Pandemic response gaps: Infection prevention and control lessons learned during coronavirus disease 2019 (COVID-19) outbreaks in skilled nursing facilities in Detroit, Michigan.

BACKGROUND: Hospitalizations among skilled nursing facility (SNF) residents in Detroit increased in mid-March 2020 due to the coronavirus disease 2019 (COVID-19) pandemic. Outbreak response teams were deployed from local healthcare systems, the Centers for Disease Control and Prevention (CDC), and the Detroit Health Department (DHD) to understand the infection prevention and control (IPC) gaps in SNFs that may have accelerated the outbreak. METHODS: We conducted 2 point-prevalence surveys (PPS-1 and PPS-2) at 13 Detroit SNFs from April 8 to May 8, 2020. The DHD and partners conducted facility-wide severe acute respiratory coronavirus virus 2 (SARS-CoV-2) testing of all residents and staff and collected information regarding resident cohorting, staff cohorting, and personnel protective equipment (PPE) utilized during that time. RESULTS: Resident cohorting had been implemented in 7 of 13 (58.3%) SNFs prior to point-prevalence survey 1 (PPS-1), and other facilities initiated cohorting after obtaining PPS-1 results. Cohorting protocols of healthcare practitioners and environmental service staff were not established in 4 (31%) of 13 facilities, and in 3 facilities (23.1%) the ancillary staff were not assigned to cohorts. Also, 2 SNFs (15%) had an observation unit prior to PPS-1, 2 (15%) had an observation unit after PPS-1, 4 (31%) could not establish an observation unit due to inadequate space, and 5 (38.4%) created an observation unit after PPS-2. CONCLUSION: On-site consultations identified gaps in IPC knowledge and cohorting that may have contributed to ongoing transmission of SARS-CoV-2 among SNF residents despite aggressive testing measures. Infection preventionists (IPs) are critical in guiding ongoing IPC practices in SNFs to reduce spread of COVID-19 through response and prevention.

Initial and Repeated Point Prevalence Surveys to Inform SARS-CoV-2 Infection Prevention in 26 Skilled Nursing Facilities - Detroit, Michigan, March-May 2020.

Skilled nursing facilities (SNFs) are focal points of the coronavirus disease 2019 (COVID-19) pandemic, and asymptomatic infections with SARS-CoV-2, the virus that causes COVID-19, among SNF residents and health care personnel have been described (1-3). Repeated point prevalence surveys (serial testing of all residents and health care personnel at a health care facility irrespective of symptoms) have been used to identify asymptomatic infections and have reduced SARS-CoV-2 transmission during SNF outbreaks (1,3). During March 2020, the Detroit Health Department and area hospitals detected a sharp increase in COVID-19 diagnoses, hospitalizations, and associated deaths among SNF residents. The Detroit Health Department collaborated with local government, academic, and health care system partners and a CDC field team to rapidly expand SARS-CoV-2 testing and implement infection prevention and control (IPC) activities in all Detroit-area SNFs. During March 7-May 8, among 2,773 residents of 26 Detroit SNFs, 1,207 laboratory-confirmed cases of COVID-19 were identified during three periods: before (March 7-April 7) and after two point prevalence surveys (April 8-25 and April 30-May 8): the overall attack rate was 44%. Within 21 days of receiving their first positive test results, 446 (37%) of 1,207 COVID-19 patients were hospitalized, and 287 (24%) died. Among facilities participating in both surveys (n = 12), the percentage of positive test results declined from 35% to 18%. Repeated point prevalence surveys in SNFs identified asymptomatic COVID-19 cases, informed cohorting and IPC practices aimed at reducing transmission, and guided prioritization of health department resources for facilities experiencing high levels of SARS-CoV-2 transmission. With the increased availability of SARS-CoV-2 testing, repeated point prevalence surveys and enhanced and expanded IPC support should be standard tools for interrupting and preventing COVID-19 outbreaks in SNFs.

CYP3A5 as a candidate gene for hypertension: no support from an unselected indigenous West African population.

CYP3A5 (cytochrome P450, family 3, subfamily A, polypeptide 5) expression stimulates the sodium retentive actions of the mineralocorticoid receptor causative of hypertension, probably by means of its ability to substantially increase the level of 6ß-hydroxylase activity. Most Black individuals are functional CYP3A5 expressers, and this is a candidate gene for the high incidence of hypertension in Black populations. The study investigates whether CYP3A5 expression results in higher blood pressure in a Ghanaian population. Real-time PCR was used to genotype 898 DNA samples for the CYP3A5*3 and CYP3A5*6 single-nucleotide polymorphisms with technically adequate genotyping for 881 samples. Of these, 803 were genetic CYP3A5 expressers, 44 nonexpressers and 34 uncertain (CYP3A5*3/*6). Although there was a trend in the proportion of hypertensive individuals as CYP3A5 expression decreased, using a two-sided t-test, no statistically significant relationship was established between systolic or diastolic pressure and CYP3A5*3 or CYP3A5*6 genotypes, or their haplotypes (Systolic confidence interval: -8.44 to -7.70, P=0.93, Diastolic confidence interval: -4.89 to 4.85, P=0.99). We conclude, therefore, that there is either no association between CYP3A5 expression and blood pressure or, if there is a relationship, the strength of the association is very small.

Awareness and Knowledge of Glaucoma Among Adult Patients at the Eye Clinic of a Teaching Hospital.

BACKGROUND: Primary open angle glaucoma (POAG) is an irreversible blinding disease that often presents late because it is symptomless in the early stages. Prognosis depends on early diagnosis and treatment and patient understanding of their condition. Many patients present late because of poor awareness and knowledge. This study was conducted to assess patient's awareness and knowledge of glaucoma in a referral Teaching Hospital. METHODS: Descriptive cross-sectional study conducted among glaucoma patients aged 40 years and above attending the Komfo Anokye Teaching Hospital (KATH). Patients were selected by simple random sampling. They were recruited after informed consent had been given. A questionnaire on demographics, socio-economics and awareness of glaucoma was administered. RESULTS: There were a total of 117 participants, 61 males and 56 females. The median and modal age group was 50 and 59 years. Amongst the participants, 74% were aware of glaucoma. There were no significant statistical difference in the various age groups, sex, ethnic group or religion and their awareness of glaucoma (P > 0.05).There were statistically significant differences between those who had higher education and their awareness of glaucoma (P < 0.001). Yet only 27% of these had accurate knowledge of glaucoma. CONCLUSION: Glaucoma awareness in patients attending Komfo Anokye Teaching Hospital is high. Higher education was associated with higher awareness yet this was not translated into accurate knowledge as there were significant misconceptions. There is the need to review the contents of health education with the aim of reducing dangerous misconception of glaucoma and targeting the lower socioeconomic population.

Lipid disorders in hospital attendants in Kumasi, Ghana.

BACKGROUND: Lipid disorders are common worldwide and contribute to a significant proportion of the burden of atherosclerotic cardiovascular diseases. OBJECTIVES: To determine the prevalence of lipid disorders among patients reporting at Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. DESIGN: Cross-sectional study. SETTING: Directorate of Medicine and Polyclinic outpatient clinics of KATH. PARTICIPANTS: A total of 424 patients, 20 years and over reporting for the first time to KATH were recruited. 77 had neither diabetes mellitus (DM) nor systemic hypertension (HPT) (controls), 94 had only DM, 109 had only HPT and 144 had both. METHODS: A questionnaire was administered after informed consent. Anthropometric measurements were then taken and blood investigations including total cholesterol (TC), high-density lipoprotein cholesterol (HDL) and triglycerides (TG) were done. Low-density lipoprotein cholesterol (LDL) was calculated using the Friedwald formula. The atherogenic index or ratio was the ratio of TC to HDL. RESULTS: The prevalence of lipid abnormalities was 60% for high TC, 32% for high TG, 17% for low HDL and 61% for high LDL. The mean (± standard deviation) TC was 5.33 (± 1.31) mmol/L, mean TG was 1.52 (± 0.81) mmol/L, mean HDL was 1.65 (± 0.57) mmol/L and mean LDL was 3.42 (± 1.22) mmol/L. The mean atherogenic index was 3.40 and 9% of the participants had an atherogenic index more than or equal to 5. CONCLUSION: The prevalence of lipid disorders was high in adult patients in Kumasi and there is the need to increase awareness, screening, detection, treatment and control of these disorders.

Pantethine rescues phosphopantothenoylcysteine synthetase and phosphopantothenoylcysteine decarboxylase deficiency in Escherichia coli but not in Pseudomonas aeruginosa.

Coenzyme A (CoA) plays a central and essential role in all living organisms. The pathway leading to CoA biosynthesis has been considered an attractive target for developing new antimicrobial agents with novel mechanisms of action. By using an arabinose-regulated expression system, the essentiality of coaBC, a single gene encoding a bifunctional protein catalyzing two consecutive steps in the CoA pathway converting 4'-phosphopantothenate to 4'-phosphopantetheine, was confirmed in Escherichia coli. Utilizing this regulated coaBC strain, it was further demonstrated that E. coli can effectively metabolize pantethine to bypass the requirement for coaBC. Interestingly, pantethine cannot be used by Pseudomonas aeruginosa to obviate coaBC. Through reciprocal complementation studies in combination with biochemical characterization, it was demonstrated that the differential characteristics of pantethine utilization in these two microorganisms are due to the different substrate specificities associated with endogenous pantothenate kinase, the first enzyme in the CoA biosynthetic pathway encoded by coaA in E. coli and coaX in P. aeruginosa.

T594M mutation of the beta-subunit of the epithelial sodium channel in Ghanaian populations from Kumasi and London and a possible association with hypertension.

We have tested 186 individuals from Ghana, 95 indigenous and 91 who have settled in the United Kingdom, for the presence of the T594M mutation in the beta-subunit of the epithelial sodium channel, which is associated with hypertension in black populations. The group living in Ghana had a mean age of 27 years and were normotensive, but had an increased frequency of the T allele compared to the London-based population. If this is reflected in larger studies, and the link with hypertension is maintained in the Ghanaian population, this mutation could be a significant cause of hypertension in Ghana.