Arsenic-contaminated water in Bangladesh linked to resistant bacteria in children

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An observational study in Bangladesh found that fecal carriage of antibiotic-resistant Escherichia coli in children was associated with associated with high levels of arsenic in contaminated water, researchers reported yesterday in PLOS Pathogens.

Previous research in Bangladesh, where arsenic-contaminated groundwater is widespread, has suggested that exposure to arsenic might play a role in the emergence and spread of antibiotic resistance. Arsenic-resistant bacteria have been isolated from various sources, and one study has shown arsenic-induced antibiotic resistance in laboratory conditions. But empirical evidence of the connection is lacking.

To further establish a link between arsenic and antibiotic resistance, researchers from Bangladesh, Switzerland, and the United States collected drinking water and stool samples from children and their mothers in two rural areas of Bangladesh—one with high levels of arsenic in drinking water (Hajiganj) and one with low arsenic contamination (Matlab)—and compared the levels of antibiotic-resistant E coli.

Of the 251 E coli isolates collected from samples both sites, 94% were resistant to at least one antibiotic. The prevalence of antibiotic-resistant E coli was significantly higher in water in Hajiganj (48%) compared to water in Matlab (22%), and among children in Hajiganj (94%) compared to children in Matlab (76%), but not among mothers. In addition, a significantly higher proportion of E coli isolates from Hajiganj were multidrug-resistant (83%) compared to isolates from Matlab (71%), while co-resistance to arsenic and multiple antibiotics was observed in a higher proportion of water (78%) and child stool (100%) isolates in Hajiganj than in water (57%) and children (89%) in Matlab.

The association between arsenic and antibiotic resistance was observed among all E coli isolates from both areas. The odds of arsenic-resistant E coli to be resistant to beta-lactam antibiotics including ampicillin (odds ratio [OR], 3.4: 95% confidence interval [CI], 1.4 to 8.1), cefotaxime (OR, 2.5; 95% CI, 1.2 to 5.3), and ceftriaxone (OR, 3.4; 95% CI, 1.6 to 7.0) were higher compared to that of arsenic-sensitive E coli isolates.

"The positive association detected between arsenic exposure and antibiotic resistance carriage among children in arsenic-affected areas in Bangladesh is an important public health concern that warrants redoubling efforts to reduce arsenic exposure," the study authors wrote. 

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Half of COVID preprint studies later published in journals

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Slightly more than half of COVID-19–related scientific studies posted on the preprint server medRxiv were published in peer-reviewed journals within the next 2 years, according to a research letter published yesterday in JAMA Network Open.

In March 2022, researchers in Denmark, Spain, and Austria searched for all COVID-19 preprints (non–peer-reviewed papers) posted on medRxiv from Jan 1 to Dec 31, 2020. The team repeated the search in October 2022.

Of the 3,343 preprints, 1,712 (51.2%) were published in the peer-reviewed literature (579 journals) by March 2022. By October 2022, this number had risen to 1,742 (52.1%). Excluding January 2020, when only one COVID-19 article was posted, the rate of later publication in a journal ranged from 43.5% (94 of 216 preprints posted in March 2020) to 60.6% (177 of 292 preprints posted in August 2020).

Of the 1,712 preprints later published in journals, 827 (47.5%) were published in quartile 1 (top-quality) journals such as PLOS One, Scientific Reports, and BMJ Open.

The researchers noted that, since medRxiv's 2019 launch, the dissemination of research as preprints has grown rapidly, largely fueled by the COVID-19 pandemic. "Notwithstanding, this unprecedented increase in preprints has been subject to criticism, mainly because of reliability concerns owing to their lack of peer review," they wrote.

The steady rate of publication in peer-reviewed journals over the course of the study suggests that a substantial change in the proportion of medRxiv studies later published in the literature is unlikely, the authors said. "Future studies aimed at evaluating publication rates in other areas of medical science are needed," they wrote.

Early-pandemic COVID-19 infections linked to depression

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Patients who contracted COVID-19 during the first wave of the pandemic were 1.67 times more likely to show clinically significant levels of anxiety after 13 months, according to a British study published in Scientific Reports.

The study was based on a survey of 3,077 UK adults, representing a cross-section of the general population. Approximately 9% of participants (268 respondent; 8.7%) reported COVID-19 at wave 1, 8.5% (234) reported COVID-19 at wave 2, and 9.1% (237) reported COVID-19 at wave 3. In total, 393 (12.8%) participants reported COVID-19 during waves 1, 2 or 3 (March through May 2020), the authors said.

Those who reported COVID-19 during wave 1 had elevated symptoms of anxiety and depression at 1, 3, 5, and 13 months follow-up.

"The current study also found that having a pre-existing mental health condition at the beginning of the pandemic was related to increased odds of contracting probable COVID infection over the following 13 months," the authors said.

The authors found that having a pre-existing mental health condition was associated with a 31% greater odds of having probable COVID-19 over the following 13 months (odds ratio, 1.31).

Several studies have shown that lockdowns and COVID-19 measures worsened mental health for many different groups in 2020, but this is one of the first studies to gauge how and if contracting COVID-19 early in the pandemic affected long-term mental health outcomes, the authors said.

In a press release, the authors said the work was important for general practitioners (GPs) who may be seeing patients more than a year after their initial infection.

"The findings highlight the importance for GPs and other healthcare professionals to be vigilant to these longer-lasting symptoms and to put in place treatments and support for mental health, as well as physical health, for patients who may have contracted COVID-19 infection," said co-lead author Daryl O'Connor, PhD, of the University of Leeds in a university press release.

Report describes 3 cases of myocarditis following mpox infections

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A new case study from France described three men who contracted mpox and then developed myocarditis a few days after initial symptom development. The study is published in Clinical Microbiology and Infection.

The men ranged in age from 21 to 32 and developed mpox symptoms following either homosexual or heterosexual unprotected sexual encounters. In all three men, skin symptoms, including mpox rash, developed first, followed by acute chest pain, elevated cardiac markers, and biological inflammatory syndrome compatible with myocarditis.

The men had no history of heart problems, and all were hospitalized and subsequently recovered. Only one patient was treated with the antiviral tecovirimat (Tpoxx).

"These cases suggest an association between monkeypox infections and cardiac inflammatory complications. The development of chest pain in an infected patient should not be underestimated and should lead to prompt investigations for myocarditis," the authors concluded.

Previously only five cases of myocarditis attributed to monkeypox had been described in the medical literature, all in 2022, the authors wrote.

African countries report more vaccine-derived polio cases

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Six African nations reported more polio cases this week, all involving vaccine-derived strains, according to the latest update from the Global Polio Eradication Initiative (GPEI).

Madagascar and Mozambique both reported more circulating vaccine-derived poliovirus type 1 (cVDPV1) cases. In Madagascar, 3 cases were reported in three different regions, bringing the country's total for the year to 13, matching the total for 2021. Mozambique reported 2 more cases from Zambezia, lifting its total to 18.

Elsewhere, Benin, Ghana, Niger, and Togo reported more circulating vaccine-derived poliovirus type 2 (cVDPV2) cases. Benin reported 3 cases in Borgou, making its total 10 for the year. Ghana had 1 case, in Northern province, its third case of 2022. Niger reported 2 cases from Tillaberi, boosting its total to 13, and Togo reported 1 case in Plateaux, its second of the year.

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