Nevin Manimala

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S289-S297. doi: 10.3855/jidc.19920.

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is a life-threatening disease that was declared a pandemic in March 2020. Organ transplant recipients are vulnerable to infection and complications from COVID-19. The objective of this study was to investigate the rates of infection, mortality, and case-fatality ratios (CFR) in solid organ transplant recipients and patients on the waiting list for organ allocation in the period prior to the availability of specific vaccines.

METHODOLOGY: This was an observational study of official sources that are used to report information on COVID-19. Quantitative variables were described with arithmetic means and categorical variables with proportions. Percentages of positivity to infection, number of deaths, CFR, and all-cause mortality were calculated for each group and subgroup.

RESULTS: There were 2,551 eligible subjects; 602 (26.2%) were positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There were 265 (10.4%) deaths from all causes during the follow-up period; 119 (44.9%) of them were associated with COVID-19, which indicated a COVID-19-related mortality rate of 4.7 %. CFRs were 21.4% and 17.1% in transplant recipients and waitlisted patients, respectively. CFR was significantly higher in transplant recipients (23.8%) than in patients waitlisted for kidney (16.5%; p = 0.044) Among SARS-CoV-2-positive patients, the probability of dying from COVID-19 was higher in the first group (87.3% and 73%, respectively; p = 0.034).

CONCLUSIONS: COVID-19 had a significant impact on the deaths of transplant patients and patients on the solid organ waiting list during the first year of the pandemic in Colombia, before the availability of vaccines.

PMID:39863945 | DOI:10.3855/jidc.19920

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S282-S288. doi: 10.3855/jidc.20005.

ABSTRACT

INTRODUCTION: Despite efforts by health organizations to share evidence-based information, fake news hindered the promotion of social distancing and vaccination during the coronavirus disease 2019 (COVID-19) pandemic. This study analyzed COVID-19 knowledge and practices in a vulnerable area in northern Rio de Janeiro, acknowledging the influence of the complex social and economic landscape on public health perceptions.

METHODOLOGY: This cross-sectional study was conducted in Novo Eldorado – a low-income, conflict-affected neighborhood in Campos dos Goytacazes – using a structured questionnaire, following the peak of COVID-19 deaths in Brazil (July-December 2021). Statistical tests were used to delineate profiles and evaluate knowledge and preventive behaviors associated with COVID-19.

RESULTS: This study involved a cohort of 156 participants, predominantly women (74%), with an average age of 53 years. Almost half of the participants were identified as single (48%), and more than half had not completed elementary school. Notably, 68% believed they were well-informed about COVID-19. The answers to the questionnaire revealed that the majority correctly identified severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as a virus (65%); 72% recognized fever or cough as the main symptoms; and 71% recognized the importance of wearing masks. The overall mean score of the study was 7.628 (SD 1.583047). Social networks, especially ‘WhatsApp’ (65%), were the primary information sources. Those using social media or WhatsApp had higher knowledge scores (8.000 vs. 7.000, p = 0.0064).

CONCLUSIONS: Involving marginalized communities and using social media to disseminate accurate information and trust in science is necessary to tackle COVID-19 challenges.

PMID:39863944 | DOI:10.3855/jidc.20005

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S275-S281. doi: 10.3855/jidc.18659.

ABSTRACT

INTRODUCTION: Inflammation plays a role in coronavirus disease 2019 (COVID-19) pathophysiology and anti-inflammatory drugs may help reduce the disease severity. Levamisole is an anthelmintic drug with immunomodulatory and possible antiviral effects. This study aimed to evaluate the role of levamisole in the treatment of patients with COVID-19.

METHODOLOGY: In this randomized controlled clinical trial, hospitalized patients with confirmed severe COVID-19 (arterial oxygen saturation < 90%) were randomly assigned to either experimental (n = 41) or control (n = 45) groups. Levamisole 50 mg orally daily was prescribed for the first group until discharge or death, for a maximum of 7 days, along with other standard treatments. Only standard treatments were prescribed to the control group. Clinical response (either improvement or failure) at the end of the fifth and seventh days, changes in laboratory indices, length of hospitalization, and mortality rate during the study were evaluated and recorded.

RESULTS: The rate of clinical improvement in the experimental group was significantly more than in the control group on the fifth (97.6% vs. 58.7%, p < 0.001) and seventh (95.8% vs. 66.7%, p = 0.007) days. Furthermore, the mean length of hospital stays in the experimental group (8.39 ± 3.54 days) was significantly shorter than in the control group (10.78 ± 5.40 days, p = 0.024). No patients died during the study.

CONCLUSIONS: Administering levamisole to hospitalized patients with severe COVID-19 reduced hospitalization time and improved several clinical outcomes.

PMID:39863943 | DOI:10.3855/jidc.18659

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S267-S274. doi: 10.3855/jidc.20123.

ABSTRACT

INTRODUCTION: We aimed to present the changes that may occur in pulmonary functions in children who experienced more severe coronavirus disease 2019 (COVID-19) during long-term follow-up.

METHODOLOGY: A prospective longitudinal observational cohort study was conducted with 34 pediatric patients (7-18 years) who were hospitalized with COVID-19 infection (moderate n = 25, severe n = 9), and followed up at our Pediatric Infection Outpatient Clinic for approximately two years. Pulmonary function tests (PFTs) were performed using spirometry.

RESULTS: Data from the hospitalization period revealed no significant differences between the severity groups in terms of demographic, clinical, laboratory, radiological, treatment, and outcome (p > 0.05). The median time interval between COVID-19 infection and PFTs was 15 months (range 11-29 months), and there was no significant difference between severity groups (p = 0.878). Eight patients (24%) had abnormal pulmonary functions; among them, seven had an obstructive pattern (21%) and one had a restrictive pattern (3%). The severity groups had no statistical difference in pulmonary functions (p = 0.105). While forced expiratory volume in 1 second (FEV1) %, FEV1/forced vital capacity (FVC)%, and forced expiratory flow during the middle half of FVC (FEF25-75%) ratios were lower in the severe patient group, Z-scores were similar. Among the patients continuing polyclinic follow-up, 41% had persistent respiratory symptoms before PFTs. No differences were observed in PFTs when compared based on the presence of symptoms (p > 0.05).

CONCLUSIONS: We observed no significant long-term differences in pulmonary function between moderate and severe COVID-19 cases in children.

PMID:39863942 | DOI:10.3855/jidc.20123

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S260-S266. doi: 10.3855/jidc.19091.

ABSTRACT

INTRODUCTION: Invasive candidiasis is an important cause of nosocomial infection and recent studies have shown an increase in the number of cases during the coronavirus disease 2019 (COVID-19) pandemic. The present study aimed to evaluate the epidemiology and incidence of invasive candidiasis before and during the COVID-19 pandemic at a reference tertiary hospital in Brazil.

METHODOLOGY: A retrospective observational study was performed with 148 patients infected with Candida spp.

RESULTS: The incidence of invasive candidiasis was 3.43 cases per 1000 admissions in the pre-pandemic period and 4.54 cases per 1000 admissions in the pandemic period, with a particularly high incidence in the intensive care unit. Compared to the pre-pandemic period, patients presented more frequently with immunosuppression (p = 0.01), sepsis (p = 0.03), and need for mechanical ventilation (p = 0.01) during the pandemic. The prevailing type of Candida spp. infection was candidemia, mostly by C. albicans. Invasive candidiasis was associated with high mortality; 52% of the infected patients died from this disease in the pre-pandemic period, while 62% died in the pandemic period. COVID-19, mechanical ventilation, and sepsis were significantly associated with mortality (p = 0.008, p < 0.001, and p < 0.001 respectively).

CONCLUSIONS: A high incidence of Candida infection was observed at a tertiary general hospital in Brazil between 2018 and 2022. An increase in incidence of Candida infection during the COVID-19 pandemic was associated with a greater number of critical patients. Sepsis, mechanical ventilation, and COVID-19 were related to higher mortality in patients with invasive candidiasis.

PMID:39863941 | DOI:10.3855/jidc.19091

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S239-S248. doi: 10.3855/jidc.19218.

ABSTRACT

INTRODUCTION: We assessed the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and associated socio-occupational factors among delivery riders from a Brazilian city at two time points during the pandemic.

METHODOLOGY: Surveys for antibody and viral RNA testing were conducted from November 2020 to January 2021, and from March to May 2021 in a group of 117 delivery riders. A questionnaire on socio-occupational characteristics and coronavirus disease 2019 (COVID-19) preventive measures was completed. Factors associated with prevalence were analyzed using bivariate analyses and multiple logistic regression models.

RESULTS: The overall prevalence of COVID-19 was 15.4% (CI 9.0-23.0). Although not statistically significant, the prevalence was higher in the second phase of the survey (12% (CI 6.0-19.0)) than in the first (5.1% (CI 1.0-10.0)). The seroprevalence was significantly higher (p < 0.05) in the second phase of collection (10.3%) than in the first phase (3.4%). There were no statistically significant associations between the social characteristics assessed in the study and prevalence. Five behavioral variables were selected for the final multiple logistic regression model; and only the variable “cleans hands” had a significant association with the outcome, indicating that those who cleaned their hands had lower occurrence.

CONCLUSIONS: The prevalence among delivery riders was high and they were potentially exposed to risk of infection. Occupational activity and individual prevention behavior were better determinants of infection than social differences. It is necessary to take specific public measures for this group, especially during outbreaks of communicable diseases such as COVID-19.

PMID:39863939 | DOI:10.3855/jidc.19218

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S227-S238. doi: 10.3855/jidc.20325.

ABSTRACT

INTRODUCTION: Significant challenges to implementing international health regulations (IHR) at points of entry (PoEs) have been highlighted by the coronavirus disease 2019 (COVID-19) pandemic. Better assessment of the capacities of the PoEs may promote focused interventions. This study aimed to assess the capacities and practices at PoEs.

METHODOLOGY: A self-filled questionnaire based on the World Health Organization (WHO) Joint External Evaluation Tool was distributed to frontline workers at four major PoEs. A total of 368 questionnaires were distributed and 308 were completed. Online interviews were conducted with key informants (n = 16). The capacity of PoE was scored by referencing the WHO checklist for core capacity requirement, and categorized into limited, partial, or full capacity. Pearson’s Chi square test was used to compare differences among PoEs. Qualitative data was thematically analyzed.

RESULTS: The majority of the 308 participants in the survey were from Ngwenya (59.4%). Approximately 68% were government employees, and 81% had more than 2 years of experience. Participants reported shortage of resources, such as medical facility (30.5%), staff (37.7%), gloves (47.7%), masks (48.4%), and isolation room; and inconsistencies in practices such as record keeping, reporting cases, and quarantine measures. The overall capacity for IHR implementation was limited, with the airport PoE showing partial capacity and the three ground PoEs having limited capacity.

CONCLUSIONS: The capacity to implement the IHR at Eswatini PoEs was limited. The results suggest the need to allocate resources to PoEs and to enhance training on practices regarding case handling, reporting, and record keeping.

PMID:39863938 | DOI:10.3855/jidc.20325

Acta Oncol. 2025 Jan 25;64:105-113. doi: 10.2340/1651-226X.2025.42367.

ABSTRACT

INTRODUCTION: To target psychological support to cancer patients most in need of support, screening for psychological distress has been advocated and, in some settings, also implemented. Still, no prior studies have examined the appropriate ‘dosage’ and whether screening for distress before cancer treatment may be sufficient or if further screenings during treatment are necessary. We examined the development in symptom trajectories for breast cancer patients with low distress before surgery and explored potential risk factors for developing burdensome symptoms at a later point in time.

METHODS: In total, 299 patients newly diagnosed with breast cancer who scored < 7 on the distress thermometer were included between August 2017 and October 2019 at the Department of Breast Surgery, Rigshospitalet, Copenhagen. Patients were followed through electronic questionnaires at baseline before surgery and after 6, 12, and 18 months. We used latent class mixed models to identify sub-groups of patients with similar development in distress, anxiety, depression, breast cancer-specific health-related quality of life, self-efficacy, and fear of recurrence over time. Logistic and multinomial regression analyses were applied to examine clinical and sociodemographic factors associated with specific symptom trajectories.

RESULTS: We did not identify any sub-groups of women with low distress at diagnosis who developed disabling psychological symptoms up to 18 months after diagnosis. However, we did identify a sub-group of 52% of the women who experienced persistent mild anxiety (Generalised Anxiety Disorder [GAD]-7 score 5-9). Adjusted for baseline treatment modalities and sociodemographic characteristics, women having low social support (odds ratio [OR]: 2.90; 95% confidence interval [CI]: 1.07-7.87) or living with a partner (OR: 3.18; 95% CI: 1.38-7.34) were more likely to experience persistent mild anxiety.

INTERPRETATION: The results show that the majority of women with low distress at breast cancer diagnosis do not experience an increase in psychological symptoms over time. Screening for distress at cancer diagnosis may be an essential step to identify most breast cancer patients in need of professional support for psychological symptoms.

PMID:39863933 | DOI:10.2340/1651-226X.2025.42367

BMC Health Serv Res. 2025 Jan 25;25(1):145. doi: 10.1186/s12913-025-12304-9.

ABSTRACT

BACKGROUND: To address the health inequity caused by decentralized management, China has introduced a provincial pooling system for urban employees’ basic medical insurance. This paper proposes a research framework to evaluate similar policies in different contexts. This paper adopts a mixed-methods approach to more comprehensively and precisely capture the causal effects of the policy. Ultimately, this paper aims to assess the impact of the UPA policy on health inequity.

METHODS: This study takes the provincial unified reform of basic medical insurance for urban employees in China as an example, uses the China Family Panel Studies (CFPS) data and related policy documents, and adopts the DID-RIF hybrid method to test the impact of the equalization of the medical insurance system on health inequity, by using the interaction term in the DID (Difference-in-Differences) model as the independent variable in the RIF (Recentered Influence Function) to exclude the influence of other interfering variables. In addition, the DID method explores the effects of UPA on medical expenditures, which can guide the improvement of the policy.

RESULTS: The empirical results show that the UPA policy increases the likelihood of patients developing chronic diseases within six months. Although factors such as age, gender, and marital status influence the probability of chronic disease, health inequity between income groups after the policy’s implementation primarily stems from the rise in outpatient and reimbursement expenses.

CONCLUSIONS: Although the gap in medical reimbursement expenses between participants of different socioeconomic statuses narrowed after the provincial medical insurance pooling reform, health inequity among the insured population increased. The equalized health insurance reform failed to address health inequities based on socioeconomic status. Additionally, the reverse reallocation of medical resources and outpatient arbitrage driven by moral hazard warrant close attention. This paper recommends that, in advancing the provincial pooling of UEBMI, greater focus should be placed on strengthening digital oversight and improving the hierarchical diagnosis and treatment system to promote social equity.

PMID:39863904 | DOI:10.1186/s12913-025-12304-9

BMC Health Serv Res. 2025 Jan 25;25(1):141. doi: 10.1186/s12913-025-12252-4.

ABSTRACT

HIV self-sampling and -testing (HIVSS/ST) reduces testing barriers and potentially reaches populations who may not test otherwise. In the Netherlands, at-home HIV tests became commercially available around 2016, but data on user experiences are limited. This study aimed to explore characteristics of users and their experiences with HIVSS/ST. In 2022 and 2023, a survey was distributed among users of one online commercial provider and one community-based provider; either users ordered a commercial online HIVSS/ST or they sought a free-of-charge HIVST via the community-based provider. Questions included usability, preferences, and barriers of HIVSS/ST-testing. We compared characteristics and experiences of users between providers, risk groups and first-time and repeat testers. In total, 133 users completed the survey; 89 (67%) via the commercial provider and 44 (33%) via the community-based provider. Response rates per provider were 2% and 26%, respectively. Users who bought their test at the commercial provider were more often Gay and Bisexual Men (GBM) (42%), 35 + years (43%), and born in the Netherlands (89%), compared to those recruited through the community-provider (respectively 27%, 25%, 14%). GBM were more often repeat and recent HIVSS/ST-testers, and using pre-exposure prophylaxis (PrEP). Women and heterosexual men were more likely to buy an HIVSS/ST as part of a combination Sexually Transmitted Infections (STI) test package. Overall, main reasons for choosing HIVSS/ST were saving time (42%), anonymity (36%) and not having to talk to a GP (35%). Twenty-two percent of the study participants experienced some problems performing the HIVSS/ST, the most reported problem was obtaining sufficient blood through the finger prick (71%). Recommendations to improve accessibility of HIVSS/ST included more awareness (advertising by trustful providers), more access locations (pharmacies/supermarkets/schools) and lower costs. Our findings indicate that HIVSS/ST is a valuable additional HIV testing method for users, but more insight into the contribution of HIVSS/ST to HIV prevention policies is needed.

PMID:39863901 | DOI:10.1186/s12913-025-12252-4