Prisma

Malaria remains a major global health challenge. Prompt, accurate diagnosis is crucial for effective case management. Current diagnostic approaches rely on invasive or minimally invasive sampling via venous or fingerpick blood draw, posing a risk to healthcare workers via the handling of potentially infectious body fluids. They may also be a barrier to recipients, particularly in malaria-endemic areas where there is routine testing of non-symptomatic individuals. Non-invasive tests based on saliva, exhaled volatile organic compounds (VOCs), and transdermal detection have the potential to increase case detection and linkage to care while reducing biosafety risks. Knowledge gaps exist regarding the feasibility and acceptability of these tools. This qualitative study, conducted in Indonesia, Peru, and Rwanda, aimed to generate evidence from end-users around the potential adoption of non-invasive diagnostic technologies, to determine whether these technologies are fit for purpose. Between October and November 2023, 24 semi-structured interviews were conducted with stakeholders and professionals working at borders, and 16 focus group discussions were conducted with caregivers of children under 5 years, pregnant women, healthcare workers, teachers and other community members (139 participants in total). The comfort non-invasive approaches offer to recipients of care was widely noted, especially compared with blood draw, which is considered painful for children. Ease of use and rapid diagnostic capabilities enabling real-time disease diagnosis were perceived as particularly beneficial in remote areas with limited healthcare infrastructure. Device portability was seen as a game-changer. Major concerns were the lack of information regarding the accuracy of non-invasive tools compared with established methods, the lack of trust in tests targeting specimens other than blood products, and their inability to differentiate between malaria species. Early engagement with stakeholders in the development of novel interventions is essential to ensure that end products meet the needs of communities.

Background Morbidity and mortality in COVID-19 patients have been associated with hypercoagulability resulting in pulmonary emboli and associated venous thromboembolism. Methods All COVID-19 patients with deep vein thromboses at a single institution were retrospectively evaluated. Typical demographic and clinicopathologic data to include outcomes were collected. Results Overall, 145 patients were assessed. Hypertension (66%), diabetes (43%), and previous thrombotic events (43%) were more prevalent in the study cohort; none were significantly associated with outcomes. Atrial fibrillation/arrhythmias (n = 22; 15%; P = 0.0110) and chronic kidney disease (n = 23; 16%; P = 0.0015) were associated with increased hospitalization and mortality in this cohort, as well as patients who had a recent hospitalization within 3 months (n = 30; P = 0.0164). Conclusions These data suggest that screening for venous thromboembolism in select COVID-19 patients should be completed to promote early diagnosis and treatment of deep vein thromboses with the goal to prevent pulmonary emboli and, overall, maximize patient outcomes.

BackgroundExposure to household air pollution from burning coal and biomass for cooking is associated with higher blood pressure and other adverse indicators of cardiovascular disease, the leading cause of death worldwide. Evidence demonstrating that switching from biomass to liquefied petroleum gas (LPG) will reduce blood pressure is limited.MethodsAs part of a larger trial of 3200 households, we conducted a randomized trial of 342 women aged 40 to 79 years who lived in households using biomass for cooking in rural areas of Guatemala, India, Peru, and Rwanda to assess the effects of a free LPG stove and fuel intervention. Systolic blood pressure (one of four primary outcomes) was measured once prior to randomization and up to five times after randomization over 18 months.ResultsA total of 418 participants were randomized (n=209 to intervention, and n=209 to control). Mean (standard deviation) systolic blood pressure at baseline was 112.7 (14.9) mmHg and 112.6 (14.7) mmHg in intervention and control participants, respectively. Adherence within the intervention arm was high. Among the 342 participants with a valid baseline and at least one valid post-randomization blood pressure measurement, mean (SD) post-randomization average systolic blood pressure was 111.5 (13.2) mmHg in the intervention arm and 111.9 (12.5) mmHg in the control arm, with an adjusted mean of difference of −0.56 mmHg (95% confidence interval, −2.19 to 1.07, p-value = 0.50).ConclusionsWe did not observe evidence that an 18-month LPG stove and fuel intervention reduced blood pressure in women.

Traumatic and stressful life events can have lasting effects on mental health, particularly among older adults in low-resource settings. In Latin America, there is limited qualitative evidence capturing the lived experiences of these events. This study explores how older adults in Peru reflect on traumatic and stressful events throughout their lives, and how these experiences continue to shape their mental health in later life. This qualitative study was nested within the Global Excellence in COPD Outcomes (GECo) study in Lima, Peru. We conducted semi-structured, narrative-based interviews with 38 older adults (≥60 years) with moderate to severe symptoms of depression (Patient Health Questionnaire-9 ≥ 10), anxiety (Beck Anxiety Inventory ≥ 16) or a history of mental health treatment. Four main categories emerged: (1) violence (emotional, physical or sexual), (2) abandonment or loss of close relatives, (3) onset of severe illness or disability and (4) other miscellaneous life disruptions. Participants described their memories of past stressful events as deeply embedded in current thoughts and, in some cases, as shaping how they experience certain emotions in the present. Addressing trauma in older adults may improve well-being in low-resource settings. Recognizing the enduring impact of life-course stressors is crucial for culturally sensitive mental health interventions.

BackgroundCaused by the parasite Trypanosoma cruzi, Chagas disease affects an estimated 7 million people globally. Diagnosis of Chagas disease in infants is urgently needed, as early detection allows for more effective treatment and reduced mortality. However, current diagnostics are inappropriate for effective detection in infants due to differences in the mechanism of disease in infants and the infant immune system, as well as lack of diagnostic sensitivity and loss to follow up. Studying peripheral biomarkers in urine can leverage physiological concentration in the bladder to increase yield of proteins secreted by pathogen, infected cells, or antigen processed by immune cells residing in different body sites.Principal findingsWe analyzed the urine of a cohort of infants who were congenitally infected with Chagas disease, using a method including affinity enrichment, mass spectrometry, and bioinformatics analysis to characterize the T. cruzi secreted peptidome. We identified 198 peptides specific for T. cruzi and analyzed them in light of their potential for diagnostic utility. Our protocol revealed that peptides of the hyper-mutating mucin-associated surface protein and trans-sialidase protein families could be identified in patient urine and can serve as diagnostic markers of disease. We developed antibodies against conserved regions of each protein and validated that these antibodies could be used to differentiate the urine of Chagas disease patients (N = 16 cases) from healthy controls (N = 19). By utilizing affinity enrichment sample preprocessing and anti-trans-sialidase and anti-MASP antibodies in tandem, we differentiated cases from controls with 87.5% sensitivity and 94.7% specificity.Conclusions/SignificanceOur work suggests that it is possible to detect Trypanosoma cruzi infection directly from a noninvasively collected fluid such as urine. A direct test in urine with this success rate would be well suited for rapid diagnosis in low-resource areas. Further studies to validate this approach are warranted.

Shigellosis is a leading cause of diarrhoea in children globally. We aimed to assess the burden of specific Shigella species and Shigella flexneri serotypes, characterise their clinical syndromes and natural immunity, and evaluate their relevance as causes of diarrhoea and linear growth faltering. In the MAL-ED birth cohort study, children younger than 17 days were enrolled from Nov 3, 2009, to Feb 29, 2012, in Bangladesh, Brazil, India, Nepal, Pakistan, Peru, Tanzania, and South Africa and were followed up for 2 years. In this retrospective substudy, we retested Shigella quantitative PCR-positive diarrhoeal and non-diarrhoeal stool samples with molecular subtyping assays. We estimated the prevalence of specific Shigella species and serotypes, estimated their associations with diarrhoea and clinical characteristics using generalised linear mixed models, estimated their associations with linear growth using linear regression, and used longitudinal infection data to estimate protection due to previous infection using the Andersen and Gill extension of the Cox model. 1715 children (874 [51·0%] male and 841 [49·0%] female) with complete follow-up to 2 years provided 45 835 stool samples collected between age 0 and 2 years. 1294 (75·5%) children had at least one Shigella detection in a non-diarrhoeal or asymptomatic stool and 507 (29·6%) had at least one Shigella-attributed diarrhoea episode. In this substudy, we were able to type 1202 samples. The most common species and serotypes were Shigella sonnei (366 [30·4%] of 1202), S flexneri 2a (250 [20·8%]), and S flexneri 6 (296 [24·6%]). The associations of S flexneri and S sonnei detection with diarrhoea versus asymptomatic control stools were similar. Compared with diarrhoea episodes attributable to S flexneri, those attributable to S sonnei were less likely to be bloody (prevalence ratio 0·36 [95% CI 0·23 to 0·56]) or severe (prevalence ratio 0·58 [0·35 to 0·96]). The associations between asymptomatic Shigella infections and impaired linear growth at age 2 years were stronger for S flexneri than S sonnei (S flexneri length-for-age Z score difference -0·18 [95% CI -0·29 to -0·07] and S sonnei length-for-age Z score difference -0·07 [-0·21 to 0·07]). Examination of longitudinal infections showed that previous S sonnei infection was associated with a lower hazard of subsequent S sonnei diarrhoea (calibrated hazard ratio 0·41 [95% CI 0·19 to 0·90]). Otherwise, evidence for homotypic or heterotypic natural immunity was not apparent. This study provides data on prevailing Shigella species and serotypes in settings with a high burden of disease, underscoring the importance of asymptomatic S flexneri infection on growth impairment and the severity of S flexneri diarrhoea. Upcoming Shigella vaccines might need to induce immune responses that improve upon those produced by natural infection. Bill & Melinda Gates Foundation.

To discuss a unique case of acute HIV seroconversion presenting as Stiff Person Syndrome Disorder (SPSD) and emphasizing the need of a clearer diagnostic criteria and treatment modalities of such autoimmune diseases (ADs) in HIV patients for a better prognosis.

To emphasize the rare and complex neuropsychiatric manifestations of idiopathic hypoparathyroidism (IHP), specifically focusing on persistent seizure disorder and auditory hallucinations, and to discuss the challenges in management requiring a multidisciplinary approach.

Antimicrobial resistance (AMR) is a growing threat to global public health. In hospitals, infant mortality due to bacterial sepsis is associated with AMR. The epidemiology of AMR in Bolivia (a lower-middle-income country) has not been sufficiently discussed. The aim of this study was to analyze AMR patterns over 8 years at a pediatric hospital in patients with hospital-acquired bloodstream infections. This is a retrospective and analytical revision of AMR in bacteria isolated from blood cultures, performed between 2012 and 2019, in a pediatric hospital in Bolivia. Data analysis was conducted with Stata v14.0, and Fisher's exact tests were used to determine statistical significance. Four hundred and fifty-five (7.2%) positive blood cultures were identified from 6315 blood culture reports between 2012 and 2019. Klebsiella pneumoniae was the most frequently isolated bacteria and showed a significant change in its AMR profile over the 8 years of the study. Gram-negative bacteria and Staphylococcus aureus were also frequently isolated, and all demonstrated high levels of resistance to commonly used antibiotics. Overall, most of the clinically important microorganisms had high rates of AMR. In the present study, we report that isolated bacteria showed significant resistance to multiple drugs, and most demonstrated increased resistance over time. Worryingly, K. pneumoniae showed an increasing resistance to commonly used antibiotics. Overall, despite the limitations, our study, which is one of the first of its kind in Bolivia, demonstrates the need for stricter policies of antibiotic stewardship in similar settings due to the global threat of AMR.