381 research outputs found
Trachipleistophora hominis infection in the myocardium and skeletal muscle of a patient with AIDS
No full textCurry, A. ; Beeching, N.J. ; Gilbert, J.D. ; Scott, G. ; Rowland, P.L. ; Currie, B.J
Brucella canis workshop
No full textWe are excited to announce the organisation of the joint Workshop - "B.canis in Europe: Gaps and challenges in controlling the spread", between two OH EJP projects, COHESIVE and IDEMBR, on May 18th 2021. The workshop will start at 09:45 (CET) and will be first of many regarding the current knowledge, issues and unknowns about Brucella canis, one of the Europe's fastest developing pathogens. The workshop agenda is attached.
We are excited to see you all there, and are looking forward to an informative and productive discussion!
Best regards,
The organising committee,
Rob Dewar (APHA), Elina Lahti (SVA), Claire Ponsart (ANSES), John McGiven (APHA), Kitty Maassen (RIVM), Emily Dobell (PHE), Falk Melzer (FLI), Nicholas Beeching (NHS), Fabrizio De Massis (IZSAM), Andrew Frost (APHA), Charlotte Cook (APHA), Alessandro Gerada (NHS
Brucellosis in pregnancy: results of multicenter ID-IRI study
No full textdemirdal, tuna/0000-0002-9046-5666; cag, yakup/0000-0002-3855-7280; Beeching, Nicholas/0000-0002-7019-8791Brucellosis in pregnant women is reported to be associated with obstetric complications (OCs), and adequate data for human brucellosis during pregnancy are largely lacking. We performed this multicenter retrospective cross-sectional study to evaluate the epidemiology, clinical course, treatment responses, and outcomes of brucellosis among pregnant women. The study period comprised a 14-year period from January 2002 to December 2015. All consecutive pregnant women diagnosed with brucellosis in 23 participating hospitals were included. Epidemiological, clinical, laboratory, therapeutic, and outcome data along with the assessment data of the neonate were collected using a standardized questionnaire. Data of 242 patients were analyzed. The OC rate was 14.0% (34/242) in the cohort. Of the 242 women, 219 (90.5%) delivered at term, 3 (1.2%) had preterm delivery, 15 (6.2%) aborted, and 5 (2.1%) had intrauterine fetal demise. Seventeen (7.0%) of the newborns were considered as low birth weight. Spontaneous abortion (6.1%) was the commonest complication. There were no maternal or neonatal deaths and pertinent sequelae or complications were not detected in the newborns. Splenomegaly (p=0.019), nausea and/or vomiting (p41IU/L; p=0.025), oligohydramnios on ultrasonography (p=0.0002), history of taking medication other than Brucella treatment during pregnancy (p=0.027), and Brucella bacteremia (p=0.029) were the significant factors associated with OCs. We recommend that pregnant women with OC or with fever should be investigated for brucellosis if they live in or have traveled to an endemic area
Developing and applying serological and molecular skills to the virological analysis of HIV-infected patients from Kumasi, Ghana
No full textBackground : Virological monitoring is critical in the management of HIV-infected patients, providing a standard in the assessment of disease prognosis and progression, guiding the initiation of ART and treatment selection, monitoring therapeutic success and establishing treatment failure and drug resistance. The absence of viral load monitoring can impact upon individual and public health through failure to maintain viral suppression, and increased risk of drug resistance. HIV management at the KATH HIV clinic, Kumasi, Ghana, does not include virological monitoring due to the lack of laboratory infrastructure and technical skills, thus the virological response to ART among treated patients at the centre is not fully understood. Moreover, data on the prevalence of HCV infection in both the general population and HIV-positive patients in Ghana are limited, with seroprevalence estimates ranging from 0.5% to 18.7% documented among different Ghanaian populations, possibly due to differences in study populations and the serological assays employed. Furthermore, these previous studies did not attempt confirmation of HCV status by PCR or RIBA. The aim of this study is to determine the HIV virological response in a HIV/HBV co-infected cohort from KATH, ascertain the specificity and sensitivity of commercially available HCV serological assays, and develop an assay that could be used as an alternative for HCV RNA testing in Kumasi.
Methods: 247 HIV/HBV co-infected patients attending the KATH HIV clinic were recruited into a prospective HIV and viral hepatitis study, of which HIV-1 viral load was determined for 183 ART-experienced patients at study entry using the Abbott Real Time HIV-1 assay. The HIV-1 viral load detection among patients who had been on ART for at least 24 weeks was assessed. HIV positive samples from KATH with known HCV-RNA status were tested with two automated anti-HCV antibody assays, the Abbott Architect anti-HCV, Vitros Anti-HCV, and two manual EIAs, Monolisa HCV Ag-Ab ULTRA, and the ORTHO HCV 3.0 ELISA System with Enhanced SAVe. Of the last three assays the performance and the respective assay cut-offs likely to be indicative of RNA positivity were evaluated using their PCR and Architect results as reference. The development of an in-house indirect sandwich HCV core antigen EIA which could be used as an alternative for HCV-RNA testing was attempted.
Results: Overall, 58/183 (37.4%) patients who received treatment for at least 24 weeks showed a viral load >40 copies/mL with a median level of 826 copies/mL (IQR: 65 - 26752). Their CD4 T-cell counts were lower compared to patients with undetectable viral load (P= 0.002, Mann Whitney U test). Among the four HCV antibody assays the Ortho was found to be the most specific assay that could be employed in a limited resource setting such as Kumasi, and an S/CO ratio of 3.65 was found to be most likely to be indicative of HCV RNA positivity. The HCV core EIA development was not completed in time due to poor activity of commercially available agents.
Conclusion: Through this study, skills in HIV viral load and EIA development have been acquired that could be applied to improve virological monitoring at KATH with the necessary infrastructure in place. Further studies are required to identify factors that are associated with poor viral response in this cohort. The ORTHO HCV 3.0 ELISA System with Enhanced SAVe can be regarded as a suitable diagnostic tool for HCV infection in Kumasi, but further studies are required to establish the S/CO ratio most likely to be indicative of HCV RNA positivity
Training and assessment of medical specialists in clinical microbiology and infectious diseases in Europe
No full textBackground: There is wide variation in the availability and training of specialists in the diagnosis and management of infections across Europe. Objectives: To describe and reflect on the current objectives, structure and content of European curricula and examinations for the training and assessment of medical specialists in Clinical (Medical) Microbiology (CM/MM) and Infectious Diseases (ID). Sources: Narrative review of developments over the past two decades and related policy documents and scientific literature. Content: Responsibility for curricula and examinations lies with the European Union of Medical Specialists (UEMS). The ID Section of UEMS was inaugurated in 1997 and the MM Section separated from Laboratory Medicine in 2008. The sections collaborate closely with each other and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). Updated European Training Requirements (ETR) were approved for MM in 2017 and ID in 2018. These comprehensive curricula outline the framework for delivery of specialist training and quality control for trainers and training programmes, emphasizing the need for documented, regular formative reviews of progress of trainees. Competencies to be achieved include both specialty-related and generic knowledge, skills and professional behaviours. The indicative length of training is typically 5 years; a year of clinical training is mandated for CM/MM trainees and 6 months of microbiology laboratory training for ID trainees. Each Section is developing examinations using multiple choice questions to test the knowledge base defined in their ETR, to be delivered in 2022 following pilot examinations in 2021. Implications: The revised ETRs and European examinations for medical specialists in CM/MM and ID provide benchmarks for national authorities to adapt or adopt locally. Through harmonization of postgraduate training and assessment, they support the promotion and recognition of high standards of clinical practice and hence improved care for patients throughout Europe, and improved mobility of trainees and specialists. Nick J. Beeching, Clin Microbiol Infect 2021;27:1581 (c) 2021 The Author(s). Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/)
The Spatial Impacts of a Massive Rail Disinvestment Program: The Beeching Axe
No full textTransport investment is a popular policy instrument and many recent studies have investigated whether new infrastructure generates economic benefits and has spatial economic impacts. Our work approa ches the question differently and looks at what happens when a substantial part of a national railway network is dismantled, as happened during the 1950s, 60s and 70s in Britain. Part of this disinvestment occurred following controversial reports on railwa y profitability and structure in the early 1960s – a course of action known colloquially as ‘the Beeching Axe’ after the author of the reports. The removal of railways is often blamed for the decline of rural areas and peripheral towns in post -war Britain. This rail disinvestment program was targeted at removal of underused and unprofitable lines and not specifically targeted at local economic performance. Even so, we find that there is a relationship between pre -war population decline and the depth of the rail cuts in the post 1950 period. Conditional on these pre -trends, we show that loss of access by rail did cause relative population decline, decline in the proportion of skilled workers, and decline in the proportion of young people in affected areas. The elasticity of population with respect to changes in centrality (or mark et access) is around 0.3 in our main estimates. Instrumental variables estimates based on the network structure of the cuts yield higher elasticities. An implication of these findings is that rail transport infrastructure plays an important role in shaping the spatial structure of the economy
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