Weekly Research Round-up #1: January 1-7

This is a recap of all the research articles I found interesting, especially those related to infectious diseases, emerging and reemerging infections, antimicrobial resistance and One Health or EcoHealth approach. This is a regular new series I intend to write about on a regular basis.

1. Should AED Devices Be Routinely Included in Wilderness Medical Kits?
   • This article, published in the journal Wilderness and Environmental Medicine grapples with a basic question that plagues traige and early management of wilderness and competitive adventure related issues: whether to include an automated external defibrillator (AED) in the kit.
   • The jury is still out on the utility of the inclusion of the now ubiquitously available AED in the wilderness and adveture lovers’ kits.

1. Cervical amoebiasis mimicking cervical carcinoma: A rare presentation of a common infection
   • The Journal of Infection and Public Health reports the presentation of a rare complication of a common ailment: a patient with cervical amebiasis presented with clinical features mimicking cervical carcinoma.
   • Fortunately, the identification of trophozoites in the clinical specimen helped clinched the diagnosis and the patient made a complete and uneventful recovery following treatment with Metronidazole and Diloxanide Furoate.
   • The question remains: how much of a clinical index of suspicion should we maintain for such rare cases?

1. Dengue, chikungunya and Zika co-infection in a patient from Colombia
   • With the emergent Zika virus sweeping through large tracts of Latin America, it was only a matter of time before such a report came out. The Journal of Infection and Public Health reports a case with co-infection of dengue, chikungunya and Zika viruses from a patient in Colombia. With increasing overlap in the endemic zones for these viruses, it is only reasonable to expect more and more patients to report with co-infection of two or more of these arboviruses.
   • The obvious problem is identifying effective means to control the spread of these agents in developing countries.
   • The challenge will be two folds:
     1. Developing sensitive and specific diagnostics that help in appropriate diagnosis, and ruling out chances of cross-immunity confounding the diagnostic process
     2. Identifying whether all agents in the co-infected patient are responsible for disease causation or there is an innocent bystander effect in the mix.

1. Health literacy and Infectious Diseases: Why does it matter?
   • Infectious disease prevention and control is a complex issue which needs to address several systems and behavior patterns which may be changed through sustained investment aimed at improving health literacy.
   • The International Journal of Infectious Diseases reports a study based on search of multiple databases which found that health literacy was patchy in preventive issues like hand hygiene and diarrhea, prevention of tuberculosis, etc.
   • Lack of health literacy was associated with poor adoption of protective behaviors. There needs to be a more concerted effort which considers the infectious diseases within a wider set of determinants, including systems, environmental and human/behavioral factors.

1. Impacts of neglected tropical disease on incidence and progression of HIV/AIDS, tuberculosis, and malaria: scientific links 
   • A large proportion of the Sub-Saharan population living below the poverty line are affected by neglected tropical diseases. This paper in the International Journal of Infectious Diseases goes on to describe the impact
   • The study concludes: “A combination of immunological, epidemiological, and clinical factors can contribute to these interactions and add to a worsening prognosis for people affected by HIV/AIDS, TB, and malaria. Together these results point to the impacts of the highest-prevalence NTDs on the health outcomes of malaria, HIV/AIDS, and TB and present new opportunities to design innovative public health interventions and strategies for these ‘big three’ diseases.”

1. Bridging the gap between evidence and policy for infectious diseases: How models can aid public health decision-making
   • This article, published in the International Journal of Infectious Diseases points to a very critical aspect of decision making in infectious diseases. The criticism that a lot of the decision making in infectious diseases is driven by expert opinion is a valid one, and one that we have to turn to because of the lack of comprehensive data. In this paper, the authors contend that a closer relationship between the disciplines of mathematical modeling and public health could help solve the problem.
   • The authors have used a novel diagnostic technique for diagnosis of tuberculosis to develop a framework of collaboration between public health personnel and mathematical modellers.
   • The authors clearly articulate the issues related to the difficulty of understanding and creating mathematical models – something which is a real barrier for public health doctors because of their limited exposure to higher mathematics.

1. First report of New Delhi metallo-β-lactamase 5 (NDM-5)-producing Escherichia coli from blood cultures of three leukemia patients
   • When the superbug scare first hit, in addition to the biological and medical apprehensions, there was a huge political fall out concerning the name of the newly identified multidrug resistant bacteria. With time, those debates have been buried, somewhat.
   • In the International Journal of Infectious Diseases, the authors have reported three leukemia patients from China, all of whom had attended the same ICU, and ended up as some of the first known people to suffer from New Delhi metallo beta lactamase 5 producing, carbapenem resistant E coli.

1. First case report of bacteremia due to ‘Campylobacter-like organism 3’
   • Campylobacter like organism 3 (CLO3) is a rare strain of Helicobacter which has not been known to cause bacteremia… till now. CLO3 has been previously identified as a cause for enterocolitis, but it is SO new, that there has been no official species definition as of now.
   • A 75 year old man, suffering from prostate cancer and having an indwelling catheter, suffered from bacteremia caused by CLO3.
   • The authors state: Biochemical testing indicated that the isolates were catalase-positive, negative for nitrate reduction and urease activity, and positive for indoxyl acetate hydrolysis. The isolate was identified as CLO-3 by sequence analysis of the 16S rRNA and hsp60 genes. Although CLO-3 is known to cause enterocolitis, bacteremia due to CLO-3 has not been described. There have been an increasing number of reports of bacteremia caused by Helicobacter cinaedi and Helicobacter fennelliae, which were first reported as CLO-1 and CLO-2, and CLO-3 may represent another emerging cause of Helicobacter-induced bacteremia.

1. Ethics of ART interruption after stem-cell transplantation
   • A very interesting article in the Lancet HIV this week deals with the ethical dilemma of stopping ART in patients after hemopoietic stem cell transplantation. This comes in the wake of the cure of Timothy Brown, better known in the popular media as The Berlin Patient, who received two HSCTs from a donor who was homozygous for CCR5Δ32 mutation.
   • The real question was whether this would prove to be similarly miraculous in other patients. Subsequently four more patients received similar HSCTs, with only one of them receiving it from a donor with a homozygous CCR5Δ32 mutation.
   • Unfortunately, the ART interruption followed by the HSCTs have not gone down too well; all four patients seemed to have suffered from a rebound in viral counts post transplant, after ART interruption, and landed up with morbidity related to this.
   • The ethical nature of this ART interruption remains debatable, considering that this seems like a therapeutic trial, against an established treatment mode. Unfortunately, the article is behind a paywall, so I could not get at the full text. But this promises to be an interesting debate as we inch closer to understanding what lay behind the cure of the Berlin Patient.

1. BMC Medicine brings tutorials on Peer review
   • This is basically a set of tutorials and an accompanying covering editorial that introduces the basics of peer review for junior reviewers and young scientists. I read through a couple of these articles and they seemed quite instructional!
   • The covering Editorial by Sabina Alam and Jigisha Patel: Peer review: tips from field experts for junior reviewers
   • It is always a tough business reading and reviewing randomized controlled trials and this tutorial breaks it down for young researchers: A guide to performing a peer review of randomised controlled trials.
   • Statistical analysis has always been a major pain in the neck for reviewers and scientists alike. For those like me, who do not have traditional and conventional training in statistics, but whose work is intricately woven around the statistical niche, this tutorial by Darren Greenwood and Jennifer Freeman makes for a welcome read: How to spot a statistical problem: advice for a non-statistical reviewer.
   • With the rapid emergence of systematic reviews and meta analyses as the gold standard in the world of evidence based medicine, it is imperative that young reviewers are conversant in the techniques of appraisal of SR/MAs. This tutorial by David Moher stresses on how to leverage existing tools and check lists to ensure robust review of systematic reviews and meta analyses: Optimal strategies to consider when peer reviewing a systematic review and meta-analysis.

Word of the Week: Autochthonous Transmission

• The word autochthonous literally means “native to the soil”
• Autochthonous Transmission refers to the transmission of a communicable disease from one infected person, to a susceptible person, in a particular geographic area, which is endemic for that disease.
• With the climate change kicking in, there has been an increase in the geographic range of vectors and as a result, areas which were previously not known for diseases like malaria and dengue are now suffering from them. Naturally, visitors to such places are at risk of acquiring the disease.

That is all I had this week. If something caught your eye and you would like to point me in its direction, please do drop in a comment.