Posts filed under ‘Infecciones Gin/Obs’

The projected timeframe until cervical cancer elimination in Australia: a modelling study

The Lancet Public Health October 20, 2018

Michaela T Hall, MMath Kate T Simms, PhDJie-Bin Lew, PhDMegan A Smith, PhDJulia ML Brotherton, PhDMarion Saville, MBChB et al.

Background

In 2007, Australia was one of the first countries to introduce a national human papillomavirus (HPV) vaccination programme, and it has since achieved high vaccination coverage across both sexes. In December, 2017, organised cervical screening in Australia transitioned from cytology-based screening every 2 years for women aged from 18–20 years to 69 years, to primary HPV testing every 5 years for women aged 25–69 years and exit testing for women aged 70–74 years. We aimed to identify the earliest years in which the annual age-standardised incidence of cervical cancer in Australia (which is currently seven cases per 100 000 women) could decrease below two annual thresholds that could be considered to be potential elimination thresholds: a rare cancer threshold (six new cases per 100 000 women) or a lower threshold (four new cases per 100 000 women), since Australia is likely to be one of the first countries to reach these benchmarks.

Methods

In this modelling study, we used Policy1-Cervix—an extensively validated dynamic model of HPV vaccination, natural history, and cervical screening—to estimate the age-standardised incidence of cervical cancer in Australia from 2015 to 2100. We incorporated age-specific coverage of the Australian National HPV Vaccination Program in girls, including the catch-up programme, and the inclusion of boys into the vaccine programme from 2013, and a change from the quadrivalent to the nonavalent vaccine from 2018. We also modelled the effects of the transition to primary HPV screening. We considered two scenarios for future screening recommendations regarding the cohorts who will be and who have been offered the nonavalent vaccine: either that HPV screening every 5 years continues, or that no screening would be offered to these women.

Findings

We estimate that, in Australia, the age-standardised annual incidence of cervical cancer will decrease to fewer than six new cases per 100 000 women by 2020 (range 2018–22), and to fewer than four new cases per 100 000 women by 2028 (2021–35). The precise year of attaining these rates is dependent on the population used for age-standardisation, HPV screening behaviour and test characteristics, the incremental effects of vaccination of men on herd immunity in women, and assumptions about the future frequency of benign hysterectomies. By 2066 (2054–77), the annual incidence of cervical cancer will decrease and remain at fewer than one case per 100 000 women if screening for HPV every 5 years continues for cohorts who have been offered the nonavalent vaccine, or fewer than three cases per 100 000 women if these cohorts are not screened. Cervical cancer mortality is estimated to decrease to less than an age-standardised annual rate of one death per 100 000 women by 2034 (2025–47), even if future screening is only offered to older cohorts that were not offered the nonavalent vaccine.

Interpretation

If high-coverage vaccination and screening is maintained, at an elimination threshold of four new cases per 100 000 women annually, cervical cancer could be considered to be eliminated as a public health problem in Australia within the next 20 years. However, screening and vaccination initiatives would need to be maintained thereafter to maintain very low cervical cancer incidence and mortality rates.

Funding: National Health and Medical Research Council (Australia).

FULL TEXT

https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30183-X/fulltext

PDF

https://www.thelancet.com/action/showPdf?pii=S2468-2667%2818%2930183-X

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October 4, 2018 at 7:24 am

Diagnostic Performance of a Molecular Test versus Clinician Assessment of Vaginitis

Clin. Microbiol. June 2018 56:13 e00252-18

Jane R. Schwebke, Charlotte A. Gaydos, Paul Nyirjesy, Sonia Paradis, Salma Kodsi, and Charles K. Cooper

Vaginitis is a common complaint, diagnosed either empirically or using Amsel’s criteria and wet mount microscopy. This study sought to determine characteristics of an investigational test (a molecular test for vaginitis), compared to reference, for detection of bacterial vaginosis, Candida spp., and Trichomonas vaginalis. Vaginal specimens from a cross-sectional study were obtained from 1,740 women (≥18 years old), with vaginitis symptoms, during routine clinic visits (across 10 sites in the United States).

Specimens were analyzed using a commercial PCR/fluorogenic probe-based investigational test that detects bacterial vaginosis, Candida spp., and Trichomonas vaginalis. Clinician diagnosis and in-clinic testing (Amsel’s test, potassium hydroxide preparation, and wet mount) were also employed to detect the three vaginitis causes.

All testing methods were compared to the respective reference methods (Nugent Gram stain for bacterial vaginosis, detection of the Candida gene its2, and Trichomonas vaginalis culture). The investigational test, clinician diagnosis, and in-clinic testing were compared to reference methods for bacterial vaginosis, Candida spp., and Trichomonas vaginalis.

The investigational test resulted in significantly higher sensitivity and negative predictive value than clinician diagnosis or in-clinic testing. In addition, the investigational test showed a statistically higher overall percent agreement with each of the three reference methods than did clinician diagnosis or in-clinic testing.

The investigational test showed significantly higher sensitivity for detecting vaginitis, involving more than one cause, than did clinician diagnosis. Taken together, these results suggest that a molecular investigational test can facilitate accurate detection of vaginitis.

abstract

http://jcm.asm.org/content/56/6/e00252-18.abstract

PDF

http://jcm.asm.org/content/56/6/e00252-18.full.pdf+html

June 12, 2018 at 7:34 am

Diagnostic Performance of a Molecular Test versus Clinician Assessment of Vaginitis

Journal of Clinical Microbiology June 2018 V.56 N.6

Jane R. Schwebke, Charlotte A. Gaydos, Paul Nyirjesy, Sonia Paradis, Salma Kodsi and Charles K. Cooper

a University of Alabama at Birmingham, Birmingham, Alabama, USA

b Johns Hopkins University, Baltimore, Maryland, USA

c Drexel University College of Medicine, Philadelphia, Pennsylvania, USA

d Becton, Dickinson and Company, BD Life Sciences—Diagnostic Systems, Quebec, QC, Canada

e Becton, Dickinson and Company, BD Life Sciences—Diagnostic Systems, Sparks, Maryland, USA

Vaginitis is a common complaint, diagnosed either empirically or using Amsel’s criteria and wet mount microscopy. This study sought to determine characteristics of an investigational test (a molecular test for vaginitis), compared to reference, for detection of bacterial vaginosis, Candida spp., and Trichomonas vaginalis. Vaginal specimens from a cross-sectional study were obtained from 1,740 women (≥18 years old), with vaginitis symptoms, during routine clinic visits (across 10 sites in the United States). Specimens were analyzed using a commercial PCR/fluorogenic probe-based investigational test that detects bacterial vaginosis, Candida spp., and Trichomonas vaginalis. Clinician diagnosis and in-clinic testing (Amsel’s test, potassium hydroxide preparation, and wet mount) were also employed to detect the three vaginitis causes. All testing methods were compared to the respective reference methods (Nugent Gram stain for bacterial vaginosis, detection of the Candida gene its2, and Trichomonas vaginalis culture). The investigational test, clinician diagnosis, and in-clinic testing were compared to reference methods for bacterial vaginosis, Candida spp., and Trichomonas vaginalis. The investigational test resulted in significantly higher sensitivity and negative predictive value than clinician diagnosis or in-clinic testing. In addition, the investigational test showed a statistically higher overall percent agreement with each of the three reference methods than did clinician diagnosis or in-clinic testing. The investigational test showed significantly higher sensitivity for detecting vaginitis, involving more than one cause, than did clinician diagnosis. Taken together, these results suggest that a molecular investigational test can facilitate accurate detection of vaginitis.

abstract

http://jcm.asm.org/content/56/6/e00252-18.abstract?etoc

PDF

http://jcm.asm.org/content/56/6/e00252-18.full.pdf+html

May 28, 2018 at 9:29 am

The Brief Case: Disseminated Neisseria gonorrhoeae in an 18-Year-Old Female

Journal of Clinical Microbiology April 2018 V.56  N.4

Julianne E. Burns and Erin H. Graf

CASE

An 18-year-old previously healthy female presented to a Philadelphia, PA, pediatric emergency department in February for further evaluation of polyarticular arthritis. Two weeks prior, she had presented to an outside hospital with body aches and onset of acute pain in the left arm and leg. The etiology was thought to be cervical radiculopathy, and she was discharged on naproxen and prednisone. She returned to the outside hospital 5 days later without improvement and now with pain and swelling in her left knee, right thumb, right wrist, and bilateral ankles. She had a markedly elevated erythrocyte sedimentation rate (ESR) of 80 mm/h (reference range, 0 to 20 mm/h) and C-reactive protein (CRP) of 76.6 mg/dl (reference range, 0 to 0.9 mg/dl). A workup for autoimmune disease included negative results for antinuclear antibody, rheumatoid factor, and anticyclic citrullinated peptide. Serologic testing for Lyme disease was also negative……

PDF

http://jcm.asm.org/content/56/4/e00932-17.full.pdf+html

 

 

Closing the Brief Case: Disseminated Neisseria gonorrhoeae in an 18-Year-Old Female

SELF ASSESSMENT QUESTIONS

Which of the following specimens is recommended and FDA cleared for nucleic acid amplification testing (NAAT) in suspected cases of disseminated Neisseria gonorrhoeae?

a-Whole blood

b-Urine

c-Synovial fluid

d.Serum

PDF

http://jcm.asm.org/content/56/4/e00933-17.full.pdf+html

March 27, 2018 at 8:21 am

Maternal colonization or infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae in Africa: A systematic review and meta-analysis

International Journal of Infectious Diseases November 2017 V.64 N. P.58–66

Andre N.H. Bulabula, Angela Dramowski, Shaheen Mehtar

Highlights

  • The prevalence of colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) in pregnant and/or post-partum women in Africa is 17% (95% confidence interval 10–23%).
  • The pooled proportions from reviewed studies suggest a greater proportion of ESBL-E colonization in pregnant women compared to post-partum women.
  • The rate of maternal colonization with ESBL-E is greater in community settings than in hospital settings.
  • The most frequently reported ESBL-encoding gene in Africa is CTX-M.

Objective

To summarize published studies on the prevalence of and risk factors for maternal bacterial colonization and/or infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) in pregnant and/or post-partum women in Africa.

Methods

A systematic review was conducted using the PubMed, Scopus, and Google Scholar databases. Bibliographies of included eligible studies were manually searched to identify additional relevant articles. No language restriction was applied. The timeframe of the search included all records from electronic database inception to July 15, 2017. A random-effects meta-analysis was performed to summarize the prevalence and the 95% confidence intervals (CI) of ESBL-E colonization or infection in pregnant or post-partum women in Africa. The meta-analysis was conducted using STATA IC 13.1 software and the metaprop function/plugin.

Results

Ten studies (seven on pregnant women and three on post-partum women) were included, documenting a 17% prevalence of maternal colonization with ESBL-E in Africa (95% CI 10–23%). The prevalence of ESBL-E in community isolates exceeded that in isolates from the hospital setting (22% vs. 14%). The most frequently reported ESBL-encoding gene was CTX-M (cefotaxime hydrolyzing capabilities). Data on risk factors for maternal ESBL-E colonization and infection are very limited.

Conclusions

The prevalence of colonization and/or infection with ESBL-E in pregnant and post-partum women in Africa exceeds that reported from high- and middle-income settings, representing a risk for subsequent neonatal colonization and/or infection with ESBL-E.

abstract

http://www.ijidonline.com/article/S1201-9712(17)30221-7/fulltext

PDF

http://www.ijidonline.com/article/S1201-9712(17)30221-7/pdf

February 9, 2018 at 1:21 pm

 Clinical evaluation of early acquisition of Staphylococcus aureus carriage by newborns

International Journal of Infectious Diseases November 2017 V.64 N. P.9–14

Ayala Maayan-Metzger, Tzipora Strauss, Carmit Rubin, Hanaa Jaber, Mordechai Dulitzky,

Aylana Reiss-Mandel, Eyal Leshem, Galia Rahav, Gili Regev-Yochay

Abstract

Background

Little is known about neonatal Staphylococcus aureus carriage. Sites and clinical outcomes of S. aureus colonization during the first month of life were evaluated in this study.

Methods

A cohort of 279 infants born at term to 277 mothers was included. Maternal S. aureus colonization status was examined before labor. Newborns were screened for nasal, auricular, umbilical, and rectal colonization, one to three times within 100 h after birth, and infants of carrier mothers were re-screened at 1 month. Medical data were recorded from the medical charts at discharge and at the 1-month follow-up interview.

Results

Overall 43 out of 279 (15.4%) infants acquired S. aureus within the first days of life. The only two predictors of S. aureus carriage in the postnatal period were maternal S. aureus carriage (odds ratio 7.905, 95% confidence interval 3.182–19.638) and maternal antibiotic treatment during labor (odds ratio 0.121, 95% confidence interval 0.016–0.949). Among colonized children, the nose (56%) and rectum (40%) were more frequently colonized, while ear (26%) and umbilicus (16%) colonization were less common. Co-colonization at two sites was rare (4%), but always predicted carriage at 1 month of age. Maternal and neonatal characteristics, including neonatal outcomes, were similar between S. aureus carrier and non-carrier infants during the first month of life.

Conclusions

Maternal carriage is the major predictor of neonatal S. aureus carriage. The nose and rectum are the main sites of neonatal carriage. S. aureus carriage was not associated with neonatal complications throughout the first month of life. The long-term significance of early S. aureus carriage is yet to be determined.

abstract

http://www.ijidonline.com/article/S1201-9712(17)30219-9/fulltext

PDF

http://www.ijidonline.com/article/S1201-9712(17)30219-9/pdf

February 9, 2018 at 1:20 pm

Antimicrobial prophylaxis in caesarean section delivery.

Exp Ther Med. August 2016 V.12 N.2 P.961-964.

Liu R1, Lin L1, Wang D1.

Author information

1 Department of Obstetrics, People’s Hospital of Linyi, Linyi, Shandong 276000, P.R. China.

Abstract

Antimicrobial prophylaxis is used routinely for pre-, intra- and post-operative caesarean section.

One of the most important risk factors for postpartum infection is caesarean delivery.

Caesarean section shows a higher incidence of infection than vaginal delivery.

It is complicated by surgical site infections, endometritis or urinary tract infection.

The aim of the present study was to assess the usage of antimicrobials in women undergoing caesarean section at a Tertiary Care Hospital.

A prospective study was conducted in 100 women during the period of February 2013 to August 2013 in the inpatient Department of Gynaecology and Obstetrics.

Data collected included the age of the patient, gravidity, and type of caesarean section, which was analyzed for the nature and number of antimicrobials prescribed, duration of treatment, polypharmacy, fixed-dose combinations, generic/brand names used and failure of prophylaxis. Antimicrobial prophylaxis was administered to the patients.

The most commonly prescribed antimicrobial was a combination of ceftriaxone and sulbactam. Of 100 patients, 87% were aged 20-35 years.

The highest proportion of patients were primigravida 72%.

Elective procedure was carried out in 38%, the remaining were emergency C-section in whom intra- and post-operative antimicrobial prophylaxis was given for a duration of 7 days.

In total, 27% patients were reported with infection even after the antimicrobial prophylaxis. In conclusion, pre-operative prophylaxis was given in the early rupture of membranes.

Fixed-dose combinations were preferred. Incidence of infection even after antimicrobial prophylaxis was reported due to pre-existing infection, debilitating disease or prolonged rupture of membranes.

Patients with recurrent infection were shifted to amoxicillin and clavulinic acid combination. Drugs were prescribed only by brand names which is of concern.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4950587/pdf/etm-12-02-0961.pdf

February 9, 2018 at 1:16 pm

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