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Hayon J, Lupo S, Poveda C, Jones KM, Qian Q, Wu H, Giordano TP, Fleischmann CJ, Bern C, Whitman JD, Clark EH. Adaptation of Chagas Disease Screening Recommendations for a Community of At-risk HIV in the United States. Clin Infect Dis 2024; 78:453-456. [PMID: 37805935 DOI: 10.1093/cid/ciad616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/05/2023] [Accepted: 10/04/2023] [Indexed: 10/10/2023] Open
Abstract
Chagas disease (CD), caused by Trypanosoma cruzi, is underdiagnosed in the United States. Improved screening strategies are needed, particularly for people at risk for life-threatening sequelae of CD, including people with human immunodeficiency virus (HIV, PWH). Here we report results of a CD screening strategy applied at a large HIV clinic serving an at-risk population.
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Affiliation(s)
- Jesica Hayon
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Sofia Lupo
- McGovern School of Medicine, University of Texas, Houston, Texas, USA
| | - Cristina Poveda
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
- Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Hospital Center for Vaccine Development, Houston, Texas, USA
| | - Kathryn M Jones
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
- Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Hospital Center for Vaccine Development, Houston, Texas, USA
| | - Qian Qian
- Department of Biostatistics & Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Hulin Wu
- Department of Biostatistics & Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Thomas P Giordano
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Charles J Fleischmann
- Department of Laboratory Medicine, University of California SanFrancisco School of Medicine, San Francisco, California, USA
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Jeffrey D Whitman
- Department of Laboratory Medicine, University of California SanFrancisco School of Medicine, San Francisco, California, USA
| | - Eva H Clark
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
- Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
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Kelly EA, Echeverri Alegre JI, Promer K, Hayon J, Iordanov R, Rangwalla K, Zhang JJ, Fang Z, Huang C, Bittencourt CE, Reed S, Andrade RM, Bern C, Clark EH, Whitman JD. Chagas Disease Diagnostic Practices at Four Major Hospital Systems in California and Texas. J Infect Dis 2024; 229:198-202. [PMID: 37853514 PMCID: PMC11032249 DOI: 10.1093/infdis/jiad404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/15/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Chagas disease (CD) is a parasitic disease that affects ∼300 000 people living in the United States. CD leads to cardiac and/or gastrointestinal disease in up to 30% of untreated people. However, end-organ damage can be prevented with early diagnosis and antiparasitic therapy. METHODS We reviewed electronic health records of patients who underwent testing for CD at four hospital systems in California and Texas between 2016 and 2020. Descriptive analyses were performed as a needs assessment for improving CD diagnosis. RESULTS In total, 470 patients were tested for CD. Cardiac indications made up more than half (60%) of all testing, and the most frequently cited cardiac condition was heart failure. Fewer than 1% of tests were ordered by obstetric and gynecologic services. Fewer than half (47%) of patients had confirmatory testing performed at the Centers for Disease Control and Prevention. DISCUSSION Four major hospitals systems in California and Texas demonstrated low overall rates of CD diagnostic testing, testing primarily among older patients with end-organ damage, and incomplete confirmatory testing. This suggests missed opportunities to diagnose CD in at-risk individuals early in the course of infection when antiparasitic treatment can reduce the risk of disease progression and prevent vertical transmission.
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Affiliation(s)
- Emily A Kelly
- Department of Laboratory Medicine, University of California, SanFrancisco, San Francisco, California, USA
| | | | - Katherine Promer
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, California, USA
| | - Jesica Hayon
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Roumen Iordanov
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Khuzaima Rangwalla
- School of Medicine, University of California, SanFrancisco, San Francisco, California, USA
| | - Jerry J Zhang
- School of Biological Sciences, University of California, Irvine, Irvine, California, USA
| | - Zian Fang
- School of Biological Sciences, University of California, Irvine, Irvine, California, USA
| | - Cindy Huang
- School of Biological Sciences, University of California, Irvine, Irvine, California, USA
| | | | - Sharon Reed
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, California, USA
- Department of Pathology, University of California, San Diego, San Diego, California, USA
| | - Rosa M Andrade
- Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, California, USA
| | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Eva H Clark
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Jeffrey D Whitman
- Department of Laboratory Medicine, University of California, SanFrancisco, San Francisco, California, USA
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Kelly GA, Iordanov R, Franklin A, Ahmed A, Srinivasan K, Hayon J, Lasco T, Amini R, Shay S, Kulkarni PA, Al Mohajer M. Impact of gastrointestinal polymerase chain reaction panels on antibiotic utilization in hospitalized adult patients. Antimicrob Steward Healthc Epidemiol 2023; 3:e135. [PMID: 37592964 PMCID: PMC10428147 DOI: 10.1017/ash.2023.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 08/19/2023]
Abstract
Multiplex stool polymerase chain reaction (PCR) panels offer rapid comprehensive testing for patients with infectious diarrhea. We compared antibiotic utilization among hospitalized patients with suspected infectious diarrhea who underwent diagnostic testing with either a stool culture or stool PCR panel. No significant differences in antibiotic utilization were identified.
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Affiliation(s)
- Gillean A. Kelly
- Baylor College of Medicine, School of Medicine, Houston, Texas
- University of Texas Health Science Center at Houston, School of Public Health, Houston, Texas
| | - Roumen Iordanov
- Baylor College of Medicine, Department of Medicine, Section of Infectious Diseases, Houston, Texas
| | - Alex Franklin
- Baylor College of Medicine, Department of Medicine, Section of Infectious Diseases, Houston, Texas
| | - Amna Ahmed
- Baylor College of Medicine, Department of Medicine, Section of Infectious Diseases, Houston, Texas
| | - Krithika Srinivasan
- Baylor College of Medicine, Department of Medicine, Section of Infectious Diseases, Houston, Texas
| | - Jesica Hayon
- Baylor College of Medicine, Department of Medicine, Section of Infectious Diseases, Houston, Texas
| | - Todd Lasco
- Baylor College of Medicine, Department of Pathology & Immunology, Houston, Texas
| | - Rosie Amini
- Premier Inc., Department of Clinical Intelligence, Charlotte, North Carolina
| | - Sabra Shay
- Premier Inc., Department of Clinical Intelligence, Charlotte, North Carolina
| | - Prathit A. Kulkarni
- Baylor College of Medicine, Department of Medicine, Section of Infectious Diseases, Houston, Texas
- Michael E. DeBakey Veterans Affairs Medical Center, Medical Care Line, Houston, Texas
| | - Mayar Al Mohajer
- Baylor College of Medicine, Department of Medicine, Section of Infectious Diseases, Houston, Texas
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Kelly G, Iordanov R, Franklin A, Ahmed A, Srinivasan K, Hayon J, Lasco TM, Amini R, Shay S, Kulkarni PA, Mohajer MA. 185. Implementation of Multiplex Polymerase Chain Reaction in Clinical Practice: Impact on Antimicrobial Management In Infectious Diarrhea. Open Forum Infect Dis 2022. [PMCID: PMC9751986 DOI: 10.1093/ofid/ofac492.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Stool culture and stool polymerase chain reaction (PCR) panels are both used to evaluate patients with suspected infectious diarrhea. Stool PCR panels are especially advantageous because of their ability to detect a broad array of infectious pathogens in less than one hour. Our study assessed how the use of stool PCR panels instead of stool culture impacted antibiotic days of therapy (DOT) and length of therapy (LOT) in hospitalized patients with suspected infectious diarrhea. Methods In December 2021, an intervention was implemented in our hospital in which all electronic orders for stool cultures were automatically switched to stool PCR testing. The pre-intervention group was comprised of 75 hospitalized adult patients who had a stool culture obtained from September to November 2021. The post-intervention group was comprised of 81 adult patients who had a stool PCR obtained from December 2021 to February 2022. The DOT and LOT for antibiotics prescribed specifically for infectious diarrhea were determined for each patient; DOT and LOT were compared between the pre- and post- intervention groups. Results The median DOT in the pre- and post-intervention groups was 0 with a range of 0-10 and 0-8, respectively. The median LOT in the pre- and post-intervention groups was 0 (range 0-5 for both groups). No significant difference in the median DOT (Wilcoxon rank sum test, p-value = 0.967) or LOT (Wilcoxon rank sum test, p-value = 0.993) was found between the pre- and post-intervention groups (Figure 1). After adjusting for patient days present, no significant change in DOT or LOT incidence rate was found between the pre- and post-intervention groups. The DOT incidence rate ratio (RR) was 0.71 (95% CI 0.42, 1.22), and the LOT incidence RR was 0.67 (95% CI 0.36, 1.24).
DOT and LOT Comparisons between Pre- and Post-Intervention Groups ![]() Antibiotic days of therapy (DOT) stratified by study period (top) and antibiotic (LOT) stratified by study period (bottom). Conclusion An intervention of automatically changing stool culture testing to stool PCR testing did not result in a significant change in median DOT or LOT in hospitalized adult patients, nor did it result in a significant change in DOT or LOT incidence rate. These findings could be explained by an insufficient sample size (n = 156), limiting the study’s power. Additionally, most patients in the pre-intervention group received no antibiotics for infectious diarrhea, resulting in a short DOT and LOT at baseline. Disclosures Sabra Shay, BSN, MPH, Premier Inc.: Employee Prathit A. Kulkarni, M.D., Vessel Health, Inc.: Grant/Research Support.
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Affiliation(s)
- Gillean Kelly
- Baylor College of Medicine / The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas
| | | | | | - Amna Ahmed
- Baylor College of Medicine, Houston, Texas
| | | | | | - Todd M Lasco
- Baylor St. Luke's Medical Center, Houston, Texas
| | - Rosie Amini
- Premier Healthcare Inc., Seattle, Washington
| | | | - Prathit A Kulkarni
- Michael E. DeBakey VA Medical Center / Baylor College of Medicine, Houston, Texas
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Kaplan J, Centeno FH, Hayon J, Bottazzi ME, Hotez PJ, Weatherhead JE, Clark E, Woc-Colburn L. Reviewing a Decade of Outpatient Tropical Medicine in Houston, Texas. Am J Trop Med Hyg 2022; 106:1049-1056. [PMID: 35226869 PMCID: PMC8991353 DOI: 10.4269/ajtmh.21-1059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/12/2021] [Indexed: 12/15/2022] Open
Abstract
Tropical diseases cause significant morbidity among the world's poorest populations. Although more common in low- and middle-income countries, tropical diseases are also found among underserved populations living in high-income countries such as the United States. The National School of Tropical Medicine at Baylor College of Medicine and the Harris Health System founded a tropical medicine clinic-the Harris Health Tropical Medicine Clinic (HHTMC)-in Houston in 2011 in response to tropical disease-related morbidity in Texas. We conducted a retrospective chart review of a sample of patients older than 18 years of age who were referred to the HHTMC between October 2011 and January 2020. Of the 523 patients reviewed, 185 (35.4%) had mycobacterial infections, 184 (35.2%) had parasitic infections, 38 (7.3%) had fungal infections, 16 (3.1%) had eosinophilia without a confirmed clinical diagnosis, 28 (5.4%) had bacterial infections, and 13 (2.5%) had viral infections. The most common infections overall were extrapulmonary and latent tuberculosis (n = 169), neurocysticercosis (n = 78), strongyloidiasis (n = 28), Chagas disease (n = 25), and schistosomiasis (n = 12). The epidemiology of tropical diseases in the United States is understudied at national and regional levels. This 10-year retrospective study contributes to bridging this knowledge gap by detailing the frequencies of tropical disease diagnoses made at the HHTMC in Houston, TX. These data highlight areas for advancement in the field of tropical medicine within the United States, such as improving front-line health-care provider education; establishing tropical medicine clinics in areas of high prevalence such as the Gulf Coast, Appalachia, and urban areas; and developing comprehensive, systematic national tropical disease screening programs and patient registries.
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Affiliation(s)
- Julika Kaplan
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - Jesica Hayon
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas
| | - Maria Elena Bottazzi
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
| | - Peter J. Hotez
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
| | - Jill E. Weatherhead
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Eva Clark
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
- Health Services Research, Michael E. DeBakey VA Health Services Research Center of Innovations, Houston, Texas
| | - Laila Woc-Colburn
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
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Hayon J, Weatherhead JE, Clark E. 957. Evaluation of Chagas Disease Knowledge Among Providers Caring for At-risk People with HIV. Open Forum Infect Dis 2021. [DOI: 10.1093/ofid/ofab466.1152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Chagas disease (CD) is underdiagnosed in the United States due to limited healthcare provider awareness of the disease. Improving provider CD knowledge is important because >200,000 people living in the US are estimated to have CD, and 20-30% of those will develop related cardiac or gastrointestinal disease. People with HIV (PWH) and CD additionally are at risk for CD reactivation, which carries a >70% mortality rate.
Methods
The overall objective of this quality improvement project was to improve provider knowledge of CD prior to implementation of a CD screening initiative at a large HIV clinic in Houston, TX where >5,000 PWH are seen annually (~60% Latinx). We administered the survey to providers at this clinic before and after a 1-hour CD educational session, which included information about CD epidemiology, risk factors, transmission, screening, diagnostic strategies, and available treatments.
Results
Of 33 providers who took the pre-survey (16 faculty, 14 fellows, and 3 medical students), 27 (81.8%) completed all questions. Of 21 providers who took the post-survey (12 faculty, 6 fellows, and 3 medical students), 19 (90.5%) completed all questions. We identified the following CD knowledge gaps (i.e., questions initially answered incorrectly by >25% in the pre-educational session survey): CD transmission, regions of CD endemicity, CD risk factors, organ systems impacted by CD in PWH, and CD testing/follow-up procedures. In the post-educational session survey, we observed significant improvement in providers’ knowledge of CD epidemiology (correct selection of estimated number of people living with CD in the US improved from 26.7% to 90.5%, Fisher’s exact p< 0.0001), transmission (correct selection of “mother-to-child” answer improved from 73.3% to 100%, p=0.0150), and selection of correct CD testing answers improved from 51.9% to 85%, p=0.0286.
Conclusion
Improved CD awareness among healthcare providers and reliable systematic screening protocols are important in at-risk populations. Through simple administration of a 1-hour educational session, we identified and improved several CD knowledge gaps. We noted significant improvement in providers’ confidence in their CD knowledge, specifically in epidemiology, transmission, and diagnostic and screening testing.
Disclosures
All Authors: No reported disclosures
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Affiliation(s)
| | | | - Eva Clark
- Baylor College of Medicine, Houston, Texas
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Kelly EA, Echeverri Alegre JI, Promer K, Hayon J, Iordanov R, Zhang JJ, Fang Z, Huang C, Bittencourt C, Reed SL, Andrade R, Bern C, Clark E, Whitman J. 742. Evaluation of Chagas Disease Diagnostic Testing Practices in Four Hospital Systems in California and Texas. Open Forum Infect Dis 2021. [DOI: 10.1093/ofid/ofab466.939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Chagas disease (CD) is a neglected parasitic disease that affects >6 million people in the Americas, including >200,000 people in the United States (US). Medical provider knowledge of CD is key to decreasing morbidity and transmission; however, few studies have assessed diagnostic practices in US health systems serving at-risk patients. Our study aimed to describe existing provider approaches to diagnosing CD in California and Texas.
Methods
Site-based research teams at four hospital systems (the University of California [UC] San Francisco [UCSF], San Diego [UCSD], Irvine [UCI], and the Harris Health System [HHS] in Houston, TX) retrospectively identified patients ≥18 years old tested for CD between 2016-2019 and systematically extracted electronic medical record data using complementary electronic data entry forms. Specifically, eligible patients were identified using laboratory orders at UCSF and UCI, while the remaining sites employed SlicerDicer (Epic Systems). This study was approved by institutional review boards at each site.
Results
We identified 333 patients tested for CD, including 109 from UCSF, 88 from UCSD, 25 from UCI, and 111 from HHS. These patients had 125, 99, 31, and 181 tests sent to commercial laboratories, respectively. Test reactivity varied by system with the greatest percent reactivity among tests ordered at UCI (23%) followed by UCSD (16%), HHS (15%), and UCSF (10%). Among patients who screened positive for CD by commercial assays, confirmatory testing through the Centers for Disease Control and Prevention was sought for 100% at UCI; 59% at HHS, 55% at UCSF, and 40% at UCSD. The medical specialty that most often ordered CD testing was Cardiology at all UC sites (UCSF, 50%; UCSF, 55%; UCI, 35%) and Internal Medicine at HHS (46%; Cardiology ordered 13%). Only one recorded CD test was ordered by an Obstetrics/Gynecology service at any site.
Conclusion
These early results report positivity rates between our healthcare systems and demonstrate inconsistency in attaining recommended confirmatory testing, as well as a paucity of CD testing ordered through Obstetrics/Gynecology despite risk of congenital transmission. These findings suggest areas of opportunity to improve provider awareness and lay a foundation for standardizing CD diagnostic practices in the US.
Disclosures
Caryn Bern, MD, MPH, UpToDate (Wolters Kluwer) (Other Financial or Material Support, Author Royalties)
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Affiliation(s)
- Emily A Kelly
- University of California, San Francisco, San Francisco, CA
| | | | | | | | | | | | - Zian Fang
- University of California, Irvine, Irvine, CA
| | - Cindy Huang
- University of California, Irvine, Irvine, CA
| | | | | | | | - Caryn Bern
- University of California, San Francisco, San Francisco, CA
| | - Eva Clark
- Baylor College of Medicine, Houston, TX
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Abstract
Trichuriasis known as whipworm infection caused by Trichuris trichiura, is a highly prevalent soil-transmitted helminthiasis in low- and middle-income countries located in tropical and subtropical areas and affecting approximately 360 million people. Children typically harbour the largest burden of T. trichiura and they are usually co-infected with other soil-transmitted helminth (STH), including Ascaris lumbricoides and hookworm. The consequences of trichuriasis, such as malnutrition and physical and cognitive growth restriction, lead to a massive health burden in endemic regions. Despite the implementation of mass drug administration of anthelminthic treatment to school-age children, T. trichiura infection remains challenging to control due to the low efficacy of current drugs as well as high rates of post-treatment re-infection. Thus, the development of a vaccine that would induce protective immunity and reduce infection rate or community faecal egg output is essential. Hurdles for human whipworm vaccine development include the lack of suitable vaccine antigen targets and animal models for human T. trichiura infection. Instead, rodent whipworm T. muris infected mouse models serve as a major surrogate for testing immunogenicity and efficacy of vaccine candidates. In this review, we summarize recent advances in animal models for T. trichiura antigen discovery and testing of vaccine candidates, while providing an overall view of the current status of T. trichiura vaccine development.
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Affiliation(s)
- Jesica Hayon
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA
| | - Jill Weatherhead
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatrics, Section of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Peter J Hotez
- Department of Pediatrics, Section of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, TX77030, USA
| | - Maria Elena Bottazzi
- Department of Pediatrics, Section of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, TX77030, USA
| | - Bin Zhan
- Department of Pediatrics, Section of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, TX77030, USA
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Mejias-Carpio IE, Paniz-Mondolfi AE, Mogollon-Rodriguez EA, Delgado-Noguera LA, Sordillo EM, Urbina-Medina HA, Hayon J, Vetencourt-Pineda LA, Perez-Garcia LA. Assessment of Malnutrition and Intestinal Parasitoses in the Context of Crisis-Hit Venezuela: A Policy Case Study. Front Sustain Food Syst 2021. [DOI: 10.3389/fsufs.2021.634801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Venezuela is in the midst of a humanitarian crisis with a dangerous cocktail of hyperinflation, violence, minimal local food production, and policies that impact the nutrition for millions of Venezuelans. Independent data suggests that most Venezuelans are food insecure, with alarming rates of acute and chronic malnutrition, especially among children. A re-emergence of poverty-related intestinal parasitoses and anemia has aggravated their health. With little to no response from public authorities, Venezuela is now the lowest-ranked country in the world in deworming coverage. Modest independent and private epidemiological studies suggest prevalence rates as high as 60% in some regions. This article reviews public health policies regarding malnutrition and intestinal parasitoses and aims to provide a rational approach based on international recommendations for countries in crisis.
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Li P, Hayon J, Mahowald C. ACUTE MANIA: AN UNUSUAL PRESENTATION OF SMALL CELL LUNG CANCER. Chest 2020. [DOI: 10.1016/j.chest.2020.05.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Hayon J, Dapkins I, Shahin G, Colella D, Jrada M, Bhakta D, Allen. Pasco N. 311. Hepatitis C Screening Within a Large FQHC Network in Brooklyn, New York: How We Measure Across an Ethnically Diverse Population. Open Forum Infect Dis 2019. [PMCID: PMC6809810 DOI: 10.1093/ofid/ofz360.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background With over 100,000 unique lives and 600,000 visits in 2018, The Family Health Centers at NYU Langone (FHC) is one of the largest Federally Qualified Health Center network based primarily in Southwest Brooklyn New York. Within the catchment area 48% of the population report being born out of the United States, with 30% of the population describing themselves of Asian ethnicity and 42% as Latino [1]. Effective January 1, 2014 New York State law mandated hepatitis C screening to be offered to every individual born between 1945 and 1965 receiving health services. Now five years later, with the advancements in treatment options and increased access for patients where cost has become prohibitive we retrospectively reviewed how our performance has been prior to embarking on a goal of 60% screening compliance. Methods We performed a retrospective chart review looking at a denominator of patients born between 1945 and 1965 who were seen in the FHC for a visit in 2018. Patients who were previously screened since 2016, have a diagnosis of hepatitis C, history of hepatitis C documented in either past medical history, problem list or ICD code were excluded. Data abstraction for compliance in the numerator included patients who have a resulted hepatitis C antibody or have indicated current treatment (with a hepatitis C viral load). Results 51% of patients based on the aforementioned methodology have been screened in 2018. 11,577 patients were eligible with 650 patients having a documented refusal. 261 new diagnosis were made in 2018 and compliance for non-screened patients without any prior screening was 35%. Regarding racial/ethnic composition of the practice sites compared with patients screened, one practice site with an 87% Asian non-Hispanic population had a 35% compliance rate with screening where as the most predominate Hispanic population site (81% of total patients seen) had a 54% compliance rate. Conclusion Overall screening rates within the network are commendable, yet more work is being done to drive provider awareness on the need for compliance. Differences in racial/ethnic backgrounds and compliance of screening completion can be seen within the FHC network. Current efforts are focused on increasing culturally appropriate awareness amongst the patient population as well as the providers. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Jesica Hayon
- Family Health Center at NYU Langone, New York City, New York
| | | | - George Shahin
- Family Health Centers at NYU Langone, Brooklyn, New York
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Pasco N, Schubert F, Hayon J, Lee TYS, Aamir A, Chacko M, Dapkins I. 590. Tackling HIV/AIDS in Brooklyn New York Within a Network of Federally Qualified Health Centers. Open Forum Infect Dis 2018. [PMCID: PMC6253444 DOI: 10.1093/ofid/ofy210.597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background As of June 30, 2016, 122,945 New Yorkers had been diagnosed and were known to be living with HIV/AIDS. The Family Health Centers at NYU Langone (FHC) has for the past 27 years continued to build an evolving network of services which aim to tackle the epidemic through the principles of hot-spotting, elevating cultural competency, and applying the continuum of care model for the communities we serve. Methods FHC’s network covers a service area of six NYC Community Districts in Brooklyn. Utilizing best practices, FHC has built a network which addresses the cascade of care through EMR embedded screening, education on cultural competencies in the LGBTQ community, dedicated health navigators, and a comprehensive panel of providers to deal with biopsychosocial factors that prohibit access to healthcare delivery. Utilizing automated referral pathways within the EMR along with a daily review of all testing results performed within the network, care coordination teams and patient navigators are able to identify patients. Dedicated case management teams are then assigned to locate patients and link patients to treatment and assist in overcoming care access barriers. Results Within the FHC catchment area the incidence of new HIV infections was heavily concentrated among poor minorities. Among the FHC population, minority races compromised 79.3% of those PLWHA, with 58% of the population having the risk factor of MSM activity. For those patients who fall under >20% below Federal poverty level, New York’s HIV/AIDS death rate is at 74.7%. Despite national and regional trends, the FHC over the last 3 years has managed to not only to provide greater opportunities for access to care, but has increased the rate of viral load suppression among patients served (393 patients in 2014 to 416 patients in 2016 and VLSR of 92.4–95.6%.) Conclusion HIV/AIDS prevalence is still characterized by wide gaps in healthcare disparities and inequality, particularly among those communities who are poor, LGTBQ and/or minority background. By building an infrastructure that follows best practices in a culturally sensitive context, the FHC is able to provide greater access to care in a dwindling population while creating a medical home for quality care regardless of payer base, race, or gender. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Neil Pasco
- Family Health Center, Family Health Centers at NYU Langone Health, Brooklyn, New York
| | - Finn Schubert
- Clinical Research, NYU Langone Hospital-Brooklyn, Brooklyn, New York
| | - Jesica Hayon
- Internal Medicine, Family Health Centers at NYU Langone Health, Brooklyn, New York
| | - Tiffany Yi Shan Lee
- Internal Medicine, Family Health Centers at NYU Langone Health, Brooklyn, New York
| | - Anum Aamir
- Internal Medicine, Family Health Centers at NYU Langone Health, Brooklyn, New York
| | - Marilyn Chacko
- Internal Medicine, Family Health Centers at NYU Langone Health, Brooklyn, New York
| | - Isaac Dapkins
- Family Health Center, Family Health Centers at NYU Langone Health, Brooklyn, New York
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Renaud B, Coma E, Hayon J, Gurgui M, Longo C, Blancher M, Jouannic I, Betoulle S, Roupie E, Fine MJ. Investigation of the ability of the Pneumonia Severity Index to accurately predict clinically relevant outcomes: a European study. Clin Microbiol Infect 2007; 13:923-31. [PMID: 17617186 DOI: 10.1111/j.1469-0691.2007.01772.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In order to confirm the validity of the Pneumonia Severity Index (PSI) for patients in Europe, data from adults with pneumonia who were enrolled in two prospective multicentre studies, conducted in France (Pneumocom-1, n = 925) and Spain (Pneumocom-2, n = 853), were compared with data from the original North American study (Pneumonia PORT, n = 2287). The primary outcome was 28-day mortality; secondary outcomes were subsequent hospitalisation for outpatients, and intensive care unit admission and length of stay for inpatients. All outcomes within individual risk classes, and mortality rates in low-risk (PSI I-III) and higher-risk patients, were compared across the three cohorts. Overall mortality rates were 4.7% in Pneumonia PORT, 6.3% in Pneumocom-2 and 10.6% in Pneumocom-1 (p <0.01), ranging from 0.4% to 1.6% (p 0.06) for low-risk patients and from 13.0% to 19.1% (p 0.24) for high-risk patients. Despite significant differences in baseline patient characteristics, none of the study outcomes differed within the low-risk classes. The sensitivity and negative predictive value of low-risk classification for mortality exceeded 93% and 98%, respectively. Thus, in two independent European cohorts, the PSI predicted patient outcomes accurately and reliably, particularly for low-risk patients. These findings confirm the validity of the PSI when applied to patients from Europe.
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Affiliation(s)
- B Renaud
- Department of Emergency Medicine, Centre Hospitalier--Universitaire Henri Mondor (AP-HP), Créteil, France.
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Zilbermann I, Hayon J, Maimon E, Ydgar R, Korin E, Bettelheim A. Electroprecipitation of Ag(II)/Ag(III) tetraphenylsulfonate porphyrin and electrocatalytic behavior of the films. Electrochem commun 2002. [DOI: 10.1016/s1388-2481(02)00465-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Santoli F, De Jonghe B, Hayon J, Tran B, Piperaud M, Merrer J, Outin H. Mechanical ventilation in patients with acute ischemic stroke: survival and outcome at one year. Intensive Care Med 2001; 27:1141-6. [PMID: 11534561 DOI: 10.1007/s001340100998] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the prognosis of patients with acute ischemic stroke who require mechanical ventilation and to determine early factors influencing mortality. DESIGN Prospective observational study. SETTING Medical intensive care unit with a cerebrovascular emergency unit in a university-affiliated hospital. PATIENTS Fifty-eight consecutive patients (mean age 65+/-13 years) requiring mechanical ventilation in the early course of an acute ischemic stroke. MEASUREMENTS AND RESULTS Clinical data were recorded before intubation according to a standardized procedure. Mortality and functional outcome were assessed after a 1-year follow-up. Mechanical ventilation was started within 48 h after admission in 53 patients (91.4%). The mean duration of ventilation was similar in survivors (9.7+/-9.0 days) and non-survivors (8.6+/-8.7 days). Mortality was 72.4% at 1 year. Among the 16 survivors, none were in a persistent vegetative state and 11 had a Barthel index of 60, reflecting good functional status. Bilateral absence of corneal reflex and bilateral absence of pupillary light reflex had a positive predictive value of death of 1 (95% CI 0.78-1.00 and 0.74-1.00, respectively). After Cox regression analysis, presence of stupor or coma (OR 2.6, 95% CI 1.5-5.0), bilateral absence of corneal reflex before intubation (OR 3.4, 95% CI 1.4-8.7) and presence of ischemic cardiopathy (OR 2.8, 95% CI 1.4-5.5) were independent predictors of mortality. CONCLUSIONS Systematic withholding of endotracheal intubation in patients with AIS is not recommended. Careful and rigorous neurologic examination, including assessment of brain stem reflexes, might help to identify patients with a very high probability of death despite mechanical ventilation.
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Affiliation(s)
- F Santoli
- Service de Réanimation Médicale, Centre Hospitalier de Poissy-Saint Germain en Laye, France
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Lucet JC, Hayon J, Bruneel F, Dumoulin JL, Joly-Guillou ML. Microbiological evaluation of central venous catheter administration hubs. Infect Control Hosp Epidemiol 2000; 21:40-2. [PMID: 10656354 DOI: 10.1086/501696] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We compared, in three intensive care units, colonization of hubs with hub protection boxes or hubs with needleless closed connectors; 137 central venous catheters and 451 hubs were randomized in two groups with similar characteristics. Catheter and hub colonization were not different between the two groups. Among 30 colonized catheters, the same isolate was found in only two hubs; hub contamination rarely is responsible for catheter colonization in short-term catheters. Further studies are required to evaluate the benefit of protected hubs compared with unprotected hubs.
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Affiliation(s)
- J C Lucet
- Infection Control Unit, Bichat-Claude Bernard University Hospital, Paris, France
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Merrer J, De Jonghe B, Hayon J, Outin H, Simon N, Nouailhat F. [Cellulitis of the thigh caused by Haemophilus influenzae in an adult]. Presse Med 1996; 25:171. [PMID: 8728905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Hayon J, Raveh A, Bettelheim A. Electrocatalytic properties of chemically polymerized films of cobalt, iron and manganese tetrakis(o-aminophenyl)porphyrins. J Electroanal Chem (Lausanne) 1993. [DOI: 10.1016/0022-0728(93)80410-j] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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