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Aydın Ö, Apaydın Yıldırım B. Determination of systemic inflammation response index (SIRI), systemic inflammatory index (SII), HMGB1, Mx1 and TNF levels in neonatal calf diarrhea with systemic inflammatory response syndrome. Vet Immunol Immunopathol 2024; 275:110815. [PMID: 39153273 DOI: 10.1016/j.vetimm.2024.110815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 08/10/2024] [Accepted: 08/11/2024] [Indexed: 08/19/2024]
Abstract
The objective of this study was to examine the values of MX dynamin-like GTPase 1 (Mx1), high mobility group box-1 (HMGB1), systemic inflammatory response index (SIRI), systemic inflammatory index (SII), tumor necrosis factor (TNF), and other hematological indices in calves with systemic inflammatory response syndrome (SIRS). The study material was divided into two groups: the SIRS group (comprising 13 calves) and the control group (comprising 10 calves). The independent samples t-test and Mann-Whitney U test were employed for normally distributed and non-normally distributed data, respectively. The relationship between the two groups was determined using Spearman correlation coefficient analysis. Significant differences were identified between the SIRS group and the control group with regard to white blood cell (WBC; P < 0.05), neutrophil (NEU; P < 0.01), and neutrophil-to-lymphocyte ratio (NLR; P < 0.001) values, in addition to SIRI (P < 0.05), SII (P < 0.01) values. Furthermore, HMGB1 (P < 0.001), Mx1 (P < 0.05), and TNF values (P < 0.001) demonstrated notable disparities between the two groups. As a result of this study, it was concluded that there were significant increases in inflammatory hematological indices, as well as in the levels of HMGB1, Mx1, and TNF, in calves with SIRS.
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Affiliation(s)
- Ömer Aydın
- Department of Internal Medicine, Faculty of Veterinary Medicine, Atatürk University, Erzurum, Turkey.
| | - Betül Apaydın Yıldırım
- Department of Biochemistry, Faculty of Veterinary Medicine, Atatürk University, Erzurum, Turkey.
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Rhedin S, Kvist B, Caffrey Osvald E, Karte G, Smew AI, Nauclér P, Lundholm C, Almqvist C. Penicillin V versus amoxicillin for pneumonia in children-a Swedish nationwide emulated target trial. Clin Microbiol Infect 2024:S1198-743X(24)00288-X. [PMID: 38889864 DOI: 10.1016/j.cmi.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/30/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVES Although most countries recommend amoxicillin for paediatric pneumonia, there is a long tradition of treatment with penicillin V (PcV) in Sweden, thus not empirically covering Haemophilus influenzae. There are, however, large regional differences in treatment practice. The aim was to compare clinical outcomes (treatment failure and severe complications), in children aged 1-59 months treated with PcV vs. amoxicillin for pneumonia. METHODS This population-based emulated target trial included all children born in Sweden between 2001 and 2021, using national health, sociodemographic, and population registers. All pneumonia cases from hospitals and paediatric outpatient clinics in children aged 1-59 months treated as outpatients with PcV or amoxicillin between July 2005 and December 2021, were identified. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for treatment failure (newly dispensed antibiotic prescription or pneumonia-associated hospitalization day 1-14) and severe complications (lung complications, an invasive bacterial disease, admission to intensive care unit or death day 1-28) were calculated with logistic regression analysis. RESULTS PcV was prescribed in 14 766 cases and amoxicillin in 10 566. Treatment failure occurred in 7.7% with PcV vs. 4.7% with amoxicillin, aOR 1.76 (95% CI: 1.54-2.00). Severe complications were rare, with no significant difference between PcV and amoxicillin (0.3% vs. 0.2%, aOR 0.96, 95% CI: 0.53-1.73). Sensitivity and interaction analyses showed consistent results. DISCUSSION PcV treatment compared with amoxicillin, was associated with an increased risk for treatment failure but not for severe complications. The absolute risks for adverse outcomes were low in both groups suggesting a minor role of H. influenzae in paediatric pneumonia.
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Affiliation(s)
- Samuel Rhedin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Sachs' Children and Youth Hospital, Stockholm, Sweden.
| | - Beatrice Kvist
- Department of Internal Medicine, Kungälv Hospital, Sweden
| | - Emma Caffrey Osvald
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Paediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Gale Karte
- Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Awad I Smew
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Pontus Nauclér
- Division of Infectious Diseases, Department of Medicine, Solna (MedS), Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Paediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Wilcox CR, Odeh N, Clark TW, Muller I, Becque T, Todd A, Islam N, Little P, Davies F, McGavin J, Francis N. Use of the FebriDx® host-response point-of-care test may reduce antibiotic use for respiratory tract infections in primary care: a mixed-methods feasibility study. J Antimicrob Chemother 2024; 79:1441-1449. [PMID: 38708643 PMCID: PMC11144485 DOI: 10.1093/jac/dkae127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
INTRODUCTION FebriDx® is a CE-marked, single-use point-of-care test with markers for bacterial [C-reactive protein (CRP)] and viral [myxovirus resistance protein A (MxA)] infection, using finger-prick blood samples. Results are available after 10-12 min. We explored the usability and potential impact of FebriDx® in reducing antibiotic prescriptions for lower respiratory tract infection (LRTI) in primary care, and the feasibility of conducting a randomized controlled trial (RCT). METHODS Patients (aged ≥1 year) with LRTI deemed likely to receive antibiotic prescription were recruited at nine general practices and underwent FebriDx® testing. Data collection included FebriDx® results, antibiotic prescribing plan (before and after testing) and re-consultation rates. Staff completed System Usability Scale questionnaires. RESULTS From 31 January 2023 to 9 June 2023, 162 participants participated (median age 57 years), with a median symptom duration of 7 days (IQR 5-14). A valid FebriDx® result was obtained in 97% (157/162). Of 155 patients with available results, 103 (66%) had no detectable CRP or MxA, 28 (18%) had CRP only, 5 (3%) had MxA only, and 19 (12%) had both CRP and MxA. The clinicians' stated management plan was to prescribe antibiotics for 86% (134/155) before testing and 45% (69/155) after testing, meaning a 41% (95% CI: 31%, 51%) difference after testing, without evidence of increased re-consultation rates. Ease-of-use questionnaires showed 'good' user-friendliness. CONCLUSIONS Use of FebriDx® to guide antibiotic prescribing for LRTI in primary care was associated with a substantial reduction in prescribing intentions. These results support a fully powered RCT to confirm its impact and safety.
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Affiliation(s)
- Christopher R Wilcox
- Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - Nour Odeh
- Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - Tristan W Clark
- School of Clinical and Experimental Sciences, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - Ingrid Muller
- Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - Taeko Becque
- Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - Alexander Todd
- Lilliput Surgery, Shore Medical Group, Elms Avenue, Poole BH14 8EE, UK
| | - Nazrul Islam
- Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - Paul Little
- Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - Firoza Davies
- Patient and Public Involvement Representative, Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - John McGavin
- Patient and Public Involvement Representative, Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - Nick Francis
- Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
- NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
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Gupta E, Samal J, Maiwall R, Tevethia H, Grover M, Rani N, Prabhakar T, Prasad M, Tomar A, Agarwal R, Kale P, Khillan V, Alam S. Respiratory tract viral infections associated sepsis in patients with underlying liver disease: Viral sepsis an entity to look forward! Indian J Gastroenterol 2024; 43:475-484. [PMID: 38460057 DOI: 10.1007/s12664-024-01536-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/16/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Sepsis remains a global health burden associated with significant morbidity and mortality. Bacteria are known to be the predominant pathogens in sepsis; however, viral etiologies in sepsis are still under diagnosed. Respiratory viral pathogens have been previously linked to sepsis, but the knowledge of incidence, disease burden and mortality of viral-induced sepsis remains limited. This study aimed at understanding the role of respiratory viral infections in the causation of sepsis in liver disease patients. METHODS In this retrospective study, the clinical records of liver disease patients with influenza-like illness, whose requests for respiratory viral testing were received from January 2019 to December 2022, were reviewed. Respiratory viruses were identified using FilmArray 2.0 respiratory panel (BioFire Diagnostics, Utah, USA). RESULTS Of 1391 patients tested, a respiratory viral etiology was detected in 23%. The occurrence of sepsis was seen in 35%. Among these, isolated viral etiology with no other bacterial/fungal coinfection was found in 55% of patients. Rhinovirus/Enterovirus was found as the most common underlying viral etiology (23.4%). The sepsis prevalence was higher among patients with associated comorbidities (45%) and decompensated cirrhosis (84%). On multi-variable analysis, no factor was found independently associated with sepsis-related mortality. CONCLUSION This study underlines the importance of isolated viral etiology in causation of sepsis among liver disease patients. Patients with comorbidities, older age and decompensated cirrhosis are at an increased risk of developing sepsis and are associated with poorer outcomes. Accurate and timely identification of the viral etiology in sepsis would prevent the misuse of antibiotics and improve overall patient care.
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Affiliation(s)
- Ekta Gupta
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, 110 070, India.
| | - Jasmine Samal
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, 110 070, India
| | - Rakhi Maiwall
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110 070, India
| | - Harshvardhan Tevethia
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110 070, India
| | - Malika Grover
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, 110 070, India
| | - Nitiksha Rani
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, 110 070, India
| | - Tushar Prabhakar
- Department of Epidemiology and Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, 110 070, India
| | - Manya Prasad
- Department of Epidemiology and Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, 110 070, India
| | - Arvind Tomar
- Department of Pulmonary Medicine, Institute of Liver and Biliary Sciences, New Delhi, 110 070, India
| | - Reshu Agarwal
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, 110 070, India
| | - Pratibha Kale
- Department of Microbiology, Institute of Liver and Biliary Sciences, New Delhi, 110 070, India
| | - Vikas Khillan
- Department of Microbiology, Institute of Liver and Biliary Sciences, New Delhi, 110 070, India
| | - Seema Alam
- Department of Paediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110 070, India
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Makrinioti H, Homil K, Hurme P, Erkkola R, Kinnunen L, Zhu Z, Waris M, Camargo CA, Hasegawa K, Jartti T. Peripheral Blood MxA Levels During a First Acute Wheezing Episode and the Link to Childhood Asthma. Arch Bronconeumol 2024; 60:183-185. [PMID: 38278648 DOI: 10.1016/j.arbres.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 01/28/2024]
Affiliation(s)
- Heidi Makrinioti
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Kiara Homil
- Department of Paediatrics, Turku University Hospital and University of Turku, Turku, Finland
| | - Pekka Hurme
- Department of Paediatrics, Turku University Hospital and University of Turku, Turku, Finland
| | - Riku Erkkola
- Research Unit of Clinical Medicine, Medical Research Centre, University of Oulu, Oulu, Finland
| | - Lotta Kinnunen
- Research Unit of Clinical Medicine, Medical Research Centre, University of Oulu, Oulu, Finland; Department of Paediatrics, Oulu University Hospital, Oulu, Finland
| | - Zhaozhong Zhu
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Matti Waris
- Department of Clinical Microbiology, Turku University Hospital, Turku, Finland
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tuomas Jartti
- Department of Paediatrics, Turku University Hospital and University of Turku, Turku, Finland; Research Unit of Clinical Medicine, Medical Research Centre, University of Oulu, Oulu, Finland; Department of Paediatrics, Oulu University Hospital, Oulu, Finland
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Brendish NJ, Davis C, Chapman ME, Borca F, Waddington D, Hill C, White N, Clark TW. Emergency Department point-of-care antiviral host response testing is accurate during periods of multiple respiratory virus co-circulation. J Infect 2024; 88:41-47. [PMID: 37977337 DOI: 10.1016/j.jinf.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/03/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES FebriDx is a CE-marked, FDA-approved point-of-care test that detects the antiviral host response protein Myxovirus Resistance Protein A (MxA), in addition to C-reactive protein, using finger-prick blood. FebriDx MxA detection had a high negative predictive value for COVID-19 in symptomatic adults presenting to hospital in the first waves of the pandemic and was used subsequently as a 'rule out' triage tool in Emergency departments. The diagnostic accuracy of FebriDx MxA in the current context of co-circulation of influenza, SARS-CoV-2, and Respiratory Syncytial Virus (RSV), and in the era of COVID-19 vaccination, is unknown. METHODS We retrospectively evaluated the diagnostic performance of FebriDx MxA in adults with acute respiratory symptoms presenting to the Emergency Department (ED) of a large UK teaching hospital using Reverse Transcription Polymerase Chain Reaction (RT-PCR) as the reference standard (Cepheid Xpert Xpress SARS-CoV-2/Flu/RSV). RESULTS Between March 9th 2022 and March 8th 2023, 5426 patients had both FebriDx and RT-PCR testing with valid results. 999 (18.4%) of patients had influenza detected, 520 (9.6%) SARS-CoV-2, and 190 (3.5%) RSV. Negative Predictive Value (NPV) of MxA detection by FebriDx was 97.5% (96.9-98.0) for influenza, 97.1% (96.4-97.7) for SARS-CoV-2, 98.1% (97.5-98.6) for RSV, and 92.8% (91.8-93.7) for all viruses combined. CONCLUSIONS In symptomatic adults, FebriDx MxA had a high NPV for influenza and RSV, and retained a high NPV for SARS-CoV-2, in the context of virus co-circulation and widespread COVID-19 vaccination. FebriDx continues to be a useful 'rule out' triage tool in the ED and could potentially be scaled to provide a national triage solution for future viral pandemics.
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Affiliation(s)
- Nathan J Brendish
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Cai Davis
- Clinical Informatics Research Unit, NHS Blood and Transplant Southampton, Southampton, UK
| | - Mary E Chapman
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Florina Borca
- Clinical Informatics Research Unit, NHS Blood and Transplant Southampton, Southampton, UK
| | - Daniel Waddington
- Department of Emergency Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Christopher Hill
- Department of Emergency Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nicola White
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Tristan W Clark
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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A limited role for microbiological testing for childhood lower respiratory tract infections in primary care: managing diagnostic uncertainty by withholding antibiotics and watchful waiting. Clin Microbiol Infect 2022; 28:1189-1192. [PMID: 35738322 DOI: 10.1016/j.cmi.2022.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/10/2022] [Accepted: 06/12/2022] [Indexed: 11/20/2022]
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