Background Diagnosis of invasive candidiasis (IC) relies on insensitive cultures; the relative utility of fungal biomarkers in children is unclear. Methods This multinational observational cohort study enrolled patients aged >120 days and <18 years with concern for IC from 1 January 2015 to 26 September 2019 at 25 centers. Blood collected at onset of symptoms was tested using T2Candida, Fungitell (1→3)-β-D-glucan, Platelia Candida Antigen (Ag) Plus, and Platelia Candida Antibody (Ab) Plus assays. Operating characteristics were determined for each biomarker, and assays meeting a defined threshold considered in combination. Sterile site cultures were the reference standard. Results Five hundred participants were enrolled at 22 centers in 3 countries, and IC was diagnosed in 13 (2.6%). Thirteen additional blood specimens were collected and successfully spiked with Candida species, to achieve a 5.0% event rate. Valid T2Candida, Fungitell, Platelia Candida Ag Plus, and Platelia Candida Ab Plus assay results were available for 438, 467, 473, and 473 specimens, respectively. Operating characteristics for T2Candida were most optimal for detecting IC due to any Candida species, with results as follows: sensitivity, 80.0% (95% confidence interval, 59.3%–93.2%), specificity 97.1% (95.0%–98.5%), positive predictive value, 62.5% (43.7%–78.9%), and negative predictive value, 98.8% (97.2%–99.6%). Only T2Candida and Platelia Candida Ag Plus assays met the threshold for combination testing. Positive result for either yielded the following results: sensitivity, 86.4% (95% confidence interval, 65.1%– 97.1%); specificity, 94.7% (92.0%–96.7%); positive predictive value, 47.5% (31.5%–63.9%); and negative predictive value, 99.2% (97.7%–99.8%). Conclusions T2Candida alone or in combination with Platelia Candida Ag Plus may be beneficial for rapid detection of Candida species in children with concern for IC. Clinical Trials Registration NCT02220790.
Introduction Vaccines are being developed against Group B Streptococcus and respiratory syncytial virus. These vaccines are designed to be given to pregnant women to protect infants; thus, their success depends on uptake in this population. Maternal immunization programs have struggled to achieve target coverage rates. This systematic narrative synthesis aims to define the most important barriers and facilitators for maternal immunization and to identify priority areas for future research. Methods A search strategy was developed in Medline and adapted according to the requirements of additional search engines. Two reviewers independently reviewed the studies, using pre-specified inclusion and exclusion criteria. Results sections of included studies were coded, and thematic analysis was used to identify prominent themes. Results 321 studies were included in the final review. Most studies came from North America (37%), Europe (26%) or East Asia, Australia and New Zealand (22%). Low-and middle-income countries were under-represented. Five percent of studies came from Sub-Saharan Africa, and 2% came from South Asia. The prominent factors impacting maternal immunization were provider recommendation, perceived risks and benefits of maternal vaccines for the infant, race, birthplace, and access to healthcare. Few studies explored reasons behind racial and socioeconomic disparities in maternal immunization rates. Discussion A strong provider recommendation, equitable access to prenatal care and messaging that focuses on vaccine safety and infant benefits emerged as the key components for optimising vaccine uptake among pregnant women. Research among healthcare providers, minority groups and in low- and-middle-income countries was lacking. In anticipation of the expansion of maternal immunization programmes, focused research is needed to address these gaps and inform a successful public health strategy. Supplementary Information The online version contains supplementary material available at 10.1007/s10995-022-03508-0.
Objectives: Describe cumulative seroprevalence of SARS-CoV-2 antibodies during the COVID-19 pandemic among employees of a large pediatric healthcare system. Design, Setting, and Participants: Prospective observational cohort study open to adult employees at Children’s Hospital of Philadelphia, conducted April 20 – December 17, 2020. Methods: Employees were recruited starting with high-risk exposure groups, utilizing emails, flyers, and announcements at virtual town halls. At baseline, 1-month, 2-month, and 6-month timepoints, participants reported occupational and community exposures and gave a blood sample for SARS-CoV-2 antibody measurement by enzyme-linked immunosorbent assays (ELISAs). A post hoc Cox proportional hazards regression model was performed to identify factors associated with increased risk for seropositivity. Results: 1740 employees were enrolled. At 6-months, cumulative seroprevalence was 5.3%, below estimated community point seroprevalence; seroprevalence was 5.8% and 3.4% among employees with and without direct patient care, respectively. Most participants seropositive at baseline remained positive at follow-up assessments. In post hoc analysis, direct patient care (HR: 1.95, 95% CI: 1.03 to 3.68), Black race (HR: 2.70, 95% CI: 1.24 to 5.87), and exposure to a confirmed case in a non-healthcare setting (HR: 4.32, 95% CI: 2.71 to 6.88) were associated with statistically significant increased risk for seropositivity. Conclusions: Employee SARS-CoV-2 seroprevalence rates remained below the surrounding community’s point prevalence rates. Provision of direct patient care, Black race, and exposure to a confirmed case in non-healthcare setting conferred increased risk. These data can inform occupational protection measures to maximize protection of employees within the workplace during future COVID waves or other epidemics.
Purpose: Chemotherapy for pediatric acute myeloid leukemia (AML) is very intensive and many, but not all centers, require extended hospitalization until neutrophil recovery. Child and family preferences, beliefs, and experiences around hospitalization have not been systematically assessed. Patients and methods:We recruited children with AML and their parents from nine pediatric cancer centers across the United States for a qualitative interview about their experiences of neutropenia management. Interviews were analyzed using a conventional content analysis approach.Results: Of 116 eligible individuals, 86 (74.1%) agreed to participate. Interviews were conducted with 32 children and 54 parents from 57 families. Of these 57 families, 39 were cared for as inpatients and 18 were managed as outpatients. A very high proportion of respondents in both groups reported satisfaction with the Abbreviations: AML, acute myeloid leukemia; CHOP, Children's Hospital of Philadelphia.
Not long ago at a conference of consultant dermatologists I presented the case against making hydrocortisone an over the counter (OTC) product. After debate the case against won the day by 34 to 31 votes. A narrow margin, but it was an impressive victory; before the debate all the dermatologists that I questioned had said that licensing hydrocortisone as an OTC product was "probably all right."Several pharmaceutical companies are keen to introduce 1% hydrocortisone as a topical product for sale to the public without prescription. To achieve this, approval would have to be obtained for licensing it as an OTC product. Applications have been rejected in the past but the industry-no doubt looking for ways to recover from recent ill considered government attempts to reduce its profitability-is applying considerable pressure to secure approval because market research suggests that the sales potential is large.The introduction of OTC hydrocortisone would not only affect dermatologists: general practitioners and other physicians would inevitably have to deal with many of the problems that its unlimited use would bring. So here I present the meat of the debate that took place among the dermatologists and leave the general reader to form his or her own opinion.The case for OTC hydrocortisoneThe case in support of OTC hydrocortisone is a simple one. Minor skin complaints are common, most are transient, and many go unreported. Most, it is alleged, could be treated effectively and safely with 1% hydrocortisone. Rashes that do not respond to topical hydrocortisone do not matter, either because they will ultimately remit spontaneously or because the patient will eventually report to the family doctor. Self treatment of trivial dermatoses would save time both for the patient and the doctor, and save money.Two other threads in the case flow in opposite directions. One says that OTC hydrocortisone is a logical extension of self medication; the other that hydrocortisone is largely ineffective, and thus its unsupervised use is of no importance. Many dismiss the possibility that hydrocortisone will cause appreciable side effects. The case against OTC hydrocortisoneThe case against OTC hydrocortisone is based on both the weakness of the case for it and the disadvantages that its introduction would bring. Hydrocortisone is an active natural substance and it is the hormone that saves each and every one of us from Addisonian crisis. Applied topically to the rat 1% hydrocortisone reduces specific glucocorticoid cytosol receptors in the skin by 70-80%; put on normal human skin it produces vasoconstriction. The effects of topical 1% hydrocortisone are primarily local, but occasionally systemic absorption occurs. If OTC preparations are licensed and many people are exposed, iatrogenic Cushing's syndrome will be induced, albeit rarely. The very young are particularly at risk because of their high surface area/body mass ratio, as are patients with abnormal skin that allows increased absorption, and those with impaired hepatic metabolism.Ill e...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.