Availability, scope and quality of monkeypox clinical management guidelines globally : a systematic review

This work was supported by the UK Foreign, Commonwealth and Development Office and Wellcome (215091/Z/18/Z) and the Bill & Melinda Gates Foundation (OPP1209135). The GloPID-R Secretariat is a project that receives funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 874667. SL is an MRC Clinical Research Training fellow (MR/T001151/1).Background Monkeypox (MPX) is an important human Orthopoxvirus infection. There has been an increase in MPX cases and outbreaks in endemic and non-endemic regions in recent decades. We appraised the availability, scope, quality and inclusivity of clinical management guidelines for MPX globally. Methods For this systematic review, we searched six databases from inception until 14 October 2021, augmented by a grey literature search until 17 May 2022. MPX guidelines providing treatment and supportive care recommendations were included, with no exclusions for language. Two reviewers assessed the guidelines. Quality was assessed using the Appraisal of Guidelines for Research and Evaluation II tool. Results Of 2026 records screened, 14 guidelines were included. Overall, most guidelines were of low-quality with a median score of 2 out of 7 (range: 1–7), lacked detail and covered a narrow range of topics. Most guidelines focused on adults, five (36%) provided some advice for children, three (21%) for pregnant women and three (21%) for people living with HIV. Treatment guidance was mostly limited to advice on antivirals; seven guidelines advised cidofovir (four specified for severe MPX only); 29% (4/14) tecovirimat, and 7% (1/14) brincidofovir. Only one guideline provided recommendations on supportive care and treatment of complications. All guidelines recommended vaccination as post-exposure prophylaxis (PEP). Three guidelines advised on vaccinia immune globulin as PEP for severe cases in people with immunosuppression. Conclusion Our results highlight a lack of evidence-based clinical management guidelines for MPX globally. There is a clear and urgent need for research into treatment and prophylaxis including for different risk populations. The current outbreak provides an opportunity to accelerate this research through coordinated high-quality studies. New evidence should be incorporated into globally accessible guidelines, to benefit patient and epidemic outcomes. A ‘living guideline’ framework is recommended. PROSPERO registration number CRD42020167361.Publisher PDFPeer reviewe

GQ-16, a novel peroxisome proliferator-activated receptor (PPAR ) ligand, promotes insulin sensitization without weight gain

ABSTRACTBackground: PPAR agonists improve insulin sensitivity but also evoke weight gain. Results: GQ-16 is a PPAR partial agonist that blocks receptor phosphorylation by Cdk5 and improves insulin sensitivity in diabetic mice in the absence of weight gain. Conclusion: The unique binding mode of GQ-16 appears to be responsible for the compound’s advantageous pharmacological profile. Significance: Similar compounds could have promise as anti-diabetic therapeutics

Validation of OMI erythemal doses with multi-sensor ground-based measurements in Thessaloniki, Greece

The aim of this study is to validate the Ozone Monitoring Instrument (OMI) erythemal dose rates using ground-based measurements in Thessaloniki, Greece. In the Laboratory of Atmospheric Physics of the Aristotle University of Thessaloniki, a Yankee Environmental System UVB-1 radiometer measures the erythemal dose rates every minute, and a Norsk Institutt for Luftforskning (NILU) multi-filter radiometer provides multi-filter based irradiances that were used to derive erythemal dose rates for the period 2005–2014. Both these datasets were independently validated against collocated UV irradiance spectra from a Brewer MkIII spectrophotometer. Cloud detection was performed based on measurements of the global horizontal radiation from a Kipp & Zonen pyranometer and from NILU measurements in the visible range. The satellite versus ground observation validation was performed taking into account the effect of temporal averaging, limitations related to OMI quality control criteria, cloud conditions, the solar zenith angle and atmospheric aerosol loading. Aerosol optical depth was also retrieved using a collocated CIMEL sunphotometer in order to assess its impact on the comparisons. The effect of total ozone columns satellite versus ground-based differences on the erythemal dose comparisons was also investigated. Since most of the public awareness alerts are based on UV Index (UVI) classifications, an analysis and assessment of OMI capability for retrieving UVIs was also performed. An overestimation of the OMI erythemal product by 3–6% and 4–8% with respect to ground measurements is observed when examining overpass and noontime estimates respectively. The comparisons revealed a relatively small solar zenith angle dependence, with the OMI data showing a slight dependence on aerosol load, especially at high aerosol optical depth values. A mean underestimation of 2% in OMI total ozone columns under cloud-free conditions was found to lead to an overestimation in OMI erythemal doses of 1–5%.While OMI overestimated the erythemal dose rates over the range of cloudiness conditions examined, its UVIs were found to be reliable for the purpose of characterising the ambient UV radiation impact

An evaluation of global Chikungunya clinical management guidelines: A systematic review.

Background Chikungunya virus (CHIKV) has expanded its geographical reach in recent decades and is an emerging global health threat. CHIKV can cause significant morbidity and lead to chronic, debilitating arthritis/arthralgia in up to 40% of infected individuals. Prevention, early identification, and clinical management are key for improving outcomes. The aim of this review is to evaluate the quality, availability, inclusivity, and scope of evidence-based clinical management guidelines (CMG) for CHIKV globally. Methods We conducted a systematic review. Six databases were searched from Jan 1, 1989, to 14 Oct 2021 and grey literature until Sept 16, 2021, for CHIKV guidelines providing supportive care and treatment recommendations. Quality was assessed using the appraisal of Guidelines for Research and Evaluation tool. Findings are presented in a narrative synthesis. PROSPERO registration: CRD42020167361. Findings 28 CMGs were included; 54% (15/28) were produced more than 5 years ago, and most were of low-quality (median score 2 out of 7 (range 1–7)). There were variations in the CMGs’ guidance on the management of different at-risk populations, long-term sequelae, and the prevention of disease transmission. While 54% (15/28) of CMGs recommended hospitalisation for severe cases, only 39% (11/28) provided guidance for severe disease management. Further, 46% (13/28) advocated for steroids in the chronic phase, but 18% (5/28) advised against its use. Interpretation There was a lack of high-quality CMGs that provided supportive care and treatment guidance, which may impact patient care and outcomes. It is essential that existing guidelines are updated and adapted to provide detailed evidence-based treatment guidelines for different at-risk populations. This study also highlights a need for more research into the management of the acute and chronic phases of CHIKV infection to inform evidence-based care