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Melioidosis, a severe bacterial illness caused by Burkholderia pseudomallei, is prevalent in most parts of Thailand, including its southern region situated within the Malay Peninsula. Despite a lower reported incidence rate of melioidosis in the South compared to the Northeast, the mortality rate remains persistently high. This study aimed to better understand the epidemiology and investigate the presence of B. pseudomallei in the natural environment of southern Thailand. Using multi-locus sequence typing (MLST), we characterized B. pseudomallei isolates derived from human cases and compared them with previously reported sequence types (STs) from the same region. A total of 263 clinical isolates retrieved from 156 melioidosis patients between 2014 and 2020 were analyzed, revealing 72 distinct STs, with 25 (35%) matching STs from Finkelstein's environmental isolates collected in southern Thailand during 1964–1967. Notably, strains bearing STs 288, 84, 54, 289, and 46 were frequently found among patients. Additionally, we observed strain diversity with multiple STs in 13 of 59 patients, indicating exposure to various B. pseudomallei genotypes in the environmental sources of the infection. Environmental surveys were conducted in Songkhla Province to detect B. pseudomallei in soil and water samples where local patients lived. Of the 2737 soil samples from 208 locations and 244 water samples from diverse sources, 52 (25%) soil sampling locations and 63 (26%) water sources were cultured positive for B. pseudomallei. Positive soil samples were predominantly found in animal farming area and non-agricultural zones like mountains and grasslands, while water samples were frequently positive in waterfalls, streams, and surface runoffs, with only 9% of rice paddies testing positive. Collectively, a significant proportion of recent melioidosis cases in Songkhla Province can be attributed to known B. pseudomallei STs persisting in the environment for at least the past six decades. Further characterization of B. pseudomallei isolates from recent environment surveys is warranted. These findings illuminate the contemporary landscape of B. pseudomallei infections and their environmental prevalence in southern Thailand, contributing to the regional threat assessment in Thailand and Southeast Asia. Author summary: This study conducted a genetic analysis of Burkholderia pseudomallei, the bacterium causing a deadly tropical disease, from 156 patients in southern Thailand during 2014–2020. It found various genotypes, some of which were consistent with the genotypes found in the environment dating back to the 1960s. Extensive testing of soil and water in the region revealed contamination with B. pseudomallei. Areas such as animal farms, mountains, grasslands, and natural water sources e.g., streams and waterfalls, were mostly affected. This finding confirmed that some B. pseudomallei genotypes have had a long-standing presence in the environment, contributing to recent human cases. This study not only enhance our understanding of the spread of melioidosis throughout Southeast Asia but also highlights the importance of ongoing research and monitoring of B. pseudomallei in natural environments to address potential risks associated with the bacterium's persistence. [ABSTRACT FROM AUTHOR]

Aim: To show clinical characteristics, treatments, and comorbidities in chronic cough in a nationwide cohort. Methods: Two cohorts were created. A national cohort with individuals from two population-based databases; the National Patient Register and Swedish Prescribed Drug Register. Secondly, a regional cohort including primary care data. Adults with at least one cough diagnosis (ICD-10 R05) and/or individuals with ≥2 dispensed prescriptions for relevant cough-medication within the inclusion period, 2016–2018, were identified. Individuals on medications which may instigate cough or suggest acute infection or diagnosed with conditions where cough is a cardinal symptom, were excluded. Those remaining were defined as having possible refractory or unexplained chronic cough (RCC/UCC). Results: Altogether 62,963 individuals were identified with possible RCC/UCC, giving a national prevalence of about 1%. Mean age was 56 years and 60% were females. Many (44%) of the individuals with possible RCC/UCC visited cough relevant specialist clinics during the study period, but less than 20% received a cough diagnosis. A majority (63%) had evidence of RCC/UCC in the 10 years prior to inclusion in the study. In the regional cohort, including primary care data, the prevalence of RCC/UCC was doubled (2%). Cough medicines were mainly prescribed by primary care physicians (82%). Conclusion: Most individuals with possible RCC/UCC sought medical care in primary care, and had a long history of cough, with various treatments tried, indicating a substantial burden of the condition. Referrals to specialist care were very rare. The results underline the need for a structured multidisciplinary approach and future therapeutic options. [ABSTRACT FROM AUTHOR]

We examined the associations of vegetarianism with metabolic biomarkers using traditional and genetic epidemiology. First, we addressed inconsistencies in self-reported vegetarianism among UK Biobank participants by utilizing data from two dietary surveys to find a cohort of strict European vegetarians (N = 2,312). Vegetarians were matched 1:4 with nonvegetarians for non-genetic association analyses, revealing significant effects of vegetarianism in 15 of 30 biomarkers. Cholesterol measures plus vitamin D were significantly lower in vegetarians, while triglycerides were higher. A genome-wide association study revealed no genome-wide significant (GWS; 5×10−8) associations with vegetarian behavior. We performed genome-wide gene-vegetarianism interaction analyses for the biomarkers, and detected a GWS interaction impacting calcium at rs72952628 (P = 4.47×10−8). rs72952628 is in MMAA, a B12 metabolic pathway gene; B12 has major deficiency potential in vegetarians. Gene-based interaction tests revealed two significant genes, RNF168 in testosterone (P = 1.45×10−6) and DOCK4 in estimated glomerular filtration rate (eGFR) (P = 6.76×10−7), which have previously been associated with testicular and renal traits, respectively. These nutrigenetic findings indicate genotype can modify the associations between vegetarianism and health outcomes. Author summary: The popularity of vegetarianism continues to rise, particularly among those seeking to improve their overall health. However, vegetarianism studies have been susceptible to imprecise definitions of dietary intake, and to biased selection of health-conscious participants. Moreover, previous studies have not considered the modifying effects of individual genetic background. Here, we use data from two separate dietary surveys in the UK Biobank to define participants who were most likely to have followed a strict vegetarian diet. Using this cohort in an epidemiological analysis without consideration of genetics, we estimated the effects of vegetarianism on 30 serum biomarkers for cancer, diabetes, and cardiovascular, bone, renal and liver diseases. We replicated established health benefits of vegetarianism in lowering cholesterol, and found evidence of potentially negative effects, such as raised triglycerides and lowered vitamin D. Furthermore, we performed genome-wide gene-vegetarianism interaction analysis for these 30 serum biomarkers. We identified three novel genetic factors that modify the effects of vegetarianism on calcium, testosterone, and estimated glomerular filtration rate (eGFR). These novel gene-vegetarian interactions are the first of their kind, and all located within biologically relevant genes. These findings can assist in the design of personalized nutrition recommendations and future clinical trials. [ABSTRACT FROM AUTHOR]

Introduction: Sepsis is a major cause of morbidity and mortality worldwide. In the updated, 2016 Sepsis-3 criteria, sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, where organ dysfunction can be represented by an increase in the Sequential Organ Failure Assessment (SOFA) score of 2 points or more. We sought to apply the Sepsis-3 criteria to characterise the septic cohort in the Amsterdam University Medical Centres database (Amsterdam UMCdb). Methods: We examined adult intensive care unit (ICU) admissions in the Amsterdam UMCdb, which contains de-identified data for patients admitted to a mixed surgical-medical ICU at a tertiary academic medical centre in the Netherlands. We operationalised the Sepsis-3 criteria, defining organ dysfunction as an increase in the SOFA score of 2 points or more, while infection was defined as a new course of antibiotics or an escalation in antibiotic therapy, with at least one antibiotic given intravenously. Patients with sepsis were determined to be in septic shock if they additionally required the use of vasopressors and had a lactate level >2 mmol/L. Results: We identified 18,221 ICU admissions from 16,408 patients in our cohort. There were 6,312 unique sepsis episodes, of which 30.2% met the criteria for septic shock. A total of 4,911/6,312 sepsis (77.8%) episodes occurred on ICU admission. Forty-seven percent of emergency medical admissions and 36.7% of emergency surgical admissions were for sepsis. Overall, there was a 12.5% ICU mortality rate; patients with septic shock had a higher ICU mortality rate (38.4%) than those without shock (11.4%). Conclusions: We successfully operationalised the Sepsis-3 criteria to the Amsterdam UMCdb, allowing the characterization and comparison of sepsis epidemiology across different centres. [ABSTRACT FROM AUTHOR]

Traumatic spinal cord injury (TSCI) causes an insult to the central nervous system, often resulting in devastating temporary or permanent neurological impairment and disability, which places a substantial financial burden on the health-care system. This study aimed to clarify the up-to-date epidemiology and demographics of patients with TSCI treated at the largest SCI center in Japan. Data on all patients admitted to the Spinal Injuries Center with TSCI between May 2005 and December 2021 were prospectively collected using a customized, locally designed SCI database named the Japan Single Center Study for Spinal Cord Injury Database (JSSCI-DB). A total of 1152 patients were identified from the database. The study period was divided into the four- or five-year periods of 2005–2009, 2010–2013, 2014–2017, and 2018–2021 to facilitate the observation of general trends over time. Our results revealed a statistically significant increasing trend in age at injury. Since 2014, the average age of injury has increased to exceed 60 years. The most frequent spinal level affected by the injury was high cervical (C1-C4: 45.8%), followed by low cervical (C5-C8: 26.4%). Incomplete tetraplegia was the most common cause or etiology category of TSCI, accounting for 48.4% of cases. As the number of injuries among the elderly has increased, the injury mechanisms have shifted from high-fall trauma and traffic accidents to falls on level surfaces and downstairs. Incomplete tetraplegia in the elderly due to upper cervical TSCI has also increased over time. The percentage of injured patients with an etiology linked to alcohol use ranged from 13.2% (2005–2008) to 19% (2014–2017). Given that Japan has one of the highest aging populations in the world, epidemiological studies in this country will be very helpful in determining health insurance and medical costs and deciding strategies for the prevention and treatment of TSCI in future aging populations worldwide. [ABSTRACT FROM AUTHOR]

To understand how open research data sharing and reuse can be further improved in the field of Epidemiology, this study explores the facilitating role that infrastructural and institutional arrangements play in this research discipline. It addresses two research questions: 1) What influence do infrastructural and institutional arrangements have on open research data sharing and reuse practices in the field of Epidemiology? And 2) how could infrastructural and institutional instruments used in Epidemiology potentially be useful to other research disciplines? First, based on a systematic literature review, a conceptual framework of infrastructural and institutional instruments for open research data facilitation is developed. Second, the conceptual framework is applied in interviews with Epidemiology researchers. The interviews show that two infrastructural and institutional instruments have a very high influence on open research data sharing and reuse practices in the field of Epidemiology, namely (a) access to a powerful search engine that meets open data search needs and (b) support by data stewards and data managers. Third, infrastructural and institutional instruments with a medium, high, or very high influence were discussed in a research workshop involving data stewards and research data officers from different research fields. This workshop suggests that none of the influential instruments identified in the interviews are specific to Epidemiology. Some of our findings thus seem to apply to multiple other disciplines. This study contributes to Science by identifying field-specific facilitators and challenges for open research data in Epidemiology, while at the same time revealing that none of the identified influential infrastructural and institutional instruments were specific to this field. Practically, this implies that open data infrastructure developers, policymakers, and research funding organizations may apply certain infrastructural and institutional arrangements to multiple research disciplines to facilitate and enhance open research data sharing and reuse. [ABSTRACT FROM AUTHOR]

Background: Cystic echinococcosis (CE) is a neglected zoonotic disease that is caused by Echinococcus granulosus sensu lato (s.l.), the life cycle of which involves multiple hosts. We conducted a systematic review (SR) on E. granulosus s.l. in the Greater Horn of Africa (GHA), to provide a picture of its recent epidemiology across all hosts. Methods: For this SR, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, five electronic databases, as well experts in the region were consulted to retrieve records published between 2000 and 2022, reporting the presence of E. granulosus s.l. infections in any natural host in the GHA (Djibouti, Eritrea, Ethiopia, Kenya, Sudan, Somalia, South Sudan, Tanzania and Uganda). Principal findings: A total of 247 records were retained, describing the presence of E. granulosus s.l. throughout the GHA, except for Djibouti. Only few population surveys on human CE were conducted in the area, with the prevalence ranging between 0.3 and 11.3%. In animals, the reported prevalence ranged up to 61.6% in camels, 88.4% in cattle; 65.2% in goats, 9.9% in pigs, 67.8% in sheep and 94.5% in dogs. In addition, E. granulosus s.l. was also reported in wildlife. A total of five species were reported in the different hosts, namely E. granulosus sensu stricto (G1, G3, GOmo), E. canadensis (G6/7), E. ortleppi (G5), E. felidis, and E. equinus (G4). Conclusions: We confirm that E. granulosus s.l. is prevalent throughout the GHA. Nevertheless, despite our efforts to screen grey literature, an accurate assessment of the epidemiology in GHA remains challenging, due to the lack of combined host, in-depth risk factor and behavioural studies, as well as the wide diversity in subpopulations studied and diagnostic tools used. Interdisciplinary and transboundary partnerships would be essential for the design of effective control strategies, tuned to the GHA setting. Author summary: Cystic echinococcosis (CE) is a disease caused by the tapeworm Echinococcus granulosus that affects both humans and animals. In the Greater Horn of Africa (GHA), the livelihoods of millions of people depend on livestock and herding dogs. At the same time, poor animal slaughter practices still exist in the area. Therefore, the GHA is considered a textbook example for the transmission of E. granulosus. Nevertheless, although the World Health Organization (WHO) prioritized CE as one of the seven neglected zoonotic tropical diseases, a recent summary on the true extent to which the tapeworm occurs across the different host species in the GHA, and the factors that contribute to its transmission is missing. Our systematic review of the literature on the topic confirms that the tapeworm is widely spread in the GHA. At the same time, it remains difficult to accurately assess the occurrence of the worm and how exactly it spreads between the hosts, in absence of well-designed surveys. Based on the nature of the disease (involving both animals and humans) and the disease being highly prevalent in pastoralist communities that move across national borders, a firm response to control CE will require both interdisciplinary and transboundary partnerships. [ABSTRACT FROM AUTHOR]