Author Interviews, Infections / 22.01.2018

MedicalResearch.com Interview with: [caption id="attachment_39470" align="alignleft" width="250"]hospital bed CDC image CDC image[/caption] Bala Venkatesh, MBBS, MD(Int.Med), FRCA, FFARCSI, MD(UK), FCICM Director of Intensive Care, Wesley Hospital Pre-eminent specialist, Princess Alexandra Hospital Professor of Intensive Care,University of QLD Honorary Professor, University of New South WalesProfessorial Fellow, The George Institute for Global Health MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Whether hydrocortisone reduces mortality in patients with septic shock is unclear. The uncertainty about the efficacy of glucocorticoids in reducing mortality in patients with septic shock has resulted in widespread variation in clinical practice In the results published in the New England Journal of Medicine the investigators found steroids not only reduced the duration of septic shock, they also led to less blood transfusions, and the time spent on life support therapy in intensive care. However, the use of steroids did not lead to fewer deaths overall compared to placebo. Some of the findings are consistent with previous research whilst other results add new information that will inform clinicians. Our results show there is still a lot to learn about septic shock which kills up to half of those affected in some parts of the world. There are undoubtedly many other contributors to survival which we don’t yet understand. 
Author Interviews, CDC, Infections / 22.01.2018

MedicalResearch.com Interview with: [caption id="attachment_39448" align="alignleft" width="300"]National Institute of Allergy and Infectious Diseases (NIAID) NIAID image of salmonella invading an immune cell[/caption] LaTonia Richardson, PhD, Statistician Division of Foodborne, Waterborne, and Environmental Diseases, Enteric Diseases Epidemiology Branch CDC MedicalResearch.com: Who is IFSAC? Response: The Interagency Food Safety Analytics Collaboration (IFSAC) was created in 2011 by three federal agencies—the Centers for Disease Control and Prevention (CDC), the U.S. Food and Drug Administration (FDA), and the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS)—to improve coordination of federal food safety analytic efforts and address cross-cutting priorities for food safety data collection, analysis, and use.  The current focus of IFSAC’s activities is foodborne illness source attribution, defined as the process of estimating the most common food sources responsible for specific foodborne illnesses. For more information on IFSAC, visit https://www.cdc.gov/foodsafety/ifsac/index.html.
Author Interviews, HIV, NIH, PLoS / 18.01.2018

MedicalResearch.com Interview with: [caption id="attachment_39372" align="alignleft" width="300"]“HIV-infected T cell” by NIAID is licensed under CC BY 2.0 HIV-infected T-cell
NIAID image[/caption] Tae-Wook Chun, Ph.D. National Institutes of Health Bethesda, MD 20892  MedicalResearch.com: What is the background for this study? What are the main findings? Response: While antiretroviral therapy (ART) has improved the clinical outcome for people living with HIV, persistence of viral reservoirs in the peripheral blood and lymphoid tissues remains a hurdle to complete eradication of virus and cure of the infection. We know the vast majority of people living with HIV will experience plasma viral rebound within weeks of cessation of therapy. Considering that current research on the treatment of people living with HIV has been heavily focused on developing strategies aimed at achieving sustained virologic remission in the absence of ART, it is of great interest to investigate whether treatment interruption results in expansion of the viral reservoir and/or damage to the immune system. Using data from a recently concluded trial that employed short-term analytical treatment interruption (ATI), we found that, as expected, HIV DNA increased in the CD4+ T cells of individuals living with HIV during the treatment interruption phase. However, the size of the HIV reservoirs as well as immune parameters returned to baseline 6–12 months after the participants resumed ART. 
Author Interviews, Baylor College of Medicine Houston, C. difficile, Nature / 05.01.2018

MedicalResearch.com Interview with: [caption id="attachment_39226" align="alignleft" width="200"]Professor Robert Britton PhD Therapeutic Microbiology Laboratory Department of Molecular Virology and Microbiology Alkek Center for Metagenomics and Microbiome Research Baylor College of Medicine Prof. Britton[/caption] Professor Robert Britton PhD Therapeutic Microbiology Laboratory Department of Molecular Virology and Microbiology Alkek Center for Metagenomics and Microbiome Research Baylor College of Medicine MedicalResearch.com Interview: How would you summarise your findings? Response: As a brief summary of our work, certain strains of Clostridium difficile have emerged in the past 20 years that have resulted in epidemics worldwide, leading to C. difficile becoming one of the most common causes of hospital acquired infections.  Two ribotypes of C. difficile, RT027 and RT078, emerged as key epidemic ribotypes associated with increased disease prevalence and increased mortality in patients.  We found that both of these ribotypes have acquired the ability to consume the disaccharide trehalose by two completely independent mechanisms.  We further show that trehalose enhances disease severity of C. difficile infection in a manner that requires C. difficile to metabolize trehalose in mice.  We also show that trehalose is present in the distal intestine of mice and humans in concentrations that the RT027 ribotype can metabolize.  Because RT027 and RT078 strains were present in clinics at least 10-20 years prior to their becoming epidemic isolates, we looked where people would acquire trehalose in the diet. In 2000 the FDA approved trehalose for human consumption (EFSA did so in 2001) and based on the GRAS report from the FDA the amount of trehalose predicted to be consumed once released on the market would vastly increase what people get naturally from the diet.  Our data support that these two ribotypes increased in prevalence due to a change in the human diet.
Author Interviews, Infections, Pfizer, Vaccine Studies / 22.12.2017

MedicalResearch.com Interview with: [caption id="attachment_39062" align="alignleft" width="200"]Judith Absalon, M.D., M.P.H Senior Director, Vaccines Clinical Research  Pfizer Pharmaceuticals Dr. Judith Absalon[/caption] Judith Absalon, M.D., M.P.H Senior Director, Vaccines Clinical Research Pfizer Pharmaceuticals MedicalResearch.com: What is the background for these two studies? Response: Invasive serogroup B meningococcal disease (MenB) is uncommon, yet serious, is unpredictable and can strike at any age, including healthy teenagers and young adults, with potentially long-lasting and devastating consequences, including death. The data from these two Phase 3 studies, one in adolescents (Study 1009) and one young adults (Study 1016), highlight that Trumenba can help protect teens and young adults against meningococcal group B disease. Additionally, these two large Phase 3 studies confirmed the results of earlier studies and supported the transition from Accelerated to Traditional Approval in the US; were pivotal for approvals in Europe, Australia, and Canada earlier this year; and add to the growing portfolio of research for TRUMENBA.
Author Interviews, Dermatology, Environmental Risks, Infections, Occupational Health / 16.12.2017

MedicalResearch.com Interview with: Lindsey Milich Rutgers School of Public Health studiesLindsey Milich Rutgers School of Public Health studies   MedicalResearch.com: What is the background for this study? What are the main findings? Response: Much of the spotlight has been focused on hair and nail technicians, with the focus now shifting towards the health and safety of hair and nail salon clients. We wanted to assess perceived safety and health risks and prevalence of respiratory and dermal symptoms among hair and nail salon clients in New Jersey. Main findings include dermal/fungal symptoms being more prevalent among clients who visited salons three or more times within the past year, compared with those with fewer reported visits. Respiratory symptom prevalence was higher among clients with fewer salon visits, indicating a “healthy client effect”; clients with these symptoms may be less likely to return.
Author Interviews, Infections, Ophthalmology, Surgical Research / 14.12.2017

MedicalResearch.com Interview with: [caption id="attachment_38928" align="alignleft" width="130"]Dr-Penny Asbell Dr. Asbell[/caption] Penny Asbell, MD Icahn School of Medicine Mt. Sinai, New York City. MedicalResearch.com: What is the background for this study? ─     Bacterial endophthalmitis is a serious, although infrequent, complication of ocular surgery, typically caused by perioperative introduction of bacterial flora from the patient’s own conjunctiva and skin. ─     Prophylactic measures such as perioperative antibiotic treatment may minimize the risk for endophthalmitis, but can be complicated by antibiotic resistant bacteria. ─     The ongoing Antibiotic Resistance Monitoring in Ocular micRoorganisms (ARMOR) study is the only nationwide antibiotic resistance surveillance program specific to ocular pathogens. ─     The purpose of this presentation is to report on the antibiotic susceptibility profiles of bacterial isolates from the vitreous and aqueous humor collected in the ARMOR study expanding upon earlier findings.
Author Interviews, Brigham & Women's - Harvard, Infections, Leukemia, Merck, Transplantation / 12.12.2017

MedicalResearch.com Interview with: [caption id="attachment_38873" align="alignleft" width="120"]Francisco M. Marty, M.D Associate Professor, Harvard Medical School Dana–Farber Cancer Institute and Brigham and Women’s Hospital Dr. Marty[/caption] Francisco M. Marty, M.D Associate Professor, Harvard Medical School Dana–Farber Cancer Institute and Brigham and Women’s Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: Cytomegalovirus (CMV) is the most common infection in patients who undergo allogeneic hematopoietic-cell transplantation (bone marrow transplantation with cells from donors different than the patient). Up until now, we had no antiviral agent that could be used for prophylaxis (prevention) of CMV post-transplant because of the side effects of drugs available to date (ganciclovir, valganciclovir, foscarnet, cidofovir). This trial confirmed that letermovir was highly effective in preventing CMV infection when used in the first 100 days after allogeneic HCT, was associated with minimal side effects of concern and was also associated with lower all-cause mortality by Week 24 post-HCT.
Author Interviews, HIV, Infections, Lancet, STD / 12.12.2017

MedicalResearch.com Interview with: [caption id="attachment_38868" align="alignleft" width="155"]Professor Jean-Michel Molina MD Head of Department of Infectious Diseases, Hôpital Saint-Louis Paris France  Prof. Molina[/caption] Professor Jean-Michel Molina MD Head of Department of Infectious Diseases, Hôpital Saint-Louis Paris France  MedicalResearch.com: What is the background for this study? What are the main findings? Response: There is a high rate of sexually transmitted infections (STIs) among Pre-exposure prophylaxis users and we wished to assess whether post-exposure prophylaxis (PEP) with doxycycline could reduce the incidence of sexually transmitted infections in this population. We have found indeed a high rate of STIs most of them (71%) being asymptomatic and warranting therefore systematic testing. Also PEP reduced the incidence of syphilis and chlamydiae infection by 70%, not for gonorrhea due to the high rate of detection in throat swabs without any impact of PEP.
Author Interviews, C. difficile, Gastrointestinal Disease, JAMA, Transplantation / 06.12.2017

MedicalResearch.com Interview with: [caption id="attachment_38717" align="alignleft" width="231"]Clostridium difficile CDC image Clostridium difficile
CDC image[/caption] Dina Kao, MD, FRCPC Division of Gastroenterology, Department of Medicine University of Alberta Edmonton, Alberta, Canada MedicalResearch.com: What is the background for this study? What are the main findings? Response: We wanted to see what would be the best way to deliver fecal microbiota transplantation (FMT.) There were many controlled studies of FMT delivered by various methods, showing different success rates. Not only were the route of delivery different, but the amount of donor stools also varied greatly from study to study. It appeared that most of the studies delivered by the upper routes gave a smaller amount of donor stool compared to the studies delivering FMT by colonoscopy. Our hypothesis was that given the same amount of donor stool, the effectiveness would be similar by capsules and by colonsocopy.
Author Interviews, Dengue, Lancet, Vaccine Studies / 29.11.2017

MedicalResearch.com Interview with: Vianney Tricou DPhil Takeda Vaccines Pte Ltd Singapore MedicalResearch.com: What is the background for this study? What are the main findings? Response: Dengue fever is a painful, debilitating mosquito-borne disease caused by any one of the four closely related dengue virus serotypes. Forty percent of the world’s population lives under the threat of dengue, with approximately 390 million infections and 20,000 deaths occurring globally each year. Dengue virus can infect people of all ages and is a leading cause of serious illness among children in some countries in Latin America and Asia. Takeda is developing a dengue vaccine candidate to safely protect children and adults living in, or traveling to, endemic areas against all four dengue virus serotypes, regardless of previous dengue virus exposure.  Takeda’s tetravalent dengue vaccine candidate (TAK-003) is based on a live, attenuated dengue serotype 2 virus, which provides the genetic ‘backbone’ for all four vaccine viruses. Takeda’s ongoing Phase 2 DEN-204 study was designed to assess the safety and immunogenicity of different dose schedules of TAK-003 in approximately 1,800 healthy children and adolescents ages two through 17 years living in dengue-endemic countries in Latin America and Asia. Participants of the DEN-204 trial received either one primary dose of TAK-003, two primary doses of TAK-003 administered three months apart, one primary dose of TAK-003 followed by a booster dose one year later, or a placebo. Eighteen-month interim data showed that that TAK-003 is associated with a reduction in the incidence of dengue in the study participants. Data also showed that TAK-003 induced sustained antibody responses against all four serotypes of dengue virus, regardless of previous dengue exposure and dosing schedule.
Author Interviews, CDC, Infections / 27.11.2017

MedicalResearch.com Interview with: [caption id="attachment_38537" align="alignleft" width="300"]Escherichia coli CDC Image E. coli - Escherichia coli
CDC Image[/caption] Samuel J. Crowe, Ph.D., M.P.H. Food and Drug Administration College Park, MD CDC MedicalResearch.com: What is the background for this study? What are the main findings? Response: Flour has been a suspected outbreak vehicle for Shiga toxin-producing E. coli (STEC) infections since 2009, when a multistate outbreak of foodborne disease was linked to prepackaged cookie dough. The 2016 STEC outbreak investigation described in this study was the first investigation to confirm flour as the source of an E. coli outbreak. Linking the outbreak to flour was challenging for several reasons, but epidemiologic, traceback, and microbiologic data ultimately confirmed that flour produced at a single facility was the source of the illnesses.
Author Interviews, CDC, Lyme / 27.11.2017

MedicalResearch.com Interview with: [caption id="attachment_38533" align="alignleft" width="401"]This 2007 photograph depicts the pathognomonic erythematous rash in the pattern of a “bull’s-eye”, which manifested at the site of a tick bite on this Maryland woman’s posterior right upper arm, who’d subsequently contracted Lyme disease. Lyme disease patients who are diagnosed early, and receive proper antibiotic treatment, usually recover rapidly and completely. A key component of early diagnosis is recognition of the characteristic Lyme disease rash called erythema migrans. This rash often manifests itself in a “bull's-eye” appearance, and is observed in about 80% of Lyme disease patients. Lyme disease is caused by the bacterium Borrelia burgdorferi, and is transmitted to humans by the bite of infected blacklegged ticks. Typical symptoms include fever, headache, fatigue, and as illustrated here, the characteristic skin rash called erythema migrans. If left untreated, infection can spread to joints, the heart, and the nervous system. Note that there are a number of PHIL images related to this disease and its vectors. This 2007 photograph depicts the pathognomonic erythematous rash in the pattern of a “bull’s-eye”, which manifested at the site of a tick bite on this Maryland woman’s posterior right upper arm, who’d subsequently contracted Lyme disease.
Lyme disease patients who are diagnosed early, and receive proper antibiotic treatment, usually recover rapidly and completely. A key component of early diagnosis is recognition of the characteristic Lyme disease rash called erythema migrans. This rash often manifests itself in a “bull's-eye” appearance, and is observed in about 80% of Lyme disease patients.
Lyme disease is caused by the bacterium Borrelia burgdorferi, and is transmitted to humans by the bite of infected blacklegged ticks. Typical symptoms include fever, headache, fatigue, and as illustrated here, the characteristic skin rash called erythema migrans. If left untreated, infection can spread to joints, the heart, and the nervous system. From CDC image library[/caption] Kiersten Kugeler, PhD Division of Vector-Borne Diseases CDC MedicalResearch.com: What is the background for this study? What are the main findings? Response: Lyme disease has been a nationally notifiable disease in the United States since 1991. Each year, possible cases of Lyme disease are investigated and tallied by state and local public health officials according to criteria set by the surveillance case definition. States voluntarily share human case data with CDC, which summarizes the data to provide a national perspective on disease trends. This report summarizes national Lyme disease data reported during 2008-2015. Lyme disease continues to be the most commonly reported vector-borne disease in the United States with more than 275,000 cases of Lyme disease reported to CDC during the study period. Although most cases continue to be reported from states with high incidence in the Northeast, mid-Atlantic, and upper Midwest regions, case counts in most of these states have remained stable or decreased during this time. In contrast, case counts have increased in states that neighbor those with high incidence. The trend of stable to decreasing case counts in many states with high incidence may be due to multiple factors, including the possibility that occurrence of the disease has stabilized in these areas or that some state health agencies have changed their reporting practices to lower the resource burden associated with Lyme disease surveillance. Lyme disease surveillance is not meant to document every case, but rather to indicate disease trends over time, define high-risk groups, and describe the geographic distribution of the condition.
Author Interviews, Cognitive Issues, Dermatology, Infections, Mental Health Research, Neurological Disorders, NIH / 23.11.2017

MedicalResearch.com Interview with: [caption id="attachment_38474" align="alignleft" width="400"]The brain of one patient who died from sporadic Creutzfeldt-Jacob disease (sCJD) appears nearly identical to the brain of a mouse inoculated with infectious prions taken from the skin of patients who died from sCJD. The brain of one patient who died from sporadic Creutzfeldt-Jacob disease (sCJD) appears nearly identical to the brain of a mouse inoculated with infectious prions taken from the skin of patients who died from sCJD.
Case Western Reserve University[/caption]   Byron Caughey, Ph.D. Senior Investigator Chief, TSE/prion Biochemistry Section Laboratory of Persistent Viral Diseases NIH/NIAID Rocky Mountain Laboratories Hamilton, MT      MedicalResearch.com: Would you briefly explain what is meant by Creutzfeldt-Jakob disease? Response: Creutzfeldt-Jakob disease (CJD) is an incurable—and ultimately fatal—transmissible, neurodegenerative disorder in the family of prion diseases. Prion diseases can be found in many mammalian species and are due to the conversion of normally harmless prion protein molecules into abnormally folded, aggregated and self-propagating clusters and filaments in the brain. The accumulation of these clusters has been associated with tissue damage that often leaves dying neurons and microscopic sponge-like holes in the brain. In the sporadic and genetic forms of CJD this pathogenic process appears to arise spontaneously in the patient. However, the transfer of the prion protein aggregates from a Creutzfeldt-Jakob disease patient into another human or experimental animal can initiate the pathogenic process in the recipient. These infectious forms of prion protein are called prions. Human prion diseases include fatal insomnia; kuru; Gerstmann-Straussler-Scheinker syndrome; and variant, familial and sporadic CJD. Sporadic CJD is the most common human prion disease, affecting about one in one million people annually worldwide. Other prion diseases include scrapie in sheep; chronic wasting disease in deer, elk and moose; and bovine spongiform encephalopathy (BSE), or mad cow disease, in cattle.
Author Interviews, Cognitive Issues, Compliance, HIV, JAMA / 16.11.2017

MedicalResearch.com Interview with: [caption id="attachment_38366" align="alignleft" width="200"]Ryan Sanford Ryan Sanford[/caption] Ryan Sanford, MEng Department of Neurology and Neurosurgery Montreal Neurological Institute McGill University, Montréal, Québec, Canada   MedicalResearch.com: What is the background for this study? What are the main findings? Response: With the introduction of combination antiretroviral therapy (cART) the outlook for HIV+ individuals has dramatically shifted from a fatal disease to a chronic manageable condition. However, HIV-associated neurocognitive disorders are still prevalent. The etiology of this dysfunction remains unknown. Previous work has reported progressive brain atrophy in HIV+ individuals with advanced disease and poor viral suppression, but it is unclear whether stable treatment and effective viral suppression can mitigate the progression of brain atrophy. To examine this issue, we followed well-treated HIV+ individuals with good viral suppression and well-matched controls, and assessed whether ongoing brain atrophy occurs over time. The main finding in this study was the HIV+ participants had reduced brain volumes and poorer cognitive performance compared to the control group, but the changes in brain volumes and cognitive performance were similar between the groups.
Author Interviews, Cost of Health Care, HIV, Lancet / 13.11.2017

MedicalResearch.com Interview with: [caption id="attachment_38292" align="alignleft" width="97"]Dr Valentina Cambiano PhD Institute for Global Health University College London London UK Dr. Cambiano[/caption] Dr Valentina Cambiano PhD Institute for Global Health University College London London UK MedicalResearch.com: What is the background for this study? Response: Pre-Exposure Prophylaxis (PrEP) which involves the use of drugs, which are used to treat HIV, in people without HIV to prevent them from getting is a critical new advance in HIV prevention. It has been shown to reduce the risk of HIV infection by 86% and the benefits heavily out-weigh any concerns. However, introducing this intervention has a cost. When we started working on this study the National Health Services was discussing whether to introduce PrEP and if so for which populations. Unfortunately, at the moment NHS England is not providing Pre-exposure prophylaxis. However, a large study, the PrEP impact trial, funded by the NHS, has just started and this will provide PrEP to 10,000 people.
Author Interviews, Gender Differences, HIV, Sexual Health / 09.11.2017

MedicalResearch.com Interview with: [caption id="attachment_38140" align="alignleft" width="116"]Adrian Juarez, PhD, RN Assistant Professor The State University of New York School of Nursing  Department of Family, Community and Health Systems Sciences Buffalo, New York 14214 Dr. Juarez[/caption] Adrian Juarez, PhD, RN Assistant Professor The State University of New York School of Nursing Department of Family, Community and Health Systems Sciences Buffalo, New York 14214     MedicalResearch.com: What is the background for this study? Response: HIV testing is considered the initial component of HIV eradication strategies such as “seek, test, treat, and retain.” This study examines the characteristics of an urban, transgender population in western New York when volunteering for an HIV test. The use of an intersectional lens was observed in order to determine the level of influence of sexual partnership types, previous HIV and STD testing, substance use, housing status referral source and racial/gender identification on HIV testing.
Author Interviews, Dermatology, Infections, Johns Hopkins / 09.11.2017

MedicalResearch.com Interview with: [caption id="attachment_38127" align="alignleft" width="80"]Lloyd S. Miller, M.D., Ph.D. Vice Chair for Research, Department of Dermatology Associate Professor of Dermatology, Infectious Diseases, Orthopaedic Surgery & Materials Science and Engineering Faculty Member, Cellular and Molecular Medicine (CMM) and Pathobiology Graduate Programs Johns Hopkins Department of Dermatology Baltimore, MD 21231 Dr. Miller[/caption] Lloyd S. Miller, M.D., Ph.D. Vice Chair for Research, Department of Dermatology Associate Professor of Dermatology, Infectious Diseases, Orthopaedic Surgery & Materials Science and Engineering Faculty Member, Cellular and Molecular Medicine (CMM) and Pathobiology Graduate Programs Johns Hopkins Department of Dermatology Baltimore, MD 21231  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Staphylococcus aureus is a common bacterial skin pathogen and its abundance is greatly increased on affected skin of eczema patients, especially during disease flares. However, how S. aureus induces skin inflammation and exacerbates the skin inflammation is incompletely understood. In this study, we found that S. aureus exposure of mouse skin induced skin inflammation through an inflammatory mediator known as IL-36.
Author Interviews, HIV, Mental Health Research, Pediatrics / 08.11.2017

MedicalResearch.com Interview with: Marcin Jankiewicz  University of Cape Town Cape Town, South AfricaMarcin Jankiewicz  University of Cape Town Cape Town, South Africa  MedicalResearch.com: What is the background for this study? Response: The Children with HIV Early Antiretroviral (CHER) trial, conducted in Cape Town and Soweto, was designed when there was uncertainty whether to start antiretroviral therapy (ART) as soon as HIV was diagnosed (below 12 weeks of age) or to wait until there was evidence of immuno-compromise and disease progression. Also, there were concerns about maintaining adherence, long-term toxicity and also resistance in the setting of few antiretroviral options. Early outcomes showed a decreased risk in childhood mortality in the early treatment arms compared to deferred treatment, becoming standard of care globally. The CHER cohort is one of the largest and best documented of children receiving ART within the first year of life. Also, age- and community-matched HIV exposed uninfected (HEU) and HIV unexposed (HU) uninfected infants were enrolled in parallel for a linked vaccine study. We therefore had an amazing opportunity to link with a neurodevelopmental sub-study in participants from Cape Town and apply sophisticated neuroimaging modalities that could link with clinical, virological and immunological characteristics.
Author Interviews, Cannabis, Cognitive Issues, HIV / 03.11.2017

MedicalResearch.com Interview with: [caption id="attachment_37849" align="alignleft" width="107"]Richard Saitz, MD, MPH, FACP, DFASAM Department of Community Health Sciences Boston University School of Public Health Clinical Addiction Research and Education (CARE) Unit Section of General Internal Medicine, Department of Medicin Boston University School of Medicine and Boston Medical Center Boston , Massachusetts Dr. Saitz[/caption] Richard Saitz, MD, MPH, FACP, DFASAM Department of Community Health Sciences Boston University School of Public Health Clinical Addiction Research and Education (CARE) Unit Section of General Internal Medicine, Department of Medicin Boston University School of Medicine and Boston Medical Center Boston , Massachusetts MedicalResearch.com: What is the background for this study? What are the main findings? Response: Many people living with HIV infection use alcohol and other drugs including marijuana. People with HIV infection are also susceptible to cognitive dysfunction from many causes from HIV infection itself to aging. The main findings were that among people with HIV and substance use disorder, lifetime marijuana and alcohol use were not associated with cognitive dysfunction, likely due to competing risks.  But current marijuana use was associated with cognitive dysfunction.
Author Interviews, Biomarkers, Flu - Influenza, Infections / 01.11.2017

MedicalResearch.com Interview with: Ana Falcón Department of Molecular and Cellular Biology National Center for Biotechnology Spanish National Research Council (CNB-CSIC) Madrid, Spain MedicalResearch.com: What is the background for this study? Response: Influenza A virus (IAV) infection can be severe or even lethal in toddlers, the elderly and patients with certain medical conditions. Infection of apparently healthy individuals nonetheless accounts for many severe disease cases and deaths, suggesting that viruses with increased pathogenicity co-circulate with pandemic or epidemic viruses. IAV virulence and pathogenesis are dependent on complex, multigenic mechanisms involving the viral genetic characteristics, the host conditions, the virus-host interactions, and the host response to the infection. Influenza virus pathogenicity has been studied in depth for many years, and several amino acid changes have been identified as virulence determinants, however, a general pathogenicity determinant has not been characterized. A proportion of influenza virus particles have defective genome RNAs (Defective Viral Genomes-DVGs) due to internal deletions of viral segments. The DVGs have the 3’ and 5’ ends of the parental RNA segments, and most have a single, large central deletion that generates viral RNAs of 180–1000 nucleotides. The presence of DVGs potentiates the host response in cultured cells and in animal models and leads to attenuated infection, possibly through recognition of double-stranded RNA by receptors that activate antiviral signaling cascades.
Author Interviews, C. difficile, Critical Care - Intensive Care - ICUs, Infections, JAMA, Outcomes & Safety / 18.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37568" align="alignleft" width="130"]Dr. Robert Hiensch MD Assistant Professor, Medicine, Pulmonary, Critical Care and Sleep Medicine Icahn School of Medicine at Mount Sinai Dr. Hiensch[/caption] Dr. Robert Hiensch MD Assistant Professor, Medicine, Pulmonary, Critical Care and Sleep Medicine Icahn School of Medicine at Mount Sinai. MedicalResearch.com: What is the background for this study? What are the main findings? Response: New sepsis guidelines that recommend screening and early treatment for sepsis cases appear to have significant positive impacts on patient outcomes. Less research has been published on what potential side effects may result from these guidelines. Antibiotics are a cornerstone of sepsis treatment and early antibiotic administration is strongly recommended.  We examined whether the introduction of an electronic based sepsis initiative changed antibiotic prescribing patterns at our hospital. Antibiotics, even when appropriate, contribute to hospital onset Clostridium difficile infections (HO CDIs).  While the authors do not dispute the importance of antibiotic administration in sepsis, it is valuable to know whether the sepsis initiative coincided with both increased antibiotic administration and HO CDIs.
Author Interviews, CDC, JAMA, Neurological Disorders, Zika / 17.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37584" align="alignleft" width="125"]Emilio Dirlikov, PhD Epidemic Intelligence Service Officer CDC  Dr. Dirlikov[/caption] Emilio Dirlikov, PhD Epidemic Intelligence Service Officer CDC  MedicalResearch.com: What is the background for this study? What are the main findings? Response: In December 2015, Puerto Rico Department of Health (PRDH) reported its first confirmed locally acquired case of Zika virus disease. In February 2016, PRDH reported the first person diagnosed with Guillain-Barré syndrome (GBS) who also had evidence of Zika virus infection. At the time, scientific evidence of the potential association between Zika virus infection and GBS was lacking, and rigorous studies were needed. Through a collaboration between PRDH, CDC, and the University of Puerto Rico (UPR), we conducted a case-control study to determine risk factors for GBS during the 2016 Zika virus epidemic. By prospectively enrolling case-patients, we shortened the time to enrollment, increasing the likelihood of detecting Zika virus nucleic acids to confirm Zika virus infection. As a result, we found that an acute Zika virus infection confirmed by laboratory testing is a risk factor for developing Guillain-Barré syndrome. This is the first case-control study to find laboratory evidence showing this given the difficulty of confirming Zika virus infection among people diagnosed with GBS.
Author Interviews, Infections / 14.10.2017

MedicalResearch.com Interview with: Susan S. Huang, MD Professor, Infectious Disease School of Medicine Medical Director, Epidemiology and Infection Prevention UCI MedicalResearch.com: What is the background for this study? What are the main findings? Response:  The SHIELD Orange County Project is a CDC-initiated public health collaborative among nursing homes, long-term acute care (LTAC) facilities, and hospitals in the 6th largest U.S. County (Orange County, California). The 38 facilities (18 nursing homes, 3 LTACs, 17 hospitals) received targeted invitations based upon their high degree of shared patients with one another. The goal of the collaborative is to reduce multi-drug resistant organisms throughout the county using a decolonization strategy. As part of the baseline assessment, we swabbed 50 adult patients in each facility to assess the frequency that patients had multi-drug resistant organisms (MDRO) on their body. Nursing home and LTAC patients were sampled from the entire population while hospital sampling involved only adults in contact precautions. We found that an alarmingly high percent of patients had an MDRO, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum beta-lactamase producers (ESBLs), and carbapenem-resistant enterobacteriaceae (CRE).
  • For nursing homes, 64% of residents have an antibiotic resistant bacteria on their body. Almost all of these are not known to the nursing home.
  • For LTACs, 80% of patients have an antibiotic resistant bacteria on their body. 7 in 10 patients have an MDRO that is not known to the LTAC.
  • For hospitalized patients on contact precautions, 64% have an antibiotic-resistant bacteria on their body. One third have an antibiotic-resistant bacteria that is not known to the hospital.
  • Having one MDRO is highly associated with having another one/
Author Interviews, Cost of Health Care, Infections, Merck, Stem Cells, Transplantation / 12.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37450" align="alignleft" width="125"]Dr. Jonathan Schelfhout, PhD Director, Outcomes Research Merck & Co. Inc. North Wales, PA Dr. Schelfhout[/caption] Dr. Jonathan Schelfhout, PhD Director, Outcomes Research Merck & Co. Inc. North Wales, PA MedicalResearch.com: What is the background for this study? What are the main findings? Response: The cost of hematopoietic stem cell transplantation has received increased attention after it was identified as a top 10 contributor to increasing healthcare costs in an AHRQ 2016 report. Many recent studies have explored the cost of HSCT but additional research is needed on the costly complications that can follow the transplant procedure. This research is particularly relevant for inpatient decision makers, as most transplant centers receive one bundled payment for the transplant and the treatment of any complications over the first 100 days.
Author Interviews, C. difficile, CDC, Dental Research, Infections / 09.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37324" align="alignleft" width="200"]Stacy Holzbauer, DVM, MPH, DACVPM CDC Career Epidemiology Field Officer (CEFO) Commander, USPHS Minnesota Department of Health St. Paul, MN Dr. Holzbauer[/caption] Stacy Holzbauer, DVM, MPH, DACVPM CDC Career Epidemiology Field Officer (CEFO) Commander, USPHS Minnesota Department of Health St. Paul, MN MedicalResearch.com: What is the background for this study?
  • Antibiotics are not harmless drugs—Clostridium difficile infection, which can sometimes cause a deadly diarrhea, is a complication of antibiotic use and can occur after even one dose of an antibiotic.
  • The Minnesota Department of Health (MDH) is part of the larger Centers for Disease Control and Prevention (CDC) Emerging Infections Program (EIP). The healthcare-associated infection component of CDC’s EIP engages a network of state health departments and their academic medical center partners to help answer critical questions about emerging HAI threats including Clostridium difficile also known as “C. diff.”
  • In Minnesota, the majority of C. diff infections occur outside the hospital and are driven by antibiotic use in community or outpatient settings. In addition to routine surveillance data, we interview patients with C. diff who were not hospitalized prior to their infection to identify potential risks for developing C. diff infection, including identifying antibiotics received outside of routine healthcare settings.
  • Dentists prescribe approximately 10% of the antibiotics in outpatient settings, which was over 24 million prescriptions in 2013. When asked about their prescribing practices in a 2015 survey with the Minnesota Dental Association, 36% of dentists surveyed prescribed antibiotics for dental conditions that are generally not recommended to receive antibiotics according to American Dental Association (ADA) guidelines.
Author Interviews, HIV, Infections / 06.10.2017

MedicalResearch.com Interview with: Paul M. Salcuni, MPH Department of Health and Mental Hygiene New York City MedicalResearch.com: What is the background for this study? What are the main findings? Response: NYC Health Department is committed to ensuring equitable access to HIV pre-exposure prophylaxis (PrEP) for all New Yorkers who are HIV-negative and may be exposed to HIV. We examined trends in PrEP prescribing by 602 ambulatory care practices in New York City from 2014 to 2016, as well as associated patient and practice factors, to inform our comprehensive scale-up efforts. For every 100,000 medical visits in the first three months of 2014, roughly 39 involved a patient being prescribed PrEP. In the second quarter of 2016, 419 of every 100,000 medical visits at those same practices involved a PrEP prescription. Despite this nine-fold increase overall, some groups of patients among these practices were less likely to be prescribed PrEP. Those groups include men of color, women, and people getting health care at smaller private practices or practices outside of the city center.
Allergies, Asthma, Author Interviews, Pediatrics, Respiratory / 06.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37385" align="alignleft" width="160"]Giovanni Piedimonte, MD Steven and Nancy Calabrese Endowed Chair for Excellence in Pediatric Care, Research, and Education Professor & Chair of Pediatrics Cleveland Clinic Lerner College of Medicine Case Western Reserve University Dr. Piedimonte[/caption] Giovanni Piedimonte, MD Steven and Nancy Calabrese Endowed Chair for Excellence in Pediatric Care, Research, and Education Professor & Chair of Pediatrics Cleveland Clinic Lerner College of Medicine Case Western Reserve University MedicalResearch.com: What is the background for this study? What are the main findings? Response: This study proves that asthmatic children already have a hyperactive calcium channel that’s extremely sensitive to environmental triggers. If these children contract a virus, such as RSV, the hyperactive channel causes more severe symptoms that may require care in a hospital setting. When a child developed asthma or bronchitis in the past, doctors thought these conditions could only be triggered by environmental allergens. There was no explanation why two out of three children ages five and under who wheeze and cough – and still test negative for allergies. We needed to explore the mechanisms of the calcium molecule and the epithelial cells, which seem to trigger these symptoms without an allergic reaction. If the molecule’s behavior is producing the cough, we just need to figure out how to control the molecule to properly deactivate the cough mechanism in the asthmatic child
Author Interviews, Infections, MRSA / 04.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37331" align="alignleft" width="139"]Mr-Jonathan-Shahbazian Mr. Shahbazian[/caption] Mr. Jonathan Shahbazian, MPH Johns Hopkins Bloomberg School of Public Health Baltimore MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our study was designed to investigate risk factors for drug resistance in MRSA found in dust on surfaces in the home. We undertook this investigation because we were concerned first that people living in the home could pick up MRSA from these surfaces, and second, that if they picked up drug-resistant MRSA, it would be more difficult to treat them. Our main finding was that use of antibiotics by either people or pets in the home, as well as use of biocidal cleaning products, was associated with multidrug resistance (MDR) in home MRSA. This study is the first to report that use clindamycin in either humans or domestic animals was not associated with risk of MDR in the home environment. We also found that mupirocin treatment was associated with a slight increase in mupirocin resistance in the household environment, which could complicate decolonization efforts that rely on use of nasal mupirocin ointment. We found that 100% of our MRSA isolates from rural homes were MDR, suggesting living in a rural household may be a risk factor. We also found the presence of domestic pets was associated with MDR MRSA in the home environment while the presence of unwanted pests, such as mice or cockroaches, was associated with non-MDR MRSA strains at the three-month visit.
Author Interviews, Infections, OBGYNE, Pediatrics, Vaccine Studies / 03.10.2017

MedicalResearch.com Interview with: Tami H Skoff Centers for Disease Control and Prevention Atlanta, GeorgiaTami H Skoff Centers for Disease Control and Prevention Atlanta, Georgia MedicalResearch.com: What is the background for this study? What are the main findings? Response: Infants are at greatest risk for severe pertussis (whooping cough) morbidity and mortality, especially during the first months of life before infant immunizations begin.  CDC and the Advisory Committee on Immunization Practices (ACIP) currently recommend that women receive a dose of Tdap during the third trimester of each pregnancy.  This recommendation has been in place since 2012.  By getting Tdap, pregnant women pass critical short-term protection to their unborn babies. This helps protect babies until they are old enough to start getting their own whooping cough vaccines at 2 months of age. The purpose of our study was to evaluate the effectiveness of maternal Tdap during pregnancy at preventing whooping cough in infants <2 months of age. In our evaluation, Tdap administration during the third trimester of pregnancy prevented more than 3 in 4 (78%) infant cases.  Additionally, Tdap vaccination during pregnancy was even more effective (90%) at preventing whooping cough serious enough that the baby had to get treatment in a hospital.