Miracle-dz/UniFAR-FTUs huggingface dataset:
One World – One Health: The Threat of Emerging Swine Diseases. An Asian Perspective

Summary Owing to the expanding globalization, the trans‐boundary spread of an epizootic can easily result from uncontrolled animal movements and human traffic. Foot and mouth disease (FMD) is a major trans‐boundary disease in most Asian countries. Its sporadic re‐emergence suggests that collaborative FMD control strategies should be uniformly implemented in endemic countries to ensure the overall national herd vaccination coverage, biocontainment when outbreaks occur, and strict biosecurity control of animal movement between countries. Sustained commitments from governments, cooperative diplomatic relationships, and public awareness campaigns are critical to FMD control, to ensure collaboration among veterinarians, traders and farmers throughout Southeast Asia (SEA). Recently, highly pathogenic porcine reproductive and respiratory syndrome (HP‐PRRS) and porcine epidemic diarrhoea (PED) spread from China to Southeast Asian countries, causing major economic losses. Foot and mouth disease, HP‐PRRS, and PED currently remain endemic and may continue to sporadically re‐emerge, owing to inadequate public health management and/or biosecurity failures. Therefore, the risk factors must be identified to better understand the epidemiology of these diseases in an effort to develop effective control measures. International coordination through the establishment of a collaborative network supported by the World Organization for Animal Health (OIE) and the Food and Agriculture Organization (FAO) should be implemented to prevent trans‐boundary transmission among countries. This review discusses trans‐boundary swine diseases of particular importance to SEA, including FMD, HP‐PRRS and PED, with a primary focus on major factors contributing to the spread of these diseases and important control measures, reflecting the impact of globalization on disease control and surveillance.
Seroincidence of 2009 H1N1 infection in HIV-infected and HIV-uninfected women prior to vaccine availability

The 2009 H1N1 pandemic was a unique opportunity to investigate differences in influenza infection using serology by HIV status. Using serial serum specimens collected from 1 April to 30 September 2009 and the prior 2 years from Women's Interagency HIV study participants, there was no difference in serologic evidence of 2009 H1N1 infection among HIV-infected women with a CD4 cell count at least 350 cells/μl compared with HIV-uninfected women. Owing to evidence showing a greater risk of influenza-related complications, HIV-infected individuals should continue to be a priority group for vaccination.
Prolongation of Hospital Stay and Additional Costs Due to Nosocomial Bloodstream Infection in an Algerian Neonatal Care Unit

Background. Previous studies from developed countries reported that nosocomial bloodstream infection (BSI) in neonatal care units (NCUs) increases length of stay and costs. However, no such information is available for Algerian NCUs. Objective. To evaluate the influence of BSI in neonates on additional charges and length of hospital stay. Design. Prospective, nested case-control study. Setting. The 47-bed NCU of the University Hospital of Blida, Algeria. Patients and Methods. A total of 83 neonates with BSIs (case patients) and 166 neonates without BSIs (control patients), admitted to the NCU during the study period (April 2004 through December 2007), were matched for sex, birth weight, length of NCU stay, and year of hospital admission. Each patient's length of stay in the NCU was obtained prospectively on daily rounds. The estimated cost of each NCU-day was provided by the hospital's finance department. The cost of antibiotics prescribed was provided by the hospital's pharmacy department. Results. The mean additional length of NCU stay for case patients, compared with control patients, was 9.2 days (24.3 vs 15.1 days). The mean additional cost of antibiotics was $546. The mean cumulative additional cost was $1,315. Conclusion. This study highlights the effect of BSI on extra costs for NCU patients, especially costs due to prolongation of hospital stay and increased antibiotic use, and suggests that NCUs in Algeria have a financial interest in reducing the rate of BSI.
Contemporary epidemiology and prognosis of health care-associated infective endocarditis.

BACKGROUND The aim of this study was to describe the characteristics of health care-associated infective endocarditis (HAIE) and to establish the risk factors for mortality. METHODS We conducted a prospective, observational cohort study. HAIE was defined according to the following conditions: (1) symptom onset >48 h after hospitalization or within 6 months after hospital discharge; or (2) ambulatory manipulations causing endocarditis. RESULTS Eighty-three episodes of HAIE (accounting for 28.4% of all cases of endocarditis) were diagnosed. Compared with patients with community-acquired endocarditis, patients with HAIE were older (median age +/- standard deviation, 65.3 +/- 16.4 years vs. 57.8 +/- 17.0 years; P = .001), were in poorer health before disease onset (Charlson index, 2.5 +/- 2.3 vs. 1.7 +/- 2.1; P = .006), had more staphylococcal (55.4% vs. 28.3% of cases) and enterococcal infections (22.9% vs. 7.7% of cases; P < .005), underwent fewer surgeries (22.9% vs. 45.9% of cases; P < .005), and experienced a higher rate of in-hospital (45.8% vs. 22.0%) and 1-year mortality (59.5% vs. 29.6%; P < .005). In the HAIE cohort, independent predictors of in-hospital death were stroke (odds ratio [OR], 8.95; 95% confidence interval [CI], 2.04-39.31; P = .004), congestive heart failure (OR, 5.48; 95% CI, 1.77-17.03; P = .003), surgery indicated but not performed (OR, 3.74; 95% CI, 1.22-11.45; P = .021), and enterococcal infection (OR, 0.18; 95% CI, 0.04-0.78; P = .022). Independent predictors of 1-year mortality were surgery indicated but not performed (OR, 7.81; 95% CI, 2.06-29.67; P = .003), acute renal failure (OR, 7.18; 95% CI, 1.32-39.18; P = .023), and enterococcal infection (OR, 0.18; 95% CI, 0.04-0.81; P = .026). For the series overall (292 episodes), HAIE was an independent predictor of in-hospital (OR, 2.83; 95% CI, 1.34-5.98; P = .007) and 1-year mortality (OR, 2.59; 95% CI, 1.25-5.39; P = .011). CONCLUSIONS HAIE is an important health problem associated with considerable mortality. New strategies to prevent HAIE should be assessed.
Contraceptive method and pregnancy incidence among women in HIV-1-serodiscordant partnerships

Background:Effective contraception reduces unintended pregnancies and is a central strategy to reduce vertical HIV-1 transmission for HIV-1-infected women. Methods:Among 2269 HIV-1-seropositive and 1085-seronegative women from seven African countries who were members of HIV-1-serodiscordant heterosexual partnerships and who were participating in an HIV-1 prevention clinical trial, we assessed pregnancy incidence according to contraceptive method using multivariate Andersen–Gill analysis. Results:Compared with women using no contraceptive method, pregnancy incidence was significantly reduced among HIV-1-seropositive and HIV-1-seronegative women using injectable contraception [adjusted hazard ratio (aHR) 0.24, P = 0.001 and aHR 0.25, P < 0.001, respectively). Oral contraceptives significantly reduced pregnancy risk only among HIV-1-seropositive women (aHR 0.51, P = 0.004) but not seronegative women (aHR 0.64, P = 0.3), and, for both seropositive and seronegative women, oral contraceptive pill users were more likely to become pregnant than injectable contraceptive users (aHR 2.22, P = 0.01 for HIV-1-seropositive women and aHR 2.65, P = 0.09 for HIV-1-seronegative women). Condoms, when reported as being used as the primary contraceptive method, marginally reduced pregnancy incidence (aHR 0.85, P = 0.1 for seropositive women and aHR 0.67, P = 0.02 for seronegative women). There were no pregnancies among women using intrauterine devices, implantable methods or who had undergone surgical sterilization, although these methods were used relatively infrequently. Conclusion:Family planning programs and HIV-1 prevention trials need innovative ways to motivate uptake and sustained use of longer acting, less user-dependent contraception for women who do not desire pregnancy.
Streptococcus suis: an emerging human threat.

In the world of Streptococcus, S. suis has been somewhat neglected. Indeed, at this year’s Lancefield International Symposium on Streptococci and Streptococcal Diseases, only one oral presentation was devoted to this pathogen. However, this perception should change, because S. suis is emerging as an important threat to human health. S. suis is an encapsulated Grampositive coccus possessing cell-wall antigens related to Lancefield group D. There are 35 serotypes that have been described on the basis of the composition of the polysaccharide capsule [1]. S. suis infections are considered to be a major problem worldwide in the swine industry. The pathogen’s natural habitat is the upper respiratory tract of pigs, as well as the genital and alimentary tracts [1]. The pig carrier rate is near 100%, and, in the absence of treatment, mortality reaches 20% [2]. The most important clinical feature associated with S. suis infection in pigs is meningitis. In severe cases, pigs are found dead with no premonitory signs. Other manifestations are arthritis, endocarditis, pneumonia, rhinitis, abortion, and vaginitis [1]. Until recently, S. suis disease in humans has been rare [3, 4]. Since the first human case in Denmark in 1968 [5] and before 2005, only 250 S. suis infections were reported in Europe and Asia. However, S. suis recently was identified as the third most common cause of communityacquired bacterial meningitis in Hong Kong, behind S. pneumoniae and Mycobacterium tuberculosis [6], and as the leading cause of adult meningitis in Vietnam [7]. Mysteriously, only 2 cases of S. suis meningitis have been reported in Canada [8, 9], and only 1, very recently, in the United States [10]. Although the epidemiology of S. suis infections in humans remains largely undefined, nearly all cases can be ascribed to either handling or consumption of unprocessed pork meat or to close contact with pigs. Therefore, most infected people are pig farmers, abattoir workers, meat inspectors, butchers, and veterinarian practitioners [4]. In humans, S. suis usually produces a purulent or nonpurulent meningitis. Additionally, endocarditis, cellulitis, peritonitis, rhabdomyolysis, arthritis, spondylodiscitis, pneumonia, uveitis, and endopthalmitis may occur [4, 11, 12]. Both severe infections with shock and a high mortality also have been described [13, 14]. One striking feature of S. suis–related meningitis is the complication of deafness and/or vestibular dysfunction, which occurs at a rate consistently higher than that reported for other meningitis-causing bacteria and which reaches 50% and 65% in Europe and Asia, respectively [11, 12]. Most cases of S. suis infection have been attributed to serotype 2 strains; however, cases due to serotypes 4, 14, and 16 also have been reported [4]. Strains isolated from humans are phenotypically and genotypically similar to those recovered from swine within the same geographical region [15].
Correlation of YMDD mutation and breakthrough hepatitis with hepatitis B virus DNA and serum ALT during lamivudine treatment

Aim: Continuous lamivudine treatment is associated with high frequency of drug resistance. We analyzed the incidence of tyrosine‐methionine‐aspartate‐aspartate (YMDD) motif mutant and breakthrough hepatitis (BTH) in hepatitis B virus (HBV) DNA positive patients receiving lamivudine for > 1 year and correlated it with HBV DNA and alanine aminotransferase (ALT) levels to evaluate if these measurements can provide a practical option for monitoring patients in clinical practice and define early switch from lamivudine therapy.
Effects of aging and smoking on carotid intima–media thickness in HIV-infection

Objectives:To investigate the effects of aging and smoking on carotid intima–media thickness (cIMT) among patients with and without HIV. Methods:Data from a community sample of HIV-infected and HIV-uninfected participants were analyzed. Carotid intima–media thickness was measured via carotid ultrasound and smoking history was obtained via patient interview. Results:Data on 166 male and female participants with stable HIV-infection and 152 healthy HIV-uninfected participants were analyzed. Among the HIV-infected and HIV-uninfected participants, a significant association was observed between age and cIMT [r = 0.51, P < 0.0001 (HIV), r = 0.39, P < 0.0001, (non-HIV)], and between smoking burden and cIMT [r = 0.42, P < 0.0001 (HIV), r = 0.24, P = 0.003 (non-HIV)]. In multivariate regression modeling among all participants (HIV and non-HIV), a significant three-way interaction was observed between age, smoking burden, and HIV status with respect to cIMT (P < 0.010), controlling for sex, race, and traditional cardiovascular disease (CVD) risk factors, such that increased cIMT was associated with increased smoking burden and age to a greater degree among HIV-infected vs. HIV-uninfected participants. Among HIV-infected participants a significant interaction between smoking burden and age with respect to cIMT was seen (P = 0.027) controlling for race, sex, CVD risk factors, immunological function, and antiretroviral therapy use. Conclusion:A significant interaction between HIV, age, and smoking on cIMT was observed, suggesting that HIV-infection modifies the relationship of age and smoking on cIMT in this population. These findings emphasize the need to encourage smoking cessation in this population, due to its deleterious effect on subclinical atherosclerosis in older HIV-infected patients.
Differences between self-reported and electronically monitored adherence among patients receiving antiretroviral therapy in a resource-limited setting

Background:Measurement of adherence to antiretroviral therapy (ART) by patient self-report is common in resource-limited settings but widely believed to overstate actual adherence. The extent to which these measures overstate adherence has not been examined among a large patient population. Methods:HIV-infected adult patients in Kenya who initiated ART within the past 3 months were followed for 6 months. Adherence was measured by participants’ self-reports of doses missed in the past 7 days during monthly clinic visits and by continuous Medication Event Monitoring System (MEMS) in participants’ pill bottles. Seven-day self-reported adherence was compared to 7-day MEMS adherence, 30-day MEMS adherence, and adherence more than 90% during each of the first 6 months. Results:Self-reported and MEMS adherence measures were linked for 669 participants. Mean 7-day self-reported adherence was 98.7% and mean 7-day MEMS adherence was 86.0%, a difference of 12.7% (P < 0.01). The difference between the two adherence measures increased over time due to a decline in 7-day MEMS adherence. However, patients with lower MEMS adherence were in fact more likely to self-report missed doses and the difference between self-reported and MEMS adherence was similar for each number of self-reported missed doses. When analysis was limited to patients who reported rarely or never removing multiple doses at the same time, mean difference was 10.5% (P < 0.01). Conclusion:There is a sizable and significant difference between self-reported and MEMS adherence. However, a strong relationship between the measures suggests that self-reported adherence is informative for clinical monitoring and program evaluation.
Randomized, controlled trial of oral ribavirin for Japanese encephalitis in children in Uttar Pradesh, India.

BACKGROUND Japanese encephalitis is associated with high rates of mortality and disabling sequelae. To date, no specific antiviral has proven to be of benefit for this condition. We attempted to determine the efficacy of oral ribavirin treatment for reducing early mortality among children with Japanese encephalitis in Uttar Pradesh, India. METHODS Children (age, 6 months to 15 years) who had been hospitalized with acute febrile encephalopathy (a < or =2-week history of fever plus altered sensorium) were tested for the presence of immunoglobulin M antibodies to Japanese encephalitis virus with commercial immunoglobulin M capture enzyme-linked immunosorbent assay. Children with positive results were randomized to receive either ribavirin (10 mg/kg per day in 4 divided doses for 7 days) or placebo syrup through nasogastric tube or by mouth. The primary outcome was early mortality; secondary outcome measures were early (at hospital discharge; normal or nearly normal, independent functioning, dependent, vegetative state, or death) outcome, time to resolution of fever, time to resumption of oral feeding, duration of hospitalization, and late outcome (> or =3 months after hospital discharge). The study was double-blind, and analysis was by intention to treat. RESULTS A total of 153 patients were enrolled during a 3-year period; 70 patients received ribavirin, and 83 received placebo. There was no statistically significant difference between the 2 groups in the early mortality rate: 19 (27.1%) of 70 ribavirin recipients and 21 (25.3%) of 83 placebo recipients died (odds ratio, 1.10; 95% confidence interval, 0.5-2.4). No statistically significant differences in secondary outcome measures were found. CONCLUSIONS For the dosage schedule used in our study, oral ribavirin has no effect in reducing early mortality associated with Japanese encephalitis. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00216268 .
Prevalence of hepatitis B co-infection and response to antiretroviral therapy among HIV-infected patients in Tanzania

Objectives:To evaluate the prevalence of HIV/hepatitis B virus (HBV) co-infection and relationship between HIV/HBV and health outcomes in a cohort of HIV-infected adults receiving antiretroviral treatment (ART) in urban Tanzania. Design/methods:Clinical and immunologic responses to ART were compared longitudinally between HIV mono (HIV) and HIV/HBV co-infected (HIV/HBV) adults enrolled between November 2004 and September 2011 at the Management and Development for Health (MDH)-PEPFAR HIV Care and Treatment program in Dar es Salaam, Tanzania. Results:The prevalence of HIV/HBV co-infection was 6.2% (1079/17 539). Compared to HIV patients, HIV/HBV patients were more likely to be male, younger, and more immunosuppressed at ART initiation. Median ART duration was 18.6 [interquartile range (IQR) 4.9–29.5] and 18.2 (IQR 4.2–27.2) months in HIV and HIV/HBV patients, respectively. In multivariate analyses, a trend towards a higher risk of mortality was observed in HIV/HBV patients {hazard ratio 1.18 [95% confidence interval (CI) 0.98–1.42], P = 0.07} as well as lower CD4+ cell counts throughout recovery (P < 0.01) and higher risk of moderate-to-severe hepatotoxicity (P values < 0.01 for alanine transaminase > 120 and >200 IU/l). There was a higher risk of mortality in HIV/HBV patients vs. HIV patients on non-tenofovir (TDF)-containing ART [hazard ratio 1.28 (95% CI 1.02–1.61), P < 0.03], whereas there was no difference in the risk of mortality observed in HIV/HBV patients vs. HIV patients on TDF-containing ART [hazard ratio 0.70 (95% CI 0.34–1.44), P < 0.33]; interaction P = 0.30. Conclusions:HBV co-infection significantly impacted ART outcomes in this Tanzanian HIV-infected population. Further research is needed to confirm the potential beneficial effects of TDF on mortality in HIV/HBV co-infected individuals in these settings.
The Action Research Dissertation. A Guide for Students and Faculty

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α-Adrenoceptor Modulation of Norepinephrine and ATP Release in Isolated Kidneys of Spontaneously Hypertensive Rats

Abstract The present study investigates sympathetic cotransmission and its α-adrenoceptor–mediated modulation in kidneys of spontaneously hypertensive rats (SHR, 12 to 14 weeks) and age-matched normotensive Wistar-Kyoto rats (WKY). In the presence of cocaine and corticosterone, renal nerve stimulation at 1 Hz (30 seconds) induced a greater outflow of norepinephrine in SHR (4.2±0.2 pmol/g kidney) than in WKY (3.0±0.2 pmol/g kidney). The α 2 -adrenoceptor antagonist rauwolscine (0.01 to 1 μmol/L) increased the stimulation-induced norepinephrine outflow to a greater extent in SHR than in WKY. In contrast, the α 1 -adrenoceptor antagonist prazosin (0.03 to 3 μmol/L) increased the stimulation-induced norepinephrine outflow to a greater extent in WKY than in SHR. This difference was not observed in the presence of the P 1 -purinoceptor antagonist 8-( p -sulfophenyl)theophylline (100 μmol/L). Stimulation at 4 Hz (30 seconds) induced an outflow of ATP (SHR, 12.7±3.3 pmol/g kidney; WKY, 16.7±2.1 pmol/g kidney; perfusion solution without cocaine and corticosterone). Prazosin (0.03 μmol/L) markedly reduced pressor responses to stimulation and inhibited the induced ATP outflow by 60% to 70%. When prazosin (0.03 μmol/L) was present, rauwolscine (0.1 μmol/L) increased the induced outflow of norepinephrine and ATP and markedly enhanced prazosin-resistant pressor responses. These pressor responses were abolished by the P 2 -purinoceptor antagonist suramin (300 μmol/L). The results demonstrate an increased α 2 -adrenoceptor–mediated automodulation of norepinephrine release in SHR kidneys caused by increased intrasynaptic norepinephrine levels. α 1 -Adrenoceptor–mediated transjunctional modulation of norepinephrine release by endogenous adenosine is defective in SHR kidneys and may be responsible for the greater norepinephrine release in this strain. Norepinephrine and ATP are coreleased in SHR and WKY kidneys and both mediate pressor responses to stimulation. The release of ATP is identical in SHR and WKY and is, like that of norepinephrine, modulated by α 2 -adrenoceptor–mediated autoinhibition.
Comorbidity and outcome in dual diagnosis patients – characteristics of 228 inpatients

Little is known about the outcome characteristics of integrated treatment programs for patients with mental health and substance use problems. The aim ofthe present study is to describe an inpatient-population with comorbid mentalhealth disorders and substance use disorders with regard to diagnostic comorbidity and outcome. Routine outcome data on a consecutive sample of 228 patients admitted to an integrated Dual Diagnosis program in the Netherlands are presented. These data include the change in global assessment of functioning (GAF) scores between admission and discharge, remission of substance abuse, specific associations between mental health diagnoses and substance use diagnoses and whether patients completed their inpatient-treatment. Logistic regression analysis showed that the presence of a borderline personality disorder and/or cocaine dependence on admission predicted a worse outcome. There is a lack of evidence-based interventions for dual disorder patients with a borderline personality disord.