bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnosis and management of cryptococcal meningitis in HIV-infected adults
Authors: McHale Thomas C. , Boulware David R. , Kasibante John , Ssebambulidde Kenneth , Skipper Caleb P. , Abassi Mahsa 
Published: November 2023

SUMMARY
Cryptococcal meningitis is a leading cause of morbidity and mortality globally, especially in people with advanced HIV disease. Cryptococcal meningitis is responsible for nearly 20% of all deaths related to advanced HIV disease, with the burden of disease predominantly experienced by people in resource-limited countries. Major advancements in diagnostics have introduced low-cost, easy-to-use antigen tests with remarkably high sensitivity and specificity. These tests have led to improved diagnostic accuracy and are essential for screening campaigns to reduce the burden of cryptococcosis. In the last 5 years, several high-quality, multisite clinical trials have led to innovations in therapeutics that have allowed for simplified regimens, which are better tolerated and result in less intensive monitoring and management of medication adverse effects. One trial found that a shorter, 7-day course of deoxycholate amphotericin B is as effective as the longer 14-day course and that flucytosine is an essential partner drug for reducing mortality in the acute phase of disease. Single-dose liposomal amphotericin B has also been found to be as effective as a 7-day course of deoxycholate amphotericin B. These findings have allowed for simpler and safer treatment regimens that also reduce the burden on the healthcare system. This review provides a detailed discussion of the latest evidence guiding the clinical management and special circumstances that make cryptococcal meningitis uniquely difficult to treat.
Neisseria gonorrhoeae
drives
Chlamydia trachomatis
into a persistence-like state during
in vitro
co-infection
Authors: Ball Louise M. , Bronstein Ellis , Liechti George W. , Maurelli Anthony T. 
Published: November 2023

ABSTRACT

Chlamydia trachomatis
and
Neisseria gonorrhoeae
are the most prevalent bacterial sexually transmitted infections (STIs) globally. Despite frequent co-infections in patients, few studies have investigated how mono-infections may differ from co-infections. We hypothesized that a symbiotic relationship between the pathogens could account for the high rates of clinical co-infection. During
in vitro
co-infection, we observed an unexpected phenotype where the
C. trachomatis
developmental cycle was impaired by
N. gonorrhoeae. C. trachomatis
is an obligate intracellular pathogen with a unique biphasic developmental cycle progressing from infectious elementary bodies (EB) to replicative reticulate bodies (RB), and back. After 12 hours of co-infection, we observed fewer EBs than in a mono-infection. Chlamydial genome copy number remained equivalent between mono- and co-infections. This is a hallmark of Chlamydial persistence. Chlamydial persistence alters inclusion morphology but varies depending on the stimulus/stress. We observed larger, but fewer,
Chlamydia
during co-infection. Tryptophan depletion can induce Chlamydial persistence, but tryptophan supplementation did not reverse the co-infection phenotype. Only viable and actively growing
N. gonorrhoeae
produced the inhibition phenotype in
C. trachomatis
. Piliated
N. gonorrhoeae
had the strongest effect on
C. trachomatis
, but hyperpiliated or non-piliated
N. gonorrhoeae
still produced the phenotype. EB development was modestly impaired when
N. gonorrhoeae
were grown in transwells above the infected monolayer.
C. trachomatis
serovar L2 was not impaired during co-infection. Chlamydial impairment could be due to cytoskeletal or osmotic stress caused by an as-yet-undefined mechanism. We conclude that
N. gonorrhoeae
induces a persistence-like state in
C. trachomatis
that is serovar dependent.
The clinical epidemiology, management, and outcomes of patients diagnosed with encephalitis in North Carolina, 2015–2020
Authors: Fellner Anuva , White Samuel , Rockwell Emmanuel , Giandomenico Dana , Diaz Monica M. , Weber David J. , Miller Melissa B. , Boyce Ross M. 
Published: November 2023

ABSTRACT

Historically, the underlying cause of encephalitis was often not identified, even though the condition was responsible for substantial morbidity and mortality. The past decade, however, has witnessed the establishment of consensus case definitions and management guidelines, accompanied by rapid advances in molecular diagnostic techniques. The objective of this study was to describe the epidemiology of and routine care practices for patients diagnosed with encephalitis at a large academic tertiary referral hospital. A retrospective analysis of adults and children admitted to the University of North Carolina Medical Center between 2015 and 2020 was conducted. Cases of interest were identified by ICD9 and ICD10 codes with a diagnosis of encephalitis confirmed through record review. One-third (82, 31.6%) of the cohort did not have a lumbar puncture performed. Of the 177 patients who had a diagnostic lumbar puncture performed, 87 (49.2%) cases were a result of a confirmed infectious pathogen. Herpes simplex virus (HSV)-1 (
n
= 9) and HSV-2 (
n
= 12) were the most common infectious causes, followed by varicella zoster virus (VZV) (
n
= 16) and
Toxoplasma gondii
(
n
= 5). There were no confirmed cases of enterovirus or arboviral diseases, but less than half of patients were tested for these pathogens. The case fatality rate was 10.7% (
n
= 19) overall and 12.6% (
n
= 11) in those with infectious causes. Despite advances in diagnostics, a high proportion of cases (
n
= 75, 42.0%) were still classified as idiopathic. The use of order sets and/or multiplex testing (i.e., “encephalitis panel”) may improve the diagnosis of infectious encephalitis.

IMPORTANCE
Despite the relatively high mortality and the difficulty in diagnosis, nearly one-third of patients hospitalized with a documented diagnosis of encephalitis did not undergo a lumbar puncture (LP). When an LP was performed, pathogen-specific testing was greatly underutilized. Infectious etiologies were most common, but over 40% of cases were idiopathic at discharge. These findings suggest that there is a substantial opportunity to improve the quality of care through more accurate and timely diagnosis.
Trichophyton indotineae
and other terbinafine-resistant dermatophytes in North America
Authors: Lockhart Shawn R. , Smith Dallas J. , Gold Jeremy A. W. 
Published: November 2023

ABSTRACT

Dermatophyte infections (a.k.a. ringworm, tinea) affect an estimated 20%–25% of the world’s population. In North America, most dermatophytoses are caused by
Trichophyton rubrum
or
Trichophyton mentagrophytes
species complexes. Severe and antifungal-resistant dermatophytoses are a growing global public health problem. A new species of the
T. mentagrophytes
species complex,
Trichophyton indotineae
, has recently emerged and is notable for the severe infections it causes, its propensity for antifungal resistance, and its global spread. In this issue of the
Journal of Clinical Microbiology
, C. F. Cañete-Gibas, J. Mele, H. P. Patterson, et al. (J Clin Microbiol 61:e00562-23, 2023,
https://doi.org/10.1128/JCM.00562-23
) summarize the results of speciation and AFST performed on North American dermatophyte isolates received at a fungal diagnostic reference laboratory. Within their collection, 18.6% of isolates were resistant to terbinafine (a first-line oral antifungal for dermatophytoses), and similar proportions of
T. rubrum
and
T. indotineae
demonstrated terbinafine resistance. The authors also found that
T. indotineae
has been present in North America since at least 2017. These findings highlight the importance of increased surveillance efforts to monitor trends in severe and antifungal-resistant dermatophytoses and the need for antifungal stewardship efforts, the success of which is contingent upon improving laboratory capacity for dermatophyte speciation and AFST.
Whole-genome sequence of
Bacillus velezensis
strain R22 isolated from
Oryza sativa
rhizosphere in Bulgaria
Authors: Petrova Penka , Gerginova Maria , Arsov Alexander , Armenova Nadya , Tsigoriyna Lidia , Gergov Emanoel , Petrov Kaloyan 
Published: November 2023

ABSTRACT

Bacillus velezensis
R22 was isolated from a rice rhizosphere in Bulgaria. Its genome (assembled into 14 scaffolds) has a size of 4.08 Mbp and a G + C content of 46.35%. Nine full biosynthetic clusters for antimicrobials were predicted, among them two new gene clusters probably encoding polyketides named macrolactin R22 and velezensin.
Genome sequences of cluster GA phages Phonegingi and Dropshot
Authors: McLean Natalie , Jackson Tabitha , Govardhan Yajat , Dharanendiran Aditi , Bost Caden , Brown Frederick , Cowen Benjamin , Deselem Jenna , Parkhurst Nico , Stewart Jacob , Leonard Justin , Collins D. Parks 
Published: November 2023

ABSTRACT

Bacteriophages Phonegingi and Dropshot were isolated from soil in North Carolina using the host
Microbacterium foliorum
. Both phages have siphovirus morphologies. Based on gene content similarity to one another and to other actinobacteriophages, both phages are assigned to phage cluster GA.
Elucidating the impact of bacterial lipases, human serum albumin, and FASII inhibition on the utilization of exogenous fatty acids by
Staphylococcus aureus
Authors: Pruitt Emily L. , Zhang Rutan , Ross Dylan H. , Ashford Nathaniel K. , Chen Xi , Alonzo Francis , Bush Matthew F. , Werth Brian J. , Xu Libin 
Published: November 2023

ABSTRACT

Staphylococcus aureus
only synthesizes straight-chain saturated fatty acids (SCFAs) or branched-chain saturated fatty acids via the type II fatty acid synthesis (FASII) pathway, but as a highly adaptive pathogen,
S. aureus
can also utilize host-derived exogenous fatty acids (eFAs), including SCFAs and unsaturated fatty acids (UFAs).
S. aureus
secretes three lipases, glycerol ester hydrolase (Geh),
S. aureus
lipase 1, and SAUSA300_0641, which could release fatty acids from host lipids. Once released, the FAs are phosphorylated by the fatty acid kinase and incorporated into the bacterial lipids. In this study, we determined the substrate specificity of
S. aureus
secreted lipases, the effect of human serum albumin (HSA) on eFA incorporation, and the effect of FASII inhibitor AFN-1252 on eFA incorporation using comprehensive lipidomics. When grown with major donors of fatty acids, cholesteryl esters (CEs) and triglycerides (TGs), Geh was found to be the primary lipase responsible for hydrolyzing CEs, but other lipases could compensate for the function of Geh in hydrolyzing TGs. Lipidomics showed that eFAs were incorporated into all major
S. aureus
lipid classes and that fatty acid-containing HSA can serve as a source of eFAs. Furthermore,
S. aureus
grown with UFAs displayed increased membrane fluidity and increased production of reactive oxygen species (ROS). Exposure to AFN-1252 enhanced UFAs in the bacterial membrane, even without a source of eFAs, indicating the inhibition of double bond reduction by FabI. Thus, the incorporation of eFAs alters the
S. aureus
lipidome, membrane fluidity, and ROS formation, which could affect host-pathogen interactions and susceptibility to membrane-targeting antimicrobials.

IMPORTANCE

Incorporation of host-derived exogenous fatty acids (eFAs), particularly unsaturated fatty acids (UFAs), by
Staphylococcus aureus
could affect the bacterial membrane fluidity and susceptibility to antimicrobials. In this work, we found that glycerol ester hydrolase (Geh) is the primary lipase hydrolyzing cholesteryl esters and, to a lesser extent, triglycerides and that human serum albumin (HSA) could serve as a buffer of eFAs, where low levels of HSA facilitate the utilization of eFAs but high levels of HSA inhibit it. The fact that the type II fatty acid synthesis (FASII) inhibitor, AFN-1252, leads to an increase in UFA content even in the absence of eFA suggests that membrane property modulation is part of its mechanism of action. Thus, Geh and/or the FASII system look to be promising targets to enhance
S. aureus
killing in a host environment by restricting eFA utilization or modulating membrane properties, respectively.
Early use of intravitreal triamcinolone to inhibit traumatic proliferative vitreoretinopathy: a randomised clinical trial
Authors: Guo Haixia , Yu Jinguo , He Tiangeng , Chen Song , Sun Zhuoyu , Zhang Jingkai , Sun Zhiyong , Yang Wenhui , Yao Baoqun , Yang Xueli , Liu Yuanyuan , Zhang Mingxue , Meng Yu , Yang Likun , Yan Hua 
Published: November 2023

AimsTo evaluate the efficacy and safety of intravitreal triamcinolone acetonide (TA) injection at the end of emergency surgery for open globe injury (OGI) to suppress traumatic proliferative vitreoretinopathy (TPVR).MethodsA single-centre, participant-masked, prospective, randomised controlled clinical trial. A total of 68 globe rupture patients with zone III were randomised to the control group (n=34) or the TA group (n=34) in 1:1 allocation ratio. Patients were treated with 0.1 mL TA in the TA group and 0.1 mL balanced salt solution in the control group at the end of emergency surgery. The primary outcome was the assessment of TPVR during vitrectomy 10±3 days later. Secondary outcomes included visual acuity (VA), retinal attachment rate, macular attachment rate, proliferative vitreoretinopathy (PVR) recurrent rate, side effects 6 months after vitrectomy.ResultsDuring vitrectomy, the TPVR grade of the control group was significantly more severe than the TA group (p=0.028). The TPVR score was significantly better in the TA group (9.30±0.82) than in the control group (6.44±1.06) (p=0.036). The final VA improved in 23 eyes (92%) in the TA group and in 14 eyes (63.64%) in the control group (p=0.008). The retinal attachment rates were 88% and 63.64% in the TA and control group, respectively (p=0.049). The two groups showed no significant difference in macular repositioning and PVR recurrent rate (p=0.215, 0.191). Temporary intraocular pressure elevation occurred in one eye in the TA group after emergency surgery.ConclusionsEarly intravitreal TA injection for OGI effectively reduces TPVR, increases surgical success and improves visual prognosis.
Improving cognition in people with multiple sclerosis: study protocol for a multiarm, randomised, blinded trial of multidomain cognitive rehabilitation using a video-serious game (E-SEP cognition)
Authors: Lenne Bruno , Degraeve Béatrice , Davroux Jessy , Norberciak Laurène , Kwiatkowski Arnaud , Donze Cécile 
Published: November 2023

IntroductionMultiple sclerosis (MS) is a prevalent neurological disease characterised by disseminated areas of demyelination and atrophy within the central nervous system, inducing cognitive disorders in 45%–65% of persons with MS (PwMS). Neuropsychology and neuroimaging studies provide evidence of the effectiveness of cognitive rehabilitation interventions, including memory and attention. Recently, serious game therapy (SGT) has been used in rehabilitation to improve cognitive processing speed. The aim of this study is to describe the protocol of a randomised controlled trial (RCT) to test the efficacy of a tablet-based cognitive home intervention among ambulatory PwMS, in comparison to a standardised neuropsychological rehabilitation.Methods and analysisThis will be a parallel-assignment, double-blinded, RCT. One hundred and fifty (75 per arm) PwMS will be randomly assigned to receive cognitive rehabilitation session over 4 months (four 20-min sessions/week) of either: (1) tablet-based SGT or (2) conventional cognitive exercises. The same assessor will evaluate outcome measures at three points: at baseline (T0), after the 16 therapy sessions weeks (T1), and 6 months after the end of treatment (T2). The primary outcomes were the scores from theBrief International Cognitive Assessment for Multiple Sclerosis(BICAMS). Data analysis will be performed to compare the efficacy of the two treatments. We expect superior efficiency of tablet-based SGT in contrast to conventional cognitive exercises, based on BICAMS measures of speed processing information and episodic memory.Ethics and disseminationThe trial protocol is registered on ClinicalTrials.Gov (NCT04694534) and benefits from a favourable opinion from an ethics committee (RC-P0066-2018-A00411-54).
Relationship between individual-level social capital and non-communicable diseases among adults in Honiara, Solomon Islands
Authors: Tsuchiya Chihiro , Pitakaka Frida , Daefoni Julia , Furusawa Takuro 
Published: November 2023

ObjectiveSolomon Islands is experiencing a change in disease burden, from communicable to non-communicable diseases (NCDs). Urgent action is necessary to reduce the risk of high economic and personal costs associated with NCDs. Social capital refers to the trust, norms and networks that provide social benefits and it is related to health. Despite the strong social bonds among Solomon Islanders, research on the association between social capital and health is lacking. Therefore, this study examines the state of individual social capital and its connection to NCD-related factors in the capital of the Solomon Islands.MethodIn 2019, we conducted a cross-sectional study on 200 adults aged 20–80 years in urban and periurban settlements of the capital. Anthropometric measurements, questionnaires and interview surveys were conducted.ResultsThis study identified higher prevalence of obesity, blood glucose levels and blood pressure compared with previous studies in both study areas. Multiple linear regression analysis reported that in the periurban area, cognitive social capital was negatively associated with body mass index (BMI) (p=0.005), whereas joining a group was positively associated with BMI (p=0.01). In the urban area, social support from individuals and cognitive social capital were negatively associated with blood glucose levels (p=0.03, p=0.007). Moreover, cognitive social capital was negatively associated with systolic blood pressure and diastolic blood pressure (p=0.03, p=0.006). However, joining citizenship activity was positively associated with glucose levels (p=0.04).ConclusionThis study observed that participants living with people of the same linguistic group had high trust in each other. Furthermore, higher cognitive social capital and social support may reduce the risk of NCD-related factors, unlike joining group activities.Public health implicationsFindings suggest that health professionals should consider the influence of social capital on health promotion and interventions to be effective.
Association between the stage of labour during caesarean delivery with adverse maternal and neonatal outcomes among referred mothers to tertiary centres in resource-limited settings
Authors: Zewdu Dereje , Tantu Temesgen , Degemu Fikretsion , Abdlwehab Mukerem 
Published: November 2023

ObjectiveAlthough the caesarean delivery (CD) rate has substantially increased, little is known about its impacts when performed in the first and second stages of labour on fetomaternal outcomes, especially among referred mothers. Thus, this study aimed to investigate the association between CDs performed during the first and second stages of labour and poor maternal and neonatal outcomes among mothers referred to tertiary centres.SettingThis retrospective cohort study analysed medical records of mother–infant pairs from September 2020 to May 2023 in Southern Ethiopia.ParticipantsWe retrospectively collected data from 848 participants who underwent emergency CD on a referral basis during the study period.Primary outcome measureThe primary outcomes of interest were adverse maternal and neonatal outcomes. Data were analysed using descriptive and inferential statistics.ResultsOf the 848 CDs, 722 (85.2%) and 126 (14.8%) were performed at the first and second stages of labour, respectively. Caesarean sections performed at the second stage were higher with nulliparity, increased maternal age, and birth weight. Compared with the first-stage CD, the second-stage CD was associated with a significantly increased risk of adverse maternal (OR 3.7, 95% CI 2.4 to 5.7) and neonatal outcomes (OR 2.0; 95% CI 1.3 to 2.9), including neonatal death.ConclusionSecond-stage CDs have an increased risk of adverse maternal and neonatal outcomes. Strengthening and improving obstetric emergency surgical services and intensive neonatal care for those populations would help decrease the maternal and fetal negative consequences.
Connecting pathogen transmission and healthcare worker cognition: a cognitive task analysis of infection prevention and control practices during simulated patient care
Authors: Mumma Joel M , Weaver Bradley W , Morgan Jill S , Ghassemian Golpar , Gannon Paige R , Burke Kylie B , Berryhill Brandon A , MacKay Rebecca E , Lee Lindsay , Kraft Colleen S 
Published: November 2023

BackgroundRelatively little is known about the cognitive processes of healthcare workers that mediate between performance-shaping factors (eg, workload, time pressure) and adherence to infection prevention and control (IPC) practices. We taxonomised the cognitive work involved in IPC practices and assessed its role in how pathogens spread.MethodsForty-two registered nurses performed patient care tasks in a standardised high-fidelity simulation. Afterwards, participants watched a video of their simulation and described what they were thinking, which we analysed to obtain frequencies of macrocognitive functions (MCFs) in the context of different IPC practices. Performance in the simulation was the frequency at which participants spread harmless surrogates for pathogens (bacteriophages). Using a tertiary split, participants were categorised into a performance group: high, medium or low. To identify associations between the three variables—performance groups, MCFs and IPC practices—we used multiblock discriminant correspondence analysis (MUDICA).ResultsMUDICA extracted two factors discriminating between performance groups. Factor 1 captured differences between high and medium performers. High performers monitored the situation for contamination events and mitigated risks by applying formal and informal rules or managing their uncertainty, particularly for sterile technique and cleaning. Medium performers engaged more in future-oriented cognition, anticipating contamination events and planning their workflow, across many IPC practices. Factor 2 distinguished the low performers from the medium and high performers who mitigated risks with informal rules and sacrificed IPC practices when managing tradeoffs, all in the context of minimising cross-contamination from physical touch.ConclusionsTo reduce pathogen transmission, new approaches to training IPC (eg, cognitive skills training) and system design are needed. Interventions should help nurses apply their knowledge of IPC fluidly during patient care, prioritising and monitoring situations for risks and deciding how to mitigate risks. Planning IPC into one’s workflow is beneficial but may not account for the unpredictability of patient care.