Abstract Background Integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) is recommended for HIV treatment but has been associated with metabolic adverse effects. However, real-world longitudinal data on these metabolic changes remain limited. This study aimed to characterize weight gain, dyslipidemia, and hepatic steatosis in ART-naïve people living with HIV (PLWH) initiating INSTI-based versus efavirenz (EFV)-based therapy. Methods This prospective cohort study enrolled 772 participants at Nanfang Hospital, Southern Medical University from 2020 to 2023. Participants were categorized into 3 groups: EFV/tenofovir disoproxil fumarate (TDF)/lamivudine (3TC) (n = 389); elvitegravir/cobicistat (EVG/c)/tenofovir alafenamide (TAF)/emtricitabine (FTC) or bictegravir (BIC)/TAF/FTC (n = 168); and dolutegravir (DTG)/3TC or DTG/3TC/TDF (n = 215). Metabolic parameters—including body mass index (BMI), lipids, and hepatic steatosis assessed via controlled attenuation parameter (CAP)—were evaluated at baseline, 6, 12, and 24 months using generalized estimating equations. Results At 24 months, INSTI-based regimens were associated with significantly higher BMI compared to EFV/TDF/3TC (all P < 0.001), with no difference between INSTI subtypes. All groups showed early increases in triglycerides (TG) and total cholesterol (TC) that stabilized after 12 months; TG and TC levels at 24 months did not differ significantly between TAF-containing INSTI regimens and other groups. The prevalence of hepatic steatosis (CAP ≥ 238 dB/m) peaked at 31.2% at year 1 and declined to 28.8% at year 2. Multivariate analysis identified higher BMI (OR 1.55, 95% CI 1.44–1.67; p < 0.001), elevated TG (OR 1.44, 95% CI 1.22–1.70; p < 0.001), and elevated LDL-C (OR 1.90, 95% CI 1.21–2.98; p = 0.005) as independent risk factors. Conclusion INSTI-based ART was associated with sustained weight gain but did not worsen long-term dyslipidemia compared to an EFV-based regimen in a real-world setting. Hepatic steatosis correlated with metabolic parameters rather than INSTI exposure.
The COVID-19 pandemic demonstrated in practice the need for direct collaboration between governing and scientific institutions. Information exchange proved to be the only tool to control the situation before a vaccine is developed and to determine the dynamics of public trust in institutions. Communication, in these terms, is an instrument for legitimizing imposed measures in society and a decisive factor for their political success. In the context of a health crisis, the role of politicians as communicators should not be underestimated because of the influence they have over the media and public life on the one hand, and because of the existing intersections between public health goals and political interest, on the other. Political response to pandemic situations in different countries is based on established cultural traditions and political priorities, often focusing on social values that unite the majority within the society. Political orientation could influence factors such as perceived risk and behaviour. Although politicization of anti-epidemic measures in 2020 determined subsequent attitudes toward prevention in different countries, positive outcomes have been seen when political leaders engaged with the people and called for unity. Empathy and personal example, as well as the use of social media, have been reported as good practices. While initially the induction of fear stimulated compliance, in the long term it has been viewed as harmful and as a source of distrust.
Natasha Howard, Hannah Clapham, Manar Marzouk
et al.
Background Dengue cases are increasing despite continued efforts to control its vectors, with the Asia-Pacific region projected to bear a substantial proportion of the global burden. However, literature on dengue vector control methods and evidence use in national control programmes in the region is limited. We thus aimed to explore expert perspectives on current methods and how to improve dengue vector control programmes across the region.Methods We conducted remote semi-structured interviews with a purposive sample of 23 dengue vector control experts with experience in the Asia-Pacific region, analysing data using an abductive thematic approach.Findings Participants indicated that monitoring, evaluation and operational research related to dengue vector control methods was deprioritised in many countries across the region and that national vector control resources were often directed to relatively inefficient yet highly visible insecticide-based methods such as adulticide fogging. They suggested additional investment in other forms of vector control, including Wolbachia-based technologies that show potential and should be tested in larger urban settings. They also noted that traditional environmental control methods such as source reduction and biocontrol were potentially the most sustainable Aedes vector control methods if conducted through better-resourced and better-evidenced community engagement approaches.Conclusions The focus on visible and familiar methods evinces political concern for performative vector control. While understandable, refocusing national dengue vector control priorities on monitoring and evaluation/research evidence and mobilising communities can help Asia-Pacific countries improve Aedes mosquito management and therefore health outcomes.
Medicine (General), Infectious and parasitic diseases
Sepsis is a leading cause of death among patients with HIV, but early diagnosis remains a challenge. This study evaluates the diagnostic performance of monocyte distribution width (MDW) in detecting sepsis in patients with HIV. A prospective observational study was conducted at Shanghai Public Health Center, involving 488 hospitalized patients with HIV aged 18–65 between December 2022 and August 2023. MDW was measured at admission, and its diagnostic accuracy was compared with Sepsis-3 criteria. Survival rates on day 28 and 90 were also recorded. Additionally, five machine learning (ML) models were tested to enhance diagnostic efficacy. Of 488 subjects, 90 were in the sepsis group and 398 in the control group. MDW showed a diagnostic area under the curve (AUC) of 0.82, comparable to C-reactive protein (CRP) and Procalcitonin (PCT) with AUCs of 0.78 and 0.82, respectively. With a cut-off value of 25.25, MDW had a sensitivity of 0.83 and specificity of 0.76. The positive and negative predictive values were 44% and 95%, respectively. When MDW was combined with platelet count, serum albumin, and hemoglobin in a random forest model, the AUC improved to 0.931. The model achieved a sensitivity of 1.00 and specificity of 0.732. MDW is a useful diagnostic marker for sepsis in patients with HIV, with strong sensitivity and specificity. Combining MDW with other lab markers can further enhance diagnostic accuracy.Trial registration: ClinicalTrials.gov identifier: NCT05036928..
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still going on, and as the epidemic situation continues, the genome of SARS-CoV-2 is also mutating and evolving, resulting in more and more SARS-CoV-2 mutant strains, which have brought serious pressure on the prevention and control of COVID-19. Given that the COVID-19 is still spreading, it is extremely important to rapidly identify SARS-CoV-2 variants by nucleic acid assays. Thus, developing highly sensitive and specific assays that are suitable for field testing, high-throughput, and automation, as well as other diagnostic applications for SARS-CoV-2 variants, is urgently needed. This paper reviews the research progress of novel CRISPR-based diagnostic methods for SARS-CoV-2 variants.
The accurate estimation of time-varying transmission rates is fundamental for understanding infectious disease dynamics and implementing effective public health interventions. To this end, we propose an improved inverse method for estimating time-varying transmission rates in low-prevalence settings, where conventional data preprocessing approaches often fail due to sparse case observations. To overcome this difficulty, we introduce an exponential B-spline interpolation approach that integrates both continuous and discrete inverse methods. This method ensures that transmission rate estimates remain non-negative and smooth, even when the observed data exhibit low cases. We apply this approach to several infectious disease models using real-world data from China, including a scarlet fever model, a multi-strain influenza model, and an age-structured influenza model. The results show that our method provides accurate transmission rate estimates, particularly in low-prevalence infectious diseases and multi-group epidemic models, demonstrating its robustness and applicability across various epidemiological contexts. The improved inverse method offers a new perspective for epidemiological modeling and provides reliable technical support for related theoretical exploration and public health decision-making.
Betül Saygın, Ahmet Onur Girişgin, Suna Aslı Zengin
et al.
Objective: Scabies infestation is a major parasitic disease affecting both human and animal health worldwide. This study aimed to determine the distribution of scabies infestation in stray dogs in Bursa province. Methods: The study material was obtained from stray dogs suspected of mange kept in a municipal shelter in Bursa between June 2020 and February 2022. Samples from stray dogs were examined in a laboratory, and dogs with scabies were determined. Results: During the study, samples were collected from 205 (115 males, 90 females) scabies-suspected stray dogs, 58 (28.29%) of which had scabies. Demodex spp. were detected in 35 of the positive dogs (60.34%) (D. canis, D. injae), 19 (32.76%) Sarcoptes scabiei canis, 2 (3.44%) mixed infestation (Sarcoptes and Demodex), and 2 (3.44%) Otodectes cynotis agents. It was determined that 32 (55.17%) of 58 scabies-positive dogs were male and 26 (44.83%) were female. The association of infestations with age, season, and sex has not been found to be statistically meaningful. Conclusion: This study identified scabies agents and their prevalence rate in stray dogs of Bursa province, Türkiye.
This paper studies qualitative properties of solutions of nonlocal infectious SIR epidemic models (1.3)-(1.5), with the homogeneous Neumann boundary conditions, Dirichlet boundary conditions and free boundary, respectively. We first use the upper and lower solutions method and the Lyapunov function method to prove the global asymptotically stabilities of the disease-free equilibrium and the unique positive equilibrium of (1.3). Then we use the theory of topological degree in cones to study the positive equilibrium solutions of (1.4), including the necessary and sufficient conditions for the existence, and the uniqueness in some special case. At last, for the free boundary problem (1.5), we study the longtime behaviors of solutions and criteria for spreading and vanishing. The highlights are to overcome failures of the Lyapunov functional method and comparison principle, and difficulties in the maximum principle and Hopf boundary lemma of boundary value problems caused by nonlocal terms.
Abstract Background Chronic endometritis (CE) is a disease of continuous and subtle inflammation occurring in the endometrial stromal area, which is often asymptomatic or present with non-specific clinical symptoms. Methods This study investigated the composition and distribution of the intrauterine microbiota of 71 patients who underwent hysteroscopy during the routine clinical inspection of infertility. Among them, patients who were diagnosed with chronic endometritis (CE) were allocated into CE group (n = 29) and others into non-CE group (n = 42). There was no significant difference in average age between the two groups (P = 0.19). Uterine flushing fluid was collected by the self-developed cervical trocar uterine cavity sampler and 16S rRNA sequencing was performed. Results The alpha diversity in the CE group was significantly higher than that in the non-CE group (P < 0.05). Firmicutes (newly named Bacillota) were the dominant phylum in the non-CE group (72.23%), while their abundance was much lower in the CE group (49.92%), but there was no statistically significant difference between the two groups. The abundances of Actinobacteriota and Cyanobacteria in the CE group were significantly higher than those in the non-CE group (P < 0.05). At the genus level, the abundance of Lactobacillus dominated in all samples, which presented a significantly lower abundance in the CE group (40.88%) than that in the non-CE group (64.22%) (P < 0.05). Correspondingly, the abundance of non-Lactobacillus was higher in the CE group, among which Pseudomonas and Cutibacterium increased significantly (P < 0.01). Moreover, compared with the non-CE group, the pathways involved in arginine and proline metabolism and retinol metabolism were significantly enriched in the CE group (P < 0.05), while the metabolism of lipid and prenyltransferases were significantly decreased in the CE group (P < 0.05). Conclusions A certain microbial community was colonized in the uterine cavity, which was dominated by Lactobacillus. The structure and distribution of intrauterine microbiota in the CE group were different from those in the non-CE group by showing a lower abundance of Lactobacillus, and a significantly higher abundance of Pseudomonas and Cutibacterium. Additionally, the microbial metabolism was altered in the CE group. This study elaborated the alteration of intrauterine microbiota in CE patients, which may contribute to the diagnosis of CE and provide a reference for antibiotic treatment of CE.
Therapeutics. Pharmacology, Infectious and parasitic diseases
Joseph Kengni Tameze, Kéziah Korpak, Michèle Compagnie
et al.
We report a rare case of recurrent Achromobacter xylosoxidans bacteremia in an older woman in 2014 and 2020. During the more recent bacteremia, a diagnosis of mitral endocarditis was made. The patient could not have surgery because of severe comorbidities and a high operative risk. Combined antibiotic therapy was given with piperacillin/tazobactam and trimethoprim/sulfamethoxazole (TMP/SMX). Antibiotic therapy was administered for six weeks with a good response, but the patient relapsed after six days with A. xylosoxidans bacteremia and cardiac decompensation. Antibiotic therapy was resumed, using meropenem and TMP/SMX, but the patient died one month after the recurrence. We review the 22 cases of A. xylosoxidans endocarditis that have been described in the literature.
Weijie Sun, Sunil Vasu Kalmady, Amir Salimi
et al.
Electrocardiogram (ECG) abnormalities are linked to cardiovascular diseases, but may also occur in other non-cardiovascular conditions such as mental, neurological, metabolic and infectious conditions. However, most of the recent success of deep learning (DL) based diagnostic predictions in selected patient cohorts have been limited to a small set of cardiac diseases. In this study, we use a population-based dataset of >250,000 patients with >1000 medical conditions and >2 million ECGs to identify a wide range of diseases that could be accurately diagnosed from the patient's first in-hospital ECG. Our DL models uncovered 128 diseases and 68 disease categories with strong discriminative performance.
We introduce a general class of branching Markov processes for the modelling of a parasite infection in a cell population. Each cell contains a quantity of parasites which evolves as a diffusion with positive jumps. The drift, diffusive function and positive jump rate of this quantity of parasites depend on its current value. The division rate of the cells also depends on the quantity of parasites they contain. At division, a cell gives birth to two daughter cells and shares its parasites between them. Cells may also die, at a rate which may depend on the quantity of parasites they contain. We study the long-time behaviour of the parasite infection.
Tércia Moreira Ribeiro da Silva, Ana Carolina Micheletti Gomide Nogueira de Sá, Ed Wilson Rodrigues Vieira
et al.
Abstract Background Due to the social isolation measures adopted in an attempt to mitigate the risk of transmission of SARS-CoV-2, there has been a reduction in vaccination coverage of children and adolescents in several countries and regions of the world. Objective Analyze the number of doses of vaccine against Measles-Mumps-Rubella (MMR) applied before and after the beginning of mitigation measures due to COVID-19 pandemic in Brazil. Methods The data collected refer to the number of doses of the MMR vaccine applied monthly to the target population residing in Brazil: cahildren, aged 12 months (first dose) and children, aged 9 years (second dose), from April 2019 to December 2020. Differences in MMR vaccine doses from April 2019 to March 2020 (before the start of mitigation measures) and April 2020 to September 2020 (after the start of the mitigation measures) were evaluated. Spatial analysis identified clusters with a high percentage of reduction in the median of applied doses no Brazil. Results There was a reduction in the median of doses applied in the Regions North (− 33.03%), Northeast (− 43.49%) and South (− 39.01%) e nos Estados Acre (− 48.46%), Amazonas (− 28.96%), Roraima (− 61.91%), Paraíba (− 41.58%), Sergipe (− 47.52%), Rio de Janeiro (-59.31%) and Santa Catarina (− 49.32) (p < 0.05). High-high type spatial clusters (reduction between 34.00 and 90.00%) were formed in the five regions of Brazil (Moran’s I = 0.055; p = 0.01). Conclusion A reduction in the number of MMR vaccine doses was evidenced as a possible effect by the restrictive actions of COVID-19 in Brazil.
Abstract Background Social media have in recent years challenged the way in which research questions are formulated in epidemiology and medicine, and in particular when it comes to women’s health. They have contributed to the emergence of ‘new’ public health topics (e.g. gynaecological and obstetric violence, long-Covid), the unearthing of testimonials of medical injustice, and in some cases, the creation of new evidence and changes in medical practice. Main text From a theoretical and methodological perspective, we observe two powerful mechanisms at play on social media, which can facilitate the implementation of feminist epidemiological research and address so-called anti-feminist bias: social media as a ‘third’ space and the power of groups. Social media posts can be seen as inhabiting a third space, akin to what is said off the record or in-between doors, at the end of a therapy session. Researchers somehow miss the opportunity to use the third spaces that people occupy. Similarly, another existing space that researchers are seldom interested in are peer-groups. Peer-groups are the ideal terrain to generate bottom-up research priorities. To some extent, their on-line versions provide a safe and emancipatory space, accessible, transnational, and inclusive. We would argue that this could bring feminist epidemiology to scale. Conclusion Given the emancipatory power of social media, we propose recommendations and practical implications for leveraging the potential of online-sourced feminist epidemiology at different stages of the research process (from design to dissemination), and for increasing synergies between researchers and the community. We emphasise that attention should be paid to patriarchal sociocultural contexts and power dynamics, the mitigation of risks for political recuperation and stigmatisation, and the co-production of respectful discourse on studied populations.
To enable a deep learning-based system to be used in the medical domain as a computer-aided diagnosis system, it is essential to not only classify diseases but also present the locations of the diseases. However, collecting instance-level annotations for various thoracic diseases is expensive. Therefore, weakly supervised localization methods have been proposed that use only image-level annotation. While the previous methods presented the disease location as the most discriminative part for classification, this causes a deep network to localize wrong areas for indistinguishable X-ray images. To solve this issue, we propose a spatial attention method using disease masks that describe the areas where diseases mainly occur. We then apply the spatial attention to find the precise disease area by highlighting the highest probability of disease occurrence. Meanwhile, the various sizes, rotations and noise in chest X-ray images make generating the disease masks challenging. To reduce the variation among images, we employ an alignment module to transform an input X-ray image into a generalized image. Through extensive experiments on the NIH-Chest X-ray dataset with eight kinds of diseases, we show that the proposed method results in superior localization performances compared to state-of-the-art methods.
Matthew J. Young, Matthew J. Silk, Alex J. Pritchard
et al.
How self-organization leads to the emergence of structure in social populations remains a fascinating and open question in the study of complex systems. One frequently observed structure that emerges again and again across systems is that of self-similar community, i.e., homophily. We use a game theoretic perspective to explore a case in which individuals choose affiliation partnerships based on only two factors: the value they place on having social contacts, and their risk tolerance for exposure to threat derived from social contact (e.g., infectious disease, threatening ideas, etc.). We show how diversity along just these two influences are sufficient to cause the emergence of self-organizing homophily in the population. We further consider a case in which extrinsic social factors influence the desire to maintain particular social ties, and show the robustness of emergent homophilic patterns to these additional influences. These results demonstrate how observable population-level homophily may arise out of individual behaviors that balance the value of social contacts against the potential risks associated with those contacts. We present and discuss these results in the context of outbreaks of infectious disease in human populations. Complementing the standard narrative about how social division alters epidemiological risk, we here show how epidemiological risk may deepen social divisions in human populations.