BackgroundIn areas where the prevalence of soil-transmitted helminthiasis (STH) is >20%, the World Health Organization (WHO) recommends that deworming medication be given periodically to preschool-age children. To reduce risk of choking-related deaths in children <3 years old, WHO recommends that deworming tablets be crushed and given with water. Little is known about how widely this is practiced or its effectiveness.Methodology and principal findingsAlbendazole distributions for STH were observed for children 1–4 years old in 65 sites in India and Haiti. Information was recorded on child demographics; child demeanor immediately before, as well as struggling or resistance during albendazole administration; tablet form (i.e., crushed or not); and adverse swallowing events (ASEs), including choking, spitting; coughing; gagging; vomiting; and expelling a crushed tablet in a “cloud” of powder. Of 1677 children observed, 248 (14.8%) had one or more ASEs. ASE risk was 3.6% with whole tablets, 25.4% with crushed tablets, and 34.6% when crushed tablets were mixed with water. In multivariate analysis, ASE risk was significantly associated with children 1 year (OR 2.7) or 2 years (OR 2.9) of age; male gender (OR 1.6); non-content child demeanor (fearful, fussy, or combative) before albendazole administration (OR 4.3); child struggling when given albendazole (OR 2.1); and giving water, either after the tablet or mixed with it (OR 5.8). Eighteen (1.1%) children choked, none fatally; 17 choking incidents occurred with crushed tablets. In a multivariate analysis that controlled for distribution site, the only significant risk factor for choking was non-content demeanor (OR 20.6).Conclusions and significanceDeworming-related choking deaths in young children are preventable. In our sample, risk of choking could have been reduced by 79.5% if deworming tablets were not given to young children who were fussy, fearful, or combative or who struggled to resist tablet administration, with only an 18.4% reduction in drug coverage.

No abstract

Approximately 8% of the human genome, over four-times more than its protein-coding regions, comprises sequences of viral origin that are known as human endogenous retroviral elements (HERVs). Present in the genome of all human cells, HERVs resulted from the integration of now-extinct exogenous retroviruses into mammalian ancestor germ cells or their precursors on several occasions, sometimes as long as tens of millions of years ago. Most HERVs have become silenced because of mutations such as substitutions, insertions, or deletions, and as a result of epigenetic changes, and are vertically transmitted in the population. Considered for a long time to be part of the "junk DNA", HERVs were shown, in more recent years, to perform critical functions in the host. Two of the very few HERVs known to encode functional proteins, syncytin-1 and syncytin-2, are critical during embryogenesis, when they contribute to the formation of the placenta and facilitate tolerance of the maternal immune system towards the developing fetus. Homologs of syncytin-encoding genes were described in several other species, and it appears that during evolution they were stably endogenized into the respective genomes on multiple occasions and became co-opted for critical physiological functions. The aberrant expression of HERVs has been linked to conditions that include infectious, autoimmune, malignant, and neurological diseases. HERVs, our genomic fossils and storytellers, provide a fascinating and somewhat mysterious insight into our co-evolution with viruses, and will undoubtedly offer many teachings, surprises, and paradigm changes for years to come.

Background In recent years, the number of cases of syphilis has been increasing at both local and global levels. In this study, we sought to profile how this increase in cases has translated to the inpatient setting by examining inpatient admissions due to or complicated by syphilis at any stage. Methods At a single-center, multisite health institution, charts for patients older than 18 years admitted between April 2017 and October 2020 with a diagnosis of syphilis were reviewed. Cases were characterized into stages of primary, secondary, latent, tertiary, and neuro/ocular syphilis, with all neuro/ocular cases categorized together despite the potential for neuro/ocular syphilis at any stage. Medical history, laboratory data, hospital course, and treatment outcomes were recorded. Results Eighty-one charts met inclusion, with a mean age of 49 years. Seventy-two percent were cisgender men, 42% were documented as men who have sex with men, and 49% were of Black race. Thirty-three percent had been previously diagnosed with syphilis, and 70% of that group had previously received treatment. Forty-one percent were HIV+. Fifty-one percent were cases of neurosyphilis, and 42% were latent. The mean LOS was 10 days, with 11% readmitted within 30 days. Conclusions These results formulate a profile for the outlook and course of hospitalizations for or complicated by syphilis in an urban setting. In light of these findings, and given the rising incidence of syphilis in the world, opportunities for further investigation into prevention, impact, and outcome quality are more necessary than ever.