently present with higher than normal rates of infection and protracted wound healing. The beta-defensin family of antimicrobial peptides responds to bacterial, fungal and viral invasion. As part of the innate immune system, these cationic peptides normally expressed by epithelial cells are important early responders that, together with other components of the innate immune response, act to inhibit microbial infection. Our initial observations led us to question whether glucose or a metabolite of glucose could contribute to antimicrobial peptide dysfunction, and thus compromise control of infection. Elevated levels of glucose result in increased production of dicarbonyls, a class of molecule that can selectively react with proteins having an unusually high content of cationic amino acids, such as arginine and lysine. We first investigated the effects of two well-characterized dicarbonyls, methylglyoxal (MGO) and glyoxal (GO) on recombinant beta-defensin 2 (rHBD-2) structure using MALDI TOF and LC/MS/MS mass spectral analysis of the recombinant peptide. We found MGO to be particularly reactive with the rHBD-2 peptide as it readily and irreversibly adducted to two arginine residues and the N-terminal glycine. Next we tested in vitro for the effects of adducted rHBD-2 on antimicrobial and chemotactic functions, both essential to an effective innate and adaptive immune response in vivo. Through radial diffusion testing on gram-negative E. coli and P. aeruginosa, and gram-positive S. aureus, and a chemotaxis assay for CEM-SS cells, we found that both antimicrobial and chemotactic functions of rHBD-2 were significantly compromised by MGO.
10 Aug Methadone For IV Drug Addiction Reduces HIV Infections
MedicalResearch.com Interview with:
Dr. Keith Ahamad, a clinician scientist at the BC Centre for Excellence in HIV/AIDS and a Family Doctor trained and certified in Addiction Medicine.
He is Division Lead for Addiction Medicine in the department of Family and Community Medicine at Providence Health Care, and is also an addiction physician at the St. Paul’s Addiction Medicine Consult Service, the Immunodeficiency Clinic and Vancouver Detox. He is also Lead Study Clinician for CHOICES, a US National Institutes of Drug Abuse (NIDA) funded clinical trial looking at an opioid receptor blocker (Vivitrol) to treat opioid or alcohol addiction in HIV positive patients.
MedicalResearch: What is the background for this study?
Dr. Ahamad: Previous methadone research has mostly been done in restrictive settings, such as the USA, where methadone can only be dispensed through restrictive methadone programs and cannot be prescribed through primary care physician’s offices. Since a systematic review in 2012, randomised controlled trials have compared methadone treatment provided at restrictive specialty clinics with primary care clinics, which have shown the benefits of primary care models of methadone delivery on heroin treatment outcomes, but not on HIV incidence.
MedicalResearch: What are the main findings?
Dr. Ahamad: After adjusting for factors commonly associated with HIV, methadone remained independently associated in protecting against HIV in this group of injection drug users. Those study participants who were not prescribed methadone at baseline were almost four times more likely to contract HIV during study follow up.
MedicalResearch: What should clinicians and patients take away from your report?
Dr. Ahamad: Methadone is an effective medication in treating opioid addiction. Through international randomized control trials, we already know that when prescribed though primary care offices, access to this life-saving medication is increased, effective, and increases patient satisfaction. Now, through our study, we have evidence that when delivered in this manner, it also decreases the spread of HIV.
07 Aug Simple Internet Program Increased Handwashing and Reduced Infections
MedicalResearch.com Interview with: Paul Little MBBS, BA, MD, DLSHTM, MRCP, FRCGP, FMedSci Professor of Primary Care Research University of Southampton
Medical Research: What is the background for this study? What are the main findings? Prof. Little: Hand washing has been recommended to help prevent respiratory infections (coughs, colds flu, sore throats) - this can be important in normal winters but might be especially important in pandemic flu years. However, there has been little evidence from randomised trials to date to show that handwashing works. [caption id="attachment_16369" align="alignleft" width="350"]
A simple internet based intervention to support increasing hand washing behavior reduced the numbers of infections caught and the number of infections given to family members,[/caption]
06 Aug Majority of New HIV Infections Occur in Men Who Have Sex With Men
MedicalResearch.com Interview with:
Adaora Adimora, MD, MPH
Chair,Professor of Medicine School of Medicine
University of North Carolina, Chapel Hill.
MedicalResearch: What is the current scope of the HIV epidemic?
Dr. Adimora: The Centers for Diseases Control and Prevention (CDC) estimates that there are 1.2 million people living with HIV in the U.S. Nearly 13% are undiagnosed and unaware of their status. Men who have sex with men represented 54% of all people living with HIV in 2011. While new infection rates are stable, a majority of new infections (63%) are occurring among men who have sex with men. We have seen alarming increases among young black men who have sex with men who account for 55% of new infections among men who have sex with men. New infections among women have decreased slightly but black and Hispanic/Latina women represent 62% and 17% of new infections respectively among women.[i] While there have been decreases in new HIV infections among people who inject drugs in recent years, the serious outbreak largely among injection drug users in Scott County, Indiana identified this past spring[ii] puts us on high alert to improve access to preventive services and substance use treatment, including access to sterile syringes and equipment.
My responses will generally focus on the U.S. epidemic but want to acknowledge that globally an estimated 36.9 million people were living with HIV at the end of 2014 with just 51% of them being diagnosed and more than 34 million deaths were attributed to HIV-related causes.[iii]
06 Aug Tenovir Gel May Reduce Risk of Both HIV and Herpes Simplex
MedicalResearch.com Interview with:
Dr. Salim Abdool Karim at CAPRISA
Doris Duke Medical Research Institute
South Africa
Medical Research: What is the background for this study? What are the main findings?
Response: Globally, Herpes simplex virus type-2 (HSV-2) is among the most common sexually transmitted infections and is the leading cause of genital ulcers. Available global estimates indicate that approximately 417 million sexually active adults between the ages of 15 and 49 years had an existing prevalent HSV-2 infection in 2012. Current interventions to prevent HSV-2 infection, including condoms, circumcision, and antiviral treatment among heterosexual, HSV-2-discordant couples, have demonstrated protection levels ranging from 6% to 48%. This study showed that peri-coital tenofovir gel reduced HSV-2 acquisition in women by 51%, rising to 71% in high gel-users.
31 Jul Cancer Drug Can Activate HIV Reservoirs To Target For Eradication
MedicalResearch.com Interview with:
Dr. Satya Dandekar PhD
Professor and Chair
Department of Medical Microbiology and Immunology
UC Davis
Medical Research: What is the background for this study? What are the main findings?
Dr. Dandekar: Current anti-retroviral therapy is effective in suppressing HIV replication and enhancing immune functions in HIV infected individuals. However, it fails to eradicate the latent HIV reservoirs. Therapy interruption leads to a rapid viral rebound in these patients. Eradication of latent HIV reservoirs is essential to achieve HIV cure. A “shock and kill” strategy for HIV cure has been proposed that involves reactivation of latent viral reservoirs using latency reversal agents (LRA) and eradication by the immune response. This highlights the need to identify potent LRAs to optimally activate latent HIV reservoirs so that immune surveillance and clearance mechanisms can be effectively engaged in the process of viral eradication. We have found that ingenol-3-angelate (PEP005), an anti-cancer drug can effectively reactivate latent HIV. It is a protein kinase C agonist that activates NF-kB and stimulates HIV expression. In combination with another compound, JQ1, a previously known p-TEFb agonist, the efficacy of PEP005 for HIV reactivation is markedly increased. In addition, ingenol-3-angelate decreases the expression of HIV co-receptors on immune cells, which potentially will help preventing further spread of the virus. The use of ingenol-3-angelate in combination with other latency reversal agents provides an excellent opportunity to optimally activate latent HIV reservoirs and target them for eradication.