理学最新文献

Background: Human immunodeficiency virus (HIV) recency testing provides data that can be used to monitor the trend of new HIV infections. The effectiveness of using people identified with recent infection to identify partners with new HIV infection through partner notification services (PNS) is not well documented.

Aim: To determine the pooled prevalence of recency testing coverage, recent infection, reclassification (recent to long-term infection) and PNS cascade among newly diagnosed people living with HIV.

Methods: PubMed, Cochrane Library and Embase were searched for articles published between January 2018 and November 2024. Studies were included if they reported recency coverage and/or PNS among people newly diagnosed with HIV and used recent infection testing algorithm (RITA). Recency coverage was defined as proportion of people tested using rapid testing for recent infection (RTRI) among those newly diagnosed with HIV. RITA further classifies RTRI results using viral load results (≥ 1000 copies/mL vs < 1000 copies/mL) to confirm recency status. For studies with PNS, we evaluated the cascade: Number of partners elicited, successfully contacted, eligible for HIV testing, tested and HIV diagnosis. PNS effectiveness was measured by proportion of new HIV diagnoses from tested partners. Using random effects models, we computed the pooled estimate of recency outcomes and 95% confidence intervals (CIs).

Results: Twenty-five studies from 17-low- and middle-income countries were included. Of 276315 newly diagnosed people living with HIV, 79864 underwent RTRI with an overall pooled recency coverage of 87% (95%CI: 67-96). The pooled prevalence of RTRI and RITA recency were 12% (95%CI: 9-16) and 7% (95%CI: 4-10), respectively. Pooled prevalence of RTRI reclassification was 34% (95%CI: 22-49). Of the recent cases who agreed to PNS, 253 partners were elicited with an estimated elicitation ratio of 1:1.6. Among partners elicited, 99% were successfully contacted, 75% were eligible for testing, 68% tested for HIV, and 15% were diagnosed with HIV.

Conclusion: High recency testing coverage among newly diagnosed individuals demonstrates the feasibility of monitoring new HIV infections in LMIC. While PNS yielded moderate HIV diagnoses, its targeted approach remains a critical strategy for identifying undiagnosed cases.

Hepatitis A virus (HAV) infection remains a significant public health concern in many developing countries. The annual incidence of HAV infection is 1.5 million, though this figure may be underestimated owing to the infection's asymptomatic nature and the presence of milder disease variants. The clinical spectrum of HAV infection now ranges from asymptomatic infection to fulminant hepatitis. Despite the availability of safe and highly effective vaccines, HAV infections remain a major contributor to acute viral hepatitis worldwide.

Background: Selenium (Se) is an essential soil mineral that can be incorporated into animal feedstuffs. Because of a lack of soil Se in some regions, organic or inorganic supplementation strategies must be implemented to prevent deficiencies and promote optimal ovine health. Therefore, the objectives of this study were to assess how inorganic versus organic Se supplementation influenced ewe Se status and immune function during late gestation and postpartum. Dorset Rideau ewes (n = 110) were fed a Se deficient diet from gestation d 110 through postpartum d 49 and received one of four daily oral Se treatments diluted in 5 mL of sugar water: 0 mg Se, 0.3 mg inorganic Se, 0.3 mg organic Se, and 0.6 mg organic Se. Throughout the trial, the ewes received various immune challenges, including intramuscular immunizations with a novel antigen (ovalbumin; OVA) on trial d 0 and 10, an intradermal OVA challenge on d 20, and a lipopolysaccharide (LPS) endotoxin challenge on trial d 49.

Results: The organic Se treatment groups had higher serum Se concentrations on most trial days compared to the 0.3 mg inorganic and control groups (P < 0.05). No significant treatment differences were found for the dermal hypersensitivity response to OVA, anti-OVA antibody response, glutathione peroxidase activity, cytokine response, cortisol response, or rectal temperature (P > 0.05). However, 4 h post-LPS injection, the serum albumin concentration was significantly lower in the 0.3 mg inorganic group compared to both organic Se groups, potentially indicating a higher degree of inflammation in the ewes supplemented with the inorganic Se.

Conclusions: The results of this study indicate that organic Se supplementation can promote a higher Se status in ewes over time, but Se supplementation during this study period did not affect tested immunological parameters. This lack of difference in immune responsiveness between groups may be due to an absence of true serum Se deficiencies in the Se-deficient group or the levels of Se supplementation being insufficient to significantly improve immunocompetence.

Between 2021 and 2023, approximately 400 pediatric cases of acute hepatitis of unknown etiology (AHUE) were reported in European countries and the United States. In 2023, three pediatric studies revealed that adeno-associated virus serotype 2 (AAV-2) infection was associated with AHUE. This article presents a summary and comparison of the results of metagenomic sequencing, viral whole-genome sequencing, virus-specific real-time polymerase chain reaction (PCR) and histological analysis of the liver, all of which were among the common investigative methods used in the three pediatric studies. All three pediatric studies revealed 80% or greater rates of positivity for AAV-2 in cases of AHUE according to metagenomic sequencing. Moreover, on the basis of PCR results, two studies revealed high AAV-2 positivity rates (96.4% and 81.2%) among cases of AHUE. These findings suggest that AAV-2 is a pathogen in AHUE. Coinfection with AAV-2 and one or more helper viruses (human adenovirus, human herpesvirus 6B, Epstein-Barr virus, etc.), high viral loads of AAV-2 in blood, anti-AAV-2 IgM and human leukocyte antigen typing could be candidate diagnostic criteria for AHUE. AAV-2 infection should be incorporated into clinical guidelines for the management of acute liver failure. Cidofovir can be administered if coinfection with AAV-2 and HAdV is detected.

This retrospective cohort study from Rwanda demonstrated the likelihood of maternal disclosure and peer support in preventing mother-to-child human immunodeficiency virus (HIV) transmission. High sustained maternal viral load suppression (91.0%) and exceptional infant testing uptake (100% at 6 weeks) correlated with a low 0.7% infant HIV incidence. To eliminate mother-to-child transmission of HIV, effective strategies must engage male partners in disclosure, reduce stigma, improve health literacy, and provide structural peer-support for enhancing adherence and mental health.

Background: In tropical Asia, arbovirus-induced encephalitis continues to be a serious public health issue. Encephalitis is caused by wide range of neurotropic pathogens, and flaviviruses are one of the main causative agents in the area. Sri Lanka reports a considerable number of central nervous system infections annually. Both dengue and Japanese encephalitis are endemic, and cases of Zika and West Nile virus infections were reported occasionally in Sri Lanka. Although reported number of Japanese encephalitis cases has reduced in the past, aetiological diagnosis in majority of encephalitis cases is still unknown.

Aim: To detect dengue virus (DENV) infections in individuals in the central region of Sri Lanka who were clinically suspected of having encephalitis.

Methods: A retrospective observational analysis was conducted on 99 cerebrospinal fluid samples received to a virology laboratory from patients in the central part of Sri Lanka who were clinically suspected of having encephalitis. Samples were analyzed using reverse transcriptase polymerase chain reaction (RT-PCR) with universal flavivirus primers to detect flaviviral RNA followed by DENV serotyping real-time RT-PCR, and an immunoglobulin M (IgM) detection enzyme-linked immunosorbent assay to detect IgM antibodies indicative of a possible recent DENV infection.

Results: DENV aetiology was detected in 6 (6.06%) cerebrospinal fluid samples, and all were confirmed as DENV infections. A single positive result (1.01%) was yielded through RT-PCR and was identified as DENV serotype 3. Serology testing detected 05 (5.05%) anti-dengue IgM positives and further investigation indicated probable DENV aetiology. Among positives 02 (33.33%) were children (aged less than 14 years), and rest were adults.

Conclusion: These findings underscore the presence of DENV-associated central nervous system infections and highlight the need for broader surveillance and more advanced diagnostic approaches in the future.

Hepatitis A, a vaccine-preventable liver infection caused by the hepatitis A virus, is undergoing significant epidemiological shifts worldwide. Traditionally considered a disease of childhood in endemic regions, improved sanitation, economic development, and widespread vaccination have led to a decline in incidence, particularly in developed nations. However, this decline has resulted in a growing population of susceptible adults, increasing the risk of severe outbreaks. Additionally, changes in travel patterns, urbanization, and socioeconomic disparities have altered disease distribution, leading to sporadic outbreaks in low-endemicity regions and a rising burden in certain high-risk populations. This review explores the evolving epidemiology of hepatitis A, emphasizing the transition from endemic childhood infections to adult susceptibility. We examine the impact of changing risk factors, including shifting demographics, increased international travel, and regional disparities in vaccination coverage. Furthermore, the review highlights the emergence of new viral strains and their potential implications for disease control. Updated vaccination policies, including targeted immunization strategies and their role in preventing outbreaks, are also discussed. Given these dynamic changes, continued surveillance and public health preparedness tailored to evolving risk groups are crucial for sustained hepatitis A control. By synthesizing recent epidemiological data and policy updates, this review provides insights into the future of hepatitis A prevention and control, offering guidance for clinicians, researchers, and public health professionals.

Background: The coronavirus disease 2019 (COVID-19) pandemic has had profound physical, psychological, and social consequences, with lasting effects on health-related quality of life (HRQoL) among people with a history of COVID-19.

Aim: To synthesize the current evidence on HRQoL and long-term health outcomes among people with a history of COVID-19 in India.

Methods: We incorporated studies from India reporting post-COVID HRQoL outcomes using validated instruments, including the 5-level EuroQol 5-Dimensional questionnaire, the EuroQol Visual Analogue Scale, the Short Form-36 Health Survey, the World Health Organization Quality of Life-Brief Version, and the European Health Interview Survey-Quality of Life. Pooled mean 5-level EuroQol 5-Dimensional questionnaire scores with 95%CIs were calculated for HRQoL. Adjusted odds ratios were pooled for comorbidity, disease severity, intensive care unit admission, age, sex, and vaccination status using random-effects models.

Results: Three studies (n = 1526) reported EuroQol instruments, with the 5-level EuroQol 5-Dimensional questionnaire utility scores suitable for quantitative pooling. The pooled mean utility was 0.83 (95%CI: 0.75-0.92), although heterogeneity was high because the included studies represented clinically distinct populations. Across all studies, several determinants were consistently associated with impaired HRQoL. Older adults (≥ 60 years) had higher odds of poor HRQoL [pooled odds ratio (OR) = 1.83, 95%CI: 1.43-2.35], and females were more likely to experience impaired HRQoL (pooled OR = 1.74, 95%CI: 1.44-2.10), whereas males had a lower risk (pooled OR = 0.58, 95%CI: 0.48-0.70). Being unvaccinated increased the likelihood of persistent symptoms or reduced HRQoL (pooled OR = 1.60, 95%CI: 1.21-2.14). Comorbidity (pooled OR = 1.94, 95%CI: 1.43-2.63) and severe acute COVID-19 or intensive care unit admission (pooled OR = 2.77, 95%CI: 2.13-3.59) were also strongly associated with poorer HRQoL Six additional studies utilizing disparate instruments (EuroQol Visual Analogue Scale, Short Form-36 Health Survey, World Health Organization Quality of Life-Brief Version, European Health Interview Survey-Quality of Life) were excluded from quantitative synthesis due to measurement heterogeneity.

Conclusion: Post-COVID HRQoL in people with a history of COVID-19 in India is suboptimal, with greater impairment observed among older adults, females, patients with comorbidities or severe disease, and unvaccinated individuals. These findings highlight the need for targeted rehabilitation and preventive strategies.

Acute respiratory infections (ARIs) are the main cause of morbidity and mortality worldwide, especially among children. The human bocavirus (HBoV) is a non-enveloped DNA virus that was recently identified as a respiratory pathogen associated with respiratory tract infections (RTIs), predominantly in infants and young children. It is also detected from the gastrointestinal tract in children. The prevalence of HBoV1 acute respiratory tract infection varies across age groups, ranging from 10.3% to 12.51% in individuals under 3 years of age. The spectrum of clinical presentation includes mild upper RTIs, acute exacerbation of asthma, bronchitis, bronchiolitis, pneumonia, and multi-organ failure. Although HBoV is often detected in patients with ARIs who have other respiratory viruses (17%-85%), recent studies have identified it as the sole aetiology for mild to severe ARIs. Children with pre-existing medical conditions infected with HBoV often have a risk of severe illness. HBoV infection is diagnosed primarily by detecting viral DNA in respiratory samples using molecular methods. Currently, there is no specific antiviral treatment for HBoV infections and the cases are managed symptomatically. General preventive measures used for the prevention of viral RTIs are applicable, as there is no effective vaccine against this virus. The HBoV has been implicated in RTIs, particularly in children, and has also been detected in cases of gastroenteritis. Despite its global prevalence, the exact pathogenic role of HBoV remains unclear due to frequent co-infections with other viruses. This mini-review discusses the virology, epidemiology, clinical manifestations, diagnosis, and potential treatment approaches related to HBoV infections.

Hepatitis C virus (HCV) infection, traditionally regarded as a hepatotropic disease, is increasingly recognized as a systemic condition with significant thrombotic implications. Chronic HCV induces a persistent proinflammatory and prothrombotic state that substantially elevates the risk of both venous and arterial events. Mechanistically, HCV drives endothelial dysfunction, enhances platelet activation, disrupts coagulation and fibrinolytic balance, and promotes immune-mediated vascular injury through cryoglobulinemia and chronic systemic inflammation. Clinical manifestations range from portal vein thrombosis and venous thromboembolism to coronary artery disease and ischemic stroke, highlighting the far-reaching consequences of virus-driven coagulopathy. Emerging evidence challenges the historical view of cirrhosis as a "naturally anticoagulated" state, instead describing a fragile hemostatic balance prone to both bleeding and thrombosis. Direct-acting antiviral therapy has transformed outcomes, not only achieving sustained virological response but also reversing systemic inflammation, improving endothelial function, and reducing thrombotic complications. However, patients with advanced fibrosis and comorbidities remain at elevated risk despite viral clearance, underscoring the need for ongoing surveillance. This minireview highlights the interplay between hepatic dysfunction, viral-induced inflammation, and cardiovascular sequelae in chronic HCV, emphasizing the importance of integrating thrombotic risk assessment into clinical care and research frameworks.