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Guo H, Liang J, Lin H, Zhou X, Zhang Z, Lai L, Zhang T, Wang Z, Zhou J, Sun J, Liao J, Jiang M, Yang Z. Differentiate Clinical Characteristics Between Viral Pneumonia and Mycoplasma pneumoniae and Nomograms for Predicting Mycoplasma pneumoniae : A Retrospective Study in Primary Hospitals. Pediatr Infect Dis J 2023; 42:1035-1040. [PMID: 37820276 PMCID: PMC10629606 DOI: 10.1097/inf.0000000000004082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE To identify the difference in clinical characteristics between viral pneumonia and Mycoplasma pneumoniae , providing cues on their differential diagnosis for primary hospitals with the insufficient pathogen detection capacity. METHODS We retrospectively reviewed the medical records of hospitalized children with acute respiratory tract infections, and pathogenic microbes test results were analyzed. Clinical characteristics, routine blood parameters and hospitalization duration and fee were compared between M. pneumoniae and viral pneumonia. We used in the multivariable logistic regression to predict the probability of children with M. pneumoniae and graphically represented by a dynamic nomogram. The discrimination and clinical utility of the model were confirmed by receiver operating characteristic and decision curve analysis curves. RESULT A total of 375 children with community-acquired pneumonia were included. Mycoplasma infection accounted for the largest proportion (22.13%). The incidence of both hypothermia and vomiting was lower in M. pneumoniae compared to viral pneumonia (hypothermia: 10.50% vs. 0.00%; vomiting: 7.90% vs. 0.00%). The prevalence of hyperthermia was higher in M. pneumoniae (hyperthermia: 89.5% vs. 100%). Procalcitonin, peripheral blood white blood cell count and lymphocyte levels were higher in the viral pneumonia group, and eosinophil levels were conversely lower. As for the duration of illness, the mean length of stay was 5.20 ± 2.12 (viral pneumonia) and 6.27 ± 2.48 days ( M. pneumoniae ). Children with M. pneumoniae had higher overall hospital costs and required more medical treatment. The above were all statistically significant with a P < 0.05. The scoring system was established based on the above results. Receiver operating characteristic curves showed good model-discrimination ability with 0.844 of the area under the curve in the training set and 0.778 in the test set. Decision curve analysis curves demonstrated the discriminative superiority of this model. The web-based dynamic nomogram calculator is accessible at https://zhxylxy0160128.shinyapps.io/Nomogram/ . CONCLUSION Nomograms have satisfactory discrimination, and clinical utility may benefit in predicting the probability of developing M. pneumoniae in children. Children with M. pneumoniae have a higher burden than those with viral pneumonia and may require more intensive in-hospital monitoring.
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Affiliation(s)
- Huixian Guo
- From the Department of Respiration, Guangzhou Yuexiu District Children’s Hospital, Guangzhou, China
| | - Jingyi Liang
- Department of Respiratory Research, National Center for Respiratory medicine, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Haowen Lin
- Department of Clinical Medicine, The First Clinical College, Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Xingyou Zhou
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Zhou Zhang
- From the Department of Respiration, Guangzhou Yuexiu District Children’s Hospital, Guangzhou, China
| | - Laiqing Lai
- From the Department of Respiration, Guangzhou Yuexiu District Children’s Hospital, Guangzhou, China
| | - Tao Zhang
- From the Department of Respiration, Guangzhou Yuexiu District Children’s Hospital, Guangzhou, China
| | - Zhufeng Wang
- Department of Respiratory Research, National Center for Respiratory medicine, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Junhou Zhou
- Department of Respiratory Research, National Center for Respiratory medicine, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Jiaxi Sun
- Department of Respiratory Research, National Center for Respiratory medicine, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Jiayi Liao
- From the Department of Respiration, Guangzhou Yuexiu District Children’s Hospital, Guangzhou, China
| | - Mei Jiang
- Department of Respiratory Research, National Center for Respiratory medicine, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Zifeng Yang
- Department of Respiratory Research, National Center for Respiratory medicine, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
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Sako A, Gu Y, Masui Y, Yoshimura K, Yanai H, Ohmagari N. Prescription of anti-influenza drugs in Japan, 2014-2020: A retrospective study using open data from the national claims database. PLoS One 2023; 18:e0291673. [PMID: 37792686 PMCID: PMC10550188 DOI: 10.1371/journal.pone.0291673] [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: 01/24/2023] [Accepted: 09/01/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Both physicians and patients are proactive towards managing seasonal influenza in Japan and six drugs are approved. Although many countries have national influenza surveillance systems, data on nationwide prescription practices of anti-influenza drugs are lacking. Therefore, we aimed to clarify the status of anti-influenza drug use in Japan by analyzing real-world data. METHODS This retrospective study analyzed open data from the National Database of Health Insurance Claims and Specific Health Checkups, which covers most claims data from national health insurance. We estimated the annual number of patients prescribed anti-influenza drugs, which drugs they were prescribed, the patients' age and sex distribution, drug costs, and regional disparities for the period 2014-2020. RESULTS For 2014-2019, an estimated 6.7-13.4 million patients per year were prescribed anti-influenza drugs, with an annual cost of 22.3-48.0 billion JPY (Japanese Yen). In addition, 21.1-32.0 million rapid antigen tests were performed at a cost of 30.1-47.1 billion JPY. In 2017, laninamivir was the most frequently prescribed anti-influenza drug (48%), followed by oseltamivir (36%), while in 2018, the newly introduced baloxavir accounted for 40.8% of prescriptions. After the emergence of COVID-19, the estimated number of patients prescribed anti-influenza drugs in 2020 dropped to just 14,000. In 2018, 37.6% of prescriptions were for patients aged < 20 years compared with 12.2% for those aged ≥ 65 years. Prescriptions for inpatients accounted for 1.1%, and the proportion of prescriptions for inpatients increased with age, with men were more likely than women to be prescribed anti-influenza drugs while hospitalized. CONCLUSIONS Based on our clarification of how influenza is clinically managed in Japan, future work should evaluate the clinical and economic aspects of proactively prescribing anti-influenza drugs.
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Affiliation(s)
- Akahito Sako
- Department of Internal Medicine, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Chiba, Japan
| | - Yoshiaki Gu
- Department of Infectious Diseases, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Bunkyo-ku, Tokyo, Japan
| | - Yoshinori Masui
- Department of Internal Medicine, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Chiba, Japan
| | - Kensuke Yoshimura
- Center for Next Generation of Community Health, Chiba University Hospital, Chuo-ku, Chiba, Japan
| | - Hidekatsu Yanai
- Department of Internal Medicine, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Chiba, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, Center Hospital, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
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Mukai E, Fukushima W, Morikawa S, Nakata K, Hiroi S, Fujioka M, Matsushita T, Kubota M, Yagi Y, Takechi T, Takasaki Y, Shindo S, Yamashita Y, Yokoyama T, Kiyomatsu Y, Matsumoto K, Maeda A, Kondo K, Ito K, Kase T, Ohfuji S, Hirota Y. No association between inactivated influenza vaccination and influenza viral load at diagnosis among young Japanese children: An observational study of the 2013/2014 through 2017/2018 influenza seasons. Influenza Other Respir Viruses 2023; 17:e13213. [PMID: 37885369 PMCID: PMC10603291 DOI: 10.1111/irv.13213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/01/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The association between inactivated influenza vaccination and viral load in young children remains unclear. METHODS During the 2013/2014 to 2017/2018 influenza seasons in Japan, children under 6 years of age with pre-defined influenza-like illness and influenza-positive status by real-time RT-PCR were recruited at pediatric clinics for this observational study. Influenza viral load was measured for the most predominant subtype/lineage in each season. Using median dichotomized viral load as an outcome, a multilevel logistic regression model was applied to estimate the multivariable adjusted odds ratio (MOR) and 95% confidence interval (CI) for higher viral load. RESULTS A total of 1,185 influenza-positive children were analyzed. The median log10 viral load copy number (copies per milliliter) was 5.5 (interquartile range, 4.6 to 6.1) and did not differ by vaccination status: 5.5 for unvaccinated, 5.7 for one dose, and 5.5 for two doses (p = 0.67). The MOR of vaccinated (one or two doses) versus unvaccinated children was 1.19 (95% CI: 0.86-1.64). Other factors showing significant associations with higher viral load were positive results for A(H1N1)pdm09 and A(H3N2) in comparison with B/Yamagata. The respective MORs were 3.25 (95% CI: 2.28-4.64) and 1.81 (95% CI: 1.32-2.49). Significantly elevated MORs against higher viral load were also observed for higher body temperature at influenza diagnosis and shorter duration from fever onset to specimen collection. CONCLUSION No association was observed between inactivated-influenza vaccination and viral load at influenza-positive diagnosis. Influenza subtype/lineage, body temperature, and time elapsed since fever onset were significantly associated with viral load.
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Affiliation(s)
- Emiko Mukai
- Department of Public HealthOsaka City University Graduate School of MedicineOsakaJapan
| | - Wakaba Fukushima
- Department of Public HealthOsaka Metropolitan University Graduate School of MedicineOsakaJapan
- Research Center for Infectious Disease SciencesOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| | - Saeko Morikawa
- Department of VirologyOsaka Institute of Public HealthOsakaJapan
| | - Keiko Nakata
- Department of VirologyOsaka Institute of Public HealthOsakaJapan
| | - Satoshi Hiroi
- Department of VirologyOsaka Institute of Public HealthOsakaJapan
| | | | | | | | | | | | | | | | | | | | | | - Kazuhiro Matsumoto
- Department of Public HealthOsaka City University Graduate School of MedicineOsakaJapan
| | - Akiko Maeda
- Department of Public HealthOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| | - Kyoko Kondo
- Management BureauOsaka Metropolitan University HospitalOsakaJapan
| | - Kazuya Ito
- Osaka Metropolitan University Graduate School of NursingOsakaJapan
| | - Tetsuo Kase
- Department of Public HealthOsaka Metropolitan University Graduate School of MedicineOsakaJapan
- Research Center for Infectious Disease SciencesOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| | - Satoko Ohfuji
- Department of Public HealthOsaka Metropolitan University Graduate School of MedicineOsakaJapan
- Research Center for Infectious Disease SciencesOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| | - Yoshio Hirota
- Clinical Epidemiology Research Center SOUSEIKAI Medical Group (Medical Co. LTA)FukuokaJapan
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Chan PSF, Fang Y, Kawuki J, Chen S, Liang X, Mo PKH, Wang Z. Parental Acceptance, Parental Hesitancy, and Uptake of Seasonal Influenza Vaccination among Children Aged 6-59 Months: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2023; 11:1360. [PMID: 37631928 PMCID: PMC10459009 DOI: 10.3390/vaccines11081360] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023] Open
Abstract
This systematic review and meta-analysis summarises the literature on parental acceptance, parental hesitancy, uptake, and the associated factors of seasonal influenza vaccination (SIV) among children aged 6-59 months. Studies were sourced from the following platforms: PubMed, Web of Science, MEDLINE, and EMBASE databases. A random-effects model was used to evaluate the prevalence and 95% confidence intervals (CI) of parental acceptance, parental hesitancy, and SIV uptake in the last flu season and lifetime among children. A total of 36 studies were included for analysis. The overall prevalence was 64% for parental acceptance (95% CI: 51-75%), 34% for parental hesitancy (95% CI: 22-48%), 41% for SIV uptake in the last flu season (95% CI: 33-50%), and 46% for SIV uptake in a lifetime (95% CI: 20-74%). Associated factors of parental acceptance/hesitancy and uptake included the age of the children or parents, parental education level, household income level, ethnicity, and other modifiable factors, including perceived benefits, perceived barriers, perceived severity, perceived susceptibility, and cues to action related to SIV. Meta-regression analyses revealed regional differences in parental acceptance (Americas: 79% vs. Asia: 60%). The results provided implications informing us of the development of intervention programs targeting parents to improve SIV coverage among young children.
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Affiliation(s)
- Paul Shing-fong Chan
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (P.S.-f.C.); (J.K.); (S.C.); (X.L.); (P.K.-h.M.)
| | - Yuan Fang
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China;
| | - Joseph Kawuki
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (P.S.-f.C.); (J.K.); (S.C.); (X.L.); (P.K.-h.M.)
| | - Siyu Chen
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (P.S.-f.C.); (J.K.); (S.C.); (X.L.); (P.K.-h.M.)
| | - Xue Liang
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (P.S.-f.C.); (J.K.); (S.C.); (X.L.); (P.K.-h.M.)
| | - Phoenix Kit-han Mo
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (P.S.-f.C.); (J.K.); (S.C.); (X.L.); (P.K.-h.M.)
| | - Zixin Wang
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (P.S.-f.C.); (J.K.); (S.C.); (X.L.); (P.K.-h.M.)
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Hanaki N, Miyata J, Yamada Y, Shiga T. Choosing Wisely® in Japanese Emergency Medicine: Nine Recommendations to Improve The Value of Health Care. J Emerg Med 2023; 64:371-379. [PMID: 37019499 DOI: 10.1016/j.jemermed.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/09/2022] [Accepted: 01/06/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND The overuse of diagnostic and therapeutic modalities has become an issue in the field of emergency medicine. The health care system of Japan aims to provide the most appropriate quality and quantity of care at the right price, while focusing on patient value. The Choosing Wisely® campaign was launched in Japan and other countries. OBJECTIVE In this article, recommendations were discussed to improve the field of emergency medicine based on the state of the Japanese health care system. METHODS The modified Delphi method, a consensus-building method, was used in this study. The final recommendations were developed by a working group of 20 medical professionals, students, and patients, consisting of members of the emergency physician electronic mailing list. RESULTS From the 80 candidates recommended and excessive actions gathered, nine recommendations were formulated after two Delphi rounds. The recommendations included the suppression of excessive behavior and the implementation of appropriate medical treatment, like rapid pain relief and the application of ultrasonography during central venous catheter placement. CONCLUSIONS This study formulated recommendations to improve the field of Japanese emergency medicine, based on the feedback of patients and health care professionals. The nine recommendations will be helpful for all people involved in emergency care in Japan because they have the potential to prevent the overuse of diagnostic and therapeutic modalities, while maintaining the appropriate quality of patient care.
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Affiliation(s)
- Nao Hanaki
- Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Jun Miyata
- Department of Island and Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Goto-shi, Nagasaki, Japan
| | - Yoshie Yamada
- Department of Healthcare Epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Shiga
- Department of Emergency Medicine, International University of Health and Welfare, Tokyo, Otawara, Japan
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Jhutty SS, Boehme JD, Jeron A, Volckmar J, Schultz K, Schreiber J, Schughart K, Zhou K, Steinheimer J, Stöcker H, Stegemann-Koniszewski S, Bruder D, Hernandez-Vargas EA. Predicting Influenza A Virus Infection in the Lung from Hematological Data with Machine Learning. mSystems 2022; 7:e0045922. [PMID: 36346236 PMCID: PMC9765554 DOI: 10.1128/msystems.00459-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The tracking of pathogen burden and host responses with minimally invasive methods during respiratory infections is central for monitoring disease development and guiding treatment decisions. Utilizing a standardized murine model of respiratory influenza A virus (IAV) infection, we developed and tested different supervised machine learning models to predict viral burden and immune response markers, i.e., cytokines and leukocytes in the lung, from hematological data. We performed independently in vivo infection experiments to acquire extensive data for training and testing of the models. We show here that lung viral load, neutrophil counts, cytokines (such as gamma interferon [IFN-γ] and interleukin 6 [IL-6]), and other lung infection markers can be predicted from hematological data. Furthermore, feature analysis of the models showed that blood granulocytes and platelets play a crucial role in prediction and are highly involved in the immune response against IAV. The proposed in silico tools pave the path toward improved tracking and monitoring of influenza virus infections and possibly other respiratory infections based on minimally invasively obtained hematological parameters. IMPORTANCE During the course of respiratory infections such as influenza, we do have a very limited view of immunological indicators to objectively and quantitatively evaluate the outcome of a host. Methods for monitoring immunological markers in a host's lungs are invasive and expensive, and some of them are not feasible to perform. Using machine learning algorithms, we show for the first time that minimally invasively acquired hematological parameters can be used to infer lung viral burden, leukocytes, and cytokines following influenza virus infection in mice. The potential of the framework proposed here consists of a new qualitative vision of the disease processes in the lung compartment as a noninvasive tool.
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Affiliation(s)
- Suneet Singh Jhutty
- Frankfurt Institute for Advanced Studiesgrid.417999.b, Frankfurt am Main, Germany
- Faculty of Biological Sciences, Goethe University, Frankfurt am Main, Germany
| | - Julia D. Boehme
- Immune Regulation Group, Helmholtz Centre for Infection Researchgrid.7490.a, Braunschweig, Germany
- Infection Immunology Group, Institute of Medical Microbiology, Infection Control and Prevention, Health Campus Immunology, Infectiology and Inflammation, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Andreas Jeron
- Immune Regulation Group, Helmholtz Centre for Infection Researchgrid.7490.a, Braunschweig, Germany
- Infection Immunology Group, Institute of Medical Microbiology, Infection Control and Prevention, Health Campus Immunology, Infectiology and Inflammation, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Julia Volckmar
- Immune Regulation Group, Helmholtz Centre for Infection Researchgrid.7490.a, Braunschweig, Germany
- Infection Immunology Group, Institute of Medical Microbiology, Infection Control and Prevention, Health Campus Immunology, Infectiology and Inflammation, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Kristin Schultz
- Immune Regulation Group, Helmholtz Centre for Infection Researchgrid.7490.a, Braunschweig, Germany
- Department of Infection Genetics, Helmholtz Centre for Infection Researchgrid.7490.a, Braunschweig, Germany
| | - Jens Schreiber
- Department of Pneumology, Health Campus Immunology, Infectiology and Inflammation, Otto-von-Guericke University Magdeburggrid.5807.a, Magdeburg, Germany
| | - Klaus Schughart
- Department of Infection Genetics, Helmholtz Centre for Infection Researchgrid.7490.a, Braunschweig, Germany
- Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- University of Veterinary Medicine Hannover, Hannover, Germany
| | - Kai Zhou
- Frankfurt Institute for Advanced Studiesgrid.417999.b, Frankfurt am Main, Germany
| | - Jan Steinheimer
- Frankfurt Institute for Advanced Studiesgrid.417999.b, Frankfurt am Main, Germany
| | - Horst Stöcker
- Frankfurt Institute for Advanced Studiesgrid.417999.b, Frankfurt am Main, Germany
- Institut für Theoretische Physik, Goethe Universität Frankfurt, Frankfurt am Main, Germany
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - Sabine Stegemann-Koniszewski
- Department of Pneumology, Health Campus Immunology, Infectiology and Inflammation, Otto-von-Guericke University Magdeburggrid.5807.a, Magdeburg, Germany
| | - Dunja Bruder
- Immune Regulation Group, Helmholtz Centre for Infection Researchgrid.7490.a, Braunschweig, Germany
- Infection Immunology Group, Institute of Medical Microbiology, Infection Control and Prevention, Health Campus Immunology, Infectiology and Inflammation, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Esteban A. Hernandez-Vargas
- Frankfurt Institute for Advanced Studiesgrid.417999.b, Frankfurt am Main, Germany
- Department of Mathematics and Statistical Science, University of Idaho, Moscow, Idaho, USA
- Institute for Modeling Collaboration and Innovation, University of Idaho, Moscow, Idaho, USA
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Lee WC, Ho MC, Leu SW, Chang CC, Lin CK, Lin CM, Fang YH, Huang SY, Lin YC, Chuang MC, Yang TM, Hung MS, Chou YL, Tsai YH, Hsieh MJ. The impacts of bacterial co-infections and secondary bacterial infections on patients with severe influenza pneumonitis admitted to the intensive care units. J Crit Care 2022; 72:154164. [PMID: 36209697 DOI: 10.1016/j.jcrc.2022.154164] [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: 07/08/2022] [Revised: 09/08/2022] [Accepted: 09/18/2022] [Indexed: 11/05/2022]
Abstract
PURPOSES This study investigated the prevalence and clinical outcomes of pulmonary bacterial co-infections and secondary bacterial infections in patients with severe influenza pneumonitis. METHODS We retrospectively analyzed the data of adult patients with severe influenza pneumonitis admitted to medical ICUs. Bacterial co-infections and secondary bacterial infections were identified. The risk factors of bacterial infection were evaluated. The outcomes of patients regarding co-infection or secondary bacterial infection were analyzed. RESULTS We identified 117 critically ill patients with laboratory-confirmed influenza pneumonitis admitted to the medical ICUs. Klebsiella pneumoniae (31.4%) and Staphylococcus aureus (22.8%) were the most identified bacteria in patients with bacterial co-infection. A high proportion of methicillin-resistant Staphylococcus aureus (17.1%) was noted. Liver cirrhosis and diabetes mellitus were the independent risk factors for bacterial co-infection. Acinetobacter baumannii (30.7%) and S. aureus (23.1%) were the most often identified bacteria in patients with secondary bacterial pneumonia. Patients with secondary bacterial infections had a longer duration of mechanical ventilation, and longer ICU and hospital stay. CONCLUSIONS High rates of drug-resistant bacterial co-infections and secondary bacterial infections were identified in patients with severe influenza pneumonitis requiring ICU care and were associated with more morbidity in these patients.
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Affiliation(s)
- Wei-Chun Lee
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan
| | - Meng-Chin Ho
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan
| | - Shaw-Woei Leu
- Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Taoyuan, Taiwan
| | - Che-Chia Chang
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan
| | - Chin-Kuo Lin
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan
| | - Chieh-Mo Lin
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan
| | - Yu-Hung Fang
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan
| | - Shu-Yi Huang
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan
| | - Yu-Ching Lin
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan; Department of Medicine, School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Min-Chun Chuang
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan
| | - Tsung-Ming Yang
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan
| | - Ming-Szu Hung
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan; Department of Medicine, School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Yen-Li Chou
- Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan
| | - Ying-Huang Tsai
- Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Taoyuan, Taiwan; Department of Respiratory Therapy, School of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Meng-Jer Hsieh
- Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Taoyuan, Taiwan; Department of Respiratory Therapy, School of Medicine, Chang-Gung University, Taoyuan, Taiwan.
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Bibby HL, de Koning L, Seiden-Long I, Zelyas N, Church DL, Berenger BM. A pragmatic randomized controlled trial of rapid on-site influenza and respiratory syncytial virus PCR testing in paediatric and adult populations. BMC Infect Dis 2022; 22:854. [PMID: 36384484 PMCID: PMC9667852 DOI: 10.1186/s12879-022-07796-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background Rapid/point-of-care respiratory virus nucleic acid tests (NAT) may improve oseltamivir, antibiotic, diagnostic test, and hospital bed utilization. Previous randomized controlled trials (RCT) on this topic have not used standard procedures of an accredited healthcare and laboratory system. Methods We conducted a parallel RCT at two hospitals [paediatric = Alberta Children’s Hospital (ACH); primarily adult = Peter Lougheed Centre (PLC)]. Patients with a respiratory viral testing order were randomized to testing at either a central accredited laboratory (standard arm) or with a rapid polymerase chain reaction test at an on-site accredited laboratory followed by standard testing [rapid on-site test (ROST) arm] based on day of specimen receipt at the laboratory. Patients and clinicians were blinded to assignment. The primary outcome for ACH was inpatient length of stay (LOS) and for PLC was the proportion of inpatients prescribed oseltamivir. Results 706 patient encounters were included at ACH; 322 assigned to ROST (181 inpatients) and 384 to the standard arm (194 inpatients). 422 patient encounters were included at PLC; 200 assigned to ROST (157 inpatients) and 222 to the standard arm (175 inpatients). The rate of oseltamivir prescription and number of doses given was reduced in PLC inpatients negative for influenza in the ROST arm compared to standard arm [mean 14.9% (95% CI 9.87–21.9) vs. 27.5% (21.0–35.2), p = 0.0135; mean 2.85 doses (SEM 2.39–3.32) vs. 4.17 doses (3.85–4.49) p = 0.022, respectively]. ROST also significantly reduced oseltamivir use at ACH, reduced chest radiographs (ACH), and laboratory test ordering (PLC), but not antibiotic prescriptions. ROST also reduced the median turnaround time by > 24 h (ACH and PLC). The LOS at ACH was not significantly different between the ROST and standard arms [median 4.05 days (SEM 1.79–18.2) vs 4.89 days (2.07–22.9), p = 0.062, respectively]. No adverse events were reported. Conclusions In a RCT representing implementation of ROST in an accredited laboratory system, we found that a ROST improved oseltamivir utilization and is the first RCT to show reduced ancillary testing in both paediatric and adult populations. A larger study is required to assess reduction in paediatric LOS as ACH was underpowered. These findings help justify the implementation of rapid on-site respiratory virus testing for inpatients. Trial registration ISRCTN, number 10110119, Retrospectively Registered, 01/12/2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07796-3.
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Walsh PS, Schnadower D, Zhang Y, Ramgopal S, Shah SS, Wilson PM. Association of Early Oseltamivir With Improved Outcomes in Hospitalized Children With Influenza, 2007-2020. JAMA Pediatr 2022; 176:e223261. [PMID: 36121673 PMCID: PMC9486642 DOI: 10.1001/jamapediatrics.2022.3261] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/13/2022] [Indexed: 12/15/2022]
Abstract
Importance Oseltamivir is recommended for all children hospitalized with influenza, despite limited evidence supporting its use in the inpatient setting. Objective To determine whether early oseltamivir use is associated with improved outcomes in children hospitalized with influenza. Design, Setting, and Participants This multicenter retrospective study included 55 799 children younger than 18 years who were hospitalized with influenza from October 1, 2007, to March 31, 2020, in 36 tertiary care pediatric hospitals who participate in the Pediatric Health Information System database. Data were analyzed from January 2021 to March 2022. Exposures Early oseltamivir treatment, defined as use of oseltamivir on hospital day 0 or 1. Main Outcomes and Measures The primary outcome was hospital length of stay (LOS) in calendar days. Secondary outcomes included 7-day hospital readmission, late (hospital day 2 or later) intensive care unit (ICU) transfer, and a composite outcome of in-hospital death or use of extracorporeal membrane oxygenation (ECMO). Inverse probability treatment weighting (IPTW) based on propensity scoring was used to address confounding by indication. Mixed-effects models were used to compare outcomes between children who did and did not receive early oseltamivir treatment. Outcomes were also compared within high-risk subgroups based on age, presence of a complex chronic condition, early critical illness, and history of asthma. Results The analysis included 55 799 encounters from 36 hospitals. The median (IQR) age of the cohort was 3.61 years (1.03-8.27); 56% were male, and 44% were female. A total of 33 207 patients (59.5%) received early oseltamivir. In propensity score-weighted models, we found that children treated with early oseltamivir had shorter LOS (median 3 vs 4 days; IPTW model ratio, 0.52; 95% CI, 0.52-0.53) and lower odds of all-cause 7-day hospital readmission (3.5% vs 4.8%; adjusted odds ratio [aOR], 0.72; 95% CI, 0.66-0.77), late ICU transfer (2.4% vs 5.5%; aOR, 0.41; 95% CI, 0.37-0.46), and the composite outcome of death or ECMO use (0.9% vs 1.4%; aOR, 0.63; 95% CI, 0.54-0.73). Conclusions and Relevance Early use of oseltamivir in hospitalized children was associated with shorter hospital stay and lower odds of 7-day readmission, ICU transfer, ECMO use, and death. These findings support the current recommendations for oseltamivir use in children hospitalized with influenza.
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Affiliation(s)
- Patrick S. Walsh
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - David Schnadower
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Yin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Sriram Ramgopal
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Emergency Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Samir S. Shah
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Hospital Medicine Center, Cincinnati, Ohio
| | - Paria M. Wilson
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Walsh PS, Schnadower D, Zhang Y, Ramgopal S, Shah SS, Wilson PM. Assessment of Temporal Patterns and Patient Factors Associated With Oseltamivir Administration in Children Hospitalized With Influenza, 2007-2020. JAMA Netw Open 2022; 5:e2233027. [PMID: 36149655 PMCID: PMC9508650 DOI: 10.1001/jamanetworkopen.2022.33027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Oseltamivir therapy is recommended for all pediatric inpatients with influenza, particularly those with high-risk conditions, although data regarding its uptake and benefits are limited. OBJECTIVE To describe temporal patterns and independent patient factors associated with the use of oseltamivir and explore patterns in resource use and patient outcomes among children hospitalized with influenza. DESIGN, SETTING, AND PARTICIPANTS This multicenter retrospective cross-sectional study was conducted at 36 tertiary pediatric hospitals participating in the Pediatric Health Information System in the US. A total of 70 473 children younger than 18 years who were hospitalized with influenza between October 1, 2007, and March 31, 2020, were included. EXPOSURES Hospitalization with a diagnosis of influenza. MAIN OUTCOMES AND MEASURES The primary outcome was the use of oseltamivir, which was described by influenza season and by hospital. Patient factors associated with oseltamivir use were assessed using multivariable mixed-effects logistic regression models. Secondary outcomes were resource use (including antibiotic medications, chest radiography, supplemental oxygen, positive pressure ventilation, central venous catheter, and intensive care unit [ICU]) and patient outcomes (length of stay, late ICU transfer, 7-day hospital readmission, use of extracorporeal membrane oxygenation, and in-hospital mortality), which were described as percentages per influenza season. RESULTS Among 70 473 children hospitalized with influenza, the median (IQR) age was 3.65 (1.05-8.26) years; 30 750 patients (43.6%) were female, and 39 715 (56.4%) were male. Overall, 16 559 patients (23.5%) were Black, 36 184 (51.3%) were White, 14 133 (20.1%) were of other races (including 694 American Indian or Alaska Native [1.0%], 2216 Asian [3.0%], 372 Native Hawaiian or Pacific Islander [0.5%], and 10 850 other races [15.4%]), and 3597 (5.1%) were of unknown race. A total of 47 071 patients (66.8%) received oseltamivir, increasing from a low of 20.2% in the 2007-2008 influenza season to a high of 77.9% in the 2017-2018 season. Use by hospital ranged from 43.2% to 79.7% over the entire study period and from 56.5% to 90.1% in final influenza season studied (2019-2020). Factors associated with increased oseltamivir use included the presence of a complex chronic condition (odds ratio [OR], 1.42; 95% CI, 1.36-1.47), a history of asthma (OR, 1.31; 95% CI, 1.23-1.38), and early severe illness (OR, 1.19; 95% CI, 1.13-1.25). Children younger than 2 years (OR, 0.81; 95% CI, 0.77-0.85) and children aged 2 to 5 years (OR, 0.83; 95% CI, 0.79-0.88) had lower odds of receiving oseltamivir. From the beginning (2007-2008) to the end (2019-2020) of the study period, the use of antibiotic medications (from 74.4% to 60.1%) and chest radiography (from 59.2% to 51.7%) decreased, whereas the use of oxygen (from 33.6% to 29.3%), positive pressure ventilation (from 10.8% to 7.9%), and central venous catheters (from 2.5% to 1.0%) did not meaningfully change. Patient outcomes, including length of stay (median [IQR], 3 [2-5] days for all seasons), readmissions within 7 days (from 4.0% to 3.4%), use of extracorporeal membrane oxygenation (from 0.5% to 0.5%), and in-hospital mortality (from 1.1% to 0.8%), were stable from the beginning to the end of the study period. CONCLUSIONS AND RELEVANCE In this cross-sectional study of children hospitalized with influenza, the use of oseltamivir increased over time, particularly among patients with high-risk conditions, but with wide institutional variation. Patient outcomes remained largely unchanged. Further work is needed to evaluate the impact of oseltamivir therapy in this population.
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Affiliation(s)
- Patrick S. Walsh
- Department of Pediatrics, Section of Pediatric Emergency Medicine, Medical College of Wisconsin, Milwaukee
| | - David Schnadower
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Yin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Sriram Ramgopal
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Division of Emergency Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Samir S. Shah
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medicine Center, Cincinnati, Ohio
| | - Paria M. Wilson
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Zadran A, Ho AVD, Zadran L, Ventura Curiel IJ, Pham TT, Thuan DTB, Kost GJ. Optimizing Public Health Preparedness for Highly Infectious Diseases in Central Vietnam. Diagnostics (Basel) 2022; 12:diagnostics12092047. [PMID: 36140451 PMCID: PMC9497681 DOI: 10.3390/diagnostics12092047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
Our primary objectives were (a) to determine the need for and the availability of point-of-care testing (POCT) for infectious diseases and (b) to recommend point-of-care testing strategies and Spatial Care PathsTM (SCPs) that enhance public health preparedness in the regional districts of Thua Thien Hue Province (TTHP), Central Vietnam, where we conducted field surveys. Medical professionals in seven community health centers (CHCs), seven district hospitals (DHs) and one provincial hospital (PH) participated. Survey questions (English and Vietnamese) determined the status of diagnostic testing capabilities for infectious diseases and other acute medical challenges in TTHP. Infectious disease testing was limited: six of seven CHCs (86%) lacked infectious disease tests. One CHC (14%, 1/7) had two forms of diagnostic tests available for the detection of malaria. All CHCs lacked adequate microbiology laboratories. District hospitals had few diagnostic tests for infectious diseases (tuberculosis and syphilis), blood culture (29%, 2/7), and pathogen culture (57%, 4/7) available. The PH had broader diagnostic testing capabilities but lacked preparedness for highly infectious disease threats (e.g., Ebola, MERS-CoV, SARS, Zika, and monkeypox). All sites reported having COVID-19 rapid antigen tests; COVID-19 RT-PCR tests were limited to higher-tier hospitals. We conclude that infectious disease diagnostic testing should be improved and POC tests must be supplied near patients’ homes and in primary care settings for the early detection of infected individuals and the mitigation of the spread of new COVID-19 variants and other highly infectious diseases.
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Affiliation(s)
- Amanullah Zadran
- Point-of-Care Testing Center for Teaching and Research (POCT CTR) Pathology and Laboratory Medicine, School of Medicine, University of California, Davis, CA 95616, USA
- Correspondence: (A.Z.); (G.J.K.); Tel.: +1-(510)-779-8698 (A.Z.)
| | - An V. D. Ho
- Department of Orthopedics and Rehabilitation, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 70000, Vietnam
| | - Layma Zadran
- Point-of-Care Testing Center for Teaching and Research (POCT CTR) Pathology and Laboratory Medicine, School of Medicine, University of California, Davis, CA 95616, USA
| | - Irene J. Ventura Curiel
- Point-of-Care Testing Center for Teaching and Research (POCT CTR) Pathology and Laboratory Medicine, School of Medicine, University of California, Davis, CA 95616, USA
| | - Tang-Tung Pham
- Faculty of Medicine, Phan Chau Trinh University, No 9 Nguyen Gia Thieu St, Dien Ban Ward, Dien Ngoc District, Danang City 550000, Vietnam
| | - Duong Thi Bich Thuan
- College of Health Sciences, VinUniversity, Vinhomes Ocean Park, Gia Lam District, Hanoi 100000, Vietnam
| | - Gerald J. Kost
- Point-of-Care Testing Center for Teaching and Research (POCT CTR) Pathology and Laboratory Medicine, School of Medicine, University of California, Davis, CA 95616, USA
- Correspondence: (A.Z.); (G.J.K.); Tel.: +1-(510)-779-8698 (A.Z.)
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Uysal P, Teksoz D, Aksan H, Durmus S, Uslu-Besli L, Cuhadaroglu C, Gelisgen R, Simsek G, Uzun H. Relationship between serum sialic acid levels and prolidase activity with airflow obstruction in patients with COPD. Medicine (Baltimore) 2022; 101:e28949. [PMID: 35356903 PMCID: PMC10684178 DOI: 10.1097/md.0000000000028949] [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: 10/01/2021] [Accepted: 02/09/2022] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Our aim in this study was to evaluate the prognostic significance of sialic acid (SA) and prolidase activity and to evaluate the association between airflow obstruction severity and these parameters in chronic obstructive pulmonary disease (COPD) patients.Ninety-four patients (84 M, 10 F) and 34 healthy subjects (19 M, 15 F) were included into the study. COPD staging was performed to COPD patients according to new global initiative for chronic obstructive lung disease criteria which includes pulmonary function tests, symptoms and hospitalization; COPD patients were divided into 4 subgroups as group A (n = 25), group B (n = 19), group C (n = 20), and group D (n = 28).SA and C-reactive protein levels were significantly higher than the control group in all COPD groups. SA levels were significantly higher in group B patients than the control and group A. Prolidase activity was significantly lower than control group in total COPD groups (P < .05). There was a weak negative correlation between SA and forced vital capacity (r = -0.217, P = .038) and forced expiratory volume in 1 second (FEV1) (r = -0.210, P = .045), whereas weak positive correlation was present between SA and Creactive protein (r = 0.247, P = .018) in all patient groups. There was weak positive correlation between prolidase and FEV1 (r = 0.222, P = .033) and FEV1/forced vital capacity (r = 0.230, P = .027).Our study shows that systemic inflammation, prolidase activity, and SA levels in stable COPD patients are associated with airflow obstruction severity. In addition to the prolidase activity; SA levels might be associated with inflammation.
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Affiliation(s)
- Pelin Uysal
- Department of Chest Diseases, Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, Maslak Hospital, Istanbul, Turkey,Department of Biochemistry, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey,Department of Biochemistry, Faculty of Medicine, Halic University, Istanbul, Turkey,Department of Biochemistry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey,Department of Nuclear Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey,Department of Physiology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey,Department of Medical Biochemistry, Faculty of Medicine, Istanbul Atlas University, Istanbul, Turkey
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13
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Hamdan L, Probst V, Haddadin Z, Rahman H, Spieker AJ, Vandekar S, Stewart LS, Williams JV, Boom JA, Munoz F, Englund JA, Selvarangan R, Staat MA, Weinberg GA, Azimi PH, Klein EJ, McNeal M, Sahni LC, Singer MN, Szilagyi PG, Harrison CJ, Patel M, Campbell AP, Halasa NB. Influenza clinical testing and oseltamivir treatment in hospitalized children with acute respiratory illness, 2015-2016. Influenza Other Respir Viruses 2022; 16:289-297. [PMID: 34704375 PMCID: PMC8818823 DOI: 10.1111/irv.12927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Antiviral treatment is recommended for all hospitalized children with suspected or confirmed influenza, regardless of their risk profile. Few data exist on adherence to these recommendations, so we sought to determine factors associated with influenza testing and antiviral treatment in children. METHODS Hospitalized children <18 years of age with acute respiratory illness (ARI) were enrolled through active surveillance at pediatric medical centers in seven cities between 11/1/2015 and 6/30/2016; clinical information was obtained from parent interview and chart review. We used generalized linear mixed-effects models to identify factors associated with influenza testing and antiviral treatment. RESULTS Of the 2299 hospitalized children with ARI enrolled during one influenza season, 51% (n = 1183) were tested clinically for influenza. Clinicians provided antiviral treatment for 61 of 117 (52%) patients with a positive influenza test versus 66 of 1066 (6%) with a negative or unknown test result. In multivariable analyses, factors associated with testing included neuromuscular disease (aOR = 5.35, 95% CI [3.58-8.01]), immunocompromised status (aOR = 2.88, 95% CI [1.66-5.01]), age (aOR = 0.93, 95% CI [0.91-0.96]), private only versus public only insurance (aOR = 0.78, 95% CI [0.63-0.98]), and chronic lung disease (aOR = 0.64, 95% CI [0.51-0.81]). Factors associated with antiviral treatment included neuromuscular disease (aOR = 1.86, 95% CI [1.04, 3.31]), immunocompromised state (aOR = 2.63, 95% CI [1.38, 4.99]), duration of illness (aOR = 0.92, 95% CI [0.84, 0.99]), and chronic lung disease (aOR = 0.60, 95% CI [0.38, 0.95]). CONCLUSION Approximately half of children hospitalized with influenza during the 2015-2016 influenza season were treated with antivirals. Because antiviral treatment for influenza is associated with better health outcomes, further studies of subsequent seasons would help evaluate current use of antivirals among children and better understand barriers for treatment.
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Affiliation(s)
- Lubna Hamdan
- Department of Pediatrics, Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Varvara Probst
- Department of Pediatrics, Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Zaid Haddadin
- Department of Pediatrics, Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Herdi Rahman
- Department of Pediatrics, Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Andrew J. Spieker
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Simon Vandekar
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Laura S. Stewart
- Department of Pediatrics, Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - John V. Williams
- Pediatric Infectious Diseases, Institute for Infection, Inflammation, and Immunity in Children, University of Pittsburgh School of MedicineUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Julie A. Boom
- Primary Care Practice at Palm Center, Immunization Project, Baylor College of MedicineTexas Children's HospitalHoustonTexasUSA
| | - Flor Munoz
- Pediatrics and Molecular Virology and Microbiology, Baylor College of MedicineTexas Children's HospitalHoustonTexasUSA
| | - Janet A. Englund
- Department of Pediatrics, Division of Infectious DiseasesSeattle Children's HospitalSeattleWashingtonUSA
| | | | - Mary A. Staat
- Pediatric Infectious Diseases, University of Cincinnati College of MedicineCincinnati Children's Hospital and Medical CenterCincinnatiOhioUSA
| | - Geoffrey A. Weinberg
- Pediatric Infectious DiseasesUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Parvin H. Azimi
- Pediatric Infectious DiseasesChildren's Hospital and Research CenterOaklandCaliforniaUSA
| | - Eileen J. Klein
- Department of Pediatrics, Division of Emergency MedicineSeattle Children's HospitalSeattleWashingtonUSA
| | - Monica McNeal
- Pediatric Infectious Diseases, University of Cincinnati College of MedicineCincinnati Children's Hospital and Medical CenterCincinnatiOhioUSA
| | - Leila C. Sahni
- Department of Pediatrics, Section of Hematology‐Oncology, Baylor College of MedicineTexas Children's HospitalHoustonTexasUSA
| | - Monica N. Singer
- Pediatric Infectious DiseasesChildren's Hospital and Research CenterOaklandCaliforniaUSA
| | - Peter G. Szilagyi
- Department of PediatricsUniversity of California at Los Angeles Mattel Children's HospitalLos AngelesCaliforniaUSA
| | | | - Manish Patel
- National Center for Immunization and Respiratory Diseases, Division of Viral DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Angela P. Campbell
- Epidemiology and Prevention Branch, Influenza Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Natasha B. Halasa
- Department of Pediatrics, Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
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Current Practices and Recommendations for Prioritizing Patients Mimicking Upper Respiratory Tract Symptoms in Period of Covid 19 Pandemic: A Strategic Perspective. Indian J Otolaryngol Head Neck Surg 2022; 74:3229-3234. [PMID: 35127461 PMCID: PMC8799419 DOI: 10.1007/s12070-021-02993-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/18/2021] [Indexed: 11/06/2022] Open
Abstract
Upper respiratory tract symptoms can be caused by many diseases like Covid 19 disease, common cold, seasonal flu or allergy. This present a diagnostic dilemma in OPD to clinically identify which patient is suspected of Covid 19 disease and which is not. Which patient needs immediate Covid 19 testing, as not all patients presenting with these symptoms have Covid 19 disease. To develop a criteria which can help clinician in OPD while dealing with cases of upper respiratory tract symptoms and to highlight this grey area which needs further research. 107 patients with upper respiratory tract symptom over a period of 1 month, fulfilling the inclusion and exclusion criteria were evaluated and analysed. Patients were divided into 2 groups. Group I is High suspicion group having 43 cases, Group II Low Suspicion group having 64 cases. In group I there were 29 Covid 19 positive cases (67.44%). In group II there were 3 Covid 19 positive cases (4.6%). By dividing the patients of upper respiratory tract symptoms into three groups (I & II) a system can be made for proper, timely and efficient treatment of such cases.
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Mechanisms contributing to adverse outcomes of COVID-19 in obesity. Mol Cell Biochem 2022; 477:1155-1193. [PMID: 35084674 PMCID: PMC8793096 DOI: 10.1007/s11010-022-04356-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/07/2022] [Indexed: 01/08/2023]
Abstract
A growing amount of epidemiological data from multiple countries indicate an increased prevalence of obesity, more importantly central obesity, among hospitalized subjects with COVID-19. This suggests that obesity is a major factor contributing to adverse outcome of the disease. As it is a metabolic disorder with dysregulated immune and endocrine function, it is logical that dysfunctional metabolism contributes to the mechanisms behind obesity being a risk factor for adverse outcome in COVID-19. Emerging data suggest that in obese subjects, (a) the molecular mechanisms of viral entry and spread mediated through ACE2 receptor, a multifunctional host cell protein which links to cellular homeostasis mechanisms, are affected. This includes perturbation of the physiological renin-angiotensin system pathway causing pro-inflammatory and pro-thrombotic challenges (b) existent metabolic overload and ER stress-induced UPR pathway make obese subjects vulnerable to severe COVID-19, (c) host cell response is altered involving reprogramming of metabolism and epigenetic mechanisms involving microRNAs in line with changes in obesity, and (d) adiposopathy with altered endocrine, adipokine, and cytokine profile contributes to altered immune cell metabolism, systemic inflammation, and vascular endothelial dysfunction, exacerbating COVID-19 pathology. In this review, we have examined the available literature on the underlying mechanisms contributing to obesity being a risk for adverse outcome in COVID-19.
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McAndrew T, Reich NG. Adaptively stacking ensembles for influenza forecasting. Stat Med 2021; 40:6931-6952. [PMID: 34647627 PMCID: PMC8671371 DOI: 10.1002/sim.9219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 01/01/2023]
Abstract
Seasonal influenza infects between 10 and 50 million people in the United States every year. Accurate forecasts of influenza and influenza-like illness (ILI) have been named by the CDC as an important tool to fight the damaging effects of these epidemics. Multi-model ensembles make accurate forecasts of seasonal influenza, but current operational ensemble forecasts are static: they require an abundance of past ILI data and assign fixed weights to component models at the beginning of a season, but do not update weights as new data on component model performance is collected. We propose an adaptive ensemble that (i) does not initially need data to combine forecasts and (ii) finds optimal weights which are updated week-by-week throughout the influenza season. We take a regularized likelihood approach and investigate this regularizer's ability to impact adaptive ensemble performance. After finding an optimal regularization value, we compare our adaptive ensemble to an equal-weighted and static ensemble. Applied to forecasts of short-term ILI incidence at the regional and national level, our adaptive model outperforms an equal-weighted ensemble and has similar performance to the static ensemble using only a fraction of the data available to the static ensemble. Needing no data at the beginning of an epidemic, an adaptive ensemble can quickly train and forecast an outbreak, providing a practical tool to public health officials looking for a forecast to conform to unique features of a specific season.
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Affiliation(s)
- Thomas McAndrew
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, United States,College of Health, Lehigh University, Bethlehem, Pennsylvania, United States,Correspondence: Thomas McAndrew, Lehigh University Bethlehem, Pennsylvania, United States of America.
| | - Nicholas G. Reich
- College of Health, Lehigh University, Bethlehem, Pennsylvania, United States
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Campbell AP, Tokars JI, Reynolds S, Garg S, Kirley PD, Miller L, Yousey-Hindes K, Anderson EJ, Oni O, Monroe M, Kim S, Lynfield R, Smelser C, Muse AT, Felsen C, Billing LM, Thomas A, Mermel E, Lindegren ML, Schaffner W, Price A, Fry AM. Influenza Antiviral Treatment and Length of Stay. Pediatrics 2021; 148:peds.2021-050417. [PMID: 34470815 DOI: 10.1542/peds.2021-050417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Antiviral treatment is recommended for hospitalized patients with suspected and confirmed influenza, but evidence is limited among children. We evaluated the effect of antiviral treatment on hospital length of stay (LOS) among children hospitalized with influenza. METHODS We included children <18 years hospitalized with laboratory-confirmed influenza in the US Influenza Hospitalization Surveillance Network. We collected data for 2 cohorts: 1 with underlying medical conditions not admitted to the ICU (n = 309, 2012-2013) and an ICU cohort (including children with and without underlying conditions; n = 299, 2010-2011 to 2012-2013). We used a Cox model with antiviral receipt as a time-dependent variable to estimate hazard of discharge and a Kaplan-Meier survival analysis to determine LOS. RESULTS Compared with those not receiving antiviral agents, LOS was shorter for those treated ≤2 days after illness onset in both the medical conditions (adjusted hazard ratio: 1.37, P = .02) and ICU (adjusted hazard ratio: 1.46, P = .007) cohorts, corresponding to 37% and 46% increases in daily discharge probability, respectively. Treatment ≥3 days after illness onset had no significant effect in either cohort. In the medical conditions cohort, median LOS was 3 days for those not treated versus 2 days for those treated ≤2 days after symptom onset (P = .005). CONCLUSIONS Early antiviral treatment was associated with significantly shorter hospitalizations in children with laboratory-confirmed influenza and high-risk medical conditions or children treated in the ICU. These results support Centers for Disease Control and Prevention recommendations for prompt empiric antiviral treatment in hospitalized patients with suspected or confirmed influenza.
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Affiliation(s)
- Angela P Campbell
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jerome I Tokars
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sue Reynolds
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shikha Garg
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Lisa Miller
- Communicable Disease Branch, Colorado Department of Public Health and Environment, Denver, Colorado
| | - Kimberly Yousey-Hindes
- Connecticut Emerging Infections Program, Yale School of Public Health, Yale University, New Haven, Connecticut
| | - Evan J Anderson
- Pediatrics and Medicine, Emory University School of Medicine and the Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | | | - Maya Monroe
- Emerging Infections Program, Maryland Department of Health, Baltimore, Maryland
| | - Sue Kim
- Communicable Disease Division, Michigan Department of Health and Human Services, Lansing, Michigan
| | | | - Chad Smelser
- New Mexico Department of Health, Santa Fe, New Mexico
| | - Alison T Muse
- New York State Department of Health, Albany, New York
| | | | - Laurie M Billing
- Bureau of Infectious Diseases, Ohio Department of Health, Columbus, Ohio
| | - Ann Thomas
- Oregon Public Health Division, Portland, Oregon
| | | | | | | | - Andrea Price
- Bureau of Epidemiology, Salt Lake County Health Department, Salt Lake City, Utah
| | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
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18
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Evidence-based interventions cause multifold increase of influenza immunization rates in a free clinic. J Am Assoc Nurse Pract 2021; 32:817-823. [PMID: 31577666 DOI: 10.1097/jxx.0000000000000302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Every year in the United States, influenza-related infection causes thousands of deaths, the complications of which require millions of dollars in hospital-related care. The influenza vaccine is proven to effectively reduce incidence of infection and complications from influenza viruses. LOCAL PROBLEM A clinic in southeast Florida for the uninsured offered influenza immunization at no cost to its patients, yet the immunization rate was still low. METHODS A quality improvement project was conducted to determine whether the use of evidenced-based bundled interventions would increase the rate of the influenza vaccination at the clinic. INTERVENTIONS The bundled interventions included mass communication, leadership, improved work flow, and improved access. RESULTS Evidence-based interventions led to a 597% increase in the influenza uptake rate. Trends were analyzed by using data gathered from the electronic medical record regarding patient demographics, influenza immunization uptake rate, type of visit for the immunizations, and reason for declining. Overcoming the access barrier led to great improvements in this clinic. Initially more vaccines were given in nurse visits; as the season progressed, more vaccines were given by providers in the clinic. Common reasons for patient refusal of the vaccine were fear of side effects and fear of contracting the influenza virus. Streamlined documentation could promote continued staff compliance over time. CONCLUSIONS To reduce influenza-related costs and improve health outcomes, it is imperative that nurse practitioners use evidence-based interventions in the practice setting to increase influenza uptake rates in the adult uninsured population.
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19
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Fartoukh M, Voiriot G, Guérin L, Ricard JD, Combes A, Faure M, Benghanem S, de Montmollin E, Tandjaoui-Lambiotte Y, Vieillard-Baron A, Maury E, Diehl JL, Razazi K, Lemiale V, Trouiller P, Planquette B, Savale L, Heming N, Marey J, Carrat F, Lapidus N. Seasonal burden of severe influenza virus infection in the critically ill patients, using the Assistance Publique-Hôpitaux de Paris clinical data warehouse: a pilot study. Ann Intensive Care 2021; 11:117. [PMID: 34324076 PMCID: PMC8319596 DOI: 10.1186/s13613-021-00884-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/03/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose At the critical care level, the flu surveillance system is limited in France, with heterogeneous regional modalities of implementation. Materials, patients and methods We aimed at assessing the relevance of the Assistance Publique-Hôpitaux de Paris (AP-HP) clinical data warehouse for estimating the burden of the influenza epidemic on medical adult critical care units of the AP-HP, and outcome of patients during the flu season 2017–2018. This exploratory multi-site epidemiological study comprised all consecutive adult stays (n = 320) in 18 medical intensive care units (ICU) or intermediate care wards (ICW) for probable or confirmed Influenza virus infection during the 2017–2018 flu season. Results Patients admitted to ICU/ICW had low vaccination coverage (21%), required life support in 60% of cases, stayed in the ICU for a median of 8 days, and had high 28-day mortality rate (19.7%; 95% confidence interval 15.5–24.5). Early prognostic factors included age, core temperature, the acute organ failures score, and the early administration of antiviral therapy. Conclusions Data directly extracted from the electronic medical records stored in the data warehouse provide detailed clinical, care pathway and prognosis information. The real-time availability should enable to detect and assess the burden of the most severe cases. By a firmer and more acute monitoring and adjustment of care and patient management, hospitals could generate more ICU/ICW capacities, sensitize their emergency department and contribute to the recommendations from health authorities. This pilot study is of particular relevance in the context of emerging epidemics of severe acute respiratory diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00884-8.
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Affiliation(s)
- Muriel Fartoukh
- Service de Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75020, Paris, France. .,Groupe de Recherche Clinique CARMAS, Collégium Gallilée, Créteil, France.
| | - Guillaume Voiriot
- Service de Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75020, Paris, France.,Groupe de Recherche Clinique CARMAS, Collégium Gallilée, Créteil, France
| | - Laurent Guérin
- Service de Médecine Intensive-Réanimation, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Jean Damien Ricard
- Medical and Surgical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, 92700, Colombes, France.,Infection, Antimicrobials, Modelling and Evolution, IAME UMR 1137 Institut National de la Santé et de la Recherche Médicale, Université de Paris, 75018, Paris, France
| | - Alain Combes
- Service de Médecine Intensive Réanimation, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France.,INSERM-UMRS 1166, iCAN Institute of Cardiometabolism/Nutrition, Sorbonne Université, Paris, France
| | - Morgane Faure
- Service de Médecine Intensive - Réanimation (Département "R3S"), Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France.,UMR_S 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM, Sorbonne Université, Paris, France
| | - Sarah Benghanem
- Medical Intensive Care Unit, Groupe Hospitalier Paris Centre-Cochin University Hospital-Assistance Publique-Hôpitaux de Paris, Paris University, 75014, Paris, France
| | - Etienne de Montmollin
- UMR 1137, IAME, Université de Paris, Paris, France.,Medical and Infectious Diseases ICU, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yacine Tandjaoui-Lambiotte
- Assistance Publique-Hôpitaux de Paris, Service de Réanimation médico-chirurgicale, CHU Avicenne; INSERM U1272 Hypoxie & Poumon, Bobigny, France
| | - Antoine Vieillard-Baron
- Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Boulogne Billancourt, France.,Faculty of Medicine Simone Veil, Saint Quentin en Yvelines, France.,Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Faculty of Paris Saclay, Villejuif, France
| | - Eric Maury
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75571, Paris, France.,U 1136, Inserm, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, 75012, Paris, France
| | - Jean-Luc Diehl
- Service de Médecine Intensive Réanimation, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France.,Faculty of Pharmacy, INSERM UMR-S1140, Paris Descartes University, Paris, France
| | - Keyvan Razazi
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France.,Groupe de Recherche Clinique CARMAS, Université Paris Est Créteil, Créteil, France
| | - Virginie Lemiale
- Service de Médecine Intensive et Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France.,ECSTRA Team, Biostatistics and Clinical Epidemiology, Center of Epidemiology and Biostatistics Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale, Paris Diderot Sorbonne University, Paris, France
| | - Pierre Trouiller
- Service de Réanimation Polyvalente, Hôpital Antoine Béclère, Assistance Publique-Hôpitaux de Paris, Paris Sud University, Clamart, France
| | - Benjamin Planquette
- Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, 75015, Paris, France.,Biosurgical Research Laboratory (Carpentier Foundation), Assistance Publique-Hôpitaux de Paris, Georges Pompidou European Hospital, 75015, Paris, France
| | - Laurent Savale
- Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France.,Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,INSERM UMR_S 999, Le Kremlin-Bicêtre, France
| | - Nicholas Heming
- General Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Raymond-Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - Jonathan Marey
- Service de Pneumologie, Institut Cochin, INSERM U1016, Université de Paris, Assitance Publique-Hôpitaux de Paris, Paris, France
| | | | - Fabrice Carrat
- Unité de Santé Publique, INSERM, Institut Pierre Louis d'Epidemiologie et de Sante Publique, Hopital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75012, Paris, France
| | - Nathanael Lapidus
- Unité de Santé Publique, INSERM, Institut Pierre Louis d'Epidemiologie et de Sante Publique, Hopital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75012, Paris, France
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20
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Lesmanawati DAS, Veenstra P, Moa A, Adam DC, MacIntyre CR. A rapid risk analysis tool to prioritise response to infectious disease outbreaks. BMJ Glob Health 2021; 5:bmjgh-2020-002327. [PMID: 32513862 PMCID: PMC7282290 DOI: 10.1136/bmjgh-2020-002327] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 01/12/2023] Open
Abstract
Epidemics are influenced by both disease and societal factors and can grow exponentially over short time periods. Epidemic risk analysis can help in rapidly predicting potentially serious outcomes and flagging the need for rapid response. We developed a multifactorial risk analysis tool 'EpiRisk' to provide rapid insight into the potential severity of emerging epidemics by combining disease-related parameters and country-related risk parameters. An initial set of 18 disease and country-related risk parameters was reduced to 14 following qualitative discussions and the removal of highly correlated parameters by a correlation and clustering analysis. Of the remaining parameters, three risk levels were assigned ranging from low (1) moderate (2) and high (3). The total risk score for an outbreak of a given disease in a particular country is calculated by summing these 14 risk scores, and this sum is subsequently classified into one of four risk categories: low risk (<21), moderate risk (21-29), high risk (30-37) and extreme risk (>37). Total risk scores were calculated for nine retrospective outbreaks demonstrating an association with the actual impact of those outbreaks. We also evaluated to what extent the risk scores correlate with the number of cases and deaths in 61 additional outbreaks between 2002 and 2018, demonstrating positive associations with outbreak severity as measured by the number of deaths. Using EpiRisk, timely intervention can be implemented by predicting the risk of emerging outbreaks in real time, which may help government and public health professionals prevent catastrophic epidemic outcomes.
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Affiliation(s)
- Dyah A S Lesmanawati
- Center for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Daerah Istimewa Yogyakart, Indonesia.,District Health Office, Yogyakarta City, Yogyakarta, Indonesia
| | | | - Aye Moa
- Biosecurity Program, The Kirby Institute, Kensington, New South Wales, Australia
| | - Dillon C Adam
- Biosecurity Program, The Kirby Institute, Kensington, New South Wales, Australia
| | - Chandini Raina MacIntyre
- Biosecurity Program, The Kirby Institute, Kensington, New South Wales, Australia.,Arizona State University College of Health Solutions, Phoenix, Arizona, USA
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21
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Díaz-Hernández HA, Vázquez-Anaya G, Miranda-Zazueta G, Castro-Narro GE. The impact of different infectious complications on mortality of hospitalized patients with liver cirrhosis. Ann Hepatol 2021; 19:427-436. [PMID: 32299682 DOI: 10.1016/j.aohep.2020.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 02/23/2020] [Accepted: 02/23/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Bacterial infections are common complications in patients with cirrhosis and are associated with poor prognosis. There are no studies that analyze the impact of different infectious complications in the mortality of these patients, so we aimed to perform this evaluation. MATERIALS AND METHODS We performed a case-control study in adult patients with cirrhosis with a follow-up period of one year. We recorded demographic data, prognostic scales, infectious complications and mortality at 30, 90 and 365 days. For the survival analysis, Kaplan-Meyer survival curve was performed and hazard ratios were calculated with 95% confidence intervals by Cox-regression in univariate and multivariate models. For the comparison between groups the Chi squared test, Fisher's exact test and Mann-Whitney U test were performed. RESULTS We included 500 patients. Median age was 58 years, predominant sex was woman (52%) and the most common infections were urinary tract infections (35%), pneumonia (28.2%) and spontaneous bacterial peritonitis (SBP) (18%). From the patients, 40.4% were CTP score C and median MELD score was 15. In the univariate analysis, infections in general, SBP, pneumonia and central nervous system (CNS) infections had an increased mortality at the three follow up periods, however in the multivariate analysis with the prognostic scales, only pneumonia (HR 2.03, CI 95%[1.06-3.86]) and CNS infections (HR 4.84, CI 95%[1.38-16.93]) remained with increased mortality. CONCLUSIONS Some infectious complications, as pneumonia and CNS infections, increase mortality in hospitalized patients with cirrhosis, regardless of the severity of liver disease.
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Affiliation(s)
- Héctor Adrián Díaz-Hernández
- Department of Gastrointestinal Endoscopy, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Gerardo Vázquez-Anaya
- Department of Gastroenterology, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Vasco de Quiroga 15, Mexico City, Mexico
| | - Godolfino Miranda-Zazueta
- Department of Gastroenterology, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Vasco de Quiroga 15, Mexico City, Mexico
| | - Graciela Elia Castro-Narro
- Department of Gastroenterology, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Vasco de Quiroga 15, Mexico City, Mexico.
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22
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Zhou Y, Niu M, Zhang D, Liu Z, Wu Q, Chen J, Zhang H, Zhang P, Pei J. Screening for Anti-Inflammation Quality Markers of Lianhua Qingwen Capsule Based on Network Pharmacology, UPLC, and Biological Activity. Front Pharmacol 2021; 12:648439. [PMID: 34177573 PMCID: PMC8226139 DOI: 10.3389/fphar.2021.648439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 06/01/2021] [Indexed: 01/12/2023] Open
Abstract
Influenza is a common respiratory infectious disease. In China, Lianhua Qingwen capsule (LHQWC), a drug with significant clinical efficacy and few side effects, is commonly used to treat influenza. However, the composition of LHQWC is complicated, and currently used quality control methods cannot ensure its consistency. In this study, combined with its clinical efficacy, the targets of LHQWC were screened using network pharmacology. Then, anti-inflammation quality markers of LHQWC were screened and judged by combined chemical with biological evaluation. Cyclooxygenase-2 (COX-2) was identified as one of the main targets of the anti-inflammatory activity of LHQWC. The rate of inhibition of COX-2 by different batches of LHQWC was determined. Furthermore, seven components of LHQWC were identified. The potential quality markers were screened by spectral-effect relationship. As a result, chlorogenic acid, isochlorogenic acid B, and isochlorogenic acid C were identified and confirmed as anti-inflammatory quality markers of LHQWC. We hope that these findings provide a scientific basis for the accurate quality control of LHQWC and serve as a reference for the quality control of other drugs.
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Affiliation(s)
- Yongfeng Zhou
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,The Fifth Medical Centre, Chinese PLA People's Liberation Army General Hospital, Beijing, China
| | - Ming Niu
- The Fifth Medical Centre, Chinese PLA People's Liberation Army General Hospital, Beijing, China
| | - Dingkun Zhang
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhenxing Liu
- The Fifth Medical Centre, Chinese PLA People's Liberation Army General Hospital, Beijing, China
| | - Qinghua Wu
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jiang Chen
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Haizhu Zhang
- College of Pharmacy, Dali University, Dali, China
| | - Ping Zhang
- The Fifth Medical Centre, Chinese PLA People's Liberation Army General Hospital, Beijing, China
| | - Jin Pei
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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23
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Dimopoulou D, Vourli S, Douros K, Pournaras S, Papaevangelou V. Use of point-of-care molecular tests reduces hospitalization and oseltamivir administration in children presenting with influenza-like illness. J Med Virol 2021; 93:3944-3948. [PMID: 32965697 DOI: 10.1002/jmv.26538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/14/2020] [Accepted: 09/21/2020] [Indexed: 01/15/2023]
Abstract
Influenza is associated with increased morbidity, healthcare costs, hospitalization rates, and mortality in children. Rapid immunochromatography assay (ICA), a test with low sensitivity, is often used as point-of-care (POC) test. Recently, the rapid syndromic molecular test FilmArray has become available. This observational study aims to evaluate whether the use of FilmArray would decrease the use of antivirals and hospitalization rates among children presenting to the emergency room (ER) with influenza-like illness (ILI) symptoms. Nasopharyngeal swabs were prospectively collected from children, aged 0-16 years, presenting with ILI at the ER of a tertiary hospital during the peak endemic period. Patients were allocated to be tested by either FilmArray or ICA. The use of antivirals and hospitalization rates were noted. Logistic regression models were used to investigate the impact of testing methods on decision-making. Overall, 80 children were included (mean age: 5 years). Admissions were more likely to occur if an ICA test was performed (OR, 3.16; 95% CI, 1.01-9.82; p = .046). Oseltamivir administration was more likely among children who had undergone the ICA test (OR, 4.67; 95% CI, 1.06-20.43; p = .041). The implementation of rapid molecular test had no impact on complementary diagnostic testing or antibacterial prescription. The use of FilmArray significantly reduced both hospitalization and oseltamivir administration in children. Further knowledge on the use of POC tests is required to improve current management of children presenting with ILI and decrease associated healthcare costs.
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Affiliation(s)
- Dimitra Dimopoulou
- Third Department of Pediatrics, ATTIKON University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sophia Vourli
- Laboratory of Microbiology, ATTIKON University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Douros
- Third Department of Pediatrics, ATTIKON University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Pournaras
- Laboratory of Microbiology, ATTIKON University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, ATTIKON University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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24
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Sansone M, Andersson M, Gustavsson L, Andersson LM, Nordén R, Westin J. Extensive Hospital In-Ward Clustering Revealed By Molecular Characterization of Influenza A Virus Infection. Clin Infect Dis 2021; 71:e377-e383. [PMID: 32011654 DOI: 10.1093/cid/ciaa108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/31/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Nosocomial transmission of influenza A virus (InfA) infection is not fully recognized. The aim of this study was to describe the characteristics of hospitalized patients with InfA infections during an entire season and to investigate in-ward transmission at a large, acute-care hospital. METHODS During the 2016-17 season, all hospitalized patients ≥18 years old with laboratory-verified (real-time polymerase chain reaction) InfA were identified. Cases were characterized according to age; sex; comorbidity; antiviral therapy; viral load, expressed as cycle threshold values; length of hospital stay; 30-day mortality; and whether the InfA infection met criteria for a health care-associated influenza A infection (HCAI). Respiratory samples positive for InfA that were collected at the same wards within 7 days were chosen for whole-genome sequencing (WGS) and a phylogenetic analysis was performed to detect clustering. For reference, concurrent InfA strains from patients with community-acquired infection were included. RESULTS We identified a total of 435 InfA cases, of which 114 (26%) met the HCAI criteria. The overall 30-day mortality rate was higher among patients with HCAI (9.6% vs 4.6% among non-HCAI patients), although the difference was not statistically significant in a multivariable analysis, where age was the only independent risk factor for death (P < .05). We identified 8 closely related clusters (involving ≥3 cases) and another 10 pairs of strains, supporting in-ward transmission. CONCLUSIONS We found that the in-ward transmission of InfA occurs frequently and that HCAI may have severe outcomes. WGS may be used for outbreak investigations, as well as for evaluations of the effects of preventive measures.
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Affiliation(s)
- Martina Sansone
- Department of Clinical Microbiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria Andersson
- Department of Clinical Microbiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Gustavsson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars-Magnus Andersson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Rickard Nordén
- Department of Clinical Microbiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Westin
- Department of Clinical Microbiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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25
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O’Rourke RW, Lumeng CN. Pathways to Severe COVID-19 for People with Obesity. Obesity (Silver Spring) 2021; 29:645-653. [PMID: 33270351 PMCID: PMC7753541 DOI: 10.1002/oby.23099] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 12/13/2022]
Abstract
Increased morbidity and mortality from coronavirus disease 2019 (COVID-19) in people with obesity have illuminated the intersection of obesity with impaired responses to infections. Although data on mechanisms by which COVID-19 impacts health are being rapidly generated, there is a critical need to better understand the pulmonary, vascular, metabolic, and immunologic aspects that drive the increased risk for complications from COVID-19 in people with obesity. This review provides a broad overview of the intersection between COVID-19 and the physiology of obesity in order to highlight potential mechanisms by which COVID-19 disease severity is increased by obesity and identify areas for future investigation toward developing tailored therapy for people with obesity who develop COVID-19.
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Affiliation(s)
- Robert W. O’Rourke
- Department of SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Department of SurgeryAnn Arbor Veterans Affairs Healthcare SystemAnn ArborMichiganUSA
| | - Carey N. Lumeng
- Division of Pediatric PulmonologyDepartment of PediatricsUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Department of Molecular and Integrative PhysiologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
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Bai Y, Tao X. Comparison of COVID-19 and influenza characteristics. J Zhejiang Univ Sci B 2021; 22:87-98. [PMID: 33615750 PMCID: PMC7885750 DOI: 10.1631/jzus.b2000479] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023]
Abstract
The emergence of coronavirus disease 2019 (COVID-19) not only poses a serious threat to the health of people worldwide but also affects the global economy. The outbreak of COVID-19 began in December 2019, at the same time as the influenza season. However, as the treatments and prognoses of COVID-19 and influenza are different, it is important to accurately differentiate these two different respiratory tract infections on the basis of their respective early-stage characteristics. We reviewed official documents and news released by the National Health Commission of the People's Republic of China, the Chinese Center for Disease Control and Prevention (China CDC), the United States CDC, and the World Health Organization (WHO), and we also searched the PubMed, Web of Science, Excerpta Medica database (Embase), China National Knowledge Infrastructure (CNKI), Wanfang, preprinted bioRxiv and medRxiv databases for documents and guidelines from earliest available date up until October 3rd, 2020. We obtained the latest information about COVID-19 and influenza and summarized and compared their biological characteristics, epidemiology, clinical manifestations, pathological mechanisms, treatments, and prognostic factors. We show that although COVID-19 and influenza are different in many ways, there are numerous similarities; thus, in addition to using nucleic acid-based polymerase chain reaction (PCR) and antibody-based approaches, clinicians and epidemiologists should distinguish between the two using their respective characteristics in early stages. We should utilize experiences from other epidemics to provide additional guidance for the treatment and prevention of COVID-19.
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Affiliation(s)
- Yu Bai
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xiaonan Tao
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
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Gökçe Ş, Dörtkardeşler BE, Aslan A. Normocomplementemic Urticarial Vasculitis Associated with A/H1N1 in a Child. Case Report. SN COMPREHENSIVE CLINICAL MEDICINE 2020; 2:2962-2964. [PMID: 33263100 PMCID: PMC7687979 DOI: 10.1007/s42399-020-00661-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 11/28/2022]
Abstract
Urticarial vasculitis is an entity characterized by urticarial rashes that are typically pruritic and painful, associated with angioedema and purpura. Influenza viruses are common respiratory pathogens that can cause seasonal infections and global human morbidity/mortality. A 4.5-year-old girl presented with fever and painful urticarial skin lesions leaving post-inflammatory hyperpigmentation. The nasal specimens showed a positive for influenza A/H1N1. On the basis of these findings, a diagnosis of urticarial vasculitis associated with A/H1N1 was concluded. Taking the results together, we suggest that urticarial vasculitic lesions can be considered to the list of cutaneous manifestations during the seasonal flu.
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Affiliation(s)
- Şule Gökçe
- Ege University Faculty of Medicine, Department of Pediatrics, General Pediatrics Unit, Ege University Childrens’ Hospital, Bornova, 35040 Izmir, Turkey
| | - Burçe Emine Dörtkardeşler
- Ege University Faculty of Medicine, Department of Pediatrics, General Pediatrics Unit, Ege University Childrens’ Hospital, Bornova, 35040 Izmir, Turkey
| | - Aslı Aslan
- Department of Medical Genetics, Faculty of Medicine, Ege University, 35100 Izmir, Turkey
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Arfaras-Melainis A, Cordero H, Goyal A, Benes L, Salgunan R. Acute Influenza B Infection Presenting as Cardiac Tamponade: A Case Report. Cureus 2020; 12:e11799. [PMID: 33409044 PMCID: PMC7779153 DOI: 10.7759/cureus.11799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Influenza A and B acute infections usually affect primarily the respiratory system. In rare cases, however, the cardiovascular system is also compromised either via the direct effect of the virus or via the worsening of preexisting cardiac conditions. We present a rare case of acute Influenza B infection presenting as pericardial effusion and cardiac tamponade. A healthy 32-year-old female was presented to the emergency room with influenza-like symptoms for four days, where she was monitored for a few hours and was subsequently discharged to home after testing positive for Influenza B by polymerase chain reaction (PCR). On the fifth day, she returned to the emergency room with worsening symptoms, primarily exertional dyspnea. She was hypotensive and tachycardic and temporarily improved with fluid administration. She was transferred to the intensive care unit, where a bedside point of care ultrasound (POCUS) and later a formal transthoracic echocardiogram revealed that she had pericardial effusion with sonographic signs of cardiac tamponade. Emergent pericardiocentesis was performed and resulted in hemodynamic and symptomatic improvement. The pericardial drain that was initially left in place and continued to drain pericardial fluid (700 ccs in total), was removed 3 days later, after echocardiographic confirmation of the resolution of the pericardial effusion. She completed a five-day course of Oseltamivir and was subsequently discharged home safely. In summary, our case describes an acute Influenza B infection that was complicated by pericardial effusion and cardiac tamponade. It also highlights the importance of bedside POCUS and echocardiography in the early diagnosis and treatment of cardiac tamponade cases, frequently with pericardiocentesis as in our case.
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Affiliation(s)
- Angelos Arfaras-Melainis
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, USA.,Cardiology, Attikon University Hospital, Athens, GRC
| | - Hernando Cordero
- Pulmonary and Critical Care Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, USA
| | - Aditya Goyal
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, USA
| | - Linda Benes
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, USA
| | - Reka Salgunan
- Pulmonary and Critical Care Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, USA
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Mac S, O’Reilly R, Adhikari NKJ, Fowler R, Sander B. Point-of-care diagnostic tests for influenza in the emergency department: A cost-effectiveness analysis in a high-risk population from a Canadian perspective. PLoS One 2020; 15:e0242255. [PMID: 33196653 PMCID: PMC7668582 DOI: 10.1371/journal.pone.0242255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/30/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Our objective was to assess the cost-effectiveness of novel rapid diagnostic tests: rapid influenza diagnostic tests (RIDT), digital immunoassays (DIA), rapid nucleic acid amplification tests (NAAT), and other treatment algorithms for influenza in high-risk patients presenting to hospital with influenza-like illness (ILI). METHODS We developed a decision-analytic model to assess the cost-effectiveness of diagnostic test strategies (RIDT, DIA, NAAT, clinical judgement, batch polymerase chain reaction) preceding treatment; no diagnostic testing and treating everyone; and not treating anyone. We modeled high-risk 65-year old patients from a health payer perspective and accrued outcomes over a patient's lifetime. We reported health outcomes, quality-adjusted life years (QALYs), healthcare costs, and net health benefit (NHB) to measure cost-effectiveness per cohort of 100,000 patients. RESULTS Treating everyone with no prior testing was the most cost-effective strategy, at a cost-effectiveness threshold of $50,000/QALY, in over 85% of simulations. This strategy yielded the highest NHB of 15.0344 QALYs, but inappropriately treats all patients without influenza. Of the novel rapid diagnostics, NAAT resulted in the highest NHB (15.0277 QALYs), and the least number of deaths (1,571 per 100,000). Sensitivity analyses determined that results were most impacted by the pretest probability of ILI being influenza, diagnostic test sensitivity, and treatment effectiveness. CONCLUSIONS Based on our model, treating high-risk patients presenting to hospital with influenza-like illness, without performing a novel rapid diagnostic test, resulted in the highest NHB and was most cost-effective. However, consideration of whether treatment is appropriate in the absence of diagnostic confirmation should be taken into account for decision-making by clinicians and policymakers.
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Affiliation(s)
- Stephen Mac
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Canada
| | - Ryan O’Reilly
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Canada
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Neill K. J. Adhikari
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Robert Fowler
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Canada
- ICES, Toronto, Canada
- Public Health Ontario, Toronto, Canada
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Bodo EC, Boucher EA, Shultz KH. Oseltamivir-Associated Supraventricular Tachycardia in an Infant. J Pediatr Pharmacol Ther 2020; 25:654-657. [PMID: 33041722 DOI: 10.5863/1551-6776-25.7.654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Oseltamivir is a neuraminidase inhibitor that is labeled for prophylaxis and treatment of influenza. We describe a previously healthy 4-month-old infant who tested positive for influenza A and was started on oseltamivir. One hour after receiving his first dose of oseltamivir, the infant had a diaphoretic episode and appeared grey and clammy. The infant was subsequently seen by the primary care physician and referred for admission to the hospital. Approximately 40 minutes after the second dose of oseltamivir in the hospital, the infant's heart rate rose to greater than 300 bpm. An electrocardiogram was suggestive of supraventricular tachycardia. At the time of the event, the infant received 2 doses of adenosine, and oseltamivir was discontinued prior to transfer to a tertiary facility for a higher level of care.
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Lytras T, Mouratidou E, Andreopoulou A, Bonovas S, Tsiodras S. Effect of Early Oseltamivir Treatment on Mortality in Critically Ill Patients With Different Types of Influenza: A Multiseason Cohort Study. Clin Infect Dis 2020; 69:1896-1902. [PMID: 30753349 DOI: 10.1093/cid/ciz101] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 01/30/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The available evidence on whether neuraminidase inhibitors reduce mortality in patients with influenza is inconclusive and focuses solely on influenza A/H1N1pdm09. We assessed whether early oseltamivir treatment (≤48 hours from symptom onset) decreases mortality compared to late treatment in a large cohort of critically ill patients with influenza of all types. METHODS The study included all adults with laboratory-confirmed influenza hospitalized in intensive care units (ICUs) in Greece over 8 seasons (2010-2011 to 2017-2018) and treated with oseltamivir. The association of early oseltamivir with mortality was assessed with log-binomial models and a competing risks analysis estimating cause-specific and subdistribution hazards for death and discharge. Effect estimates were stratified by influenza type and adjusted for multiple covariates. RESULTS A total of 1330 patients were studied, of whom 622 (46.8%) died in the ICU. Among patients with influenza A/H3N2, early treatment was associated with significantly lower mortality (relative risk, 0.69 [95% credible interval {CrI}, .49-.94]; subdistribution hazard ratio, 0.58 [95% CrI, .37-.88]). This effect was purely due to an increased cause-specific hazard for discharge, whereas the cause-specific hazard for death was not increased. Among survivors, the median length of ICU stay was shorter with early treatment by 1.8 days (95% CrI, .5-3.5 days). No effect on mortality was observed for A/H1N1 and influenza B patients. CONCLUSIONS Severely ill patients with suspected influenza should be promptly treated with oseltamivir, particularly when A/H3N2 is circulating. The efficacy of oseltamivir should not be assumed to be equal against all types of influenza.
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Affiliation(s)
- Theodore Lytras
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - Elisavet Mouratidou
- Hellenic Centre for Disease Control and Prevention, Athens, Greece.,European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University.,Humanitas Clinical and Research Center, Milan, Italy
| | - Sotirios Tsiodras
- Hellenic Centre for Disease Control and Prevention, Athens, Greece.,Fourth Department of Internal Medicine, Attikon University Hospital, University of Athens Medical School, Greece
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Chen L, Han X, Li Y, Zhang C, Xing X. Invasive pulmonary aspergillosis in immunocompetent patients hospitalised with influenza A-related pneumonia: a multicenter retrospective study. BMC Pulm Med 2020; 20:239. [PMID: 32907585 PMCID: PMC7479745 DOI: 10.1186/s12890-020-01257-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Increasing cases of pulmonary aspergillosis (IPA) in immunocompetent patients with severe influenza have been reported. Howevere, the risk factors for occurence and death are largely unknown. METHODS Data of hospitalised patients with influenza A-related pneumonia (FluA-p) obtained from five teaching hospitals from 2031 to 2018, were reviewed. Univariate and multivariate logistical regression analyses were performed to determine the risk factors involved in the acquisition and 60-day mortality in IPA patients. RESULTS Of the 693 FluA-p patients included in the study, 3.0% (21/693) were IPA patients with a 60-day mortality of 42.9% (9/21). Adjusted for confounders, a Cox proportional hazard model showed that IPA was associated with increased risk for 60-day mortality [hazard ratio (HR) 4.336, 95% confidence interval (CI) 1.191-15.784, p = 0.026] in FluA-p patients. A multivariate logistic regression model confirmed that age (odd ratio (OR) 1.147, 95% CI 1.048-1.225, p = 0.003), systemic corticosteroids use before IPA diagnosis (OR 33.773, 95% CI 5.681-76.764, p < 0.001), leukocytes > 10 × 109/L (OR 1.988, 95% CI 1.028-6.454, p = 0.029) and lymphocytes < 0.8 × 109/L on admission (OR 34.813, 95% CI 1.676-73.006, p = 0.022), were related with the acquisition of IPA. Early neuraminidase inhibitor use (OR 0.290, 95% CI 0.002-0.584, p = 0.021) was associated with a decreased risk for a 60-day mortality in IPA patients. CONCLUSIONS Our results showed that IPA worsen the clinical outcomes of FluA-p patients. The risk factors for the acquisition and death were helpful for the clinicians in preventing and treating IPA.
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Affiliation(s)
- Liang Chen
- Department of Infectious Diseases, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Beijing, China.
| | - Xiudi Han
- Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao City, Shandong Province, China
| | - Yanli Li
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Chunxiao Zhang
- Department of Pulmonary and Critical Care Medicine, Beijing Huimin Hospital, Beijing, China
| | - Xiqian Xing
- Department of Pulmonary and Critical Care Medicine, the 2nd People's Hospital of Yunnan Province, Kunming City, Yunnan Province, China
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Evaluation of Lateral-Flow Assay for Rapid Detection of Influenza Virus. BIOMED RESEARCH INTERNATIONAL 2020; 2020:3969868. [PMID: 32964030 PMCID: PMC7495160 DOI: 10.1155/2020/3969868] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/11/2020] [Indexed: 12/22/2022]
Abstract
Background Influenza virus mainly causes acute respiratory infections in humans. However, the diagnosis of influenza is not accurate based on clinical evidence, as the symptoms of flu are similar to other respiratory virus. The lateral-flow assay is a rapid method to detect influenza virus. But the effectiveness of the technique in detecting flu viruses is unclear. Hence, a meta-analysis would be performed to evaluate the accuracy of LFA in detecting influenza virus. Methods Relevant literature was searched out in PubMed, Embase, Web of Science, and Cochrane Library databases with the keywords "lateral flow assay" and "flu virus". By Meta-DiSc software, pooled sensitivity, pooled specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), summary receiver operating characteristic curve (SROC), and area under the curve (AUC) can be calculated. Results This meta-analysis contains 13 studies and 24 data. The pooled sensitivity and specificity of the influenza virus detected by LFA were 0.84 (95% CI: 0.82-0.86) and 0.97 (95% CI: 0.97-0.98), respectively. The pooled values of PLR, NLR, DOR, and SROC were 32.68 (17.16-62.24), 0.17 (0.13-0.24), 334.07 (144.27-773.53), and 0.9877. No publication bias was found. Conclusions LFA exhibited high sensitivity and specificity in diagnosing influenza virus. It is a valuable alternative method which can diagnose influenza virus quickly. However, more evidence is required to confirm whether LFA is comparable to traditional methods for detecting the virus.
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Das RR, Jaiswal N, Dev N, Jaiswal N, Naik SS, Sankar J. Efficacy and Safety of Anti-malarial Drugs (Chloroquine and Hydroxy-Chloroquine) in Treatment of COVID-19 Infection: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2020; 7:482. [PMID: 32850924 PMCID: PMC7403461 DOI: 10.3389/fmed.2020.00482] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/16/2020] [Indexed: 01/15/2023] Open
Abstract
Background: Anti-malarial drugs inhibit coronaviruses in-vitro. Few published studies have evaluated the safety and efficacy of these drugs in the treatment of COVID-19 infection. Materials and Methods: This is a systematic review and meta-analysis of clinical trials and observational studies. Major database searches were carried out up until June 5, 2020. Participants admitted with RT-PCR-confirmed SARS Cov-2 (COVID-19) infection were included. The "Intervention group" received anti-malarial drugs with or without other drugs (Azithromycin) administered as an adjunct to the standard treatment/care. The "Control group" received treatment except anti-malarial drugs. The primary outcome is "all-cause mortality." Secondary outcome measures were effects on clinical and laboratory parameters and adverse events. Results: Of 3,472 citations, 17 (six clinical trials and 11 observational studies) studies provided data of 8,071 participants. Compared to the control, Hydroxy-chloroquine (HCQ) has no significant effect on mortality [(OR 0.87; 95% CI 0.46-1.64); eight observational studies; N = 5,944]. Data from a single, small non-randomized trial (N = 42) also reached a similar conclusion (OR 1.94; 95% CI 0.07-50.57; p = 0.69). Compared to the control, HCQ plus Azithromycin (AZM) significantly increased mortality [(OR 2.84; 95% CI 2.19-3.69); four observational studies; N = 2,310]. Compared to the control, risk of any adverse event was significantly increased in HCQ group [(OR 3.35; 95% CI 1.58-7.13); four clinical trials; N = 263]. Compared to control, risk of adverse cardiac events (abnormal ECG, arrhythmia, or QT prolongation) were not significantly increased in HCQ group (but significantly increased in the HCQ plus AZM group). The GRADE evidence generated for all the outcomes was of "very low-quality." Conclusions: As very low quality evidence suggests an increased risk of mortality and adverse event with HCQ plus Azithromycin combination (not HCQ alone), caution should be exercised while prescribing this combination for treatment of hospitalized adults with COVID-19 infection. Good quality, multi-centric RCTs (including both hospitalized and non-hospitalized patients) are required for any firm recommendation to be made during the ongoing pandemic. OSF Protocol Registration Link: https://osf.io/6zxsu.
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Affiliation(s)
| | - Nishant Jaiswal
- Evidence Based Health Informatics Unit, Department of Telemedicine, PGIMER, Chandigarh, India
| | - Nishanth Dev
- Department of Medicine, VMMC, Safdarjung Hospital, New Delhi, India
| | - Nikita Jaiswal
- Department of Microbiology, MM Institute of Medical Sciences and Research, MMU (Deemed to be University), Ambala, India
| | | | - Jhuma Sankar
- Department of Pediatrics, AIIMS New Delhi, New Delhi, India
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Development of A4 antibody for detection of neuraminidase I223R/H275Y-associated antiviral multidrug-resistant influenza virus. Nat Commun 2020; 11:3418. [PMID: 32647286 PMCID: PMC7347576 DOI: 10.1038/s41467-020-17246-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 06/11/2020] [Indexed: 11/08/2022] Open
Abstract
The emergence and spread of antiviral drug-resistant viruses have been a worldwide challenge and a great concern for patient care. We report A4 antibody specifically recognizing and binding to the mutant I223R/H275Y neuraminidase and prove the applicability of A4 antibody for direct detection of antiviral multidrug-resistant viruses in various sensing platforms, including naked-eye detection, surface-enhanced Raman scattering-based immunoassay, and lateral flow system. The development of the A4 antibody enables fast, simple, and reliable point-of-care assays of antiviral multidrug-resistant influenza viruses. In addition to current influenza virus infection testing methods that do not provide information on the antiviral drug-resistance of the virus, diagnostic tests for antiviral multidrug-resistant viruses will improve clinical judgment in the treatment of influenza virus infections, avoid the unnecessary prescription of ineffective drugs, and improve current therapies.
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Das RR, Behera B, Mishra B, Naik SS. Effect of chloroquine and hydroxychloroquine on COVID-19 virological outcomes: An updated meta-analysis. Indian J Med Microbiol 2020; 38:265-272. [PMID: 33154234 PMCID: PMC7709583 DOI: 10.4103/ijmm.ijmm_20_330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/18/2020] [Accepted: 07/27/2020] [Indexed: 12/15/2022]
Abstract
As anti-malarial drugs have been found to inhibit Corona viruses in vitro, studies have evaluated the effect of these drugs inCOVID-19 infection. We conducted an updated meta-analysis of clinical trials and observational studies published till June 2020. Patients with reverse transcription polymerase chain reaction (RT-PCR) confirmed Severe Acute Respiratory Syndrome Coronavirus 2 (COVID-19) infection were included. The drugs used in the intervention group are Chloroquine (CQ)/Hydroxychloroquine (HCQ) with or without Azithromycin. The primary outcome is time to achieve virological cure. Of 1040 citations, 11 studies provided data of 1215 patients. Compared to control, CQ/HCQ has no significant effect on the time to negative COVID-19 RT-PCR results, neither in clinical trials (mean difference [MD] 1.55; 95% confidence interval [CI] - 0.7 to 3.79; P = 0.18; n = 180), nor in observational studies (MD 1.14; 95%CI - 11.98 to 14.26; P = 0.86, n = 407). CQ/HCQ did not affect the virological cure after day 3, 7, 10, 14, 21 and 28; except after day 5, as shown by a single small non-randomised trial (odds ratio [OR] 9.33; 95% CI 1.51 to 57.65; P = 0.02, n = 30). Pooled data from 2 observational studies showed a significant effect of CQ/HCQ on virological cure by after day 10 (OR 7.86; 95% CI 4.4 to 14.04, P < 0.001, n = 373) and day 14 (OR 6.37; 95% CI 3.01 to 13.48, P < 0.001, n = 407). The GRADE evidence generated was of "very low-quality/certainty". To conclude, CQ/HCQ does not affect the time to virological cure compared to usual/standard of care in COVID-19 infection. Recurrent infection in a smaller number of patients was noted in the CQ/HCQ group. As the evidence generated was of "very low-quality/certainty)", large good quality studies are needed to confirm the present findings.
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Affiliation(s)
- Rashmi Ranjan Das
- Department of Pediatrics and Microbiology, AIIMS, Bhubaneswar, Odisha, India
| | - Bijayini Behera
- Department of Pediatrics and Microbiology, AIIMS, Bhubaneswar, Odisha, India
| | | | - Sushree Samiksha Naik
- Department of Obstetrics and Gynecology, Capital Hospital, Bhubaneswar, Odisha, India
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Li Y, Wang H, Wang F, Du H, Liu X, Chen P, Wang Y, Lu X. Comparison of hospitalized patients with pneumonia caused by COVID-19 and influenza A in children under 5 years. Int J Infect Dis 2020; 98:80-83. [PMID: 32535301 PMCID: PMC7289729 DOI: 10.1016/j.ijid.2020.06.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/05/2020] [Accepted: 06/06/2020] [Indexed: 01/08/2023] Open
Abstract
The clinical manifestations of COVID-19 children are milder than those of influenza A children under 5 years. The laboratory tests of COVID-19 children are milder than those of influenza A children under 5 years. Imaging results more commonly presented as ground-glass opacities in COVID-19 patients.
Background Since the outbreak of Coronavirus Disease 2019 (COVID-19) in Wuhan, considerable attention has been paid to its epidemiology and clinical characteristics in children. However, it is also crucial for clinicians to differentiate COVID-19 from other respiratory infectious diseases, such as influenza viruses. Methods This was a retrospective study. Two groups of COVID-19 patients (n = 57) and influenza A patients (n = 59) were enrolled. We analyzed and compared their clinical manifestations, imaging characteristics and treatments. Results The proportions of cough (70.2%), fever (54.4%) and gastrointestinal symptoms (14.1%) in COVID-19 patients were lower than those of influenza A patients (98.3%, P < 0.001; 84.7%, P < 0.001; and 35.6%, P = 0.007; respectively). In addition, COVID-19 patients showed significantly lower levels of leukocytes (7.87 vs. 9.89 × 109 L–1, P = 0.027), neutrophils (2.43 vs. 5.16 × 109 L–1, P < 0.001), C-reactive protein (CRP; 3.7 vs. 15.1 mg/L, P = 0.001) and procalcitonin (PCT; 0.09 vs. 0.68 mm/h, P < 0.001), while lymphocyte levels (4.58 vs. 3.56 × 109 L–1; P = 0.006) were significantly higher compared with influenza A patients. In terms of CT imaging, ground-glass opacification in chest CT was more common in COVID-19 patients than in influenza A patients (42.1% vs. 15%, P = 0.032). In contrast, consolidation was more common in influenza A patients (25%) than in COVID-19 patients (5.2%, P = 0.025). Conclusion The clinical manifestations and laboratory tests of COVID-19 children are milder than those of influenza A children under 5 years. Additionally, imaging results more commonly presented as ground-glass opacities in COVID-19 patients.
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Affiliation(s)
- Ying Li
- Department of Respiratory Medicine, Wuhan Children' Hospital, Wuhan, China
| | - Haizhou Wang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China; Hubei Clinical Center & Key Lab of Intestinal & Colorectal Diseases, Wuhan, China
| | - Fan Wang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China; Hubei Clinical Center & Key Lab of Intestinal & Colorectal Diseases, Wuhan, China
| | - Hui Du
- Department of Respiratory Medicine, Wuhan Children' Hospital, Wuhan, China
| | - Xueru Liu
- Department of Respiratory Medicine, Wuhan Children' Hospital, Wuhan, China
| | - Peng Chen
- Department of Respiratory Medicine, Wuhan Children' Hospital, Wuhan, China
| | - Yanli Wang
- Department of Respiratory Medicine, Wuhan Children' Hospital, Wuhan, China
| | - Xiaoxia Lu
- Department of Respiratory Medicine, Wuhan Children' Hospital, Wuhan, China.
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Chu SE, Seak CJ, Su TH, Chaou CH, Tseng HJ, Li CH. Prognostic accuracy of SIRS criteria and qSOFA score for in-hospital mortality among influenza patients in the emergency department. BMC Infect Dis 2020; 20:385. [PMID: 32471385 PMCID: PMC7256917 DOI: 10.1186/s12879-020-05102-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 05/17/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The seasonal influenza epidemic is an important public health issue worldwide. Early predictive identification of patients with potentially worse outcome is important in the emergency department (ED). Similarly as with bacterial infection, influenza can cause sepsis. This study was conducted to investigate the effectiveness of the Systemic Inflammatory Response Syndrome (SIRS) criteria and the quick Sequential Organ Failure Assessment (qSOFA) score as prognostic predictors for ED patients with influenza. METHODS This single-center, retrospective cohort study investigated data that was retrieved from a hospital-based research database. Adult ED patients (age ≥ 18 at admission) with laboratory-proven influenza from 2010 to 2016 were included for data analysis. The initial SIRS and qSOFA scores were both collected. The primary outcome was the utility of each score in the prediction of in-hospital mortality. RESULTS For the study period, 3561 patients met the study inclusion criteria. The overall in-hospital mortality was 2.7% (95 patients). When the qSOFA scores were 0, 1, 2, and 3, the percentages of in-hospital mortality were 0.6, 7.2, 15.9, and 25%, respectively. Accordingly, the odds ratios (ORs) were 7.72, 11.92, and 22.46, respectively. The sensitivity and specificity was 24 and 96.2%, respectively, when the qSOFA score was ≥2. However, the SIRS criteria showed no significant associations with the primary outcome. The area under the receiver operating characteristic curve (AUC) was 0.864, which is significantly higher than that with SIRS, where the AUC was 0.786 (P < 0.01). CONCLUSIONS The qSOFA score potentially is a useful prognostic predictor for influenza and could be applied in the ED as a risk stratification tool. However, qSOFA may not be a good screening tool for triage because of its poor sensitivity. The SIRS criteria showed poor predictive performance in influenza for mortality as an outcome. Further research is needed to determine the role of these predictive tools in influenza and in other viral infections.
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Affiliation(s)
- Sheng-En Chu
- Department of Emergency Medicine, Linkou Medical Center, Chang-Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Chen-June Seak
- Department of Emergency Medicine, Linkou Medical Center, Chang-Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Tse-Hsuan Su
- Department of Emergency Medicine, Linkou Medical Center, Chang-Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Chung-Hsien Chaou
- Department of Emergency Medicine, Linkou Medical Center, Chang-Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang-Gung University, Taoyuan, Taiwan.,Chang Gung Medical Education Research Centre, Chang-Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsiao-Jung Tseng
- Clinical Trial Center, Chang-Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Huang Li
- Department of Emergency Medicine, Linkou Medical Center, Chang-Gung Memorial Hospital, Taoyuan, Taiwan. .,College of Medicine, Chang-Gung University, Taoyuan, Taiwan. .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang-Gung University, Taoyuan, Taiwan.
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Tang W, Cao Z, Han M, Wang Z, Chen J, Sun W, Wu Y, Xiao W, Liu S, Chen E, Chen W, Wang X, Yang J, Lin J, Zhao Q, Yan Y, Xie Z, Li D, Yang Y, Liu L, Qu J, Ning G, Shi G, Xie Q. Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial. BMJ 2020; 369:m1849. [PMID: 32409561 PMCID: PMC7221473 DOI: 10.1136/bmj.m1849] [Citation(s) in RCA: 643] [Impact Index Per Article: 160.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of hydroxychloroquine plus standard of care compared with standard of care alone in adults with coronavirus disease 2019 (covid-19). DESIGN Multicentre, open label, randomised controlled trial. SETTING 16 government designated covid-19 treatment centres in China, 11 to 29 February 2020. PARTICIPANTS 150 patients admitted to hospital with laboratory confirmed covid-19 were included in the intention to treat analysis (75 patients assigned to hydroxychloroquine plus standard of care, 75 to standard of care alone). INTERVENTIONS Hydroxychloroquine administrated at a loading dose of 1200 mg daily for three days followed by a maintenance dose of 800 mg daily (total treatment duration: two or three weeks for patients with mild to moderate or severe disease, respectively). MAIN OUTCOME MEASURE Negative conversion of severe acute respiratory syndrome coronavirus 2 by 28 days, analysed according to the intention to treat principle. Adverse events were analysed in the safety population in which hydroxychloroquine recipients were participants who received at least one dose of hydroxychloroquine and hydroxychloroquine non-recipients were those managed with standard of care alone. RESULTS Of 150 patients, 148 had mild to moderate disease and two had severe disease. The mean duration from symptom onset to randomisation was 16.6 (SD 10.5; range 3-41) days. A total of 109 (73%) patients (56 standard of care; 53 standard of care plus hydroxychloroquine) had negative conversion well before 28 days, and the remaining 41 (27%) patients (19 standard of care; 22 standard of care plus hydroxychloroquine) were censored as they did not reach negative conversion of virus. The probability of negative conversion by 28 days in the standard of care plus hydroxychloroquine group was 85.4% (95% confidence interval 73.8% to 93.8%), similar to that in the standard of care group (81.3%, 71.2% to 89.6%). The difference between groups was 4.1% (95% confidence interval -10.3% to 18.5%). In the safety population, adverse events were recorded in 7/80 (9%) hydroxychloroquine non-recipients and in 21/70 (30%) hydroxychloroquine recipients. The most common adverse event in the hydroxychloroquine recipients was diarrhoea, reported in 7/70 (10%) patients. Two hydroxychloroquine recipients reported serious adverse events. CONCLUSIONS Administration of hydroxychloroquine did not result in a significantly higher probability of negative conversion than standard of care alone in patients admitted to hospital with mainly persistent mild to moderate covid-19. Adverse events were higher in hydroxychloroquine recipients than in non-recipients. TRIAL REGISTRATION ChiCTR2000029868.
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Affiliation(s)
- Wei Tang
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhujun Cao
- Department of Infectious Disease, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Mingfeng Han
- Department of Respiratory Medicine, No 2 People's Hospital of Fuyang City, Fuyang, Anhui, China
| | - Zhengyan Wang
- Department of Respiratory Medicine, Suizhou Hospital, Hubei University of Medicine, Suizhou, Hubei, China
| | - Junwen Chen
- Department of Respiratory and Critical Care Medicine, Xiangyang No 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei, China
| | - Wenjin Sun
- Department of Infectious Diseases, Central Hospital of Ezhou, Ezhou, Hubei, China
| | - Yaojie Wu
- Department of Cardiovascular Medicine, Yunmeng People's Hospital, Xiaogan, Hubei, China
| | - Wei Xiao
- Department of Respiratory Medicine, First People's Hospital of Jingzhou City, Jingzhou, Hubei, China
| | - Shengyong Liu
- Department of Infectious Diseases, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, Xiaogan, Hubei, China
| | - Erzhen Chen
- Department of Emergency Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Chen
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiongbiao Wang
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiuyong Yang
- Department of Respiratory Medicine, Hubei Space Hospital of Xiaogan, Xiaogan, Hubei, China
| | - Jun Lin
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Qingxia Zhao
- Department of Infectious Disease, The Sixth People's Hospital of Zhengzhou, Zhengzhou, Henan, China
| | - Youqin Yan
- Department of Infectious Disease, Wuhan No 7 Hospital, Wuhan, Hubei, China
| | - Zhibin Xie
- Departments of Respiratory Medicine, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, Xiaogan, Hubei, China
| | - Dan Li
- Department of Respiratory Medicine, The Third People's Hospital of Yichang, Yichang, Hubei, China
| | - Yaofeng Yang
- Department of Respiratory Medicine, Xiao Gan First People's Hospital, Xiaogan, Hubei Province, China
| | - Leshan Liu
- Clinical Research Centre, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jieming Qu
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guang Ning
- Shanghai National Research Centre for Endocrine and Metabolic Diseases, State Key Laboratory of Medical Genomics, Shanghai Institute for Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guochao Shi
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qing Xie
- Department of Infectious Disease, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Uyeki TM, Bernstein HH, Bradley JS, Englund JA, File TM, Fry AM, Gravenstein S, Hayden FG, Harper SA, Hirshon JM, Ison MG, Johnston BL, Knight SL, McGeer A, Riley LE, Wolfe CR, Alexander PE, Pavia AT. Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenzaa. Clin Infect Dis 2020; 68:e1-e47. [PMID: 30566567 DOI: 10.1093/cid/ciy866] [Citation(s) in RCA: 332] [Impact Index Per Article: 83.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/05/2018] [Indexed: 12/19/2022] Open
Abstract
These clinical practice guidelines are an update of the guidelines published by the Infectious Diseases Society of America (IDSA) in 2009, prior to the 2009 H1N1 influenza pandemic. This document addresses new information regarding diagnostic testing, treatment and chemoprophylaxis with antiviral medications, and issues related to institutional outbreak management for seasonal influenza. It is intended for use by primary care clinicians, obstetricians, emergency medicine providers, hospitalists, laboratorians, and infectious disease specialists, as well as other clinicians managing patients with suspected or laboratory-confirmed influenza. The guidelines consider the care of children and adults, including special populations such as pregnant and postpartum women and immunocompromised patients.
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Affiliation(s)
- Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Henry H Bernstein
- Division of General Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - John S Bradley
- Division of Infectious Diseases, Rady Children's Hospital.,University of California, San Diego
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle Children's Hospital
| | - Thomas M File
- Division of Infectious Diseases Summa Health, Northeast Ohio Medical University, Rootstown
| | - Alicia M Fry
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stefan Gravenstein
- Providence Veterans Affairs Medical Center and Center for Gerontology and Healthcare Research, Brown University, Providence, Rhode Island
| | - Frederick G Hayden
- Division of Infectious Diseases and International Health, University of Virginia Health System, Charlottesville
| | - Scott A Harper
- Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jon Mark Hirshon
- Department of Emergency Medicine, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Michael G Ison
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - B Lynn Johnston
- Department of Medicine, Dalhousie University, Nova Scotia Health Authority, Halifax, Canada
| | - Shandra L Knight
- Library and Knowledge Services, National Jewish Health, Denver, Colorado
| | - Allison McGeer
- Division of Infection Prevention and Control, Sinai Health System, University of Toronto, Ontario, Canada
| | - Laura E Riley
- Department of Maternal-Fetal Medicine, Massachusetts General Hospital, Boston
| | - Cameron R Wolfe
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - Paul E Alexander
- McMaster University, Hamilton, Ontario, Canada.,Infectious Diseases Society of America, Arlington, Virginia
| | - Andrew T Pavia
- Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City
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Abstract
BACKGROUND AND PURPOSE Infection from influenza virus causes tens of thousands of deaths annually in the United States, costing millions to manage hospital complications. Barriers exist for patients to choose the influenza vaccine, which is proven to effectively reduce incidence of infection and complications from influenza virus. A significant percent of uninsured patients are at high risk of these complications because of chronic illness. This article examines the literature for evidence of effective interventions to increase influenza uptake rate in the uninsured adult population. METHODS Literature review of data sources including the Cumulative Index to Nursing and Allied Health Literature, PubMed, Scopus, and the Cochrane Database of Systematic Reviews. CONCLUSIONS Effective interventions include free vaccines, mass communication efforts, implementing an influenza questionnaire, training health care workers, using a vaccine facilitator, implementing a standing orders policy and opt-out policy, scheduling year-round appointments, clinicians recommending the vaccine, clinician audit and feedback, tracking in an electronic medical record, and narrative communication techniques. IMPLICATIONS FOR PRACTICE To reduce influenza-related costs, and improve health outcomes, it is imperative that nurse practitioners use evidence-based interventions in the practice setting to increase influenza uptake rates in the adult uninsured population.
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Lee H, Park G, Lee KS, Jin H, Chun KJ, Kim JH. Knowledge, Adherence to Lifestyle Recommendations, and Quality of Life Among Koreans With Heart Failure. J Cardiovasc Pharmacol Ther 2020; 25:324-331. [PMID: 32233801 DOI: 10.1177/1074248420916324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To assess heart failure (HF) knowledge, adherence to lifestyle recommendations, and quality of life (QOL) among Koreans with HF and identify factors influencing QOL. METHODS A cross-sectional and correlational design was used and a total of 142 Koreans with HF were recruited between April 2012 and September 2013. Data were analyzed using multiple logistic regression with SPSS version 21.0. RESULTS The mean age of participants was 64.1 ± 7.4 years. A higher proportion of participants were male, married, unemployed, had a high education level, and class I New York Heart Association (NYHA) functional status. A higher proportion of participants had ≥2 comorbidities and the most prevalent comorbidity was diabetes. The mean score of HF knowledge was 6.9 (possible range 0-15) and the most frequent incorrect items were "proper actions to reduce thirst" and "causes of leg swelling" in both better and worse QOL groups. Among the recommended lifestyle, pneumococcal vaccination had the least adherence in both groups. Multiple logistic regression showed that patients in NYHA class I, with a higher left ventricular ejection fraction, who had knowledge of "amount of fluid intake a day" and consumed more than moderate alcohol tended to have better QOL. Conclusion: More active interventions targeting HF knowledge in proper actions to reduce thirst, causes of leg swelling, and the amount of fluid intake per day are required. Patients with HF in more serious condition need special attention regarding the risk of worse QOL. The role of alcohol consumption in QOL among HF patients in Korea needs further exploration.
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Affiliation(s)
- Haejung Lee
- College of Nursing, Pusan National University, Yangsan-si, South Korea
| | - Gaeun Park
- Department of Nursing, Pusan National University Yangsan Hospital, Yangsan-si, South Korea
| | - Kyoung Suk Lee
- College of Nursing, Seoul National University, Gwanak-gu, Seoul, Korea
| | - HyeKyung Jin
- College of Nursing, Kaya University, Gimhae-si, South Korea
| | - Kook-Jin Chun
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan-si, South Korea
| | - Jong Hyun Kim
- Department of Internal Medicine, BHC Hanseo Hospital, Busan, South Korea
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Kutty PK, Jain S, Taylor TH, Bramley AM, Diaz MH, Ampofo K, Arnold SR, Williams DJ, Edwards KM, McCullers JA, Pavia AT, Winchell JM, Schrag SJ, Hicks LA. Mycoplasma pneumoniae Among Children Hospitalized With Community-acquired Pneumonia. Clin Infect Dis 2020; 68:5-12. [PMID: 29788037 DOI: 10.1093/cid/ciy419] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 05/14/2018] [Indexed: 12/22/2022] Open
Abstract
Background The epidemiology of Mycoplasma pneumoniae (Mp) among US children (<18 years) hospitalized with community-acquired pneumonia (CAP) is poorly understood. Methods In the Etiology of Pneumonia in the Community study, we prospectively enrolled 2254 children hospitalized with radiographically confirmed pneumonia from January 2010-June 2012 and tested nasopharyngeal/oropharyngeal swabs for Mp using real-time polymerase chain reaction (PCR). Clinical and epidemiological features of Mp PCR-positive and -negative children were compared using logistic regression. Macrolide susceptibility was assessed by genotyping isolates. Results One hundred and eighty two (8%) children were Mp PCR-positive (median age, 7 years); 12% required intensive care and 26% had pleural effusion. No in-hospital deaths occurred. Macrolide resistance was found in 4% (6/169) isolates. Of 178 (98%) Mp PCR-positive children tested for copathogens, 50 (28%) had ≥1 copathogen detected. Variables significantly associated with higher odds of Mp detection included age (10-17 years: adjusted odds ratio [aOR], 10.7 [95% confidence interval {CI}, 5.4-21.1] and 5-9 years: aOR, 6.4 [95% CI, 3.4-12.1] vs 2-4 years), outpatient antibiotics ≤5 days preadmission (aOR, 2.3 [95% CI, 1.5-3.5]), and copathogen detection (aOR, 2.1 [95% CI, 1.3-3.3]). Clinical characteristics were non-specific. Conclusions Usually considered as a mild respiratory infection, Mp was the most commonly detected bacteria among children aged ≥5 years hospitalized with CAP, one-quarter of whom had codetections. Although associated with clinically nonspecific symptoms, there was a need for intensive care in some cases. Mycoplasma pneumoniae should be included in the differential diagnosis for school-aged children hospitalized with CAP.
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Affiliation(s)
- Preeta K Kutty
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Seema Jain
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Thomas H Taylor
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anna M Bramley
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maureen H Diaz
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Krow Ampofo
- University of Utah Health Sciences Center, Salt Lake City
| | - Sandra R Arnold
- Le Bonheur Children's Hospital, Memphis.,University of Tennessee Health Science Center, Memphis
| | - Derek J Williams
- Vanderbilt University Medical Center, Nashville.,Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville
| | - Kathryn M Edwards
- Vanderbilt University Medical Center, Nashville.,Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville
| | - Jonathan A McCullers
- Le Bonheur Children's Hospital, Memphis.,University of Tennessee Health Science Center, Memphis.,St Jude Children's Research Hospital, Memphis, Tennessee
| | - Andrew T Pavia
- University of Utah Health Sciences Center, Salt Lake City
| | | | | | - Lauri A Hicks
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Barrett JP, Rosen IM, Stout LR, Rosen SE. Influenza Vaccination, Self-reported Illness, and Obstacles for Vaccination Among the 2010 ROTC Warrior Forge Cadet Cohort. Mil Med 2020; 185:610-616. [PMID: 32074350 DOI: 10.1093/milmed/usz257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION This study evaluates a large cohort of college students after the 2009-2010 pandemic H1N1 influenza season. The objective was to assess influenza vaccination status, influenzalike illnesses (ILIs), and other characteristics associated with attaining immunizations. METHODS This study was conducted during the summer 2010 the Reserve Officer Training Corps Leadership Development and Assessment Course involving 6272 college students. A voluntary, anonymous questionnaire was administered to assess study objectives. RESULTS Vaccination rates were 39.9% for pandemic H1N1, 40.6% for seasonal influenza, and 32.6% for receiving both vaccinations. Age less than 25 and having a Reserve Officer Training Corps scholarship were associated with lower odds of receiving vaccinations, whereas entering the nursing field and simultaneous membership in the Army reserve forces were associated with higher odds of vaccination. There are 11.2% of respondents reported having an ILI, including 4.3% with severe ILI. There were 4184 reasons indicated for not attaining influenza vaccinations, which are listed in categorical groupings. CONCLUSIONS A historical anchor for vaccination rates and ILI is provided in a large cohort of college students following the 2009 H1N1 influenza pandemic. Influenza immunization locations were determined, as was self-reported obstacles to receiving vaccinations. These are important results for public health leaders seeking to increase vaccination rates during future influenza seasons.
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Affiliation(s)
- John P Barrett
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Irene M Rosen
- Madigan Army Medical Center, 9040A Jackson Ave, Joint Base Lewis-McChord, WA 98431
| | - Louis R Stout
- Landstuhl Regional Medical Center, Unit 33100, APO-AE 09180, Germany
| | - Stephanie E Rosen
- Madigan Army Medical Center, 9040A Jackson Ave, Joint Base Lewis-McChord, WA 98431
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Vázquez-Agra N, Alende-Castro V, Macía-Rodriguez C, Marques-Afonso AT, Vidal-Vazquez M, Blanco VR, Novo-Veleiro I. Prognostic Factors and Analytical Abnormalities in Patients Admitted With the Diagnosis of Influenza in a Third Level Hospital During the 2015–2016 Season. OPEN RESPIRATORY ARCHIVES 2020. [DOI: 10.1016/j.opresp.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lewandowski K, Xu Y, Pullan ST, Lumley SF, Foster D, Sanderson N, Vaughan A, Morgan M, Bright N, Kavanagh J, Vipond R, Carroll M, Marriott AC, Gooch KE, Andersson M, Jeffery K, Peto TEA, Crook DW, Walker AS, Matthews PC. Metagenomic Nanopore Sequencing of Influenza Virus Direct from Clinical Respiratory Samples. J Clin Microbiol 2019; 58:e00963-19. [PMID: 31666364 PMCID: PMC6935926 DOI: 10.1128/jcm.00963-19] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/21/2019] [Indexed: 01/11/2023] Open
Abstract
Influenza is a major global public health threat as a result of its highly pathogenic variants, large zoonotic reservoir, and pandemic potential. Metagenomic viral sequencing offers the potential for a diagnostic test for influenza virus which also provides insights on transmission, evolution, and drug resistance and simultaneously detects other viruses. We therefore set out to apply the Oxford Nanopore Technologies sequencing method to metagenomic sequencing of respiratory samples. We generated influenza virus reads down to a limit of detection of 102 to 103 genome copies/ml in pooled samples, observing a strong relationship between the viral titer and the proportion of influenza virus reads (P = 4.7 × 10-5). Applying our methods to clinical throat swabs, we generated influenza virus reads for 27/27 samples with mid-to-high viral titers (cycle threshold [CT ] values, <30) and 6/13 samples with low viral titers (CT values, 30 to 40). No false-positive reads were generated from 10 influenza virus-negative samples. Thus, Nanopore sequencing operated with 83% sensitivity (95% confidence interval [CI], 67 to 93%) and 100% specificity (95% CI, 69 to 100%) compared to the current diagnostic standard. Coverage of full-length virus was dependent on sample composition, being negatively influenced by increased host and bacterial reads. However, at high influenza virus titers, we were able to reconstruct >99% complete sequences for all eight gene segments. We also detected a human coronavirus coinfection in one clinical sample. While further optimization is required to improve sensitivity, this approach shows promise for the Nanopore platform to be used in the diagnosis and genetic analysis of influenza virus and other respiratory viruses.
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Affiliation(s)
- Kuiama Lewandowski
- Public Health England, National infection Service, Porton Down, Salisbury, United Kingdom
| | - Yifei Xu
- Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford, United Kingdom
- Oxford NIHR BRC, John Radcliffe Hospital, Headington, Oxford, United Kingdom
| | - Steven T Pullan
- Public Health England, National infection Service, Porton Down, Salisbury, United Kingdom
| | - Sheila F Lumley
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, United Kingdom
| | - Dona Foster
- Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford, United Kingdom
- Oxford NIHR BRC, John Radcliffe Hospital, Headington, Oxford, United Kingdom
| | - Nicholas Sanderson
- Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford, United Kingdom
- Oxford NIHR BRC, John Radcliffe Hospital, Headington, Oxford, United Kingdom
| | - Alison Vaughan
- Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford, United Kingdom
- Oxford NIHR BRC, John Radcliffe Hospital, Headington, Oxford, United Kingdom
| | - Marcus Morgan
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, United Kingdom
| | - Nicole Bright
- Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford, United Kingdom
| | - James Kavanagh
- Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford, United Kingdom
| | - Richard Vipond
- Public Health England, National infection Service, Porton Down, Salisbury, United Kingdom
| | - Miles Carroll
- Public Health England, National infection Service, Porton Down, Salisbury, United Kingdom
| | - Anthony C Marriott
- Public Health England, National infection Service, Porton Down, Salisbury, United Kingdom
| | - Karen E Gooch
- Public Health England, National infection Service, Porton Down, Salisbury, United Kingdom
| | - Monique Andersson
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, United Kingdom
| | - Katie Jeffery
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, United Kingdom
| | - Timothy E A Peto
- Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford, United Kingdom
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, United Kingdom
- Oxford NIHR BRC, John Radcliffe Hospital, Headington, Oxford, United Kingdom
| | - Derrick W Crook
- Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford, United Kingdom
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, United Kingdom
- Oxford NIHR BRC, John Radcliffe Hospital, Headington, Oxford, United Kingdom
| | - A Sarah Walker
- Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford, United Kingdom
| | - Philippa C Matthews
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford, United Kingdom
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Oxford NIHR BRC, John Radcliffe Hospital, Headington, Oxford, United Kingdom
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Long-Hay P, Yamamoto E, Bun S, Savuth T, Buntha S, Sokdaro S, Kariya T, Saw YM, Sengdoeurn Y, Hamajima N. Outbreak detection of influenza-like illness in Prey Veng Province, Cambodia: a community-based surveillance. NAGOYA JOURNAL OF MEDICAL SCIENCE 2019; 81:269-280. [PMID: 31241062 PMCID: PMC6556457 DOI: 10.18999/nagjms.81.2.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
On June 4, 2016, the Prey Veng Provincial Health Department reported a total of 107 patients with influenza-like illness (ILI) from Chakhlanh village to the Cambodian Ministry of Health. To confirm the outbreak and evaluate its clinical and epidemiological characteristics, the investigation team visited the village and reviewed the case-based surveillance (CBS) data on severe respiratory infection (SRI) and patients' records in health facilities. The team interviewed all households in the village from May 1 to June 5, 2016 and obtained the following data: age, medical history, date of onset, treatment, symptoms, and history of contact with patients or dead poultry. Nasal swab samples were collected from suspected ILI cases to test for influenza virus by RT-PCR. The investigation detected 498 suspected ILI cases, including 288 females. Although the incidence of suspected ILI cases who visited health centers was 63.0 per 1,000 persons per month, the attack rate was 27.1 per 100 population. The major age group was 5-14 years followed by 0-4 years. Major symptoms were cough, fever, runny nose, and headache. Six of seven nasal swab samples were positive for influenza A/H1N1 pdm09 virus. Most children with flu symptoms had contact with previous cases. This study showed that the ILI outbreak might be caused by seasonal influenza A/H1N1 pdm09 spread from person to person. Poor living conditions and poor hygiene and sanitation practices were environmental factors that caused the outbreak. As the CBS system was unable to identify this epidemic, it needs to be improved.
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Affiliation(s)
- Puthik Long-Hay
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Cambodian Applied Epidemiology Training, Communicable Disease Control Department, Ministry of Health, Phnom Penh, Cambodia
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sreng Bun
- Cambodian Applied Epidemiology Training, Communicable Disease Control Department, Ministry of Health, Phnom Penh, Cambodia
| | - Thai Savuth
- Cambodian Applied Epidemiology Training, Communicable Disease Control Department, Ministry of Health, Phnom Penh, Cambodia
| | - So Buntha
- Cambodian Applied Epidemiology Training, Communicable Disease Control Department, Ministry of Health, Phnom Penh, Cambodia
| | - Soy Sokdaro
- Cambodian Applied Epidemiology Training, Communicable Disease Control Department, Ministry of Health, Phnom Penh, Cambodia
| | - Tetsuyoshi Kariya
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yu Mon Saw
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yi Sengdoeurn
- Cambodian Applied Epidemiology Training, Communicable Disease Control Department, Ministry of Health, Phnom Penh, Cambodia
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Mitha E, Krivan G, Jacobs F, Nagler A, Alrabaa S, Mykietiuk A, Kenwright A, Le Pogam S, Clinch B, Vareikiene L. Safety, Resistance, and Efficacy Results from a Phase IIIb Study of Conventional- and Double-Dose Oseltamivir Regimens for Treatment of Influenza in Immunocompromised Patients. Infect Dis Ther 2019; 8:613-626. [PMID: 31667696 PMCID: PMC6856247 DOI: 10.1007/s40121-019-00271-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Immunocompromised patients infected with influenza exhibit prolonged viral shedding and higher risk of resistance. Optimized treatment strategies are needed to reduce the risk of antiviral resistance. This phase IIIb, randomized, double-blind study (NCT00545532) evaluated conventional-dose or double-dose oseltamivir for the treatment of influenza in immunocompromised patients. METHODS Patients with primary or secondary immunodeficiency and influenza infection were randomized 1:1 to receive conventional-dose oseltamivir (75 mg adolescents/adults [≥ 13 years]; 30-75 mg by body weight in children [1-12 years]) or double-dose oseltamivir (150 or 60-150 mg, respectively), twice daily for an extended period of 10 days. Nasal/throat swabs were taken for virology assessments at all study visits. Co-primary endpoints were safety/tolerability and viral resistance. Secondary endpoints included time to symptom alleviation (TTSA) and time to cessation of viral shedding (TTCVS). RESULTS Of 228 patients enrolled between February 2008 and May 2017, 215 (199 adults) were evaluable for safety, 167 (151 adults) for efficacy, and 152 (138 adults) for resistance. Fewer patients experienced an adverse event (AE) in the conventional-dose group (50.5%) versus the double-dose group (59.1%). The most frequently reported AEs were nausea, diarrhea, vomiting, and headache. Fifteen patients had post-baseline resistance, more commonly in the conventional-dose group (n = 12) than in the double-dose group (n = 3). In adults, median TTSA was similar between arms, while median TTCVS was longer with conventional dosing. CONCLUSIONS Oseltamivir was well tolerated, with a trend toward better safety/tolerability for conventional dosing versus double dosing. Resistance rates were higher with conventional dosing in this immunocompromised patient population. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00545532. FUNDING F. Hoffmann-La Roche Ltd.
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Affiliation(s)
- Essack Mitha
- Newtown Clinical Research, Johannesburg, South Africa.
| | - Gergely Krivan
- Bone Marrow Transplantation Unit, Szent László Hospital, Budapest, Hungary
| | - Frederique Jacobs
- Infectious Diseases, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel and EBMT ALWP Office, Saint Antoine Hospital, Paris, France
| | - Sally Alrabaa
- Department of Infectious Disease and International Medicine, University of South Florida, Tampa, FL, USA
| | | | | | | | | | - Loreta Vareikiene
- Vilnius University Hospital Santaros Klinikos Nephrology Center, Vilnius, Lithuania
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Abstract
Athletes are susceptible to many acute illnesses that can interfere with their ability to train and compete as well as potentially affecting teammates and coaching staff. A solid understanding of the preventive measures, diagnosis, and management of such diseases is paramount in the care of an athletic population.
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Affiliation(s)
- Carrie A Jaworski
- Division of Primary Care Sports Medicine, NorthShore University HealthSystem, Glenview, IL, USA; Department of Family Medicine, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA.
| | - Valerie Rygiel
- Primary Care Sports Medicine Fellowship, University of Chicago/NorthShore University HealthSystem, 2180 Pfingsten Road, Suite 3100, Glenview, IL 60026, USA
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Affiliation(s)
- Asif Noor
- Department of Pediatrics, Children's Medical Center, NYU Winthrop Hospital, Mineola, NY
| | - Theresa Fiorito
- Department of Pediatrics, Children's Medical Center, NYU Winthrop Hospital, Mineola, NY
| | - Leonard R Krilov
- Department of Pediatrics, Children's Medical Center, NYU Winthrop Hospital, Mineola, NY.,Department of Pediatrics, State University of New York, Stony Brook School of Medicine, Stony Brook, NY
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