Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

https://www.cdc.gov/coronavirus/mers/downloads/Isolation2007.pdf

2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings.

INTRODUCTION The postmortem observations of Green, published in the Lancet in 1836, were the fi rst to describe the distinct pathological features of tuberculous meningitis and set it apart from the other recognised causes of ‘acute hydrocephalus’ (Green 1836). The challenge for the physician then lay in distinguishing the disease before death, and delivering the grave prognosis. Thomas Mann captures the full horror of this process in Dr Faustus as the helpless Dr Kurbis presides over the agonizing death of a small child from tuberculous meningitis: The whole thing lasted scarcely two weeks, including the earliest signs that all was not quite well with the child; from the beginnings no one – I believe no one at all – even dreamed of the horror to come ... Kurbis tested the child’s eyes, the pupils of which were tiny and showed a tendency to squint. The pulse raced. Muscular contractions developed, and an incipient rigidity of the neck. It was cerebrospinal meningitis, infl ammation of the meninges. The good man pronounced the name with a deprecating movement of the head shoulderwards, probably in the hope that they might not know the almost complete powerlessness of medical science in the face of this onslaught. Tuberculous meningitis was invariably fatal before the advent of anti-tuberculosis chemotherapy. Therefore, the need to diagnose the disorder became a priority after streptomycin was found to reduce mortality of tuberculous meningitis by one third in 1948 (MRC 1948). Progress was rapid over the next 5 years: adding para-aminosalicylic acid to streptomycin reduced mortality to 30%, and the addition of isoniazid to both of these compounds lowered the mortality still more to Robert Koch: photograph taken in the 1880s, around the time of his discovery of the tubercle bacillus (or ‘bacille Koch’, as it is still called in Vietnam).

The diagnosis and management of

Background: Dengue is a growing problem both in its geographical spread and in its intensity, and yet current global distribution remains highly uncertain. Challenges in diagnosis and diagnostic methods as well as highly variable national health systems mean no single data source can reliably estimate the distribution of this disease. As such, there is a lack of agreement on national dengue status among international health organisations. Here we bring together all available information on dengue occurrence using a novel approach to produce an evidence consensus map of the disease range that highlights nations with an uncertain dengue status. Methods/Principal Findings: A baseline methodology was used to assess a range of evidence for each country. In regions where dengue status was uncertain, additional evidence types were included to either clarify dengue status or confirm that it is unknown at this time. An algorithm was developed that assesses evidence quality and consistency, giving each country an evidence consensus score. Using this approach, we were able to generate a contemporary global map of national-level dengue status that assigns a relative measure of certainty and identifies gaps in the available evidence. Conclusion: The map produced here provides a list of 128 countries for which there is good evidence of dengue occurrence, including 36 countries that have previously been classified as dengue-free by the World Health Organization and/or the US Centers for Disease Control. It also identifies disease surveillance needs, which we list in full. The disease extents and limits determined here using evidence consensus, marks the beginning of a five-year study to advance the mapping of dengue virus transmission and disease risk. Completion of this first step has allowed us to produce a preliminary estimate of population at risk with an upper bound of 3.97 billion people. This figure will be refined in future work.

/pdf/refining-the-global-spatial-limits-of-dengue-virus-f8emry0wk5.pdf

Refining the global spatial limits of dengue virus transmission by evidence-based consensus

Cytomegalovirus establishes a lifelong latent infection following primary infection that can periodically reactivate with shedding of infectious virus. Primary infection, reactivation and reinfection during pregnancy can all lead to in utero transmission to the developing fetus. Congenital CMV infections are a major cause of permanent hearing loss and neurological impairment. In this literature review, we found that CMV infection was relatively common among women of reproductive age, with seroprevalence ranging from 45 to 100%. CMV seroprevalence tended to be highest in South America, Africa and Asia and lowest in Western Europe and United States. Within the United States, CMV seroprevalence showed substantial geographic variation as well, differing by as much as 30 percentage points between states, though differences might be explained by variation in the types of populations sampled. Worldwide, seroprevalence among non-whites tended to be 20-30 percentage points higher than that of whites (summary prevalence ratio (PR) = 1.59, 95% confidence interval (CI) = 1.57-1.61). Females generally had higher seroprevalences than males, although in most studies the differences were small (summary PR = 1.13, 95% CI = 1.11-1.14). Persons of lower socioeconomic status were more likely to be CMV seropositive (summary PR = 1.33, 95% CI = 1.32-1.35). Despite high seroprevalences in some populations, a substantial percentage of women of reproductive age are CMV seronegative and thus at risk of primary CMV infection during pregnancy. Future vaccine or educational campaigns to prevent primary infection in pregnant women may need to be tailored to suit the needs of different populations.

Review of cytomegalovirus seroprevalence and demographic characteristics associated with infection.

Background: Cervical cancer caused by human papilloma virus (HPV), is the commonest cancer in Indian women, with an estimated 132000 new cases and 76000 deaths annually. More than 100 HPV genotypes have been identified in humans of which at least 40 HPV types are found in the genital tract. Several high‐risk HPV types are known to cause the disease. There are only limited data available on the genotype distributions in this region. Methods: During the period three different cross‐sectional studies were carried out: (1) a hospital‐based cross‐sectional study in which 106 women presenting with invasive cervical cancer; (2) a hospital‐based cross‐sectional study in which 524 women presenting to have an unhealthy cervix were invited to participate; (3) a community‐based cross‐sectional study in which 465 women also underwent HPV testing. HPV typing in these studies was done by using L1 consensus PCR followed by reverse line blot hybridization assay (Roche). Results: In the hospital‐based population, among 106 invasive cervical cancers the six commonest HPV types were HPV‐16, ‐18, ‐45, ‐59, ‐33 and 73. HPV‐16/18, singly or in combination, were seen in 83% of cases. (2) In the hospital‐based population, among the 524 symptomatic hospital subjects, the overall HPV prevalence was 15.5 % and the six commonest HPV types were as follows: HPV ‐16, ‐89, ‐39, ‐52, ‐33 and 18. Among the HPV positive women accounted for HPV‐16/18 were associated with 34.3%, 45.4% and 65.7% of normal, low‐grade and high‐grade disease respectively. Among (3) the community‐based women, the overall HPV prevalence was 7 % and the six commonest HPV types were as follows: HPV‐ 16, ‐ 45, ‐52, ‐31, ‐66, and ‐18. Conclusions: A wide spectrum of HPV types is seen in north Indian women, with HPV‐16/18 are the commonest types in all populations. However, thereafter there is considerable variation. It is estimated that the HPV ‐16/18 vaccine would reduce over 75% of the total cancer burden in this region. The community population is from a confined geographical area whereas the hospital population includes not only residents of Delhi and neighbouring areas but also further states of North India as well as neighboring countries of Nepal and Bangladesh. Thus more studies are required to establish the true picture of HPV type‐distribution in this large and diverse region. Citation Information: Cancer Res 2009;69(23 Suppl):C59.

Abstract C59: Human papillomavirus genotype distribution in northern India: Implications for vaccination

5540 Background: Among oropharyngeal squamous cell carcinoma (OSCC), the true prevalence of HPV remains variable and studies have estimated that up to 60% may be HPV positive. Patients with HPV pos...

Prevalence, trends, and survival impact of human papillomavirus on oropharyngeal cancer in Indian population.

Oncogenic human papillomavirus types in a high risk population.

Expression and humoral immune response to hepatitis C virus using a plasmid DNA construct.

https://doi.org/10.1016/j.jiph.2022.11.001

Lalit Dar

Papers

Abstract C59: Human papillomavirus genotype distribution in northern India: Implications for vaccination

Prevalence, trends, and survival impact of human papillomavirus on oropharyngeal cancer in Indian population.

Oncogenic human papillomavirus types in a high risk population.

Expression and humoral immune response to hepatitis C virus using a plasmid DNA construct.

Rate of shed of SARS COV-2 viral RNA from COVID-19 cadavers