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1.
Malar J ; 18(1): 430, 2019 Dec 18.
Artículo en Inglés | MEDLINE | ID: mdl-31852480

RESUMEN

BACKGROUND: Sulfadoxine-pyrimethamine (SP) is a cornerstone of malaria chemoprophylaxis and is considered for programmes in the Democratic Republic of Congo (DRC). However, SP efficacy is threatened by drug resistance, that is conferred by mutations in the dhfr and dhps genes. The World Health Organization has specified that intermittent preventive treatment for infants (IPTi) with SP should be implemented only if the prevalence of the dhps K540E mutation is under 50%. There are limited current data on the prevalence of resistance-conferring mutations available from Eastern DRC. The current study aimed to address this knowledge gap. METHODS: Dried blood-spot samples were collected from clinically suspected malaria patients [outpatient department (OPD)] and pregnant women attending antenatal care (ANC) in four sites in North and South Kivu, DRC. Quantitative PCR (qPCR) was performed on samples from individuals with positive and with negative rapid diagnostic test (RDT) results. Dhps K450E and A581G and dhfr I164L were assessed by nested PCR followed by allele-specific primer extension and detection by multiplex bead-based assays. RESULTS: Across populations, Plasmodium falciparum parasite prevalence was 47.9% (1160/2421) by RDT and 71.7 (1763/2421) by qPCR. Median parasite density measured by qPCR in RDT-negative qPCR-positive samples was very low with a median of 2.3 parasites/µL (IQR 0.5-25.2). Resistance genotyping was successfully performed in RDT-positive samples and RDT-negative/qPCR-positive samples with success rates of 86.2% (937/1086) and 55.5% (361/651), respectively. The presence of dhps K540E was high across sites (50.3-87.9%), with strong evidence for differences between sites (p < 0.001). Dhps A581G mutants were less prevalent (12.7-47.2%). The dhfr I164L mutation was found in one sample. CONCLUSIONS: The prevalence of the SP resistance marker dhps K540E exceeds 50% in all four study sites in North and South Kivu, DRC. K540E mutations regularly co-occurred with mutations in dhps A581G but not with the dhfr I164L mutation. The current results do not support implementation of IPTi with SP in the study area.


Asunto(s)
Antimaláricos/farmacología , Resistencia a Medicamentos , Malaria/prevención & control , Plasmodium/efectos de los fármacos , Pirimetamina/farmacología , Sulfadoxina/farmacología , Adolescente , Biomarcadores/sangre , Quimioprevención/estadística & datos numéricos , Niño , Preescolar , República Democrática del Congo , Combinación de Medicamentos , Femenino , Humanos , Lactante , Recién Nacido , Masculino
2.
Malar J ; 18(1): 443, 2019 Dec 26.
Artículo en Inglés | MEDLINE | ID: mdl-31878947

RESUMEN

BACKGROUND: Rapid diagnostic tests (RDT) for malaria are common, but their performance varies. Tests using histidine-rich protein 2 (HRP2) antigen are most common, and many have high sensitivity. HRP2 tests can remain positive for weeks after treatment, limiting their specificity and usefulness in high-transmission settings. Tests using Plasmodium lactate dehydrogenase (pLDH) have been less widely used but have higher specificity, mostly due to a much shorter time to become negative. METHODS: A prospective, health centre-based, diagnostic evaluation of two malaria RDTs was performed in rural Niger during the high malaria transmission season (3-28 October, 2017) and during the low transmission season (28 January-31 March, 2018). All children under 5 years of age presenting with fever (axillary temperature > 37.5 °C) or history of fever in the previous 24 h were eligible. Capillary blood was collected by finger prick. The SD Bioline HRP2 (catalog: 05FK50) and the CareStart pLDH(pan) (catalog: RMNM-02571) were performed in parallel, and thick and thin smears were prepared. Microscopy was performed at Epicentre, Maradi, Niger, with external quality control. The target sample size was 279 children with microscopy-confirmed malaria during each transmission season. RESULTS: In the high season, the sensitivity of both tests was estimated at > 99%, but the specificity of both tests was lower: 58.0% (95% CI 52.1-63.8) for the pLDH test and 57.4% (95% CI 51.5-63.1) for the HRP2 test. The positive predictive value was 66.3% (95% CI 61.1-71.2) for both tests. In the low season, the sensitivity of both tests dropped: 91.0% (95% CI 85.3-95.0) for the pLDH test and 85.8% (95% CI 79.3-90.9) for the HRP2 test. The positive predictive value remained low for both tests in the low season: 60.5% (95% CI 53.9-66.8) for the pLDH test and 61.9% (55.0-68.4) for the HRP2 test. Performance was similar across different production lots, gender, age of the children, and, during the high season, time since the most recent distribution of seasonal malaria chemoprevention. CONCLUSIONS: The low specificity of the pLDH RDT in this setting was unexpected and is not easily explained. As the pLDH test continues to be introduced into new settings, the questions raised by this study will need to be addressed.


Asunto(s)
Antígenos de Protozoos/aislamiento & purificación , Pruebas Diagnósticas de Rutina/estadística & datos numéricos , L-Lactato Deshidrogenasa/aislamiento & purificación , Malaria Falciparum/diagnóstico , Plasmodium falciparum/aislamiento & purificación , Proteínas Protozoarias/aislamiento & purificación , Quimioprevención/estadística & datos numéricos , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Niger , Estudios Prospectivos , Estaciones del Año
3.
Infect Dis Poverty ; 8(1): 82, 2019 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-31575378

RESUMEN

BACKGROUND: The goal of soil-transmitted helminthiases (STH) control programmes is to eliminate STH-associated morbidity in the target population by reducing the prevalence of moderate- and heavy-intensity infections and the overall STH infection prevalence mainly through preventive chemotherapy (PC) with either albendazole or mebendazole. Endemic countries should measure the success of their control programmes through regular epidemiological assessments. We evaluated changes in STH prevalence in countries that conducted effective PC coverage for STH to guide changes in the frequency of PC rounds and the number of tablets needed. METHODS: We selected countries from World Health Organization (WHO)'s Preventive Chemotherapy and Transmission control (PCT) databank that conducted ≥5 years of PC with effective coverage for school-age children (SAC) and extracted STH baseline and impact assessment data using the WHO Epidemiological Data Reporting Form, Ministry of Health reports and/or peer-reviewed publications. We used pooled and weighted means to plot the prevalence of infection with any STH and with each STH species at baseline and after ≥5 years of PC with effective coverage. Finally, using the WHO STH decision tree, we estimated the reduction in the number of tablets needed. RESULTS: Fifteen countries in four WHO regions conducted annual or semi-annual rounds of PC for STH for 5 years or more and collected data before and after interventions. At baseline, the pooled prevalence was 48.9% (33.1-64.7%) for any STH, 23.2% (13.7-32.7%) for Ascaris lumbricoides, 21.01% (9.7-32.3%) for Trichuris trichiura and 18.2% (10.9-25.5%) for hookworm infections, while after ≥5 years of PC for STH, the prevalence was 14.3% (7.3-21.3%) for any STH, 6.9% (1.3-12.5%) for A. lumbricoides, 5.3% (1.06-9.6%) for T. trichiura and 8.1% (4.0-12.2%) for hookworm infections. CONCLUSIONS: Countries endemic for STH have made tremendous progress in reducing STH-associated morbidity, but very few countries have data to demonstrate that progress. In this study, the data show that nine countries should adapt their PC strategies and the frequency of PC rounds to yield a 36% reduction in drug needs. The study also highlights the importance of impact assessment surveys to adapt control strategies according to STH prevalence.


Asunto(s)
Albendazol/uso terapéutico , Antihelmínticos/uso terapéutico , Quimioprevención/estadística & datos numéricos , Helmintiasis/prevención & control , Mebendazol/uso terapéutico , Albendazol/provisión & distribución , Animales , Antihelmínticos/provisión & distribución , Ascariasis/epidemiología , Ascariasis/parasitología , Ascariasis/prevención & control , Ascaris lumbricoides/fisiología , Helmintiasis/epidemiología , Helmintiasis/parasitología , Infecciones por Uncinaria/epidemiología , Infecciones por Uncinaria/parasitología , Infecciones por Uncinaria/prevención & control , Humanos , Mebendazol/provisión & distribución , Prevalencia , Suelo/parasitología , Tricuriasis/epidemiología , Tricuriasis/parasitología , Tricuriasis/prevención & control , Trichuris/fisiología
4.
Expert Opin Pharmacother ; 20(12): 1429-1438, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31282759

RESUMEN

Introduction: Human cytomegalovirus (HCMV) or human herpesvirus 5 (HHV-5) is a ß-herpesvirus that causes widespread infection in nearly all members of the human population worldwide. Its persistence in humans after primary infection in a latent phase as well as a partial non-protective immune response is the basis for repeated re-activation/re-infection episodes occurring both in immunocompetent and immunocompromised subjects. In the latter patient populations, which include hematopoietic stem cell transplant (HSCT) recipients, HCMV reactivation episodes may be particularly severe, leading to both systemic and end-organ diseases. Since the 90s, at least four antiviral drugs targeting the DNA polymerase complex have been developed for the prevention and treatment of HCMV infections in transplant recipients, used as first-line (ganciclovir and valganciclovir) and second-line therapy (foscarnet and cidofovir). However, due to their toxicity and drug-resistance induction, new drugs with different targets were needed. Areas covered: In 2017, a new drug named letermovir (LTV), which targets the HCMV DNA terminase complex, was licensed for prophylaxis of HCMV infections in HSCT recipients. This is the focus of this review. Expert opinion: LTV safety and efficacy are promising. However, long-term adverse events and the emergence of drug-resistant HCMV strains must be investigated in extended clinical trials prior to drawing final conclusions.


Asunto(s)
Acetatos/uso terapéutico , Quimioprevención/métodos , Infecciones por Citomegalovirus/prevención & control , Citomegalovirus/efectos de los fármacos , Quinazolinas/uso terapéutico , Antivirales/uso terapéutico , Quimioprevención/estadística & datos numéricos , Cidofovir/uso terapéutico , Citomegalovirus/genética , Infecciones por Citomegalovirus/tratamiento farmacológico , Infecciones por Citomegalovirus/epidemiología , Farmacorresistencia Viral/efectos de los fármacos , Ganciclovir/uso terapéutico , Humanos , Huésped Inmunocomprometido/efectos de los fármacos , Receptores de Trasplantes/estadística & datos numéricos , Acondicionamiento Pretrasplante/métodos , Acondicionamiento Pretrasplante/estadística & datos numéricos , Valganciclovir/uso terapéutico
5.
Malar J ; 18(1): 230, 2019 Jul 10.
Artículo en Inglés | MEDLINE | ID: mdl-31291951

RESUMEN

BACKGROUND: Malaria was eliminated in Spain in 1964. Since then, more than 10,000 cases of malaria have been reported, mostly in travellers and migrants, making it the most frequently imported disease into this country. In order to improve knowledge on imported malaria cases characteristics, the two main malaria data sources were assessed: the national surveillance system and the hospital discharge database (CMBD). METHODS: Observational study using prospectively gathered surveillance data and CMBD records between 2002 and 2015. The average number of hospitalizations per year was calculated to assess temporal patterns. Socio-demographic, clinical and travel background information were analysed. Bivariate and multivariable statistical methods were employed to evaluate hospitalization risk, fatal outcome, continent of infection and chemoprophylaxis failure and their association with different factors. RESULTS: A total of 9513 malaria hospital discharges and 7421 reported malaria cases were identified. The number of reported cases was below the number of hospitalizations during the whole study period, with a steady increase trend in both databases since 2008. Males aged 25-44 were the most represented in both data sources. Most frequent related co-diagnoses were anaemia (20.2%) and thrombocytopaenia (15.4%). The risks of fatal outcome increased with age and were associated with the parasite species (Plasmodium falciparum). The main place of infection was Africa (88.9%), particularly Equatorial Guinea (33.2%). Most reported cases were visiting friends and relatives (VFRs) and immigrants (70.2%). A significant increased likelihood of hospitalization was observed for children under 10 years (aOR:2.7; 95% CI 1.9-3.9), those infected by Plasmodium vivax (4.3; 95% CI 2.1-8.7) and travellers VFRs (1.4; 95% CI 1.1-1.7). Only 4% of cases reported a correct regime of chemoprophylaxis. Being male, over 15 years, VFRs, migrant and born in an endemic country were associated to increased risk of failure in preventive chemotherapy. CONCLUSIONS: The joint analysis of two data sources allowed for better characterization of imported malaria profile in Spain. Despite the availability of highly effective preventive measures, the preventable burden from malaria is high in Spain. Pre-travel advice and appropriately delivered preventive messages needs to be improved, particularly in migrants and VFRs.


Asunto(s)
Antimaláricos/administración & dosificación , Enfermedades Transmisibles Importadas/epidemiología , Hospitalización/estadística & datos numéricos , Malaria Falciparum/epidemiología , Malaria Vivax/epidemiología , Adolescente , Adulto , Factores de Edad , Quimioprevención/estadística & datos numéricos , Enfermedades Transmisibles Importadas/parasitología , Enfermedades Transmisibles Importadas/prevención & control , Femenino , Humanos , Incidencia , Malaria Falciparum/parasitología , Malaria Falciparum/prevención & control , Malaria Vivax/parasitología , Malaria Vivax/prevención & control , Masculino , Persona de Mediana Edad , Plasmodium falciparum/fisiología , Plasmodium vivax/fisiología , Prevalencia , Factores de Riesgo , Factores Sexuales , España/epidemiología , Viaje/estadística & datos numéricos , Adulto Joven
6.
PLoS Med ; 16(4): e1002797, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-31034476

RESUMEN

BACKGROUND: The efficacy, safety, and clinical importance of extended-duration thromboprophylaxis (EDT) for prevention of venous thromboembolism (VTE) in medical patients remain unclear. We compared the efficacy and safety of EDT in patients hospitalized for medical illness. METHODS AND FINDINGS: Electronic databases of PubMed/MEDLINE, EMBASE, Cochrane Central, and ClinicalTrials.gov were searched from inception to March 21, 2019. We included randomized clinical trials (RCTs) reporting use of EDT for prevention of VTE. We performed trial sequential and cumulative meta-analyses to evaluate EDT effects on the primary efficacy endpoint of symptomatic VTE or VTE-related death, International Society on Thrombosis and Haemostasis (ISTH) major or fatal bleeding, and all-cause mortality. The pooled number needed to treat (NNT) to prevent one symptomatic or fatal VTE event and the number needed to harm (NNH) to cause one major or fatal bleeding event were calculated. Across 5 RCTs with 40,247 patients (mean age: 67-77 years, proportion of women: 48%-54%, most common reason for admission: heart failure), the duration of EDT ranged from 24-47 days. EDT reduced symptomatic VTE or VTE-related death compared with standard of care (0.8% versus 1.2%; risk ratio [RR]: 0.61, 95% confidence interval [CI]: 0.44-0.83; p = 0.002). EDT increased risk of ISTH major or fatal bleeding (0.6% versus 0.3%; RR: 2.04, 95% CI: 1.42-2.91; p < 0.001) in both meta-analyses and trial sequential analyses. Pooled NNT to prevent one symptomatic VTE or VTE-related death was 250 (95% CI: 167-500), whereas NNH to cause one major or fatal bleeding event was 333 (95% CI: 200-1,000). Limitations of the study include variation in enrollment criteria, individual therapies, duration of EDT, and VTE detection protocols across included trials. CONCLUSIONS: In this systematic review and meta-analysis of 5 randomized trials, we observed that use of a post-hospital discharge EDT strategy for a 4-to-6-week period reduced symptomatic or fatal VTE events at the expense of increased risk of major or fatal bleeding. Further investigations are still required to define the risks and benefits in discrete medically ill cohorts, evaluate cost-effectiveness, and develop pathways for targeted implementation of this postdischarge EDT strategy. TRIAL REGISTRATION: PROSPERO CRD42018109151.


Asunto(s)
Anticoagulantes/administración & dosificación , Quimioprevención/métodos , Hospitalización , Tromboembolia Venosa/prevención & control , Anciano , Anticoagulantes/efectos adversos , Quimioprevención/efectos adversos , Quimioprevención/estadística & datos numéricos , Estudios de Cohortes , Esquema de Medicación , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Tromboembolia Venosa/epidemiología
7.
Support Care Cancer ; 27(4): 1459-1469, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30374765

RESUMEN

BACKGROUND: Current guidelines (GL) recommend neutropenia prophylaxis with G-CSF after chemotherapy (CTX) for patients with high (≥ 20%), or, if additional risk factors are present, intermediate (≥ 10-20%) risk of febrile neutropenia. The first sample survey in 2012 (NP1) showed lack of GL adherence. The aim of this second sample survey was to evaluate if GL adherence and implementation have improved. METHODS: The sample size represented 1.0% of the incidences of lung and 1.1% of breast cancer in Germany in 2010. Data of patients with a febrile neutropenia (FN) risk ≥ 10% who had received at least 2 cycles of chemotherapy between October 2014 and September 2015 was surveyed retrospectively. RESULTS: Data from 573 lung cancer (LC) and 801 breast cancer (BC) patients was collected from 109 hospitals and 83 oncology practices with 222 physicians participating. Compared with the NP1 survey, GL adherence increased in LC and FN high-risk (HR) chemotherapy from 15.4 to 47.8% (p < 0.001), and in FN intermediate-risk (IR) chemotherapy from 38.8 to 44.3% (p = 0.003). In BC and FN-HR chemotherapy, GL adherence was unchanged: 85.6% vs. 85.1% (p = 0.73) but increased in FN-IR from 49.3 to 57.8% (p < 0.001). In all IR CTX cycles, there are also no significant differences in GL adherence between the first (51.3%) and subsequent cycles (51.1%; p = 0.948). In LC patients treated in certified or comprehensive cancer centers, the GL adherence in FN-HR chemotherapy was 53.0% vs. 44.9% in other centers (p = 0.295); in FN-IR chemotherapy, it was 45.1% vs. 43.8% (p = 0.750). In BC with FN-HR chemotherapy, GL adherence in certified or comprehensive centers was 85.4% vs. 84.7% in other institutions (p = 0.869); in FN-IR chemotherapy, it was 60.2% vs. 55.0% (p = 0.139). GL adherence in FN-HR chemotherapy and in FN-IR chemotherapy differed between pulmonologists and hematologist-oncologists (FN-HR: 25.0% vs. 43.6%, p < 0.001; 38.1% vs. 48.6%, p < 0.001). Comparing gynecologists with hematologist-oncologists, GL adherence in FN-HR chemotherapy was 86.2% vs. 82.5%. In FN-IR chemotherapy, GL adherence by gynecologists and hematologist-oncologists was 58.6% and 55.6%, respectively (p = 0.288; p = 0.424). Classification and regression tree analysis split pulmonologists and other specialists, with the latter adhering more to GL (p < 0.001). Hematologist-oncologists and gynecologists with more than 2 years of professional training in medical cancer therapy adhered more closely to GL than others (68.7% vs. 46.2%, p < 0.001). Pulmonologists attending ≥ 2 national congresses annually adhered more to guidelines than other pulmonologists (44.8% vs. 24.3%, p < 0.001). CONCLUSIONS: Adherence to G-CSF GL in Germany has increased but is still insufficient. Certified and comprehensive cancer centers show a higher rate of GL implementation. In GL adherence, there is still a disparity between cancer types and between oncology treatment specialists.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Neutropenia Febril Inducida por Quimioterapia/prevención & control , Factor Estimulante de Colonias de Granulocitos/uso terapéutico , Adhesión a Directriz/estadística & datos numéricos , Neoplasias Pulmonares/tratamiento farmacológico , Adulto , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/patología , Quimioprevención/métodos , Quimioprevención/normas , Quimioprevención/estadística & datos numéricos , Neutropenia Febril Inducida por Quimioterapia/epidemiología , Relación Dosis-Respuesta a Droga , Femenino , Alemania/epidemiología , Humanos , Incidencia , Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina/normas , Pautas de la Práctica en Medicina/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Encuestas y Cuestionarios
8.
Clin Infect Dis ; 68(1): 37-42, 2019 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-29790923

RESUMEN

Background: Expanding use of preexposure prophylaxis (PrEP) in ways that address current racial/ethnic disparities is an important human immunodeficiency virus (HIV) prevention goal. We investigated missed opportunities to provide PrEP during healthcare visits that occur prior to HIV infection. Methods: This retrospective cohort study linked South Carolina HIV case surveillance data to 3 statewide healthcare databases. Characteristics of patients, healthcare visits and providers, sexually transmitted diseases (STDs), and other diagnoses were assessed for medical encounters occurring before an initial HIV diagnosis. Adjusted odds ratios were used to identify correlates of missed opportunities for PrEP provision. Results: Of 885 persons newly diagnosed during the study period, 586 (66%) had 4029 visits to a healthcare facility prior to their HIV diagnosis (mean of 6.9 visits) with missed opportunities for provision of PrEP. Emergency medicine-trained clinicians conducted (61%) and primary care clinicians (family practice or internal medicine) conducted 10% of visits. Also, 42% of visits were by persons who were uninsured or self-paid, 36% had public insurance, and 18% had commercial insurance. In multivariable analyses, being female, black, or aged <30 years were statistically significant predictors of having prior healthcare visits. Among persons with at least 1 healthcare visit prior to their HIV diagnosis, 28.5% had a diagnosis of gonorrhea, syphilis, or chlamydia at any visit. Conclusions: Healthcare visits occurring among persons who would benefit from provision of PrEP, especially persons with diagnosed STDs, should be leveraged to increase use of PrEP and reduce the risk of HIV acquisition.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Quimioprevención/métodos , Infecciones por VIH/diagnóstico , Infecciones por VIH/prevención & control , Profilaxis Pre-Exposición/métodos , Prescripciones/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Quimioprevención/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Profilaxis Pre-Exposición/estadística & datos numéricos , Estudios Retrospectivos , South Carolina , Adulto Joven
9.
Support Care Cancer ; 27(1): 249-255, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-29938306

RESUMEN

PURPOSE: Despite recent advances in prophylaxis and management, 20% of patients who receive moderately to severely emetogenic chemotherapy continue to experience nausea and vomiting. Relying on patients' own words, this study sought to capture and characterize the lived experience with chemotherapy-induced nausea and vomiting (CINV) for this important subgroup of patients. METHODS: Solid tumor patients with a history of poorly controlled CINV provided informed consent and participated in a semi-structured interview, which was audio-recorded and transcribed. After data saturation, enrollment ceased, and inductive, qualitative analytic methods were employed. RESULTS: The median age of the 20 enrolled patients was 56 years (range 27-83) with an equal gender split; half had gastrointestinal cancers. Two themes emerged. First, CINV is severe and multidimensional: "It's like shredding your muscles… It's doing it over and over again." This symptom complex has psychosocial implications: "Isolation is a big thing." Financial toxicity is also implicated: "I use [an antiemetic] when I feel like it is absolutely necessary because it is so expensive I cannot afford it anyway." The second theme is underreporting of symptoms. Patients seemed to accept N/V as part of treatment and were therefore less forthcoming: "God, if you're pumping poison in your system, you gotta expect some side effects." CONCLUSIONS: These vivid data should motivate investigators to continue conducting clinical trials CINV and should remind healthcare providers about the importance of patient education on the availability of therapy for breakthrough symptomatology.


Asunto(s)
Antieméticos/uso terapéutico , Antineoplásicos/efectos adversos , Quimioprevención , Náusea , Neoplasias/tratamiento farmacológico , Vómitos , Adulto , Anciano , Anciano de 80 o más Años , Quimioprevención/métodos , Quimioprevención/estadística & datos numéricos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/prevención & control , Femenino , Humanos , Entrevistas como Asunto , Masculino , Cumplimiento de la Medicación/psicología , Cumplimiento de la Medicación/estadística & datos numéricos , Persona de Mediana Edad , Náusea/inducido químicamente , Náusea/epidemiología , Náusea/prevención & control , Neoplasias/epidemiología , Cuidados Paliativos/métodos , Cuidados Paliativos/estadística & datos numéricos , Investigación Cualitativa , Autoinforme/estadística & datos numéricos , Aislamiento Social/psicología , Insuficiencia del Tratamiento , Vómitos/inducido químicamente , Vómitos/epidemiología , Vómitos/prevención & control
10.
BMC Infect Dis ; 18(1): 650, 2018 Dec 12.
Artículo en Inglés | MEDLINE | ID: mdl-30541465

RESUMEN

BACKGROUND: About 80% of all reported sickle cell disease (SCD) cases in children anually are recorded in Africa. Although malaria is considered a major cause of death in SCD children, there is limited data on the safety and effectiveness of the available antimalarial drugs used for prophylaxis. Also, previous systematic reviews have not provided quantitative measures of preventive effectiveness. The purpose of this research was to conduct a systematic review and meta-analysis of the available literature to determine the safety and effectiveness of antimalarial chemoprophylaxis used in SCD patients. METHODS: We searched in PubMed, Medline, CINAHL, POPLine and Cochrane library, for the period spanning January 1990 to April 2018. We considered randomized or quasi-randomized controlled trials comparing any antimalarial chemoprophylaxis to, 1) other antimalarial chemoprophylaxis, 2) placebo or 3) no intervention, in SCD patients. Studies comparing at least two treatment arms, for a minimum duration of three months, with no restriction on the number of patients per arm were reviewed. The data were extracted and expressed as odds ratios. Direct pairwise comparisons were performed using fixed effect models and the heterogeneity assessed using the I-square. RESULTS: Six qualified studies that highlighted the importance of antimalarial chemoprophylaxis in SCD children were identified. In total, seven different interventions (Chloroquine, Mefloquine, Mefloquine artesunate, Proguanil, Pyrimethamine, Sulfadoxine-pyrimethamine, Sulfadoxine-pyrimethamine amodiaquine) were evaluated in 912 children with SCD. Overall, the meta-analysis showed that antimalarial chemoprophylaxis provided protection against parasitemia and clinical malaria episodes in children with SCD. Nevertheless, the risk of hospitalization (OR = 0.72, 95% CI = 0.267-1.959; I2 = 0.0%), blood transfusion (OR = 0.83, 95% CI = 0.542-1.280; I2 = 29.733%), vaso-occlusive crisis (OR = 19, 95% CI = 1.713-2.792; I2 = 93.637%), and mortality (OR = 0.511, 95% CI = 0.189-1.384; I2 = 0.0%) did not differ between the intervention and placebo groups. CONCLUSION: The data shows that antimalarial prophylaxis reduces the incidence of clinical malaria in children with SCD. However, there was no difference between the occurrence of adverse events in children who received placebo and those who received prophylaxis. This creates an urgent need to assess the efficacy of new antimalarial drug regimens as potential prophylactic agents in SCD patients. SYSTEMATIC REVIEW REGISTRATION: PROSPERO (CRD42016052514).


Asunto(s)
Anemia de Células Falciformes/tratamiento farmacológico , Antimaláricos/uso terapéutico , Quimioprevención/métodos , Malaria/prevención & control , África/epidemiología , Anemia de Células Falciformes/epidemiología , Quimioprevención/estadística & datos numéricos , Niño , Humanos , Malaria/epidemiología , Metaanálisis en Red , Parasitemia/epidemiología , Parasitemia/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Resultado del Tratamiento
12.
Natl Med J India ; 31(1): 19-21, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30348917

RESUMEN

Background: Globally, cities get flooded due to heavy rains. As the incidence of leptospirosis increases after such flooding in Mumbai, community chemoprophylaxis to selected individuals was a consensus recommendation by experts. Methods: We surveyed a total of 1 499 293 houses in severely affected areas of Mumbai (where there was waterlogging or high incidence of leptospirosis in the past) as well as in all slum areas. A total of 6 714 210 people (>50% of the population) were screened. A total of 156 934 adults, 4465 children, 359 pregnant women and 4957 high-risk adults were given prophylaxis with doxycycline or azithromycin by paramedical staff (n = 9526) under the supervision of medical staff. Social media and newspaper advertisements were used to create public awareness. Results: Compared with previous floods, there were reduced number of cases of leptospirosis due to community chemoprophylaxis (432 confirmed cases in 2005 v. 128 [59 confirmed] in 2017). Conclusions: Selective, time-bound chemoprophylaxis following floods is likely to reduce the incidence of leptospirosis, as well as associated morbidity and mortality.


Asunto(s)
Antibacterianos/uso terapéutico , Quimioprevención , Brotes de Enfermedades , Inundaciones , Leptospirosis , Adulto , Antibacterianos/administración & dosificación , Quimioprevención/métodos , Quimioprevención/estadística & datos numéricos , Niño , Servicios de Salud Comunitaria , Brotes de Enfermedades/prevención & control , Brotes de Enfermedades/estadística & datos numéricos , Femenino , Humanos , Incidencia , India/epidemiología , Leptospirosis/tratamiento farmacológico , Leptospirosis/epidemiología , Leptospirosis/prevención & control , Embarazo
13.
Virol J ; 15(1): 143, 2018 09 17.
Artículo en Inglés | MEDLINE | ID: mdl-30223845

RESUMEN

BACKGROUND: Antiretrovirals have been available in Ghana since 2003 for HIV-1 positive pregnant women for prevention of mother-to-child transmission (PMTCT). Suboptimal responses to treatment observed post-PMTCT interventions necessitated the need to investigate the profile of viral mutations generated. This study investigated HIV-1 drug resistance profiles in mothers in selected centres in Ghana on treatment with a history of prophylaxis. METHODS: Genotypic Drug Resistance Testing for HIV-1 was carried out. Subtyping was done by phylogenetic analysis and Stanford HIV Database programme was used for drug resistance analysis and interpretation. To compare the significance between the different groups and the emergence of drug resistance mutations, p values were used. RESULTS: Participants who had prophylaxis before treatment, those who had treatment without prophylaxis and those yet to initiate PMTCT showed 32% (8), 5% (3) and 15% (4) HIV-1 drug resistance associated mutations respectively. The differences were significant with p value < 0.05. Resistance Associated Mutations (RAMs) were seen in 14 participants (35%) to nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs). The most common NRTI mutation found was M184 V; K103 N and A98G were the most common NNRTI mutations seen. Thymidine Analogue Mutations (TAMs) such as M41 L, K70R and T215Y were found in all the groups; the most common of the TAMs found were M41 L and T215Y. Majority of the subtypes were CRF02_AG (82%). CONCLUSION: In Ghana initiation of uninterrupted treatment upon diagnosis, coupled with drug resistance testing, would produce a better treatment outcome for HIV-1 positive pregnant women.


Asunto(s)
Fármacos Anti-VIH/farmacología , Quimioprevención/estadística & datos numéricos , Farmacorresistencia Viral , Infecciones por VIH/virología , VIH-1/efectos de los fármacos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Mutación Missense , Fármacos Anti-VIH/administración & dosificación , Femenino , Genotipo , Ghana , Infecciones por VIH/prevención & control , VIH-1/clasificación , VIH-1/genética , VIH-1/aislamiento & purificación , Humanos , Madres , Filogenia , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Análisis de Secuencia de ADN , Resultado del Tratamiento
14.
J Acquir Immune Defic Syndr ; 79(3): 339-346, 2018 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-30063650

RESUMEN

BACKGROUND: The HIV epidemic among black men who have sex with men (BMSM) demands urgent public health attention. Pre-exposure prophylaxis (PrEP) is a highly efficacious option for preventing HIV, but characteristics of PrEP use among community samples of BMSM are not well-understood. METHODS: A serial cross-sectional survey assessment (N = 4184 BMSM reporting HIV-negative/unsure status) and HIV testing were conducted at Black Gay Pride events in 6 US cities in 2014, 2015, 2016, and 2017. RESULTS: HIV prevalence was higher among BMSM self-reporting current PrEP use (1 of 3 participants) than BMSM not self-reporting current PrEP use (1 of 5 participants) [32.3%, N = 103/319 vs. 20.0%, N = 639/3,193, adjusted odds ratio (aOR) = 1.68, 95% confidence interval (CI): 1.31 to 2.15]. BMSM reporting current PrEP use (N = 380) were more likely to report having a greater number of male sex partners (aOR = 1.02, 95% CI: 1.01 to 1.03), a sexually transmitted infection diagnosis (aOR = 2.44, 95% CI: 1.88 to 3.16), and stimulant drug use (aOR = 2.05, 95% CI, 1.21 to 3.47) when compared with BMSM not reporting current PrEP use (N = 3804). PrEP use increased from 4.7% (2014) to 15.5% (2017) (aOR = 1.19, 95% CI: 1.13 to 1.25). Among PrEP users, inability to afford health care coverage was associated with testing HIV-positive (aOR = 2.10, 95% CI: 1.24 to 3.56). CONCLUSIONS: The high prevalence of HIV infection among BMSM reporting PrEP use is concerning. It does not, however, challenge the efficacy of PrEP itself but rather the uptake of the surrounding preventative package including behavioral risk reduction support, sexually transmitted infection treatment, and medication adherence counseling. Further research to understand barriers to fully effective PrEP is needed to guide operational and behavioral interventions that close the gap on incident infection.


Asunto(s)
Grupo de Ascendencia Continental Africana , Utilización de Medicamentos/estadística & datos numéricos , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Homosexualidad Masculina , Profilaxis Pre-Exposición/estadística & datos numéricos , Adolescente , Adulto , Quimioprevención/estadística & datos numéricos , Ciudades/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Prevalencia , Estados Unidos/epidemiología , Adulto Joven
15.
J Acquir Immune Defic Syndr ; 79(3): 330-338, 2018 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-30063651

RESUMEN

BACKGROUND: Low adherence can undermine the efficacy of daily oral pre-exposure prophylaxis (PrEP). Mental health conditions, particularly depression, could be associated with low PrEP adherence, especially for women. SETTING: We analyzed data from 1013 Kenyan and Ugandan HIV-uninfected participants in the Partners Demonstration Project, an open-label study of PrEP delivered to HIV-uninfected members of serodiscordant couples. METHODS: Participants completed quarterly visits over 2 years and were encouraged to use PrEP until their partners living with HIV had ≥6 months of antiretroviral therapy use (when viral suppression was expected). PrEP adherence was measured daily with electronic medication event monitoring system caps and dichotomized into low (<80% of expected bottle openings) and high adherence. Depression was assessed annually using the 16-item Hopkins Symptom Checklist screening tool; scores >1.75 indicate "probable depression." The association between probable depression and PrEP adherence was assessed separately for men and women using generalized estimating equations and marginal structural models. RESULTS: At enrollment, 39 (11.7% of 334) women and 64 (9.4% of 679) men reported symptoms indicating probable depression, and these proportions decreased during follow-up (P < 0.001 for women and men). Probable depression was significantly associated with low PrEP adherence among women (adjusted risk ratio = 1.77; 95% confidence interval: 1.14 to 2.77; P = 0.01); there was no association between depression and adherence among men (P = 0.50). Marginal structural models and sensitivity analyses confirmed these findings. CONCLUSIONS: Depression was relatively uncommon in this population and was an independent risk factor for low PrEP adherence among women. For PrEP programs targeting African women, integration of depression screening may improve PrEP effectiveness.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Quimioprevención/estadística & datos numéricos , Depresión/complicaciones , Utilización de Medicamentos/estadística & datos numéricos , Infecciones por VIH/prevención & control , Cumplimiento de la Medicación/estadística & datos numéricos , Profilaxis Pre-Exposición/estadística & datos numéricos , Adolescente , Adulto , África Oriental , Femenino , Humanos , Masculino , Estudios Prospectivos , Adulto Joven
16.
AIDS ; 32(17): 2633-2635, 2018 11 13.
Artículo en Inglés | MEDLINE | ID: mdl-30096073

RESUMEN

: When combining results from all published surveys, about one in nine global study participants (10.7%) reported ever using preexposure prophylaxis (PrEP) by 2017, a significant increase since US FDA approval in 2012 [odds ratio (OR) = 1.6/year, P < 0.00001]. Moreover, nearly one in six US-based study participants (17.3%) and nearly one in four MSM who met the Centers for Disease Control and Prevention's PrEP indications (24.5%) reported ever using PrEP by 2016. The odds of reporting PrEP use are approximately doubling each year (OR = 1.8/year, P < 0.00001; OR = 2.0/year, P < 0.00001).


Asunto(s)
Quimioprevención/métodos , Quimioprevención/estadística & datos numéricos , Utilización de Medicamentos , Infecciones por VIH/prevención & control , Profilaxis Pre-Exposición/métodos , Profilaxis Pre-Exposición/estadística & datos numéricos , Adulto , Quimioprevención/tendencias , Femenino , Homosexualidad Masculina , Humanos , Masculino , Profilaxis Pre-Exposición/tendencias , Autoinforme , Estados Unidos , Adulto Joven
17.
Malar J ; 17(1): 295, 2018 Aug 15.
Artículo en Inglés | MEDLINE | ID: mdl-30111314

RESUMEN

BACKGROUND: Vivax malaria reemerged along the Demilitarized Zone (DMZ), Republic of Korea (ROK), in 1993. While it was hypothesized that vivax malaria would spread throughout the peninsula, nearly all cases were due to exposure near the DMZ. To reduce spillover of vivax malaria to the civilian community, the ROK Ministry of National Defense (MND) initiated malaria prevention policies including a large-scale chemoprophylaxis programme in malaria high-risk areas in 1997. The present study investigated the overall changes in the incidence of malaria among ROK soldiers and the mass chemoprophylaxis program from 1997 to 2016. RESULTS: Peak numbers of vivax malaria were reported in 2000, with most cases reported near the DMZ, before declining to the current levels. To combat the rapid increase in the number of malaria cases and its expansion throughout the ROK, the MND implemented mosquito control and personal protection programmes. The MND also implemented a large-scale vivax malaria chemoprophylaxis programme using hydroxychloroquine (400 mg weekly) in 1997, and primaquine (15 mg × 14 days) as terminal chemoprophylaxis in 2001. Additionally, an improved medical system enabled the rapid detection and treatment of malaria to reduce morbidity and decrease transmission of malaria from humans to mosquitoes. Following the full implementation of these programmes, the incidence of vivax malaria declined in both ROK Armed Forces and civilian populations. Subsequently, several changes in the ROK Armed Forces chemoprophylaxis programme were implemented, including the reduction of the period of hydroxychloroquine prophylaxis by 2 months (2008) and other changes in the chemoprophylaxis policy, e.g., only ROK Armed Forces personnel in moderate risk groups received terminal primaquine chemoprophylaxis (2011), and in 2016, the discontinuation of terminal primaquine chemoprophylaxis in moderate-risk area. CONCLUSIONS: The resurgence of vivax malaria in the ROK Armed Forces personnel near the DMZ was successfully suppressed through the implementation of a mass malaria chemoprophylaxis programme initiated by the MND in 1997, as well as several other factors that may have contributed to the reduction of malaria transmission since 2000. Given the current malaria situation in the ROK and North Korea, it is necessary to reevaluate the ROK Armed Forces and civilian malaria control policies.


Asunto(s)
Antimaláricos/uso terapéutico , Quimioprevención/estadística & datos numéricos , Control de Enfermedades Transmisibles/estadística & datos numéricos , Malaria Vivax/epidemiología , Personal Militar/estadística & datos numéricos , Política de Salud/legislación & jurisprudencia , Incidencia , Malaria Vivax/parasitología , Malaria Vivax/prevención & control , Plasmodium vivax/efectos de los fármacos , República de Corea/epidemiología , Factores de Riesgo
18.
J Eval Clin Pract ; 24(4): 758-766, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29987867

RESUMEN

RATIONALE, AIMS, AND OBJECTIVE: Contact tracing and screening is an essential strategy in tuberculosis (TB) control. Our aim is to assess factors associated with the degree of compliance with the main recommendations made to contacts of TB cases as part of the contact tracing programme, and to identify factors associated with non-compliance. METHODS: We conducted a retrospective cohort study to assess the TB contact tracing programme at a Spanish hospital over the period 1998-2013. RESULTS: A total 2269 contacts were identified corresponding to 644 active TB index cases, and initial screening indicated that 3.2% had active TB and 41.3% had latent TB infection (LTBI). Compliance with the recommendation for primary chemoprophylaxis increased significantly over the study period, rising from 76.5% in the period 1998 to 2002 to 82.7% in the period 2010 to 2013. A similar significant increase was also observed for latent tuberculosis infection treatment (46.1% in the first period to 68.0% in the latter period). Factors that were significantly associated with non-compliance with the recommendations were: being of foreign origin, alcoholism, being recommended latent tuberculosis infection treatment, repeating the tuberculin skin test at 3 months, a smear-positive index case, and an index case aged under 35 years old. CONCLUSIONS: Although compliance levels have improved over the years, it remains necessary to adopt strategies that target contacts in groups identified as being at risk of non-compliance.


Asunto(s)
Quimioprevención/estadística & datos numéricos , Trazado de Contacto , Cooperación del Paciente/estadística & datos numéricos , Tuberculosis , Adulto , Trazado de Contacto/métodos , Trazado de Contacto/estadística & datos numéricos , Femenino , Humanos , Masculino , Tamizaje Masivo/métodos , Tamizaje Masivo/normas , Tamizaje Masivo/estadística & datos numéricos , Persona de Mediana Edad , Estudios Retrospectivos , España/epidemiología , Tuberculosis/diagnóstico , Tuberculosis/epidemiología , Tuberculosis/prevención & control
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