MedicalResearch.com Interview with:
Vijay R. Ramakrishnan, MD
Assistant Professor
University of Colorado
Department of Otolaryngology
Aurora, CO 80045
Medical Research: What is the background for this study? What are the main findings?Dr. Ramakrishnan: Chronic rhinosinusitis (CRS) is an extremely common problem, associated with major quality of life alterations and financial burden. Bacteria are thought to play a role in the initiation or sustenance of the disease, at least in a subset of CRS patients. Chronic rhinosinusitis is probably a group of heterogeneous diseases with different pathways that result in the same endpoint. Here, we study the bacterial microbiome of a large group of CRS and healthy sinuses, and discover that a few clinical subtypes display unique bacterial microbiome profiles and that the microbiome may predict outcomes from severe Chronic rhinosinusitis patients electing to undergo surgery.
(more…)
MedicalResearch.com Interview with:
Dr Fiona McQuaid
Clinical Research Fellow
University of Oxford, United Kingdom
Medical Research: What is the background for this study?Response: Meningococcal B disease is a common cause of sepsis and meningitis
with significant mortality and morbidity. A multicomponent vaccine
against serogroup B meningococcus has been licensed for use in the
Europe, Australia, Canada and recently the USA (though only in the
10-25 years age group) but questions remain about how long the
bactericidal antibodies induced by infant vaccination persist and the
likely breath of strain coverage. This was a follow on study looking
at a group of children aged 5 years who had been vaccinated as infants
and a different group who were vaccinated for the first time at 5
years of age.
Medical Research: What are the main findings?Response: The percentage of children with protective antibody levels who had
been immunized as infants fell in the 20 months since their last
immunization but this varied by the strain of meingococcus B tested
and by the different infant/toddler vaccination schedules.
The children who were vaccinated for the first time at 5 years of age
showed a good antibody response, but most reported pain and redness
around the site of vaccination and 4-10% had a fever.
(more…)
MedicalResearch.com Interview with: Loren G. Miller, M.D., M.P.H.
Los Angeles Biomedical Research Institute
(LA BioMed) Infectious Disease Specialist
Medical Research: What is the background for this study?Dr. Miller: Skin and skin structure infections are extremely common reasons for persons
to seek medical care in the U.S., accounting for approximately 14.2 million
outpatient visits in 2005, the latest year for which statistics are
available, and 850,000 hospital admissions. Until this study was completed,
the most effective approach to outpatient antibiotic treatment of
uncomplicated skin infections in the era of community-acquired
methicillin-resistant Staphylococcus aureus (MRSA) was unclear. Prior to
this research, there were no data on which antibiotics were best for
treatment of these common skin infections.
Medical Research: What are the main findings?Dr. Miller: Two antibiotics frequently prescribed to treat serious skin infections -
clindamycin and trimethoprim sulfamethoxazole (TMP-SMX) - had similar rates
of success in curing uncomplicated infections in outpatients. They also had
similar rates of side effects.
To conduct the study, we recruited outpatients from emergency departments,
clinics and other healthcare facilities associated with Los Angeles County's
Harbor-UCLA Medical Center, University of Chicago Medical Center, San
Francisco General Hospital and Vanderbilt University Medical Center from May
2009 to August 2011. We studied 524 adults and children with uncomplicated
skin infections who had cellulitis, abscesses of 5 centimeters or more or
both. In the multicenter, double blind, randomized clinical trial, 264
received clindamycin and 260 received TMP-SMX. We followed the outpatients
for a month after their treatment.
We found similar outcomes for both groups - 80.3% of the outpatients who
received clindamycin and 77.7% of the outpatients in the group that received
TMP-SMX were cured within seven to 10 days after the end of their treatment.
These are not considered significant differences, so our evaluation is that
these two commonly prescribed antibiotics for serious skin infections are
similarly effective in treating uncomplicated skin infections in children
and adults who have few or no major co-existing conditions.
(more…)
MedicalResearch.com Interview with:
Lona Mody, MBBS, MSc
Associate Division Chief, Clinical and Translational Research
Associate Director, Clinical Programs, VA GRECC
Associate Professor, Internal Medicine
Research Associate Professor, Institute of Gerontology
University of Michigan Geriatrics Ann Arbor, MI
Medical Research: What is the background for this study? What are the main findings?
Response: Over 1.5 million residents live in 15,600 Nursing Homes in the US. The acuity of illness in this population has increased substantially in the last decade, as has the risk of acquiring new infections. Multi-drug resistant organisms, also known as MDROs, are endemic in this setting with prevalence estimates upwards of 35% and surpassing those in the hospitals. Nursing homes historically have had few infection prevention resources, which contributes to these high rates. Patients with indwelling devices such as urinary catheters and feeding tubes present an attractive habitat for these ‘superbugs’ and thus carry the added burden of device-related infections.
The authors examined the effect of a targeted infection program, or TIP, to reduce the prevalence of Multi-drug resistant organisms and new catheter or feeding tube infections among patients with indwelling devices. The TIP intervention was three-fold:
Surveillance for infections and Multi-drug resistant organism colonization with regular feedback to facilities;
Extensive and interactive staff education using adult learning theory about key infection prevention practices and hand hygiene; and
Use of gowns and gown when providing assistance to patients for high-risk activities such as bathing and grooming.
Staff education emphasized precautionary measures against the spread of infection and included mock game shows, songs and dances. Hands were cultured for bacteria before and after hand washing. Outcomes were measured by results of the cultures taken for each patient and monitoring infection rates.
A team of researchers from the University of Michigan and the Veterans Affairs Ann Arbor Health System has demonstrated that simple measures might be all it takes to push back at the spread of Multi-drug resistant organisms or ‘superbugs’ in nursing homes as well as reduce infections. In their study of patients with indwelling devices, MDROs were reduced by 23 percent among 418 residents in six southeast Michigan nursing homes who participated over the course of the three-year study. The numbers of catheter-associated urinary tract infections and MRSA acquisitions also decreased, 46 percent and 22 percent respectively.
The trial examined the relationship between acquisition of antimicrobial resistance among nursing home and assisted living facility residents with the use of devices by adapting new methodological approaches and study designs to study infection prevention interventions including the use of cluster-randomized study design for infection prevention interventions, adopting adult learning practices to engage frontline healthcare personnel and using multi-anatomic site sampling to demonstrate effectiveness of the program.
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MedicalResearch.com Interview with:
Dr.Yecai Liu
Division of Global Migration and Quarantine
Centers for Disease Control and Prevention, Atlanta, Georgia
Medical Research: What is the background for this study? What are the main findings?
Response: Since the early 1900s, immigrants and refugees applying for a visa to come to the United States undergo a medical examination that includes tuberculosis (TB) screening. In 2007, CDC began implementing the new screening guidelines, which require people suspected of having TB to receive a much more sensitive sputum culture test to confirm TB to ensure that those individuals who do have TB receive treatment before they arrive in the United States. These requirements have now been completely rolled out to all countries with U.S.-bound immigrants and refugees.
From 2007 through 2012, half of the 3.2 million arrivals of immigrants and refugees to the United States were screened for TB by the new screening guidelines. Out of more than 4,000 TB cases diagnosed by the new screening guidelines during this period, nearly 2,200 were smear-negative and culture positive. These cases would likely have been missed under the previous screening requirements. The results of this study showed that the updated overseas screening guidelines led to a roughly one-third decrease in the annual number of TB cases among foreign-born persons within their first year in the United States.
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MedicalResearch.com Interview with:Dr. Ana Ramírez-Boscá, MD
Department of Dermatology and Clinical Research Unit and
Vicente Navarro-López, MD
Clinical Research Unit and Infectious Diseases Unit
Centro Dermatológico Estético, Alicante, Spain
MedicalResearch: What is the background for this study? What are the main findings?Response: Infections have been related with the pathogenesis of guttate psoriasis, however antibiotic treatment does not improve prognosis nor does it affect the evolution of the disease. The association between psoriasis and other infectious diseases has been reported as well, although in these cases there is scarce information on the causative microbial likely involved and the role of these bacteria in the pathogenesis of this skin disease.
MedicalResearch: What are the main findings?Response: Bacterial DNA may be detected in bloodstream of a significant proportion of patients with active plaque psoriasis. Increased levels of pro-inflammatory cytokines in patients with presence of bacterial DNA but not in patients without presence of bacterial genomic fragments suggest a role of bacterial DNA translocation in inducing an inflammatory response.
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MedicalResearch.com Interview with:
Hallie Prescott, MD, MSc
Clinical Lecturer, Internal Medicine
Division of Pulmonary & Critical Care Medicine
University of Michigan Health System
Ann Arbor, MI 48109-2800
Medical Research: What is the background for this study? What are the main findings?
Dr. Prescott: The post-hospital period has been widely recognized as a vulnerable time for patients. In particular, patients who survive sepsis are frequently readmitted to the hospital in the following three months.
In this study, we examined data from 2,600 survivors of sepsis, a severe infection that leads to organ failure. About 42% of the sepsis patients were readmitted in the next 90 days, similar to the rate seen for patients hospitalized for other acute conditions.
However, the reasons for hospital readmission after sepsis are different. A greater number of patients are re-hospitalized for “ambulatory-care sensitive conditions”, which are conditions that could potentially be prevented or treated early in the outpatient setting to avoid a hospital stay.
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MedicalResearch.com Interview with:
Dr. Grant Hansman
CHS Research Group at CellNetworks Heidelberg University and DKFZ
Deutsches Krebsforschungszentrum
Heidelberg Germany
Medical Research: What is the background for this study? What are the main findings?
Dr. Hansman: Human noroviruses are the major cause of outbreaks of acute gastroenteritis. There are several promising vaccine candidates. Vaccines may offer some protection, but the fact that the virus changes every other year produces a challenge. Therefore, my research group investigates the possibility to produce universal antivirals targeting conserved regions on the virus capsid.
We found that a Nanobody was able to bind with a high affinity, and broad reactivity to diverse norovirus types. The Nanobody binding on the virus capsid caused the virus particles to disassemble. The disassembly of the particles may render the virus non-infectious and block viral infections.
(more…)
MedicalResearch.com Interview with:
Su-Ying Wen, MD
Chief of Department of Dermatology,
Taipei City Hospital, Renai Branch, Taipei City, Taiwan
Department of Dermatology, Taipei City Hospital, Renai Branch, Taipei City, Taiwan
Medical Research: What is the background for this study? What are the main findings?
Dr. Su-Ying Wen: Though herpes zoster is seen as a disease of the elderly, it can affect individuals in any age group including children. There are limited population-based data regarding pediatric herpes zoster.
We reported a higher incidence rate of pediatric herpes zoster than in previous studies. The higher incidence observed in this population-based study might be because it was measured in a cohort of children who were all infected with varicella rather than as other reports including individuals free of varicella infection in the denominator. Children younger than 2 years at the diagnosis of varicella had a significantly higher risk and shorter duration of developing herpes zoster. (more…)
MedicalResearch.com Interview with:
Lorena Espinoza
Center for Disease Control
MedicalResearch: What is the background for this study? What are the main findings?
Response: Men...
MedicalResearch.com Interview with:
Cyprian Wejnert
Center For Disease Control
MedicalResearch:What is the background for this study? What are the main findings?Cyprian Wejnert: Men who have sex with men (MSM) remain the risk group most severely affected by HIV in the United States, accounting for approximately two-thirds of new infections each year. Understanding racial and age disparities among MSM is critical to tailor effective prevention efforts. Our study examined data from CDC’s National HIV Behavioral Surveillance system (NHBS) from 20 U.S. cities. We assessed changes in HIV prevalence, awareness of infection, and risk behavior among MSM, by age and race, from 2008 to 2011, finding that:
o Among black Men who have sex with men, 30 percent were HIV-infected overall, and 1 in 5 black MSM aged 18-24 were infected with HIV. Compared to 14 percent and 4 percent among white MSM.
o In all age groups younger than 40 years, black Men who have sex with men were significantly more likely to be HIV-positive compared to all other racial/ethnic groups.
o Disparities in HIV prevalence between black and white MSM were greatest among the youngest MSM, and increased between 2008 and 2011.
o Black MSM were less likely to be aware of their infection than their white counterparts (54 vs. 86 percent).
o Black Men who have sex with men did not report higher levels of condomless sex overall or condomless sex with partners of discordant or unknown HIV status. (more…)
MedicalResearch.com Interview with: Dr. Ndidi Nwangwu-Ike
Center Disease Control
MedicalResearch: What is the background for this study? What are the main findings?Response: CDC data has shown encouraging signs of a decrease in new HIV infections among black women in recent years. However, African American women continue to be far more affected by HIV than women of any other race or ethnicity, with a rate of new infection 20 times that of white women and nearly five times that of Hispanic women. Ensuring people with HIV are diagnosed and remain in care is key to controlling HIV in the nation. When used consistently, antiretroviral medication can keep HIV controlled at very low levels in the body (known as viral suppression), allowing people with HIV to live longer, healthier lives and reducing the likelihood they will transmit HIV to others. Our study finds that viral suppression among women diagnosed with HIV is low, with young women and black women the least likely to achieve viral suppression. Specifically, we found that:
o Of women newly diagnosed with HIV in 2012, 83 percent were linked to care within three months of diagnosis.
o Retention in care varied by age and race/ethnicity; overall, just over half of women (52 percent) diagnosed and living with HIV in 2011 received ongoing HIV care.
o Overall, only 44 percent of women diagnosed and living with HIV in 2011 had a suppressed viral load.
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MedicalResearch.com Interview with:
Marc Brisson
Canada Research Chair in Mathematical Modeling and Health Economics of Infectious Disease
Associate Professor, Université Laval
Medical Research: What is the background for this study? What are the main findings?
Response: Since 2007, 52 countries have implemented human papillomavirus vaccination (HPV) programmes. Two HPV vaccines are currently available worldwide: the bivalent vaccine, which targets HPV types 16 and 18, causing 70-80% of cervical cancer, and the quadrivalent vaccine, which also targets HPV types 6 and 11, associated with 85-95% of anogenital wart cases. Large international randomised controlled clinical trials have shown both vaccines to be safe, well tolerated and highly efficacious against vaccine-type persistent infections and precancerous cervical lesions. Furthermore, both vaccines have shown some level of cross-protection against 3 HPV types (HPV 31, 33 and 45) not included in the vaccine and associated with a supplementary 10-15% of cervical cancers worldwide. Now that 7 years have elapsed since the implementation of the first HPV vaccination program, we verified whether the promising results from clinical trials are materialising at the population level. We conducted a meta-analysis to examine the population-level impact in countries that have introduced HPV vaccination programs.
In countries with high female vaccination coverage (<50%), our main findings indicate:
sharp declines in HPV-related outcomes among females targeted for vaccination (e.g., HPV-16/18 infection and anogenital warts declined by more than 60% in females younger than 20 years), and
evidence of cross-protection with significant reductions in HPV-31/33/45 infection among females younger than 20 years
evidence of herd effects (indirect benefit of vaccination among unvaccinated individuals) with significant reductions in anogenital warts among males and older females.
In countries with low coverage (<50%), we report:
significant reductions in HPV-16/18 infection and anogenital warts among young females, with no indication of herd effects or cross-protection. (more…)
MedicalResearch.com Interview with:
Dr. Michael Farzan PhD
Vice Chairman
Department of Immunology and Microbial Science
Florida Campus
The Scripps Research Institute
Medical Research: What is the background for this study?Dr. Farzan: The key points are that HIV-1 needs two receptors – CD4 and CCR5 – to infect cells. CD4’s primary job is to initially bind the viral entry protein, which upon CD4 binding, uncloaks its CCR5 binding site. A number of years ago we observed that CCR5 had an unusual modification that was really important to HIV-1. We later showed that antibodies – protein your body makes to protect from pathogens – mimics CCR5 by incorporating this modification. We develop a peptide from one of these antibodies that mimics CCR5.
Medical Research: What are the main findings?
Dr. Farzan: By combined a soluble form of CD4 with this CCR5-mimicking peptide, we created a protein that neutralizes all HIV-1 isolates tested, including the hardest-to-stop viruses, as well as distantly related viruses found in monkeys. It does so better than the best HIV-1 antibodies. We expressed this protein using a commonly used gene-therapy vector, and showed that after a one-time inoculation we could protect from doses much higher than most humans are likely to see, and we did so 34 weeks after the inoculation.
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MedicalResearch.com Interview Invitation
Frank Struyf MD PhD
Director, Lead Clinical Development HPV vaccines at GlaxoSmithKline Biologicals GlaxoSmithKline Vaccines,
Rixensart, Belgium
MedicalResearch: What is the background for this study? What are the main findings?Dr. Struyf: Cervical cancer is the fourth most common cancer among women, with estimates from 2012 indicating that there are 528,000 new cases and 266,000 deaths each year worldwide, the majority of cases occurring in developing countries (reference: Globocan 2012 at http://globocan.iarc.fr/old/FactSheets/cancers/cervix-new.asp). Persistent infection with oncogenic human papillomavirus (HPV) is a necessary condition for the development of invasive cervical cancer. HPV type 16 (HPV-16) and HPV-18 are found in approximately 70% of cases. We conducted the Papilloma Trial Against Cancer in Young Adults (PATRICIA), a multinational clinical trial in 14 countries in Europe, the Asia-Pacific region, North America, and Latin America and enrolled over 18,000 women. The trial showed that the HPV-16/18 AS04-adjuvanted vaccine not only prevented persistent infections and high-grade cervical lesions associated with HPV types 16 and/or 18 included in the vaccine, but also protected against some common related oncogenic HPV types not included in the vaccine. However, during the analysis of this trial, we also noticed that for some rare nonvaccine oncogenic HPV types, the vaccine efficacy against infections did not seem to match the efficacy against lesions associated with the same HPV type. To investigate this, we re-analyzed the samples from the trial using a different PCR method and found that the HPV PCR methodology used per protocol may have underestimated the efficacy for non-vaccine HPV types in cases of multiple infections. While these results do not replace the results generated according to the study protocol and included in the product label, they are reassuring, as they confirm the cross-protective efficacy of the HPV-16/18 vaccine against some HPV types related to those included in the vaccine.
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MedicalResearch.com Interview with:
Shyamasundaran Kottilil MBBS, PhD
Division of Infectious Diseases, Institute of Human Virology, University of Maryland, Baltimore
Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
Medical Research: What is the background for this study? What are the main findings?Dr. Kottilil:Due to shared routes of transmission, almost half of all HIV-infected patients also have HCV infection. Traditionally, interferon based therapies have resulted in lower cure rates of HCV in HIV-infected subjects. Treatment for HCV is rapidly changing from an injection (interferon) based therapy to oral well tolerated pill based therapy for a shorter duration.Our intention was to test whether a treatment regimen without the use of interferon and ribavirin can be effective in HIV/HCV infected patients.
Our study demonstrated that HIV/HCV connected patients without cirrhosis can be effectively treated with ledipasvir and sofosbuvir in 12 weeks. Overall 98% of patients were cured.
(more…)
MedicalResearch.com Interview With
Jacek Skarbinski, MD
Medical officer
Centers for Disease Control and Prevention
MedicalResearch: What is the background for this study? What are...
MedicalResearch.com Interview with:
Elmar A. Joura, M.D
Gynecologist
University of Vienna
MedicalResearch: What are the main findings of this study?Dr. Joura: This study demonstrates that the new ninevalent HPV vaccine induces a good immunogenicity against HPV 6/11/16/18 and gives a 97% protection against disease caused by HPV 31/33/45/52/58. This has a potential of a 90% reduction of cervical cancer and other HPV related cancers and a similar protection against genital warts. The full benefit is seen in persons without current HPV infection, this reinforces early vaccination against HPV. The safety profile was favourable.
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MedicalResearch.com Interview with:
Dr. Masae Kawamura MD
Senior Director, QuantiFERON Medical and Scientific Affairs QIAGENMedicalResearch:What is the background for this study? What are the main findings?
Dr. Kawamura: The report in The Lancet presents the baseline phase of China’s first large-scale, multi-center prospective study of the epidemiology of latent tuberculosis infection. The comparison study of more than 21,000 patients allowed detailed analysis of demographics and risk factors, along with robust comparisons within subgroups. The study’s follow-up phase is now underway, and patients with Latent Tuberculosis Infection (LTBI) will be evaluated for rates of disease and associated risks. Generally, up to 10% of people with Latent Tuberculosis Infection will develop active, contagious Tuberculosis (TB) disease at some point.
The overall TB infection rate was 18.8% measured by QuantiFERON-TB Gold compared to 28% by the traditional tuberculin skin test (TST), a difference of over 125 million people (based on 2014 population estimates from China). Unlike the tuberculin skin test, positive rates of QuantiFERON-TB Gold were not related to prior Bacille Calmette-Guérin (BCG) vaccination, but correlated with background active TB and suspect rates, as well as known risks for TB. BCG vaccination is recommended to newborns by the World Health Organization (WHO) as a matter of TB control policy in many countries, including China. (more…)
MedicalResearch.com Interview with:
Seema Jain, MD
Medical Epidemiologist
Epidemiology and Prevention Branch, Influenza Division
Centers for Disease Control and Prevention
Atlanta, GA 30329
MedicalResearch: What is the background for this study? What are the main findings?Dr. Jain: Pneumonia is the leading cause of hospitalization among children in the United States with medical costs estimated at almost $1 billion in 2009. The Centers for Disease Control and Prevention’s Etiology of Pneumonia in the Community (EPIC) study was a multi-center, active population-based surveillance study that aimed to estimate the incidence and etiology of community-acquired pneumonia requiring hospitalization in U.S. children. Children in the study were enrolled from January 2010 to June 2012 in three U.S. children’s hospitals in Memphis, Nashville, and Salt Lake City. Study staff tested children using a range of laboratory tests for viral and bacterial respiratory pathogen detection.
During the study period, the EPIC study team enrolled 2,638 children, of which 2,358 (89 percent) had radiographically-confirmed pneumonia. The median age of children in the study was 2 years old. Intensive care was required for 497 (21 percent) of the children, and three children died. Among 2,222 children with radiographic pneumonia and specimens available for both bacterial and viral testing, a pathogen was detected in 1802 (81%). One or more viruses were detected in 1,472 (66%) of these children. Bacteria were detected in 175 (8%), and bacterial and viral co-detection occurred in 155 (7%). The study estimated that annual pneumonia incidence was 15.7/10,000 children during the study period. The highest incidence was among children younger than 2 years old (62.2/10,000). Respiratory syncytial virus (RSV) was the most common pathogen detected (28%), and it was associated with the highest incidence among children younger than 2 years old with pneumonia. Human rhinovirus was detected in 22 percent of cases, but it was also identified in 17 percent of asymptomatic controls who were enrolled, by convenience sample, at the same site during the same time period; thus, making it challenging to interpret the meaning of human rhinovirus detection in children hospitalized with pneumonia. Other detected pathogens were human metapneumovirus (13%), adenovirus (11%), Mycoplasma pneumoniae (8%), parainfluenza viruses (7%), influenza (7%), coronaviruses (5%), Streptococcus pneumoniae (4%), Staphylococcus aureus (1%), and Streptococcus pyogenes (<1%). The low prevalence of bacterial detections likely reflects both the effectiveness of bacterial conjugate vaccines and suboptimal sensitivity of bacterial diagnostic tests. (more…)
MedicalResearch.com Interview with: Fernanda C. Lessa, M.D., M.P.H.
Centers for Disease Control and Prevention
Atlanta, GA
MedicalResearch: What is the background for this study? What are the main findings?Dr. Lessa: The epidemiology of Clostridium difficile has gone through dramatic changes over the last decade. C. difficile has become the most common cause of healthcare-associated infections in US hospitals and it has been also increasingly reported outside of healthcare settings. As the epidemiology of this pathogen changes, it is important to understand the magnitude and scope of this infection in the United States to help guide priorities for prevention.
Main findings:
1) C. difficilewas responsible for almost half million infections and associated with 29,000 deaths in 2011 in the United States
2) Among the patients who developed C. difficile, 83,000 had recurrent infections
3) C. difficile incidence was higher among females, whites, and persons 65 years of age or older
4) Approximately 345,400 infections occurred outside of the hospital indicating that C. difficile prevention should go beyond hospital settings.
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MedicalResearch.com Interview with:
Robert M Centor, MD, MACP
Chair ACP Board of Regents
Regional Dean, UAB Huntsville Regional Medical Campus
Huntsville, AL 35801
Professor, General Internal Medicine
UAB Birmingham, AL 35294-3407
Medical Research: What is the background for this study? What are the main findings?Dr. Centor: European researchers have shown that Fusobacterium necrophorum, an obligate gram-negative anaerobe, likely causes approximately 10% of young adult pharyngitis. This same organism is the major cause of peritonsillar abscess in the age group (and this age group has the highest rate of peritonsillar abscess). The organism also causes around 80% of the Lemierre Syndrome. We knew of no US data evaluating the role of this bacteria as a cause of pharyngitis. The European studies also did not report the signs and symptoms of Fusobacterium pharyngitis. (more…)
MedicalResearch.com Interview with:
Valerie Cluzet, MD
Hospital of the University of Pennsylvania
Division of Infectious Diseases
Philadelphia, PA 19104
MedicalResearch: What is the background for this study? What are the main findings?Dr. Cluzet: MRSA is a major cause of skin and soft tissue infection (SSTI) in the community and we know that colonization is an important risk factor for subsequent infection. Past studies have calculated duration of colonization based on colonization at hospital admission or focused on populations not representative of the typical community-dwelling patient. We wanted to identify the factors associated with duration of colonization in a typical patient that clinicians would see (i.e. adults and children presenting to ambulatory setting with a MRSA SSTI), so that the findings would be generalizable and relevant to their practice. In addition, there has been an increasing focus on the role of the household in transmission of MRSA, so wanted to specifically examine that in a longitudinal, systematic way.
There are a few major points that emerged from our study.
1) The first is that the duration of colonization after treatment for a methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infection (SSTI) is relatively short, but there is a significant subset of patients (approximately 20%) who will have persistent colonization.
2) We also found that treatment of the MRSA SSTI with clindamycin was associated with shorter duration of colonization, an association we did not see with other MRSA-active agents.
3) Finally, this study highlights the potential role of MRSA colonization among household members as a contributing factor in duration of colonization in patients.
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MedicalResearch.com Interview with: Kristen Hess ORISE Fellow
Division of HIV/AIDS Prevention,
National Center for HIV, Viral Hepatitis, STD and TB Prevention
Centers for Disease Control and Prevention Atlanta, GA
MedicalResearch:What is the background for this study? Response: Men who have sex with men (MSM) of all races continue to be the risk group most severely affected by HIV in the United States. CDC’s most recent HIV incidence data show that the number of new infections among MSM increased 12 percent between 2008 and 2010, with an even steeper increase among the youngest MSM. These data clearly show the urgent need to better understand the factors that affect their risk and to develop effective prevention interventions.
One specific factor is excessive alcohol use, which is responsible for 88,000 deaths in this nation each year, and cost the U.S. about $224 billion in 2006. Binge drinking (consuming ≥5 drinks for men on an occasion; ≥4 drinks for women) is the most common form of excessive alcohol consumption. The association between excessive alcohol consumption, including binge drinking, and risky sexual behaviors among MSM has had mixed results in the literature with some studies finding an association and others not. One limitation of previous work is that the definition of excessive alcohol consumption varies between studies, so results are not easily compared between studies and populations.
Our study examines the relationship between binge drinking and sexual risk behaviors among MSM who are current drinkers and who were either HIV-negative or unaware of their HIV status.
MedicalResearch:What are the main findings? Response: We assessed the prevalence of binge drinking, using a standard definition, among a sample of MSM recruited from 20 cities across the U.S. We also examined the association between binge drinking and several risky sexual behaviors.
The findings show that 6 in 10 MSM reported binge drinking. Those who binge drank, in comparison to non-binge drinkers, were more likely to engage in risky sexual behaviors such as sex with an HIV-positive or unknown status partner and exchange sex for money or drugs at last sex, as well as more likely to have concurrent partners and more condomless sex partners in the past year.
We also found that the likelihood of risky sexual behaviors went up with increased frequency of binge drinking. In fact, MSM who reported 10 or more binge-drinking episodes in the past month were more likely to report risky behaviors. This is a critical point, especially given that, among those who binged, 22 percent reported 10 or more binge drinking episodes in the past month. (more…)
MedicalResearch.com Interview with:
Dr. Cornejo-Juárez
Department of Infectious Disease,
Instituto Nacional de Cancerología
Tlalpan Mexico
MedicalResearch: What is the background for this study?
Dr. Cornejo: Critically ill patients in the intensive care unit are at major risk of hospital-acquired infections. Immunosuppressed patients have a higher risk related with continuous exposure to the hospital setting, mucositis and disruption of skin integrity, presence of indwelling catheters and abnormal immune system because of primary malignancy or chemotherapy. Our aimed was to investigate prevalence and outcome of hospital-acquired infections in an oncology ICU.
MedicalResearch: What are the main findings?
Dr. Cornejo: We found that hospital-acquired infections are a major problem in the ICU. Hospital-acquired infections are related with higher mortality. Multidrug resistant bacteria are frequently involved in these infections, and are associated with increased mortality.
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MedicalResearch.com Interview with:
Elmi Muller, M.B., Ch.B., M.Med.
University of Cape Town–Surgery
Groote Schuur Hospital Observatory Cape Town
Cape Town, South AfricaMedical Research: What is the background for this study?
Dr. Muller: South Africa currently offers dialysis and transplantation as a treatment option for patients with End Stage Renal Disease (ESRD). However, dialysis is not freely available to everyone, but severely limited and only available to a selected group of patients. This means that patients get assessed when they present with ESRD and they only get accepted onto a dialysis programme if they fulfill certain criteria. These criteria are criteria to assess the patient’s medical fitness in general as well as social criteria to assess whether the patient will be compliant with follow-up. In most state hospitals, patients will only be accepted onto a dialysis program if they are also fit to receive a transplant in the long run. The idea is that dialysis programs should naturally feed into transplant programs. Therefore a patient who is not a suitable transplant candidate will normally be turned down for dialysis.
In 2008, when the HIV positive-to-positive program started, patients with ESRD and HIV would be turned down for dialysis. The reason was that they were seen as unfit for transplantation and therefore not suitable dialysis patients. This meant that anybody with HIV and ESRD was doomed to die. This situation remained unchallenged for a number of years, especially as the rollout of antiretroviral therapy was quite slow in the state sector.
Because of very high HIV rates in the country, more and more HIV positive brain-dead donors presented to the Groote Schuur Hospital Transplant team. These donors were mostly braindead people who were worked up for organ donation (after consent was obtained from the family) and who then turned out to be HIV positive. In 2008 it made sense to try and marry this supply of donors with the group of HIV positive patients without any treatment options in the country.
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MedicalResearch.com Interview with:Tassaneewan Laksanasopin
PhD Candidate
Molecular and Microscale Bioengineering Lab
Columbia University
Medical Research: What is the background for this study? What are the main findings?
Response: We miniaturized and integrated all components needed for blood test (similar to ELISA) to be run on a smartphone accessory for point-of-care testing of infectious diseases. The device simultaneously detects three infectious disease markers for HIV, treponemal syphilis and nontreponemal syphilis from a finger prick of blood in just 15 minutes. In a blinded experiment in three health clinics in Rwanda, local health care workers obtained diagnostic results from 96 patients enrolled in prevention of mother-to-child transmission and voluntary counseling programs. The test performance from our triplexed test was 92-100% sensitivity and 79-92% specificity compared to the gold standard of lab-based HIV ELISA, Treponema pallidum haemagglutination and rapid plasma reagin. Importantly, patient preference for the dongle was 97% compared to lab-based tests, with most pointing to the convenience of obtaining quick results with a single finger prick. This work suggests coupling microfluidics with recent advances in consumer electronics can make certain lab-based diagnostics accessible to almost any population with access to smartphones.
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MedicalResearch.com Interview with:
Azfar-e-Alam Siddiqi, MD, PhD
Associate Chief of Science (Acting)
HIV Incidence and Case Surveillance Branch
Division of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
Medical Research: What is the background for this study? What are the main findings?
Dr. Sidiqqi: African Americans remain the population most affected by HIV in the United States -- accounting for almost half (44 percent) of all new infections and more than a third (41 percent) of people living with HIV, despite representing just 12 percent of the U.S. population. We also know that far too many African Americans living with HIV do not get the medical care and treatment they need to stay healthy and protect themselves and others. In fact, less than half (40 percent) of African Americans living with HIV are engaged in care and only one-quarter (28 percent) have the virus under control through treatment.
To better understand mortality among African Americans with HIV, our team analyzed data from the National HIV Surveillance System for 2008 through 2012. Because immune suppression caused by HIV infection can result in fatal co-illnesses, our analysis estimated deaths due to all causes, rather than limiting their analysis to deaths resulting directly from HIV infection. This method allowed us to capture the fullest picture of mortality among African Americans with HIV.
According to our new analysis, from 2008-2012, the death rate per 1,000 blacks living with HIV decreased 28 percent, more than the overall decline (22 percent) observed among all persons living with HIV and more than declines observed among other races/ethnicities (13 percent for whites and 25 percent for Hispanics). Despite substantial declines in mortality, the death rate per 1,000 blacks living with HIV in 2012 was 13 percent higher than the rate for whites and 47 percent higher than the rate for Hispanics.
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MedicalResearch.com Interview with:
Meghan F. Davis, DVM MPH PhD
Assistant Professor
Department of Environmental Health Sciences
Johns Hopkins Bloomberg School of Public Health
Medical Research: What is the background for this study? What are the main findings?
Dr. Davis: Asthma rates have been on the rise, particularly in children. Interventions targeted at allergens and other environmental factors known to exacerbate asthma are only partially successful, suggesting a role for novel drivers of morbidity among existing patients with asthma. In this study, we evaluated associations between nasal colonization with the bacterium Staphylococcus aureus and symptoms related to wheeze and asthma using data from the nationally-representative NHANES database. We found that S. aureus nasal colonization was associated with asthma symptoms in children and young adults, but not in older adults.
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MedicalResearch.com Interview with:
Ya-lin (Aileen) Huang, PhD.
Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
Atlanta, GA, 30329
Medical Research: What is the background for this study? What are the main findings?
Dr. Huang: With an estimated 50,000 new HIV infections each year in this country, and no vaccine or cure available yet, prevention is critical. Maximizing the impact of all available prevention strategies could significantly reduce new infections in this country. The purpose of this study is to provide evidence for the cost effectiveness of the interventions recommended under the funding announcement and to highlight where more cost-effectiveness studies may be needed. We limited our scope to the four interventions required under the health department funding announcement, including HIV testing, prevention with HIV-positives and their partners, condom distribution and efforts to align policies with optimal HIV prevention, care and treatment.
Our review provides an updated summary of the published evidence of cost-effectiveness of four key HIV prevention interventions recommended by CDC: HIV testing, prevention with HIV-positives and their partners, condom distribution and policy initiatives. Models suggest that more than 350,000 HIV infections have been avoided because of the nation’s HIV prevention efforts. In addition to lives saved, HIV prevention has also generated substantial economic benefits. For every HIV infection that is prevented, an estimated $402,000 (http://www.ncbi.nlm.nih.gov/pubmed/23615000) is saved in the cost of providing lifetime HIV treatment. It is estimated that HIV prevention efforts have averted more than $125 billion in medical costs since the beginning of the epidemic. (more…)
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MedicalResearch.com Interview with:
Vijay R. Ramakrishnan, MD
Assistant Professor
University of Colorado
Department of Otolaryngology
Aurora, CO 80045
Medical Research: What is the background for this study? What are the main findings?
Dr. Ramakrishnan: Chronic rhinosinusitis (CRS) is an extremely common problem, associated with major quality of life alterations and financial burden. Bacteria are thought to play a role in the initiation or sustenance of the disease, at least in a subset of CRS patients. Chronic rhinosinusitis is probably a group of heterogeneous diseases with different pathways that result in the same endpoint. Here, we study the bacterial microbiome of a large group of CRS and healthy sinuses, and discover that a few clinical subtypes display unique bacterial microbiome profiles and that the microbiome may predict outcomes from severe Chronic rhinosinusitis patients electing to undergo surgery.
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