| 1. |
- Malmberg, Stefan, 1979, et al.
(författare)
-
Acute sore throat and Fusobacterium necrophorum in primary healthcare: a systematic review and meta-analysis.
- 2021
-
Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 11:6
-
Forskningsöversikt (refereegranskat)abstract
- The main objective of this review was to describe and quantify the association between Fusobacterium necrophorum (FN) and acute sore throat in primary healthcare (PHC).In this systematic review and meta-analysis, we searched Scopus and PubMed for case-control studies reporting the prevalence of FN in patients attending primary care for an uncomplicated acute sore throat as well as in healthy controls. Only studies published in English were considered. Publications were not included if they were case studies, or if they included patients prescribed antibiotics before the throat swab, patients with a concurrent malignant disease, on immunosuppression, having an HIV infection, or patients having another acute infection in addition to a sore throat. Inclusion criteria and methods were specified in advance and published in PROSPERO. The primary outcome was positive etiologic predictive value (P-EPV), quantifying the probability for an association between acute sore throat and findings of FN in the pharynx. For comparison, our secondary outcome was the corresponding P-EPV for group A Streptococcus (GAS).PubMed and Scopus yielded 258 and 232 studies, respectively. Removing duplicates and screening the abstracts resulted in 53 studies subsequently read in full text. For the four studies of medium to high quality included in the meta-analysis, the cumulative P-EPV regarding FN was 64% (95% CI 33% to 83%). GAS, based on data from the same publications and patients, yielded a positive EPV of 93% (95% CI 83% to 99%).The results indicate that FN may play a role in PHC patients with an acute sore throat, but the association is much weaker compared with GAS.
|
|
| 2. |
- Gustafson, Deborah R., et al.
(författare)
-
Obesity, vascular disease and frailty in aging women with HIV
- 2021
-
Ingår i: Advances in Geriatric Medicine and Research. - : Hapres. - 2632-9921. ; 3:3
-
Forskningsöversikt (refereegranskat)abstract
- Women with chronic HIV infection (WWH) living in the United States, experience a disproportionately high rate of obesity compared to uninfected populations. Both overweight and obesity, particularly central obesity, are major contributors to insulin resistance, hypertension, and dyslipidemia—the major components of metabolic syndromes, including type 2 diabetes, and leading to increased cardiovascular risk, including coronary heart disease, and cerebrovascular diseases. Notably, declining physical performance and frailty co-occur with vascular morbidities as well as changes in bone. These factors tend to exacerbate each other and accelerate the aging trajectory, leading to poorer quality of life, cognitive impairments, dementia, and eventually, death. In WWH, persistent HIV infection, sustained treatment for HIV infection, and concomitant obesity, may accelerate aging-related morbidities and poorer aging outcomes. Furthermore, health disparities factors common among some WWH, are independently associated with obesity and higher vascular risk. The purpose of this review is to describe the constellation of obesity, cardio- and cerebrovascular diseases, bone health and frailty among aging WWH, a 21st century emergence.
|
|
| 3. |
- Mayne, Sean., et al.
(författare)
-
The scientific evidence for a potential link between confusion and urinary tract infection in the elderly is still confusing - A systematic literature review
- 2019
-
Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 19, s. 1-15
-
Forskningsöversikt (refereegranskat)abstract
- Context: Non-specific symptoms in elderly patients such as confusion is often suspected to be caused by a urinary tract infection (UTI) and it continues to be the most common reason for suspecting a UTI despite many other plausible causes. This leads to significant over diagnosis of UTI, increased inappropriate antibiotic use and potentially harmful outcomes through misdiagnosis. This problem is particularly prevalent in nursing homes settings. Objective: Clarify the correlation between lower UTI or bacteriuria and concurrent confusion. Setting: Any care setting for elderly (hospital, community and long term care facility). Design: A systematic literature review Main And Secondary Outcome Measures: A review of the literature was conducted assessing the association between confusion and UTI in the elderly. PubMed, Scopus and PsychInfo were searched with the following terms: confusion, delirium, altered mental status, acute confusional state, urinary tract infection, urine infection, urinary infection and bacteriuria. Inclusion criteria and methods were specified in advance and documented in the protocol, which was published with PROSPERO (registration ID CRD42015025804). Quality assessment was conducted independently by two authors. Data was extracted using a standardised extraction tool and a qualitative synthesis of evidence was made. Results: 1702 original records were identified of which 22 were included in the final analysis. Following this review, it appears that insufficient evidence is available to accurately determine if UTI and confusion are associated. Conclusion: The potential link between UTI and non-specific symptoms in elderly patients remain confusing. More epidemiological studies are unlikely to resolve this problem. The next logical step to clarify this issue should be a randomized controlled trial comparing the effect of antibiotics versus placebo using validated criteria for both UTI and confusion.
|
|
| 4. |
- Robinson, Yohan, 1977, et al.
(författare)
-
Postoperative multisegmental lumbar discitis treated by staged ventrodorsoventral intervention.
- 2007
-
Ingår i: Surgical infections. - : Mary Ann Liebert Inc. - 1096-2964 .- 1557-8674. ; 8:5, s. 529-34
-
Forskningsöversikt (refereegranskat)abstract
- Postoperative spinal infections are relatively rare. They can become life-threatening.A 56-year-old man developed multisegmental spinal infection with methicillin-resistant Staphylococcus aureus after discectomy at L3/4. A staged ventrodorsoventral intervention was needed for radical debridement and stabilization. After femoral head necrosis developed as a result of the infection, a Girdlestone hip was maintained until the joint was aseptic and a hip prosthesis could be implanted. Two years postoperatively, the patient remained free of infection recurrence.Radical debridement and a tightly controlled antibiotic regimen are necessary for the management of postoperative spinal infections. This should include staged interventions until recovery from infection is possible. Early intervention can prevent systemic sepsis caused by widespread bacterial dissemination.
|
|
| 5. |
- Axfors, Cathrine, et al.
(författare)
-
Association between convalescent plasma treatment and mortality in COVID-19 : a collaborative systematic review and meta-analysis of randomized clinical trials
- 2021
-
Ingår i: BMC Infectious Diseases. - : BioMed Central (BMC). - 1471-2334. ; 21:1
-
Forskningsöversikt (refereegranskat)abstract
- Background: Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, ). Methods: In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung-Knapp-Sidik-Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence. Results: A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92; 1.02) with between-study heterogeneity not beyond chance (I-2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis. Conclusions: Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care.
|
|
| 6. |
- Benn, C. S., et al.
(författare)
-
BCG scarring and improved child survival : a combined analysis of studies of BCG scarring
- 2020
-
Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 288:6, s. 614-624
-
Forskningsöversikt (refereegranskat)abstract
- Bacillus Calmette–Guérin (BCG) vaccine against tuberculosis (TB) is recommended given at birth in TB-endemic areas. Currently, BCG vaccination programmes use “BCG vaccination coverage by 12 months of age” as the performance indicator. Previous studies suggest that BCG-vaccinated children, who develop a scar, have better overall survival compared with BCG-vaccinated children, who do not develop a scar. We summarized the available studies of BCG scarring and child survival. A structured literature search for studies with original data and analysis of BCG scarring and mortality. Combined analyses on effect of BCG scarring on overall mortality. We identified six studies covering seven cohorts, all from Guinea-Bissau, West Africa, with evaluation of BCG scarring amongst BCG-vaccinated children and follow-up for mortality. Determinants for BCG scarring were BCG strain, intradermal injection route, size of injection wheal, and co-administered vaccines and micronutrients. In a combined analysis, having a BCG scar vs. no BCG scar was associated with a mortality rate ratio (MRR) of 0.61 (95% CI: 0.51–0.74). The proportion with a BCG scar varied from 52 to 93%; the estimated effect of a BCG scar was not associated with the scar prevalence. The effect was strongest in the first (MRR = 0.48 (0.37–0.62)) and second (MRR = 0.63 (0.44–0.92)) year of life, and in children BCG-vaccinated in the neonatal period (MRR = 0.45 (0.36–0.55). The effect was not explained by protection against TB. Confounding and genetic factors are unlikely to explain the strong association between BCG scarring and subsequent survival. Including “BCG scar prevalence” as a BCG vaccination programme performance indicator should be considered. The effect of revaccinating scar-negative children should be studied.
|
|
| 7. |
- Bisaccia, Giandomenico, et al.
(författare)
-
Post-Acute Sequelae of COVID-19 and Cardiovascular Autonomic Dysfunction : What Do We Know?
- 2021
-
Ingår i: Journal of cardiovascular development and disease. - : MDPI AG. - 2308-3425. ; 8:11, s. 1-15
-
Forskningsöversikt (refereegranskat)abstract
- Post-acute sequelae of SARS-CoV-2 (PASC), or long COVID syndrome, is emerging as a major health issue in patients with previous SARS-CoV-2 infection. Symptoms commonly experienced by patients include fatigue, palpitations, chest pain, dyspnea, reduced exercise tolerance, and "brain fog". Additionally, symptoms of orthostatic intolerance and syncope suggest the involvement of the autonomic nervous system. Signs of cardiovascular autonomic dysfunction appear to be common in PASC and are similar to those observed in postural orthostatic tachycardia syndrome and inappropriate sinus tachycardia. In this review, we report on the epidemiology of PASC, discuss current evidence and possible mechanisms underpinning the dysregulation of the autonomic nervous system, and suggest nonpharmacological and pharmacological interventions to treat and relieve symptoms of PASC-associated dysautonomia.
|
|
| 8. |
- Gunnarsson, Ronny K, 1955, et al.
(författare)
-
Group C beta hemolytic Streptococci as a potential pathogen in patients presenting with an uncomplicated acute sore throat–a systematic literature review and meta-analysis
- 2020
-
Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 38:2, s. 226-37
-
Forskningsöversikt (refereegranskat)abstract
- Objective: The pathogenicity of beta-hemolytic Streptococcus group C (GCS) in patients attending for an uncomplicated acute sore throat is unknown and it was the objective to clarify this. Design: Systematic literature review with meta-analysis. Setting Medline and Scopus were searched from inception to February 2019, with searches of reference lists, Subjects case-control studies stating prevalence of GCS in patients as well as healthy controls presented for children and adults separately. Studies including patients already treated with antibiotics and studies focused on patients with HIV, malignancy or immunosuppression were not included. Main outcome measures Pooled prevalence of GCS was compared between patients and controls using chi-square and was further explored by calculating the positive etiologic predictive value (P-EPV) showing the post-test probability of a link between a sore throat and the bacterial finding. P-EPV for GCS was compared with that for group A Streptococci (GAS) using figures from the same publications and patients. Results: Eleven studies were included. The prevalence of GCS among patients versus controls was similar in children (3.15 versus 2.87%, p =.44) but for adults higher in patients (11%) than in controls (5.6%) (p <.0001). The P-EPV for finding GCS in children with a sore throat was 9.3% (0.0–41%). The corresponding P-EPV for GCS in adults with a sore throat was 53% (36–67%) while the corresponding P-EPV for GAS in adults was 94% (90–96%). Conclusions: GCS do not seem associated with the uncomplicated acute sore throat in children but there is support for an association in adults being weaker than for GAS. A possible consequence is to ignore GCS in otherwise healthy patients at their first visit for an uncomplicated sore throat. This would enable a stronger focus on the use of modern point of care tests (POCTs) to detect GAS.Key points There is no current consensus on the pathogenicity of group C beta-hemolytic Streptococcus (GCS) in patients attending for an uncomplicated acute sore throat. This systematic literature review concludes it is unlikely that GCS is involved in the uncomplicated sore throat in otherwise healthy children. This meta-analysis found a moderate link between GCS and the uncomplicated sore throat in adults. The link in adults between GCS and the sore throat is much weaker than the corresponding link for group A beta-hemolytic Streptococcus.
|
|
| 9. |
- Hansson, Markus, et al.
(författare)
-
Hematopoietic secretory granules as vehicles for the local delivery of cytokines and soluble cytokine receptors at sites of inflammation.
- 2004
-
Ingår i: European Cytokine Network. - 1952-4005. ; 15:3, s. 167-176
-
Forskningsöversikt (refereegranskat)abstract
- Cytokines play an important role in the regulation of homeostasis and inflammation. A de-regulated cytokine function can subsequently promote chronic inflammation. This is supported by clinical evidence showing the beneficial effect of inhibiting TNF-alpha through injection of antibodies and soluble receptor in disorders such as rheumatoid arthritis and Crohn's disease. Systemic anti-TNF-alpha therapy however is associated with infectious complications. We therefore suggest a concept for the local deposition of therapeutically active agents into areas of inflammation or malignancy, based on the use of hematopoietic storage and secretory granules as delivery vehicles. Hematopoietic cells are induced to express the therapeutically active protein and to store it in the secretory lysosomes. The cells migrate into a tumour or site of inflammation, where the cells become activated and release the contents of their secretory lysosomes resulting in the local delivery of the therapeutically active protein. In support of this concept, gene transfer and granule loading can be achieved using the soluble TNF-alpha receptor (sTNFR1) after cDNA expression in hematopoietic cell lines. Endoplasmic reticulum (ER)-export can be facilitated by the addition of a transmembrane domain, and constitutive secretion can be prevented by incorporating a cytosol-sorting signal resulting in secretory lysosome targeting. The sTNFR1 is released from the transmembrane domain by proteolytic cleavage and finally, regulated sTNFR1-secretion can be triggered by a calcium signal. In vivo investigations are currently determining the feasibility of local protein delivery at sites of inflammation.
|
|
| 10. |
- Heinz, Judith, et al.
(författare)
-
Strategies to reduce antibiotic use in women with uncomplicated urinary tract infection in primary care : protocol of a systematic review and meta-analysis including individual patient data
- 2020
-
Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 10:10
-
Forskningsöversikt (refereegranskat)abstract
- Introduction: Uncomplicated urinary tract infection (UTI) in women is a common reason to present in general practice and is usually treated with antibiotics to reduce symptom severity and duration. Results of recent clinical trials indicate that non-antibiotic treatment approaches can also be effective. However, it remains unclear which patients would benefit from antibiotic treatment and which can effectively and safely be treated without antibiotics. This systematic review and meta-analysis aims to estimate the effect of treatment strategies to reduce antibiotic use in comparison with immediate antibiotic treatment and to identify prognostic factors and moderators of treatment effects. A further aim is to identify subgroups of patients benefiting from a specific therapy.Methods and analysis: A systematic literature search will be performed to identify randomised controlled trials which investigated the effect of treatment strategies to reduce antibiotic use in female adults with uncomplicated UTI compared with immediate antibiotic treatment. Therefore, the primary outcome of the meta-analysis is incomplete recovery. Anonymised individual patient data (IPD) will be collected. Aggregate data will be used for pairwise comparisons of treatment strategies using meta-analysis models with random effects accounting for potential between-study heterogeneity. Potential effect moderators will be explored in meta-regressions. For IPD, generalised linear mixed models will be used, which may be adjusted for baseline characteristics. Interactions of baseline variables with treatment effects will be explored. These models will be used to assess direct comparisons of treatment, but might be extended to networks.Ethics and dissemination: The local institutional review and ethics board judged the project a secondary analysis of existing anonymous data which meet the criteria for waiver of ethics review. Dissemination of the results will be via published scientific papers and presentations. Key messages will be promoted for example, via social media or press releases.
|
|
