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Casey K, Reilly ER, Biggs K, Caskey M, Auten JD, Sullivan K, Morrison T, Long A, Rudinsky SL. Serious bacterial infection risk in recently immunized febrile infants in the emergency department. Am J Emerg Med 2024; 80:138-142. [PMID: 38583343 DOI: 10.1016/j.ajem.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 02/25/2024] [Accepted: 03/17/2024] [Indexed: 04/09/2024] Open
Abstract
STUDY OBJECTIVES Fever following immunizations is a common presenting chiefcomplaint among infants. The 2021 American Academy of Pediatrics (AAP) febrile infant clinical practice guidelines exclude recently immunized (RI) infants. This is a challenge for clinicians in the management of the febrile RI young infant. The objective of this study was to assess the prevalence of SBI in RI febrile young infants between 6 and 12 weeks of age. METHODS This was a retrospective chart review of infants 6-12 weeks who presented with a fever ≥38 °C to two U.S. military academic Emergency Departments over a four-year period. Infants were considered recently immunized (RI) if they had received immunizations in the preceding 72 h prior to evaluation and not recently immunized (NRI) if they had not received immunizations during this time period. The primary outcome was prevalence of serious bacterial infection (SBI) further delineated into invasive-bacterial infection (IBI) and non-invasive bacterial infection (non-IBI) based on culture and/or radiograph reports. RESULTS Of the 508 febrile infants identified, 114 had received recent immunizations in the preceding 72 h. The overall prevalence of SBI was 11.4% (95% CI = 8.9-14.6) in our study population. The prevalence of SBI in NRI infants was 13.7% (95% CI = 10.6-17.6) compared to 3.5% (95% CI = 1.1-9.3) in RI infants. The relative risk of SBI in the setting of recent immunizations was 0.3 (95% CI = 0.1-0.7). There were no cases of invasive-bacterial infections (IBI) in the RI group with all but one of the SBI being urinary tract infections (UTI). The single non-UTI was a case of pneumonia in an infant who presented with respiratory symptoms within 24 h of immunizations. CONCLUSION The risk of IBI (meningitis or bacteremia) in RI infants aged 6 to 12 weeks is low. Non-IBI within the first 24 h following immunization was significantly lower than in febrile NRI infants. UTIs remain a risk in the RI population and investigation with urinalysis and urine culture should be encouraged. Shared decision making with families guide a less invasive approach to the care of these children. Future research utilizing a large prospective multi-center data registry would aid in further defining the risk of both IBI and non-IBI among RI infants.
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Affiliation(s)
- Kyla Casey
- Department of Emergency Medicine, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, United States of America.
| | - Erin R Reilly
- Department of Emergency Medicine, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, United States of America
| | - Katherine Biggs
- Department of Emergency Medicine, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, United States of America; Department of Emergency Medicine, Naval Medical Center Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA 2370, United States of America
| | - Michelle Caskey
- Department of Emergency Medicine, Naval Medical Center Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA 2370, United States of America
| | - Jonathan D Auten
- Department of Emergency Medicine, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, United States of America; Department of Emergency Medicine, Naval Medical Center Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA 2370, United States of America
| | - Kevin Sullivan
- Department of Emergency Medicine, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, United States of America
| | - Theodore Morrison
- Department of Emergency Medicine, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, United States of America
| | - Ann Long
- Department of Emergency Medicine, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, United States of America
| | - Sherri L Rudinsky
- Department of Emergency Medicine, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, United States of America; Uniformed Services University of the Health Sciences, Department of Military and Emergency Medicine, 4301 Jones Bridge Rd, Bethesda, MD 20814, United States of America
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Isa HM, Isa AJ, Alnasheet MA, Mansoor MM. Fever assessment in children under five: Are we following the guidelines? World J Clin Pediatr 2024; 13:88864. [PMID: 38596442 PMCID: PMC11000063 DOI: 10.5409/wjcp.v13.i1.88864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/17/2023] [Accepted: 01/04/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Fever is a common cause of medical consultation and hospital admission, particularly among children. Recently, the United Kingdom's National Institute for Health and Care Excellence (NICE) updated its guidelines for assessing fever in children under five years of age. The efficient assessment and management of children with fever are crucial for improving patient outcomes. AIM To evaluate fever assessment in hospitalized children and to assess its adherence with the NICE Fever in under 5s guideline. METHODS We conducted a retrospective cohort review of the electronic medical records of children under five years of age at the Department of Pediatrics, Salmaniya Medical Complex, Bahrain, between June and July 2023. Demographic data, vital signs during the first 48 h of admission, route of temperature measurement, and indications for admission were gathered. Fever was defined according to the NICE guideline. The children were divided into five groups according to their age (0-3 months, > 3-6 months, > 6-12 months, > 12-36 months, and > 36-60 months). Patients with and without fever were compared in terms of demography, indication for admission, route of temperature measurement, and other vital signs. Compliance with the NICE Fever in the under 5s guideline was assessed. Full compliance was defined as > 95%, partial compliance as 70%-95%, and minimal compliance as ≤ 69%. Pearson's χ2, Student's t test, the Mann-Whitney U test, and Spearman's correlation coefficient (rs) were used for comparison. RESULTS Of the 136 patients reviewed, 80 (58.8%) were boys. The median age at admission was 14.2 [interquartile range (IQR): 1.7-44.4] months, with the most common age group being 36-60 months. Thirty-six (26.4%) patients had fever, and 100 (73.6%) were afebrile. The commonest age group for febrile patients (> 12-36 months) was older than the commonest age group for afebrile patients (0-3 months) (P = 0.027). The median weight was 8.3 (IQR: 4.0-13.3) kg. Patients with fever had higher weight than those without fever [10.2 (IQR: 7.3-13.0) vs 7.1 (IQR: 3.8-13.3) kg, respectively] (P = 0.034). Gastrointestinal disease was the leading indication for hospital admission (n = 47, 34.6%). Patients with central nervous system diseases and fever of unknown etiology were more likely to be febrile (P = 0.030 and P = 0.011, respectively). The mean heart rate was higher in the febrile group than the afebrile group (140 ± 24 vs 126 ± 20 beats per minute, respectively) [P = 0.001 (confidence interval: 5.8-21.9)] with a positive correlation between body temperature and heart rate, r = 0.242, n = 136, P = 0.004. A higher proportion of febrile patients received paracetamol (n = 35, 81.3%) compared to the afebrile patients (n = 8, 18.6%) (P < 0.001). The axillary route was the most commonly used for temperature measurements (n = 40/42, 95.2%), followed by the rectal route (n = 2/42, 4.8%). The department demonstrated full compliance with the NICE guideline for five criteria: the type of thermometer used, route and frequency of temperature measurement, frequency of heart rate measurement, and use of antipyretics as needed. Partial compliance was noted for two criteria, the threshold of fever at 38 °C or more, and the respiratory rate assessment in febrile patients. Minimal compliance or no record was observed for the remaining three criteria; routine assessment of capillary refill, temperature reassessment 1-2 h after each antipyretic intake, and refraining from the use of tepid sponging. CONCLUSION This study showed that fever assessment in hospitalized children under five years of age was appropriate, but certain areas of adherence to the NICE guideline still need to be improved.
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Affiliation(s)
- Hasan M Isa
- Department of Pediatrics, Salmaniya Medical Complex, Manama 26671, Bahrain
- Department of Pediatrics, Arabian Gulf University, Manama 26671, Bahrain
| | - Ahmed J Isa
- Department of General Surgery, Salmaniya Medical Complex, Manama 26671, Bahrain
| | | | - Mahmood M Mansoor
- Department of Pediatrics, Salmaniya Medical Complex, Manama 26671, Bahrain
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Long E, Borland ML, George S, Jani S, Tan E, Neutze J, Phillips N, Kochar A, Craig S, Lithgow A, Rao A, Dalziel S, Oakley E, Hearps S, Singh S, Gelbart B, McNab S, Balamuth F, Weiss S, Kuppermann N, Williams A, Babl FE. Sepsis epidemiology in Austral ian and New Zealand children (SENTINEL): protocol for a multicountry prospective observational study. BMJ Open 2024; 14:e077471. [PMID: 38216206 PMCID: PMC10806766 DOI: 10.1136/bmjopen-2023-077471] [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] [Received: 07/06/2023] [Accepted: 12/20/2023] [Indexed: 01/14/2024] Open
Abstract
INTRODUCTION Sepsis affects 25.2 million children per year globally and causes 3.4 million deaths, with an annual cost of hospitalisation in the USA of US$7.3 billion. Despite being common, severe and expensive, therapies and outcomes from sepsis have not substantially changed in decades. Variable case definitions, lack of a reference standard for diagnosis and broad spectrum of disease hamper efforts to evaluate therapies that may improve sepsis outcomes. This landscape analysis of community-acquired childhood sepsis in Australia and New Zealand will characterise the burden of disease, including incidence, severity, outcomes and cost. Sepsis diagnostic criteria and risk stratification tools will be prospectively evaluated. Sepsis therapies, quality of care, parental awareness and understanding of sepsis and parent-reported outcome measures will be described. Understanding these aspects of sepsis care is fundamental for the design and conduct of interventional trials to improve childhood sepsis outcomes. METHODS AND ANALYSIS This prospective observational study will include children up to 18 years of age presenting to 12 emergency departments with suspected sepsis within the Paediatric Research in Emergency Departments International Collaborative network in Australia and New Zealand. Presenting characteristics, management and outcomes will be collected. These will include vital signs, serum biomarkers, clinician assessment of severity of disease, intravenous fluid administration for the first 24 hours of hospitalisation, organ support therapies delivered, antimicrobial use, microbiological diagnoses, hospital and intensive care unit length-of-stay, mortality censored at hospital discharge or 30 days from enrolment (whichever comes first) and parent-reported outcomes 90 days from enrolment. We will use these data to determine sepsis epidemiology based on existing and novel diagnostic criteria. We will also validate existing and novel sepsis risk stratification criteria, characterise antimicrobial stewardship, guideline adherence, cost and report parental awareness and understanding of sepsis and parent-reported outcome measures. ETHICS AND DISSEMINATION Ethics approval was received from the Royal Children's Hospital of Melbourne, Australia Human Research Ethics Committee (HREC/69948/RCHM-2021). This included incorporated informed consent for follow-up. The findings will be disseminated in a peer-reviewed journal and at academic conferences. TRIAL REGISTRATION NUMBER ACTRN12621000920897; Pre-results.
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Affiliation(s)
- Elliot Long
- Department of Emergency Medicine, The Royal Children’s Hospital, Parkville, Victoria, Australia
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Parkville, Victoria, Australia
| | - Meredith L Borland
- Department of Emergency Medicine, Perth Children’s Hospital, Perth, Western Australia, Australia
- Division of Emergency Medicine and Paediatrics, University of Western Australia, Perth, Western Australia, Australia
| | - Shane George
- Division of Emergency Medicine and Children’s Critical Care, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- School of Medicine and Menzies Institute Queensland, Griffith University, Southport, Queensland, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Shefali Jani
- Department of Emergency Medicine, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Eunicia Tan
- Kidz first Middlemore Hospital, Auckland, New Zealand
| | | | - Natalie Phillips
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- Emergency Department, Queensland Children’s Hospital, South Brisbane, Queensland, Australia
| | - Amit Kochar
- Department of Emergency Medicine, Women and Children’s Hospital, Adelaide, South Australia, Australia
- Department of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Simon Craig
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Emergency Medicine, Monash Medical Centre, Clayton, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Anna Lithgow
- Department of Paediatrics, The Royal Darwin Hospital, Tiwi, Northern Territory, Australia
| | - Arjun Rao
- Department of Emergency Medicine, Sydney Children’s Hospital, Randwick, New South Wales, Australia
- School of Women’s and Children’s Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Stuart Dalziel
- Emergency Department, Starship Children’s Hospital, Auckland, New Zealand
- Department of Surgery and Paediatrics, The University of Auckland, Auckland, New Zealand
| | - Ed Oakley
- Department of Emergency Medicine, The Royal Children’s Hospital, Parkville, Victoria, Australia
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Stephen Hearps
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Parkville, Victoria, Australia
| | - Sonia Singh
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- University of California Davis School of Medicine, Sacremento, California, USA
| | - Ben Gelbart
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Parkville, Victoria, Australia
- Intensive Care Unit, The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Sarah McNab
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of General Medicine, The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Fran Balamuth
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Scott Weiss
- Nemours Children’s Health and Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nathan Kuppermann
- Departments of Emergency Medicine and Pediatrics, University of California Davis School of Medicine and University of California Davis Health, Sacremento, California, USA
| | - Amanda Williams
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Franz E Babl
- Department of Emergency Medicine, The Royal Children’s Hospital, Parkville, Victoria, Australia
- Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
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Zhang Y, Liang S, Zhu T. Knowledge, attitudes, and practices toward over-the-counter antipyretics among fever patients: a cross-sectional study in the context of a policy change KAP of OTC antipyretics. Front Public Health 2023; 11:1267171. [PMID: 38026390 PMCID: PMC10667425 DOI: 10.3389/fpubh.2023.1267171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Background On January 8, 2023, a change in the control policy for COVID-19 was implemented in China, whereby patient self-management of fever typically entails the utilization of over-the-counter fever-reducing medications. Objective This study aimed to investigate the knowledge, attitudes, and practices (KAP) toward over-the-counter (OTC) antipyretics among fever patients. Methods This cross-sectional study was conducted between October 2022 and February 2023 at author's hospital in Wuhan, China, among fever patients on OTC antipyretics, using a self-administered questionnaire. Results A total of 481 valid questionnaires were collected, with the age of 36.05 ± 12.10 years, including 240 (49.90%) males, and 209 (43.45%) collected before policy change. The knowledge, attitudes, precautions for medication administration and decision-making practices scores were 6.86 ± 3.30 (possible range: 0-12), 16.67 ± 2.46 (possible range: 7-35), 29.98 ± 5.41 (possible range: 7-35) and 27.87 ± 1.28 (possible range: 8-40), respectively. The multivariable logistic regression analysis showed that knowledge (OR = 0.83, 95%CI: 0.81-0.92, p < 0.001) was independently associated with positive attitude. Knowledge (OR = 1.41, 95%CI: 1.28-1.56, p < 0.001), attitude (OR = 0.87, 95%CI: 0.79-0.95, p = 0.004), suburban (OR = 0.45, 95%CI: 0.23-0.88, p = 0.019) were independently associated with proactive precautions for medication administration practices. Knowledge (OR = 1.14, 95%CI: 1.07-1.22, p < 0.001), attitude (OR = 0.90, 95%CI: 0.82-0.98, p = 0.018), responding after policy change, 2023 (OR = 1.70, 95%CI: 1.10-2.63, p = 0.016) were independently associated with proactive decision making practices. Conclusion Fever patients had moderate knowledge, negative attitude, proactive precautions for medication administration practices, moderate decision-making practices. After the policy change, there was a significant increase in knowledge regarding medication administration precautions and decision-making.
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Affiliation(s)
- Yan Zhang
- Department of Infectious Diseases, People’s Hospital of Dongxihu District, Wuhan, Hubei, China
| | - Shuchang Liang
- Department of Infectious Diseases, People’s Hospital of Dongxihu District, Wuhan, Hubei, China
| | - Tao Zhu
- Department of Pediatrics, Yichang Traditional Chinese Medicine Hospital, Yichang, Hubei, China
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Tran XD, Hoang VT, Dang TTD, Vu TP, To MM, Tran TK, Do MD, Nguyen DC, Nguyen QT, Colson P, Parola P, Marty P, Gautret P. Aetiology of Acute Undifferentiated Fever Among Children Under the Age of Five in Vietnam: A Prospective Study. J Epidemiol Glob Health 2023; 13:163-172. [PMID: 37258852 PMCID: PMC10231849 DOI: 10.1007/s44197-023-00121-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/18/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND To investigate the aetiology of acute undifferentiated fever (AUF) among children under the age of five in Vietnam. METHODS This prospective study was conducted in the Thai Binh paediatric hospital, between July 2020 and July 2021 among children with AUF at admission. Real-time PCR testing 18 microbial pathogens were done on blood samples. RESULTS 286 children were included, with median age of 16 months. 64.7% were male. 53.9% were positive for at least one pathogen by PCR. Enterovirus, human herpesvirus 6, adenovirus, and varicella zoster virus PCR were positive for 31.1, 12.6, 1.4, and 1.0% patients, respectively. Other pathogens tested negative by PCR. During the hospital stay, based on clinical criteria 47.2% children secondarily presented with signs of respiratory tract infections, 18.9% had hand, foot and mouth disease, 4.6% had chickenpox. 4.2% presented signs of central nervous system infections, 1.0% had dengue (antigenic test) and 1.0% had signs of gastrointestinal infection. Finally, 23.1% patients presented a fever with or without a rash and no other symptoms and ultimately received a diagnosis of AUF. CONCLUSION Real-time PCR of blood is useful for detecting pathogens and diagnosing infectious causes of AUF. Further prospective studies with blood and urine culture testing and PCR investigation of not only blood but also cerebrospinal fluid, throat, and skin samples according to symptoms would be of interest to confirm the predominance of viral infections in children with AUF and to guide therapeutic options.
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Affiliation(s)
- Xuan Duong Tran
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Van Thuan Hoang
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | | | | | - Minh Manh To
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | | | - Manh Dung Do
- Thai Binh Paediatric Hospital, Thai Binh, Vietnam
| | - Duy Cuong Nguyen
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Quoc Tien Nguyen
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Philippe Colson
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Philippe Parola
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Pierre Marty
- Université Côte D'Azur, Inserm, C3M, Nice Cedex 3, France
- Parasitologie-Mycologie, Centre Hospitalier Universitaire L'Archet, Nice Cedex 3, France
| | - Philippe Gautret
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam.
- IHU-Méditerranée Infection, Marseille, France.
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.
- VITROME, Institut Hospitalo-Universitaire Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France.
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Kim M, Lee JH, Kwak YH, Kim HK, Kwon H, Suh D, Kim DK, Lee HN, Kim JH, Jue JH, Hwang S. Delta Neutrophil Index Does Not Differentiate Bacterial Infection without Bacteremia from Viral Infection in Pediatric Febrile Patients. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10010161. [PMID: 36670711 PMCID: PMC9857165 DOI: 10.3390/children10010161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/03/2023] [Accepted: 01/10/2023] [Indexed: 01/17/2023]
Abstract
Introduction: We sought to determine whether the delta neutrophil index (DNI), a marker that is reported to be used to predict the diagnosis, prognosis, and disease severity of bacteremia and sepsis, is useful in differentiating bacterial infection without bacteremia (BIWB) from viral infections (VI) in pediatric febrile patients in the emergency department (ED). Method: We conducted a retrospective analysis of febrile patients’ medical records from the pediatric ED of the teaching hospital. The patients with BIWB and those with VI were identified with a review of medical records. The primary outcome was the diagnostic performance of DNI in differentiating BIWB from VI. The secondary outcome was a comparison of the diagnostic performances of DNI, CRP, WBC, and neutrophil count between the two groups. Results: A total of 151 (26.3%) patients were in the BIWB group, and 423 (73.7%) were in the VI group. There was no significant difference in DNI between the two groups (3.51 ± 6.90 vs. 3.07 ± 5.82, mean ± SD, BIWB vs. VI). However, CRP levels were significantly higher in the BIWB group than in the VI group (4.56 ± 5.45 vs. 1.39 ± 2.12, mean ± SD, BIWB vs. VI, p < 0.05). The AUROCs of DNI, WBC count, neutrophil levels, RDW, and CRP levels were 0.5016, 0.5531, 0.5631, 0.5131, and 0.7389, respectively, and only CRP levels were helpful in differentiating BIWB from VI. Conclusion: In the absence of bacteremia, DNI would not be helpful in differentiating BIWB from VI in pediatric febrile patients.
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Affiliation(s)
- Maro Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 13620, Republic of Korea
| | - Jin Hee Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 13620, Republic of Korea
- Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul 03080, Republic of Korea
- Correspondence: ; Tel.: +82-31-787-7586
| | - Young Ho Kwak
- Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul 03080, Republic of Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Hyun Kyung Kim
- Department of Laboratory Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Hyuksool Kwon
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 13620, Republic of Korea
| | - Dongbum Suh
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 13620, Republic of Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Ha Ni Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Jin Hee Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Jie Hee Jue
- Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Soyun Hwang
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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Merlo F, Falvo I, Caiata-Zufferey M, Schulz PJ, Milani GP, Simonetti GD, Bianchetti MG, Fadda M. New insights into fever phobia: a pilot qualitative study with caregivers and their healthcare providers. Eur J Pediatr 2023; 182:651-659. [PMID: 36443503 PMCID: PMC9899170 DOI: 10.1007/s00431-022-04704-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 10/25/2022] [Accepted: 11/07/2022] [Indexed: 11/30/2022]
Abstract
UNLABELLED Despite the availability of clinical guidelines on the correct symptomatic management of fever in children, several studies have reported inaccurate knowledge about this symptom and inappropriate management behaviours among caregivers. There is evidence that caregivers' management of fever is largely influenced by unrealistic and unwarranted concerns about the potential harm that elevated body temperature can cause, a phenomenon commonly referred to as fever phobia. Research on fever phobia has predominantly focused on the role of fever misconceptions in triggering anxiety and impeding a proper fever management, in terms of both concept and operationalization, with little attention to the influence of the relationship between caregivers and the healthcare team. The aim of this pilot study was to explore and describe fever-related knowledge, experience and behaviour among a sample of caregivers, paediatricians and their medical assistants in the Canton of Ticino, Switzerland. We used a qualitative study design with semi-structured, one-to-one interviews with paediatricians employed in private healthcare facilities, their medical assistants and caregivers with at least one child between the ages of 0 and 3 years. We conducted individual interviews either in person or by phone, according to participants' preferences, between October 2020 and February 2021. We performed an inductive-deductive analysis of the transcripts to identify the most meaningful themes from participants' reports. The analysis of the transcripts yielded three main themes. The first theme refers to participants' awareness of the emotional component in managing the child's fever and the challenges this component presents. The second theme refers to the risk of overtreating when the child's right to be sick is not recognized and respected. The third theme refers to the importance of the relational component, showing how a solid therapeutic alliance with the healthcare team helps caregivers develop self-confidence in managing the child's fever. This study contributes to advance our understanding of fever phobia and to a better conceptualization and operationalization of this phenomenon. CONCLUSION Our results point out to the importance of going beyond a knowledge gap paradigm and recognizing both the emotional and the relational component of fever phobia, the former being entrenched in latter, that is, the unique relationship caregivers establish with their child's paediatrician and the medical assistant. WHAT IS KNOWN • Research on fever phobia has predominantly focused on the role of fever misconceptions in triggering anxiety and impeding a proper fever management, in terms of both concept and operationalization, with little attention to the relational component of this phenomenon. WHAT IS NEW • Our results point out to the importance of recognizing the emotional component of fever phobia, beyond its declarative and procedural knowledge dimensions. They also suggest that overtreating is not necessarily and not only the result of a phobia but also of a particular conception of health and the relational component of this phenomenon, which is entrenched in the unique relationship caregivers establish with their child's paediatrician and the medical assistant.
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Affiliation(s)
- Federica Merlo
- Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland ,Sasso Corbaro Foundation, Bellinzona, Switzerland
| | - Ilaria Falvo
- Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Maria Caiata-Zufferey
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Peter J. Schulz
- Faculty of Communication, Culture and Society, Università della Svizzera Italiana, Lugano, Switzerland ,Department of Communication & Media, Ewha Womans University, Seoul, Korea
| | - Gregorio P. Milani
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy ,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Giacomo D. Simonetti
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, EOC, Bellinzona, Switzerland ,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Mario G. Bianchetti
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Marta Fadda
- Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
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Rusu RN, Ababei DC, Bild W, Stoian I, Macadan I, Stanciu GD, Ciobica A, Bild V. Self-Medication in Rural Northeastern Romania: Patients' Attitudes and Habits. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14949. [PMID: 36429676 PMCID: PMC9690038 DOI: 10.3390/ijerph192214949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 06/16/2023]
Abstract
In recent years, many healthcare systems, along with healthcare professionals, have provided services in a patient-centered manner, in which patients are key actors in the care process. Encouraging self-care creates responsible patients, but it must be practiced responsibly. This study aims to analyze the tendency towards self-medication for patients from a rural area in Northeastern Romania. Data were collected using a questionnaire, which consisted of 25 questions, that has been developed by the research team. Student's T test or one-way ANOVA was used, and the reliability of the questionnaire was calculated using Cronbach's alpha coefficient. Fifty-eight patients agreed to participate and were interviewed. The results of the study suggest that respondents practice self-medication, which they resort to when their condition cannot be treated with natural remedies or herbs and when it impairs their ability to do their daily activities. Self-medication could be explained by the lack of self-care services as well as the trust patients have in the specific treatment. Patients prefer asking the pharmacist for drugs instead of visiting a physician, which could be due to higher accessibility and time-efficiency, while also being prone to stock up on certain medications due to limited access to healthcare.
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Affiliation(s)
- Razvan-Nicolae Rusu
- Department of Pharmacodynamics and Clinical Pharmacy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Daniela-Carmen Ababei
- Department of Pharmacodynamics and Clinical Pharmacy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
- Advanced Research and Development Center for Experimental Medicine (CEMEX), “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Walther Bild
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Center of Biomedical Research of the Romanian Academy, 700506 Iasi, Romania
| | - Ioana Stoian
- Department of Pharmacodynamics and Clinical Pharmacy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Ioana Macadan
- Department of Pharmacodynamics and Clinical Pharmacy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Gabriela Dumitrita Stanciu
- Advanced Research and Development Center for Experimental Medicine (CEMEX), “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Andrei Ciobica
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Veronica Bild
- Department of Pharmacodynamics and Clinical Pharmacy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
- Advanced Research and Development Center for Experimental Medicine (CEMEX), “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
- Center of Biomedical Research of the Romanian Academy, 700506 Iasi, Romania
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9
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Feng Z, Saha L, Dritsa C, Wan Q, Glebov OO. Temperature-dependent structural plasticity of hippocampal synapses. Front Cell Neurosci 2022; 16:1009970. [DOI: 10.3389/fncel.2022.1009970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
The function of the central nervous system (CNS) is strongly affected by temperature. However, the underlying processes remain poorly understood. Here, we show that hypothermia and hyperthermia trigger bidirectional re-organization of presynaptic architecture in hippocampal neurons, resulting in synaptic strengthening, and weakening, respectively. Furthermore, hypothermia remodels inhibitory postsynaptic scaffold into enlarged, sparse synapses enriched in GABAA receptors. This process does not require protein translation, and instead is regulated by actin dynamics. Induction of hypothermia in vivo enhances inhibitory synapses in the hippocampus, but not in the cortex. This is confirmed by the proteomic analysis of cortical synapses, which reveals few temperature-dependent changes in synaptic content. Our results reveal a region-specific form of environmental synaptic plasticity with a mechanism distinct from the classic temperature shock response, which may underlie functional response of CNS to temperature.
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Smit L, Redfern A, Murray S, Lishman J, van der Zalm MM, van Zyl G, Verhagen LM, de Vos C, Rabie H, Dyk A, Claassen M, Taljaard J, Aucamp M, Dramowski A. SARS-CoV-2 in children and their accompanying caregivers: Implications for testing strategies in resource limited hospitals. Afr J Emerg Med 2022; 12:177-182. [PMID: 35496826 PMCID: PMC9035358 DOI: 10.1016/j.afjem.2022.04.007] [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: 08/24/2021] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 11/01/2022] Open
Abstract
Background Identification of SARS-CoV-2 infected individuals is imperative to prevent hospital transmission, but symptom-based screening may fail to identify asymptomatic/mildly symptomatic infectious children and their caregivers. Methods A COVID-19 period prevalence study was conducted between 13 and 26 August 2020 at Tygerberg Hospital, testing all children and their accompanying asymptomatic caregivers after initial symptom screening. One nasopharyngeal swab was submitted for SARS-CoV-2 using real-time reverse-transcription polymerase chain reaction (rRT-PCR). An additional Respiratory Viral 16-multiplex rRT-PCR test was simultaneously done in children presenting with symptoms compatible with possible SARS-CoV-2 infection. Results SARS-Co-V 2 RT-PCR tests from 196 children and 116 caregivers were included in the analysis. The SARS-CoV-2 period prevalence in children was 5.6% (11/196) versus 15.5% (18/116) in asymptomatic caregivers (p<0.01). Presenting symptoms did not correlate with SARS-CoV-2 test positivity; children without typical symptoms of SARS-CoV-2 were more likely to be positive than those with typical symptoms (10.2% [10/99] vs 1% [1/97]; p<0.01). Children with typical symptoms (97/196; 49.5%) mainly presented with acute respiratory (68/97; 70.1%), fever (17/97; 17.5%), or gastro-intestinal complaints (12/97; 12.4%); Human Rhinovirus (23/81; 28.4%) and Respiratory Syncytial Virus (18/81; 22.2%) were frequently identified in this group. Children-caregiver pairs' SARS-CoV-2 tests were discordant in 83.3%; 15/18 infected caregivers' children tested negative. Symptom-based COVID-19 screening alone would have missed 90% of the positive children and 100% of asymptomatic but positive caregivers. Conclusion Given the poor correlation between SARS-CoV-2 symptoms and RT-PCR test positivity, universal testing of children and their accompanying caregivers should be considered for emergency and inpatient paediatric admissions during high COVID-19 community transmission periods. Universal PPE and optimising ventilation is likely the most effective way to control transmission of respiratory viral infections, including SARS-CoV-2, where universal testing is not feasible. In these settings, repeated point prevalence studies may be useful to inform local testing and cohorting strategies.
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Liu X, Huang S, Ma L, Ye H, Lin J, Cai X, Shang Q, Zheng C, Xu R, Zhang D. Recent advances in wearable medical diagnostic sensors and new therapeutic dosage forms for fever in children. J Pharm Biomed Anal 2022; 220:115006. [PMID: 36007307 DOI: 10.1016/j.jpba.2022.115006] [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: 06/09/2022] [Revised: 08/05/2022] [Accepted: 08/13/2022] [Indexed: 11/17/2022]
Abstract
Fever in children is one of the most common symptoms of pediatric diseases and the most common complaint in pediatric clinics, especially in the emergency department. Diseases such as pneumonia, sepsis, and meningitis are leading causes of death in children, and the early manifestations of these diseases are accompanied by fever symptoms. Accurate diagnosis and real-time monitoring of the status of febrile children, rapid and effective identification of the cause, and treatment can have a positive impact on relieving their symptoms and improving their quality of life. In recent years, wearable diagnostic sensors have attracted special attention for their high flexibility, real-time monitoring, and sensitivity. Temperature sensors and heart rate sensors have provided new advances in detecting children's body temperature and heart rate. Furthermore, some novel formulations have also received wide attention for addressing bottlenecks in medication administration for febrile children, such as difficulty in swallowing and inaccurate dosing. In this context, the present review provides recent advances of novel wearable medical sensor devices for diagnosing fever. Moreover, the application progress of innovative dosage forms of classical antipyretic drugs for children is presented. Finally, challenges and prospects of wearable sensor-based diagnostics and novel agent-based treatment of fever in children are discussed in brief.
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Affiliation(s)
- Xuemei Liu
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Shengjie Huang
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Lele Ma
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Hui Ye
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Junzhi Lin
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, PR China
| | - Xinfu Cai
- Sichuan Guangda Pharmaceutical Co. Ltd., Pengzhou 611930, PR China; National Engineering Research Center for Modernization of Traditional Chinese Medicine, Pengzhou 611930, PR China
| | - Qiang Shang
- Sichuan Guangda Pharmaceutical Co. Ltd., Pengzhou 611930, PR China; National Engineering Research Center for Modernization of Traditional Chinese Medicine, Pengzhou 611930, PR China
| | - Chuan Zheng
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, PR China.
| | - Runchun Xu
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China.
| | - Dingkun Zhang
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China.
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Krafft HS, Raak CK, Jenetzky E, Zuzak TJ, Längler A, Martin DD. Warming up for a better fever: a randomized pilot study in pediatric oncology. Pilot Feasibility Stud 2022; 8:183. [PMID: 35974359 PMCID: PMC9380316 DOI: 10.1186/s40814-022-01144-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fever in children is a major problem in pediatric oncology. Usual management leads to immediate antibiotic and antipyretic therapy, although there is consensus that antipyretic therapy should not be utilized with the sole aim of reducing body temperature. Increased body temperature during fever appears to be an effective modifier in terms of viral replication and enhanced host defense mechanisms against pathogens. Therefore, it might be beneficial to support febrile patients by applying gentle heat during the onset of fever to help the body to reach its new thermoregulatory set point. METHODS A randomized pilot study over 6 months will be conducted in a pediatric oncology department in an academic hospital in Germany. This study is a preparation for a multicenter clinical trial with two parallel groups concerning the efficacy of heat application vs. treatment as usual. One of the inclusion criteria is body temperatures ≥ 38.0 °C in n = 24 cases of patients receiving chemotherapy aged 18 months to 17 years. The first intervention consists of gentle heat application with hot water bottles at any sign of illness and onset of fever. The aim is to achieve a warm periphery equilibrated to trunk temperature of less than 0.5 °C. The second intervention is the avoidance of antipyretics. The control group receives the standard antipyretic treatment from the participating hospital. The purposes of this pilot study are proof of principle of intervention, evaluation of safety, feasibility, definition of endpoints, and to receive basic data for sample size calculation and needed resources. DISCUSSION The main goal is to improve the care of children with cancer by providing the best possible support for febrile episodes. If fever support by heat reduces discomfort, administration of antipyretics and maybe even antibiotics, this would be an advancement in oncological fever management. This pilot study is intended to provide a basis for a main, multicenter, randomized trial and demonstrate the practicability of heat application in febrile patients in pediatric oncology. TRIAL REGISTRATION German Clinical Trials Register (DRKS), DRKS00028273 . Registered on 14 April 2022.
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Affiliation(s)
- Hanno S. Krafft
- Faculty of Health/School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
| | - Christa K. Raak
- Faculty of Health/School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
| | - Ekkehart Jenetzky
- Faculty of Health/School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes-Gutenberg-University, Mainz, Germany
| | - Tycho J. Zuzak
- Department of Pediatrics, Gemeinschaftskrankenhaus, Herdecke, Germany
- Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Alfred Längler
- Faculty of Health/School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
- Department of Pediatrics, Gemeinschaftskrankenhaus, Herdecke, Germany
| | - David D. Martin
- Faculty of Health/School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
- Department of Pediatrics, Eberhard-Karls University Tübingen, Tübingen, Germany
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Network Pharmacology and Molecular Docking Study of Yupingfeng Powder in the Treatment of Allergic Diseases. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1323744. [PMID: 35855823 PMCID: PMC9288288 DOI: 10.1155/2022/1323744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/22/2022] [Indexed: 11/17/2022]
Abstract
Objective To explore the potential mechanisms of Yupingfeng Powder (YPFP) in the treatment of allergic diseases by using network pharmacology and molecular docking technology. Methods The active components and targets of YPFP were screened by the TCMSP database. The targets associated with atopic dermatitis, asthma, allergic rhinitis, and food allergy were obtained from GeneCards and OMIM databases, respectively. The intersection of the above disease-related targets was identified as allergy-related targets. Then, allergy-related targets and YPFP-related targets were crossed to obtain the potential targets of YPFP for allergy treatment. A protein-protein-interaction (PPI) network and a drug-target-disease topology network were constructed to screen hub targets and key ingredients. Next, GO and KEGG pathway enrichment analyses were performed separately on the potential targets and hub targets to identify the biological processes and signaling pathways involved. Finally, molecular docking was conducted to verify the binding affinity between key ingredients and hub targets. Results In this study, 45 active ingredients were identified from YPFP, and 48 allergy-related targets were predicted by network pharmacology. IL6, TNF, IL1B, PTGS2, CXCL8, JUN, CCL2, IL10, IFNG, and IL4 were screened as hub targets by the PPI network. However, quercetin, kaempferol, wogonin, formononetin, and 7-O-methylisomucronulatol were identified as key ingredients by the drug-target-disease topological network. GO and KEGG pathway enrichment analysis indicated that the therapeutic effect of YPFP on allergy involved multiple biological processes and signaling pathways, including positive regulation of fever generation, positive regulation of neuroinflammatory response, vascular endothelial growth factor production, negative regulation of cytokine production involved in immune response, positive regulation of mononuclear cell migration, type 2 immune response, and negative regulation of lipid storage. Molecular docking verified that all the key ingredients had good binding affinity with hub targets. Conclusion This study revealed the key ingredients, hub targets, and potential mechanisms of YPFP antiallergy, and these data can provide some theoretical basis for subsequent allergy treatment and drug development.
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Candidate Biomarkers for the Detection of Serious Infections in Children: A Prospective Clinical Study. CHILDREN 2022; 9:children9050682. [PMID: 35626858 PMCID: PMC9139697 DOI: 10.3390/children9050682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 11/16/2022]
Abstract
Serious bacterial infections (SBI) in children are associated with considerable morbidity and mortality, and their early identification remains challenging. The role of laboratory tests in this setting is still debated, and new biomarkers are needed. This prospective, observational, single-center study aims to evaluate the diagnostic role of blood biomarkers in detecting SBI in children presenting with signs of systemic inflammatory response syndrome (SIRS). A panel of biomarkers was performed, including C-reactive protein (CRP), procalcitonin (PCT), white blood cell count (WBC), absolute neutrophil count (ANC), interleukin (IL)-6, IL-8, IL-10, human terminal complement complex (C5b-9), Plasmalemma-Vesicle-associated protein 1 (PV-1), Intercellular Adhesion Molecule-1 (ICAM-1), and Phospholipase A2 (PLA2). Among 103 patients (median age 2.9 years, 60% males), 39 had a diagnosis of SBI (38%). Significant predictors of SBI were CRP (p = 0.001) and ICAM-1 (p = 0.043). WBC (p = 0.035), ANC (p = 0.012) and ANC/WBC ratio (p = 0.015) were also significantly associated with SBI in children without pre-existing neutropenia. ROC curves, however, revealed suboptimal performance for all variables. Nevertheless, a model that combined CRP and ANC/WBC ratio had more in-depth diagnostic accuracy than either of the two variables. Overall, this study confirms the limited usefulness of blood biomarkers for the early diagnosis of SBI. WBC, ANC, ANC/WBC ratio, CRP, and ICAM-1 showed the best, albeit moderate, diagnostic accuracy.
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Silvagni D, Castagno E, Cardinale F, Chiappa S, Chiaretti A, Corsini I, Ferrari E, Masi S, Meli M, Peccarisi LG, Piccotti E, Tipo V, Vitale A, Zampogna S, Zangardi T. Management of fever in infants and children in the emergency setting and during home discharge: recommendations from an Italian panel. Minerva Pediatr (Torino) 2022; 74:195-201. [PMID: 35511631 DOI: 10.23736/s2724-5276.22.06666-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In infants and children, fever is very common in the emergency setting. The overall aim of the present publication was to overview guidance and provide an algorithm for use in the emergency setting as well as recommendations to inform parents for home care. To obtain consensus, a core steering committee drafted a management algorithm and general consensus was obtained by remote voting among experts. A number of common messages are found in current guidelines: management of fever depends on age, antipyretics are indicated only for discomfort; paracetamol or ibuprofen can be recommended; physical methods for lowering temperature are discouraged. A consensus algorithm is presented in which infants <28 days are considered separately, while those >28 days and <90 days are divided into those ill or well appearing. All infants <28 days with fever ≥37.5 °C should undergo complete work-up for sepsis, strongly considered to receive empirical antibiotics ± acyclovir, and be hospitalized. All infants (between 28 and 90 days) ill appearing should undergo diagnostic work-up for sepsis, receive empirical antibiotics, and be hospitalized. In well appearing infants, diagnostic work-up should be carried out to decide admission to hospital and administration of antibiotics. Specific recommendations are also given for home discharge that can be used to inform parents about the actions to take during home care in the attempt to reinforce existing guidelines. At present, physical examination and laboratory tests, along with best clinical judgement and postdischarge guidance following a defined algorithm, are the foundation of management of febrile children.
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Affiliation(s)
- Davide Silvagni
- Department of Pediatric Emergency, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy -
| | - Emanuele Castagno
- Unit of Pediatric Emergency, Regina Margherita Children's Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Fabio Cardinale
- Unit of Pediatrics and Pediatric Emergency, Consorziale-Policlinico University Hospital, Giovanni XXIII Childern's Hospital, University of Bari, Bari, Italy
| | | | - Antonio Chiaretti
- Unit of Pediatric Emergency, Department of Woman, Child and Public Health Science, Child Health Area, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Ilaria Corsini
- Unit of Pediatric Emergency, S. Orsola-Malpighi IRCCS Polyclinic Hospital, IRCCS, Bologna, Italy
| | | | | | - Mariaclaudia Meli
- Gaspare Rodolico Polyclinic University Hospital, San Marco, Catania, Italy
| | | | | | - Vincenzo Tipo
- Santobono Pausilipon University Hospital, Naples, Italy
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Dagys A, Laucaitytė G, Volkevičiūtė A, Abramavičius S, Kėvalas R, Vitkauskienė A, Jankauskaitė L. Blood biomarkers in early bacterial infection and sepsis diagnostics in feverish young children. Int J Med Sci 2022; 19:753-761. [PMID: 35582414 PMCID: PMC9108404 DOI: 10.7150/ijms.69859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES While most feverish children have self-limiting diseases, 5-10% develop a serious and potentially life-threatening bacterial infection (BI). Due to potential risk, prompt recognition of BI and sepsis in the pediatric emergency department (PED) remains a clinical priority. The aim of the study was to evaluate the role of certain cytokines and chemokines separately and in combination with routine blood tests in early BI and sepsis diagnostics at PED. MATERIALS AND METHODS We prospectively studied children younger than 5 presenting to the PED with fever lasting for under 12 hours with high risk for serious illness. Clinical data, routine blood analysis, and inflammatory cytokine and chemokine panels were evaluated for their diagnostic abilities. Two separate analyses were carried out on the patients' data: one contrasting BI and viral infection (VI) groups, the other comparing septic and non-septic patients. RESULTS The sample comprised 70 patients (40% with BI). IL-2 was found to be the most specific biomarker to identify BI with specificity of 100%. The best discriminative ability was demonstrated by combining IL-2, IL-6, CRP, WBC, and neutrophil count: AUC 0.942 (95% Cl 0.859-0.984). IL-10 exhibited a greater AUC (0.837. 95% CI: 0.730-0.915 p<0.05) than CRP (0.807. 95% CI: 0.695-0.895 p<0.05) when predicting sepsis and showed high specificity (98%) and moderate sensitivity (75%). CONCLUSIONS IL-6 and IL-2 could increase the diagnostic ability of routine blood tests for predicting BI, as IL-10 raises specificity for recognizing sepsis in the early hours of disease onset.
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Affiliation(s)
- Algirdas Dagys
- Lithuanian University of Health Sciences, Medical Academy, Department of Pediatrics, 50161 Kaunas, Lithuania
| | - Goda Laucaitytė
- Lithuanian University of Health Sciences, Medical Academy, Department of Pediatrics, 50161 Kaunas, Lithuania
| | - Augusta Volkevičiūtė
- Laboratory of Preclinical Drug Investigation, Institute of Cardiology, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania
| | - Silvijus Abramavičius
- Laboratory of Preclinical Drug Investigation, Institute of Cardiology, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania
| | - Rimantas Kėvalas
- Lithuanian University of Health Sciences, Medical Academy, Department of Pediatrics, 50161 Kaunas, Lithuania
| | - Astra Vitkauskienė
- Lithuanian University of Health Sciences, Medical Academy, Department of Pediatrics, 50161 Kaunas, Lithuania
- Lithuanian University of Health Sciences, Medical Academy, Department of Laboratory Medicine, 50161 Kaunas, Lithuania
| | - Lina Jankauskaitė
- Lithuanian University of Health Sciences, Medical Academy, Department of Pediatrics, 50161 Kaunas, Lithuania
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Diaz Kane MM. Updates on the Evaluation and Management of Febrile Neonates. Pediatr Ann 2022; 51:e49-e51. [PMID: 35156886 DOI: 10.3928/19382359-20220120-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In August 2021, the American Academy of Pediatrics published a guideline, the first of its kind, to synthesize decades of research on the care of febrile neonates. The guideline is not meant to dictate one particular course of treatment for every clinical scenario, but rather to provide evidence-based recommendations to guide care in collaboration with the patient's caretaker(s). The guideline considers evolving bacteriology, costs of care, advances in laboratory testing and inflammatory markers, and known risks related to the hospitalization of young infants. The guideline highlights 21 key action statements to guide practitioners in the care of neonates presenting with fever, with the aim of optimizing outcomes while reducing risk and unnecessary costs. [Pediatr Ann. 2022;51(2):e49-e51.].
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Dormanesh B, Asli M, Daryanavard R, Arasteh P. Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis syndrome (PFAPA) or recurrent urinary tract infections: a case report. BMC Pediatr 2022; 22:64. [PMID: 35081911 PMCID: PMC8790877 DOI: 10.1186/s12887-021-03075-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fever is the most frequent reason for medical consultation in children, and makes up 15-25% of all consultations in primary care and emergency departments. In here we report a case of a 13 year-old girl who referred with an unusual presentation of fever and was misdiagnosed with recurrent urinary tract infection for 8 years. CASE PRESENTATION This is a Clinical Reasoning Cycle case study. A 13 year-old girl was referred with a chief complaint of recurrent fevers from 8 years. During her first febrile episode, she had a 5-day high-grade fever associated with loss of appetite. Her physical examination at that time was unremarkable. Blood tests showed leukocytosis with a shift to the left and urine examination was in favor of pyuria. The urine culture was positive for bacterial growth. The episodes of fever were repeated every 45 days. Accordingly, the patient was diagnosed as a case of recurrent urinary tract infection. In the intervals between her febrile episodes, the patient was healthy and laboratory tests were normal. Ultrasonography, voiding cystourethrogram and dimercaptosuccinic acid scans were normal. During her last visit, the patient mentioned difficulty in swallowing and on examination cervical lymph nodes, exudative tonsillitis and painful aphthous stomatitis were detected. All antibiotics were stopped and corticosteroids were started. The patient's symptoms were relieved and the interval between her febrile episodes became longer. CONCLUSIONS Our study shows that a patient should never be marked, particularly when the symptom and signs aren't completely justifying a patient's condition.
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Affiliation(s)
- Banafshe Dormanesh
- Department of Pediatric, AJA University of medical sciences, Tehran, Iran
| | - Maryam Asli
- Infectious Diseases and Tropical Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Daryanavard
- Department of Pediatric, AJA University of medical sciences, Tehran, Iran
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Lamot M, Miler M, Nikolac Gabaj N, Lamot L, Milošević M, Harjaček M, Abdović S. Serum Calprotectin Is a Valid Biomarker in Distinction of Bacterial Urinary Tract Infection From Viral Respiratory Illness in Children Under 3 Years of Age. Front Pediatr 2022; 10:768260. [PMID: 35359908 PMCID: PMC8964143 DOI: 10.3389/fped.2022.768260] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/31/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Febrile illnesses in young children can be a major diagnostic challenge, despite the routine use of various laboratory markers. Recent advancements in the understanding of inflammatory processes have highlighted the role of calprotectin, a heterodimer consisting of S100A8 and S100A9 proteins, with many studies suggesting its clinical value as a biomarker of inflammation. This research aimed to evaluate the usefulness of serum calprotectin (sCal) as a biomarker of urinary tract infection (UTI), which was due to its high pooled prevalence and feasibility of urine culture as a diagnostic reference standard selected for a model of bacterial infection in children. METHODS Febrile children aged 0-36 months with suspected UTI based on positive urinalysis or viral respiratory tract infection were included. Children with significant bacteriuria in urine culture were labeled as cases (n = 58), while those with confirmed viral infection (n = 51), as well as those with suspected UTI but sterile urine culture who went on to develop symptoms consistent with viral respiratory infection (n = 7), were labeled as controls. sCal levels were determined by a commercial immunoassay. Conventional inflammation markers (C-reactive protein, procalcitonin, white blood cell count, absolute neutrophil count, and neutrophil percentage) were measured on the day of the clinical examination. Differences in measured inflammatory markers between cases and controls were analyzed with Mann-Whitney U-test. ROC analysis reported cut-off values with the best sensitivity and specificity to distinguish bacterial UTI from viral respiratory infection. RESULTS All analyzed inflammatory biomarkers, including sCal, were significantly higher in cases than in controls. Median concentration of sCal was 4.97 μg/mL (IQR 3.43-6.42) and 2.45 μg/mL (IQR 1.63-3.85) for cases and controls, respectively (p < 0.001). For identifying bacterial UTI, sensitivity and specificity of sCal were 77.6 and 69.0%, respectively, at an adjusted cut-off point of >3.24 μg/mL (AUC 80.2%). CONCLUSION sCal could have substantial added value in the management of a child with fever and positive urinalysis and is a promising biomarker in distinction between bacterial UTI and viral respiratory causes of febrile illness in children under the age of 3 years.
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Affiliation(s)
- Mirta Lamot
- Division of Neonatology, Department of Gynecology and Obstetrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Marijana Miler
- University Department of Chemistry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Nora Nikolac Gabaj
- University Department of Chemistry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia.,Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Lovro Lamot
- Department of Pediatrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia.,Department of Pediatrics, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Milan Milošević
- Andrija Ṡtampar School of Public Health, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Miroslav Harjaček
- Department of Pediatrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia.,Department of Pediatrics, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Slaven Abdović
- Division of Pediatric Nephrology, Department of Pediatrics, Children's Hospital Zagreb, Zagreb, Croatia
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Ntamabyaliro NY, Burri C, Lula YN, Ishoso D, Engo AB, Ngale MA, Liwono JY, Mukomena ES, Mesia GK, Mampunza SM, Tona GL. Knowledge of Antimalarials and Health Seeking Behaviour of Households in Case of Suspected Malaria in Democratic Republic of the Congo. Trop Med Infect Dis 2021; 6:tropicalmed6030157. [PMID: 34462413 PMCID: PMC8406087 DOI: 10.3390/tropicalmed6030157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/17/2021] [Accepted: 08/22/2021] [Indexed: 12/07/2022] Open
Abstract
(1) Background: The Democratic Republic of the Congo (DRC) is heavily affected by malaria despite availability of effective treatments. Ignorance and unrecommended behaviour toward a suspected malaria case in households may contribute to this problem. (2) Method: In communities of one rural and one urban Health Centres in each of the 11 previous provinces of DRC, all households with a case of malaria in the 15 days prior to the survey were selected. The patient or caregiver (responder) were interviewed. Logistic regression was used to assess predictors of knowledge of recommended antimalarials and adequate behaviour in case of suspected malaria. (3) Results: 1732 households participated; about 62% (1060/1721) of the responders were informed about antimalarials, 70.1% (742/1059) knew the recommended antimalarials and 58.6% (995/1699) resorted to self-medication. Predictors of knowledge of antimalarials were education to secondary school or university, information from media and smaller households. Predictors of good behaviour were Catholic religion and smaller households. Receiving information from Community Health Workers (CHWs) failed to be determinants of knowledge or adequate behaviour. (4) Conclusion: malaria control in DRC is hampered by ignorance and non-adherence to national recommendations. These aspects are influenced by unsuccessful communication, size of households and level of education.
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Affiliation(s)
- Nsengi Y. Ntamabyaliro
- Unité de Pharmacologie Clinique, Faculté de Médecine, Université de Kinshasa, Avenue de l’Université 1, Kinshasa, Democratic Republic of the Congo; (Y.N.L.); (A.B.E.); (M.A.N.); (J.Y.L.); (G.K.M.); (S.M.M.); (G.L.T.)
- Correspondence: ; Tel.: +24-38-1517-1991
| | - Christian Burri
- Swiss Tropical and Public Health Institute, Department of Medicine, Socinstrasse 57, 4002 Basel, Switzerland;
- Department of Pharmaceutical Sciences, University of Basel, Petersplatz 1, 4001 Basel, Switzerland
| | - Yves N. Lula
- Unité de Pharmacologie Clinique, Faculté de Médecine, Université de Kinshasa, Avenue de l’Université 1, Kinshasa, Democratic Republic of the Congo; (Y.N.L.); (A.B.E.); (M.A.N.); (J.Y.L.); (G.K.M.); (S.M.M.); (G.L.T.)
| | - Daniel Ishoso
- École de Santé Publique, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo;
| | - Aline B. Engo
- Unité de Pharmacologie Clinique, Faculté de Médecine, Université de Kinshasa, Avenue de l’Université 1, Kinshasa, Democratic Republic of the Congo; (Y.N.L.); (A.B.E.); (M.A.N.); (J.Y.L.); (G.K.M.); (S.M.M.); (G.L.T.)
| | - Mireille A. Ngale
- Unité de Pharmacologie Clinique, Faculté de Médecine, Université de Kinshasa, Avenue de l’Université 1, Kinshasa, Democratic Republic of the Congo; (Y.N.L.); (A.B.E.); (M.A.N.); (J.Y.L.); (G.K.M.); (S.M.M.); (G.L.T.)
| | - Jerry Y. Liwono
- Unité de Pharmacologie Clinique, Faculté de Médecine, Université de Kinshasa, Avenue de l’Université 1, Kinshasa, Democratic Republic of the Congo; (Y.N.L.); (A.B.E.); (M.A.N.); (J.Y.L.); (G.K.M.); (S.M.M.); (G.L.T.)
| | - Eric S. Mukomena
- Programme National de Lutte Contre le Paludisme, Ministère de la Santé, Kinshasa, Democratic Republic of the Congo;
- Faculté de Médecine, Université de Lubumbashi, BP 1825, Lubumbashi, Democratic Republic of the Congo
| | - Gauthier K. Mesia
- Unité de Pharmacologie Clinique, Faculté de Médecine, Université de Kinshasa, Avenue de l’Université 1, Kinshasa, Democratic Republic of the Congo; (Y.N.L.); (A.B.E.); (M.A.N.); (J.Y.L.); (G.K.M.); (S.M.M.); (G.L.T.)
| | - Samuel M. Mampunza
- Unité de Pharmacologie Clinique, Faculté de Médecine, Université de Kinshasa, Avenue de l’Université 1, Kinshasa, Democratic Republic of the Congo; (Y.N.L.); (A.B.E.); (M.A.N.); (J.Y.L.); (G.K.M.); (S.M.M.); (G.L.T.)
- Centre Neuropsychopathologique, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Gaston L. Tona
- Unité de Pharmacologie Clinique, Faculté de Médecine, Université de Kinshasa, Avenue de l’Université 1, Kinshasa, Democratic Republic of the Congo; (Y.N.L.); (A.B.E.); (M.A.N.); (J.Y.L.); (G.K.M.); (S.M.M.); (G.L.T.)
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Kuo N, Su NY, Hou SK, Kang YN. Effects of acetaminophen and ibuprofen monotherapy in febrile children: a meta-analysis of randomized controlled trials. Arch Med Sci 2021; 18:965-981. [PMID: 35832721 PMCID: PMC9267013 DOI: 10.5114/aoms/140875] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/04/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction When a child presents with fever in the clinical encounter, parents are usually concerned about alleviating the fever. However, the indications for selecting an appropriate drug from the most commonly used antipyretic drugs, acetaminophen and ibuprofen, remain unclear. The purpose of this study was to assess the efficacy and safety of acetaminophen and ibuprofen in febrile children through a systematic review with meta-analysis of randomized controlled trials (RCTs). Material and methods Cochrane, Embase, and PubMed databases were searched for the relevant RCTs. Two authors individually extracted information on trial design, demography, rate of fever resolution, body temperature, and overall adverse events. Data were pooled mainly using a random-effects model; however, because of some sparse data, Peto odds ratios (PORs) were used for outcomes of fever resolution and adverse event. 95% confidence intervals (CIs) were also presented. Results In total, 26 RCTs (n = 4137) fulfilled eligibility criteria. Pooled estimates demonstrated that acetaminophen led to significantly lower fever resolution rates than ibuprofen did (POR = 0.91, 95% CI: 0.84-0.98; I 2 = 0%) in the subgroup of trials with a mean age of < 2 years. However, the treatment-time interaction model for body temperature demonstrated that the fever resolution effect was mainly from the time factor based on the available data (effect size = -0.20; 95% CI: -0.30 to -0.11; I 2 = 6.9%). Acetaminophen demonstrated lower overall adverse event rates than ibuprofen (POR = 0.71; 95% CI: 0.58-0.87; I 2 = 0%). Conclusions The effects of ibuprofen are similar to acetaminophen even in children with mean age of approximately 5 years. Nevertheless, acetaminophen is safer than ibuprofen, particularly in children approximately 5 years old.
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Affiliation(s)
- Ning Kuo
- Department of Emergency Medicine,Taipei Medical University Hospital, Taiwan
| | - Nien-Yin Su
- Department of Emergency Medicine,Taipei Medical University Hospital, Taiwan
| | - Sen-Kuang Hou
- Department of Emergency Medicine,Taipei Medical University Hospital, Taiwan
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
| | - Yi-No Kang
- Department of Emergency Medicine,Taipei Medical University Hospital, Taiwan
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taiwan
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Department of Health Care Management, College of Health Technology, National Taipei University of Nursing Health Sciences, Taipei, Taiwan
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22
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Green R, Webb D, Jeena PM, Wells M, Butt N, Hangoma JM, Moodley R(S, Maimin J, Wibbelink M, Mustafa F. Management of acute fever in children: Consensus recommendations for community and primary healthcare providers in sub-Saharan Africa. Afr J Emerg Med 2021; 11:283-296. [PMID: 33912381 PMCID: PMC8063696 DOI: 10.1016/j.afjem.2020.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 11/08/2020] [Accepted: 11/15/2020] [Indexed: 12/24/2022] Open
Abstract
Fever is one of the most common reasons for unwell children presenting to pharmacists and primary healthcare practitioners. Currently there are no guidelines for assessment and management of fever specifically for community and primary healthcare workers in the sub-Saharan Africa region. This multidisciplinary consensus guide was developed to assist pharmacists and primary healthcare workers in sub-Saharan Africa to risk stratify and manage children who present with fever, decide when to refer, and how to advise parents and caregivers. Fever is defined as body temperature ≥ 37.5 °C and is a normal physiological response to illness that facilitates and accelerates recovery. Although it is often associated with self-limiting illness, it causes significant concern to both parents and attending healthcare workers. Clinical signs may be used by pharmacy staff and primary healthcare workers to determine level of distress and to distinguish between a child with fever who is at high risk of serious illness and who requires specific treatment, hospitalisation or specialist care, and those at low risk who could be managed conservatively at home. In children with warning signs, serious causes of fever that may need to be excluded include infections (including malaria), non-infective inflammatory conditions and malignancy. Simple febrile convulsions are not in themselves harmful, and are not necessarily indicative of serious infection. In the absence of illness requiring specific treatment, relief from distress is the primary indication for prescribing pharmacotherapy, and antipyretics should not be administered with the sole intention of reducing body temperature. Care must be taken not to overdose medications and clear instructions should be given to parents/caregivers on managing the child at home and when to seek further medical care.
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Affiliation(s)
- Robin Green
- Department Paediatrics and Child Health, University of Pretoria, South Africa
| | - David Webb
- Houghton House Group, Johannesburg, South Africa
| | - Prakash Mohan Jeena
- Department of Paediatrics & Child Health, University of KwaZulu Natal, Durban, South Africa
| | - Mike Wells
- Division of Emergency Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | - Jackie Maimin
- South African Pharmacy Council, Johannesburg, South Africa
| | | | - Fatima Mustafa
- Steve Biko Academic Hospital, Department of Paediatrics and Child Health, University of Pretoria, South Africa
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23
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Martinelli M, Quaglietta L, Banderali G, Ferrara P, Romano C, Staiano A. Prescribing patterns, indications and adverse events of ibuprofen in children: results from a national survey among Italian pediatricians. Ital J Pediatr 2021; 47:98. [PMID: 33883005 PMCID: PMC8059227 DOI: 10.1186/s13052-021-01047-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background Despite ibuprofen widely recognized safety profile, an increase of suspected adverse events has been reported in the last decade in parallel with its growing over-the-counter use. The aims of this study were to assess the therapeutic approach to the feverish child and to evaluate the main indications and the most frequent adverse events related to ibuprofen administration in children. Methods A specific questionnaire-form regarding the management of ibuprofen therapy in children was distributed among a sample of pediatricians all over the Italian territory between September and October 2020. An electronic data collection through a specifically designed web-based platform was performed among the participating pediatricians. Results One-hundred-eighty-one pediatricians completed the survey. In case of fever, 177 (98%) participants prescribe paracetamol, while only 4 (2%) preferred ibuprofen as first choice. One-hundred-twenty-eight pediatricians (71%) administer paracetamol alone, while 53 (29.2%) use the combined/alternating treatment with ibuprofen. Ibuprofen is mostly administered for musculoskeletal pain (30%), upper respiratory tract infection (20%), headache (15%) and post-surgical pain (9%). Sixty-three (35%) out of 181 participating pediatricians reported 191 adverse events during ibuprofen administration. The most common were gastrointestinal (GI), with GI bleeding being reported in 30/191 cases (15.7%), epigastric pain in 29/191 (15.1%), non-specified abdominal pain in 22/191 (11.1%) and nausea/vomiting in 21/191 (11%). Severe adverse events including kidney damage (3.1%), complicated infections (0.5%), pneumonia associated empyema (0.5%), soft tissue infection (0.5%) and disseminated intravascular coagulation (0.5%) were also reported. The adverse events led to a hospitalization in 12% of children. In 53/191 cases (28%) the adverse events were related to a wrong dosage or prolonged therapy or errors in frequency of administration. Conclusions This survey demonstrate a sufficient awareness of Italian pediatricians regarding ibuprofen-prescribing patterns with the only possible concern related to the relatively high percentage of pediatricians performing a combining/alternating use of paracetamol and ibuprofen. The reported adverse events were mild in most of the cases and often related to errors in dosage, frequency and treatment duration, emphasizing the need for a major caution of both practitioners and patients in their use. Supplementary Information The online version contains supplementary material available at 10.1186/s13052-021-01047-y.
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Affiliation(s)
- Massimo Martinelli
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
| | | | - Giuseppe Banderali
- Clinical Department of Pediatrics and Neonatology, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Pietro Ferrara
- Institute of Pediatrics, Catholic University Medical School, Rome, Italy.,Service of Pediatrics, Campus Bio-Medico University, Rome, Italy
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Messina, Italy
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy.
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Kasbekar R, Naz A, Marcos L, Liu Y, Hendrickson K, Gorsich JC, Baun M. Threshold for defining fever varies with age, especially in children: A multi-site diagnostic accuracy study. Nurs Open 2021; 8:2705-2721. [PMID: 33735515 PMCID: PMC8363342 DOI: 10.1002/nop2.831] [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: 08/14/2020] [Revised: 12/30/2020] [Accepted: 01/31/2021] [Indexed: 11/23/2022] Open
Abstract
Aim The American Academy of Pediatrics and the European Centre for Pediatric and Adolescent Medicine guideline define fever as a temperature >38.0°C for all ages and recommend use of rectal thermometers in children <3 years. Based on new literature, this definition of fever using a fixed threshold of 38.0°C needs to be re‐examined. Design A multi‐site diagnostic accuracy study was conducted to compare an “age‐based” threshold model with a “fixed” threshold over 38.0°C on a total of 894 patients of which 373 were ill. Methods The “age‐based” and “fixed” threshold fever determinations were then compared to a clinical categorization (“well” or “ill”) conducted by a clinician through a comprehensive examination. Results The sensitivity and accuracy for the age‐based thresholds were found to be superior to the fixed thresholds in all ages and current ear thermometers were found equivalent to rectal thermometers in infants <6 months.
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Affiliation(s)
- Rajesh Kasbekar
- Kaz USA, Inc., a Helen of Troy Company, Marlborough, MA, USA
| | - Aftab Naz
- Madera Family Medical Group, Madera, CA, USA
| | | | - Yingjie Liu
- Merck Sharp & Dohme Corp, North Wales, PA, USA
| | | | - James C Gorsich
- Kaz USA, Inc., a Helen of Troy Company, Marlborough, MA, USA
| | - Matt Baun
- Kaz USA, Inc., a Helen of Troy Company, Marlborough, MA, USA
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Mohanty N, Thapa BR, Mathai J, Pai U, Mohanty N, Biradar V, Jog P, Prabhu P. Low Osmolarity Oral Rehydration Salt Solution (LORS) in Management of Dehydration in Children. Indian Pediatr 2021; 58:266-272. [PMID: 33713063 PMCID: PMC8005284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
JUSTIFICATION The IAP last published the guidelines "Comprehensive Management of Diarrhea" in 2006 and a review in 2016. The WHO in 2002 and the Government of India in 2004 recommended low osmolarity rehydration solution (LORS) as the universal rehydration solution for all ages and all forms of dehydration. However, the use of LORS in India continues to be unacceptably low at 51%, although awareness about ORS has increased from a mere 14% in 2005 to 69% in 2015. Availability of different compositions of ORS and brands in market added to the confusion. PROCESS The Indian Academy of Pediatrics constituted a panel of experts from the fields of pediatrics, pediatric gastroenterology and nutrition to update on management of dehydration in children with particular reference to LORS and issue a current practice guideline. The committee met twice at CIAP HQ to review all published literature on the aspect. Brief presentations were made, followed by discussions. The draft paper was circulated by email. All relevant inputs and suggestions were incorporated to arrive at a consensus on this practice guideline. OBJECTIVES To summarize latest literature on ORT and empower pediatricians, particularly those practicing in rural areas, on management of dehydration by augmenting LORS use. RECOMMENDATIONS It was stressed that advantages of LORS far out-weigh its limitations. Increased use of LORS can only be achieved by promoting better awareness among public and health-care providers across all systems of medicine. LORS can also be useful in managing dehydration in non-diarrheal illness. More research is required to modify ORS further to make it safe and effective in neonates, severe acute malnutrition, renal failure, cardiac and other co-morbidities. There is an urgent need to discourage production and marketing all forms of ORS not in conformity with WHO approved LORS, under a slogan "One India, one ORS".
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Affiliation(s)
- Nimain Mohanty
- Department of Pediatrics, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India. Correspondence to: Prof. Nimain Mohanty, Department of Paediatrics, MGM Medical College, Kamothe, Navi Mumbai 410209, Maharashtra, India.
| | - Babu Ram Thapa
- Department of Gastroenterology, Liver and Nutrition, PGIMER, Chandigarh, India
| | - John Mathai
- Consultant in Pediatric GE, Masonic Children's Hospital, Coimbatore, India
| | - Uday Pai
- Consultant Pediatrician, Chembur, Mumbai, India
| | | | - Vishnu Biradar
- Department of Pediatrics, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
| | - Pramod Jog
- Department of Pediatrics, DY Patil Medical College, Pune, Maharashtra, India
| | - Purnima Prabhu
- Pediatric Nutritionist, P.D. Hinduja Hospital, Mumbai, Maharashtra, India
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[Fever of unknown origin]. Monatsschr Kinderheilkd 2021; 169:416-425. [PMID: 33727731 PMCID: PMC7950420 DOI: 10.1007/s00112-021-01145-5] [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] [Accepted: 02/17/2021] [Indexed: 11/13/2022]
Abstract
Fieber unklarer Genese wird diagnostiziert, wenn das Fieber (meist definiert als Körpertemperatur ≥ 38,3 °C, gemessen rektal oder am Trommelfell) länger dauert als erwartet, also nach 5 bis 10 Tagen. Die Ursachensuche kann sich schwierig gestalten und bedarf der erhöhten Aufmerksamkeit des erfahrenen Allgemeinpädiaters in Zusammenarbeit mit pädiatrischen Infektiologen, Rheumatologen und Onkologen, der Pflege, Radiologen und anderen. In etwa der Hälfte der Fälle findet sich am Ende doch eine Infektion; weitere Ursachen sind primär entzündliche oder onkologische sowie nichtentzündliche Erkrankungen. Einzelne Ursachen mit der Gefahr des schweren Verlaufs müssen sofort behandelt werden. Ansonsten gibt es ein klares Primat der Diagnostik, die klug geplant und sowohl zielstrebig als auch breit durchgeführt wird. Anamnese, physikalischer Befund, Laborbestimmungen, apparative Diagnostik, bildgebende und histologische Untersuchungen können zur Diagnose beitragen. Die Eltern sind durch die Ungewissheit hindurchzuführen, und dem Kind sollte die Situation möglichst erleichtert werden. Es kommen auch Spontanheilungen vor. Die probatorische Gabe von Antibiotika führt selten zur Besserung. Nach weitgehendem Ausschluss von Infektion, Malignom und zunehmendem Leiden unter dem Fieber selbst, können bei hoher Entzündungsaktivität, unter dem Verdacht auf einen hyperergen Status und nach ausführlicher Aufklärung Glukokortikoide angesetzt werden. Das Management des Fiebers unklarer Genese ist eine der großen Herausforderungen der Pädiatrie.
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Denina M, Aguzzi S, Versace A, Rossi R, Pruccoli G, Mignone F, Bondone C, Garazzino S. Testing strategy for SARS-CoV-2 in the paediatric emergency department. Arch Dis Child 2021; 106:e11. [PMID: 32586931 DOI: 10.1136/archdischild-2020-319806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Marco Denina
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Sonia Aguzzi
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
| | - Antonia Versace
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
| | - Roberta Rossi
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
| | - Giulia Pruccoli
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Federica Mignone
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy
| | - Silvia Garazzino
- Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
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Powell D, Haddad SA, Gorur-Shandilya S, Marder E. Coupling between fast and slow oscillator circuits in Cancer borealis is temperature-compensated. eLife 2021; 10:60454. [PMID: 33538245 PMCID: PMC7889077 DOI: 10.7554/elife.60454] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 02/01/2021] [Indexed: 12/21/2022] Open
Abstract
Coupled oscillatory circuits are ubiquitous in nervous systems. Given that most biological processes are temperature-sensitive, it is remarkable that the neuronal circuits of poikilothermic animals can maintain coupling across a wide range of temperatures. Within the stomatogastric ganglion (STG) of the crab, Cancer borealis, the fast pyloric rhythm (~1 Hz) and the slow gastric mill rhythm (~0.1 Hz) are precisely coordinated at ~11°C such that there is an integer number of pyloric cycles per gastric mill cycle (integer coupling). Upon increasing temperature from 7°C to 23°C, both oscillators showed similar temperature-dependent increases in cycle frequency, and integer coupling between the circuits was conserved. Thus, although both rhythms show temperature-dependent changes in rhythm frequency, the processes that couple these circuits maintain their coordination over a wide range of temperatures. Such robustness to temperature changes could be part of a toolbox of processes that enables neural circuits to maintain function despite global perturbations.
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Affiliation(s)
- Daniel Powell
- Biology Department and Volen Center, Brandeis University, Waltham, United States
| | - Sara A Haddad
- Biology Department and Volen Center, Brandeis University, Waltham, United States
| | | | - Eve Marder
- Biology Department and Volen Center, Brandeis University, Waltham, United States
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Gaudenzi G, Kumbakumba E, Rasti R, Nanjebe D, Réu P, Nyehangane D, Mårtensson A, Nassejje M, Karlsson J, Mzee J, Nilsson P, Businge S, Loh E, Boum Ii Y, Andersson-Svahn H, Gantelius J, Mwanga-Amumpaire J, Alfvén T. Point-of-Care Approaches for Meningitis Diagnosis in a Low-Resource Setting (Southwestern Uganda): Observational Cohort Study Protocol of the "PI-POC" Trial. JMIR Res Protoc 2020; 9:e21430. [PMID: 33146628 PMCID: PMC7690656 DOI: 10.2196/21430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/09/2020] [Accepted: 09/13/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND A timely differential diagnostic is essential to identify the etiology of central nervous system (CNS) infections in children, in order to facilitate targeted treatment, manage patients, and improve clinical outcome. OBJECTIVE The Pediatric Infection-Point-of-Care (PI-POC) trial is investigating novel methods to improve and strengthen the differential diagnostics of suspected childhood CNS infections in low-income health systems such as those in Southwestern Uganda. This will be achieved by evaluating (1) a novel DNA-based diagnostic assay for CNS infections, (2) a commercially available multiplex PCR-based meningitis/encephalitis (ME) panel for clinical use in a facility-limited laboratory setting, (3) proteomics profiling of blood from children with severe CNS infection as compared to outpatient controls with fever yet not severely ill, and (4) Myxovirus resistance protein A (MxA) as a biomarker in blood for viral CNS infection. Further changes in the etiology of childhood CNS infections after the introduction of the pneumococcal conjugate vaccine against Streptococcus pneumoniae will be investigated. In addition, the carriage and invasive rate of Neisseria meningitidis will be recorded and serotyped, and the expression of its major virulence factor (polysaccharide capsule) will be investigated. METHODS The PI-POC trial is a prospective observational study of children including newborns up to 12 years of age with clinical features of CNS infection, and age-/sex-matched outpatient controls with fever yet not severely ill. Participants are recruited at 2 Pediatric clinics in Mbarara, Uganda. Cerebrospinal fluid (for cases only), blood, and nasopharyngeal (NP) swabs (for both cases and controls) sampled at both clinics are analyzed at the Epicentre Research Laboratory through gold-standard methods for CNS infection diagnosis (microscopy, biochemistry, and culture) and a commercially available ME panel for multiplex PCR analyses of the cerebrospinal fluid. An additional blood sample from cases is collected on day 3 after admission. After initial clinical analyses in Mbarara, samples will be transported to Stockholm, Sweden for (1) validation analyses of a novel nucleic acid-based POC test, (2) biomarker research, and (3) serotyping and molecular characterization of S. pneumoniae and N. meningitidis. RESULTS A pilot study was performed from January to April 2019. The PI-POC trial enrollment of patients begun in April 2019 and will continue until September 2020, to include up to 300 cases and controls. Preliminary results from the PI-POC study are expected by the end of 2020. CONCLUSIONS The findings from the PI-POC study can potentially facilitate rapid etiological diagnosis of CNS infections in low-resource settings and allow for novel methods for determination of the severity of CNS infection in such environment. TRIAL REGISTRATION ClinicalTrials.gov NCT03900091; https://clinicaltrials.gov/ct2/show/NCT03900091. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/21430.
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Affiliation(s)
- Giulia Gaudenzi
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Division of Nanobiotechnology, Department of Protein Science, KTH Royal Institute of Technology, SciLifeLab, Stockholm, Sweden
| | - Elias Kumbakumba
- Department of Paediatrics and Child Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Reza Rasti
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Pedro Réu
- Division of Affinity Proteomics, Department of Protein Science, KTH Royal Institute of Technology, SciLifeLab, Stockholm, Sweden
| | | | - Andreas Mårtensson
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Milly Nassejje
- Department of Paediatrics and Child Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jens Karlsson
- Department of Microbiology, Tumor, and Cell Biology, BioClinicum, Karolinska University Hospital, Stockholm, Sweden
| | - John Mzee
- Department of Paediatrics and Child Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Holy Innocents Children's Hospital, Mbarara, Uganda
| | - Peter Nilsson
- Division of Affinity Proteomics, Department of Protein Science, KTH Royal Institute of Technology, SciLifeLab, Stockholm, Sweden
| | - Stephen Businge
- Department of Paediatrics and Child Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Holy Innocents Children's Hospital, Mbarara, Uganda
| | - Edmund Loh
- Department of Microbiology, Tumor, and Cell Biology, BioClinicum, Karolinska University Hospital, Stockholm, Sweden
- SCELSE, Nanyang Technological University, Singapore, Singapore
| | - Yap Boum Ii
- Department of Paediatrics and Child Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- MSF Epicentre Mbarara Research Centre, Mbarara, Uganda
| | - Helene Andersson-Svahn
- Division of Nanobiotechnology, Department of Protein Science, KTH Royal Institute of Technology, SciLifeLab, Stockholm, Sweden
| | - Jesper Gantelius
- Division of Nanobiotechnology, Department of Protein Science, KTH Royal Institute of Technology, SciLifeLab, Stockholm, Sweden
| | - Juliet Mwanga-Amumpaire
- Department of Paediatrics and Child Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- MSF Epicentre Mbarara Research Centre, Mbarara, Uganda
| | - Tobias Alfvén
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Valentino K, Campos GJ, Acker KA, Dolan P. Abnormal Vital Sign Recognition and Provider Notification in the Pediatric Emergency Department. J Pediatr Health Care 2020; 34:522-534. [PMID: 32709522 DOI: 10.1016/j.pedhc.2020.05.005] [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: 03/14/2020] [Revised: 05/08/2020] [Accepted: 05/14/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Vital signs measurements aid in the early identification of patients at risk of clinical deterioration and determining the severity of illness. Health care providers rely on registered nurses to document vital signs and communicate abnormalities. The purpose of this project was to improve the provider notification process regarding abnormal vital signs in a pediatric emergency department. METHOD A best practice advisory (BPA) was piloted by the advanced practice providers in the pediatric emergency department. To evaluate the effects of the BPA, a mixed-methods study was employed. RESULTS Implementation of the BPA improved the provider notification process and enhanced clinical decision making. The percentage of patients discharged home with abnormal respiratory rates (10.9% vs. 5.9%, p = .31), abnormal temperatures (15.6% vs. 7.5%, p = .14), and abnormal heart rates (25% vs. 11.9%, p = .11) improved. DISCUSSION Creation and implementation of the BPA improved the abnormal vital sign communication process to providers at this single institution.
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Porturas T, Taylor RA. Forty years of emergency medicine research: Uncovering research themes and trends through topic modeling. Am J Emerg Med 2020; 45:213-220. [PMID: 33059985 DOI: 10.1016/j.ajem.2020.08.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/05/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022] Open
Abstract
STUDY OBJECTIVE Topic identification can facilitate knowledge curation, discover thematic relationships, trends, and predict future direction. We aimed to determine through an unsupervised, machine learning approach to topic modeling the most common research themes in emergency medicine over the last 40 years and summarize their trends and characteristics. METHODS We retrieved the complete reference entries including article abstracts from Ovid for all original research articles from 1980 to 2019 within emergency medicine for six widely-cited journals. Abstracts were processed through a natural language pipeline and analyzed by a latent Dirichlet allocation topic modeling algorithm for unsupervised topic discovery. Topics were further examined through trend analysis, word associations, co-occurrence metrics, and two-dimensional embeddings. RESULTS We retrieved 47,158 articles during the defined time period that were filtered to 20,528 articles for further analysis. Forty topics covering methodologic and clinical areas were discovered. These topics separated into distinct clusters when embedded in two-dimensional space and exhibited consistent patterns of interaction. We observed the greatest increase in popularity in research themes involving risk factors (0.4% to 5.2%), health utilization (1.2% to 5.0%), and ultrasound (0.7% to 3.3%), and a relative decline in research involving basic science (8.9% to 1.1%), cardiac arrest (6.5% to 2.2%), and vitals (6.3% to 1.3%) over the past 40 years. Our data show only very modest growth in mental health and substance abuse research (1.0% to 1.6%), despite ongoing crises. CONCLUSIONS Topic modeling via unsupervised machine learning applied to emergency medicine abstracts discovered coherent topics, trends, and patterns of interaction.
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Affiliation(s)
| | - R Andrew Taylor
- Department of Emergency Medicine, Yale University School of Medicine, United States.
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32
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Holt J, White L, Wheaton GR, Williams H, Jani S, Arnolda G, Ting HP, Hibbert PD, Braithwaite J. Management of fever in Australian children: a population-based sample survey. BMC Pediatr 2020; 20:16. [PMID: 31931759 PMCID: PMC6956501 DOI: 10.1186/s12887-020-1911-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/06/2020] [Indexed: 11/25/2022] Open
Abstract
Background Fever in childhood is a common acute presentation requiring clinical triage to identify the few children who have serious underlying infection. Clinical practice guidelines (CPGs) have been developed to assist clinicians with this task. This study aimed to assess the proportion of care provided in accordance with CPG recommendations for the management of fever in Australian children. Methods Clinical recommendations were extracted from five CPGs and formulated into 47 clinical indicators for use in auditing adherence. Indicators were categorised by phase of care: assessment, diagnosis and treatment. Patient records from children aged 0 to 15 years were sampled from general practices (GP), emergency departments (ED) and hospital admissions in randomly-selected health districts in Queensland, New South Wales and South Australia during 2012 and 2013. Paediatric nurses, trained to assess eligibility for indicator assessment and adherence, reviewed eligible medical records. Adherence was estimated by individual indicator, phase of care, age-group and setting. Results The field team conducted 14,879 eligible indicator assessments for 708 visits by 550 children with fever in 58 GP, 34 ED and 28 hospital inpatient settings. For the 33 indicators with sufficient data, adherence ranged from 14.7 to 98.1%. Estimated adherence with assessment-related indicators was 51.3% (95% CI: 48.1–54.6), 77.5% (95% CI: 65.3–87.1) for diagnostic-related indicators and 72.7% (95% CI: 65.3–79.3) for treatment-related indicators. Adherence for children < 3 months of age was 73.4% (95% CI: 58.0–85.8) and 64.7% (95% CI: 57.0–71.9) for children 3–11 months of age, both significantly higher than for children aged 4–15 years (53.5%; 95% CI: 50.0–56.9). The proportion of adherent care for children attending an ED was 77.5% (95% CI: 74.2–80.6) and 76.7% (95% CI: 71.7–81.3) for children admitted to hospital, both significantly higher than for children attending a GP (40.3%; 95% CI: 34.6–46.1). Conclusions This study reports a wide range of adherence by clinicians to 47 indicators of best practice for the management of febrile children, sampled from urban and rural regions containing 60% of the Australian paediatric population. Documented adherence was lowest for indicators related to patient assessment, for care provided in GP settings, and for children aged 4–15 years.
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Affiliation(s)
- Joanna Holt
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia
| | - Leslie White
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia.,School of Women's and Children's Health, University of NSW, Sydney, Australia.,Sydney Children's Hospitals Network, Westmead, Australia
| | - Gavin R Wheaton
- Division of Paediatric Medicine, Women's and Children's Health Network, SA Health, Adelaide, Australia
| | - Helena Williams
- Division of Paediatric Medicine, Women's and Children's Health Network, SA Health, Adelaide, Australia.,Southern Adelaide Local Health Network, Adelaide, Australia
| | - Shefali Jani
- Sydney Children's Hospitals Network, Westmead, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia
| | - Hsuen P Ting
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia
| | - Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia.,Australian Centre for Precision Health School of Health Science, University of South Australia, Adelaide, Australia.,South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia.
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Jansen S, Lopriore E, Naaktgeboren C, Sueters M, Limpens J, van Leeuwen E, Bekker V. Epidural-Related Fever and Maternal and Neonatal Morbidity: A Systematic Review and Meta-Analysis. Neonatology 2020; 117:259-270. [PMID: 31991422 DOI: 10.1159/000504805] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/15/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND While epidural analgesia (EA) is associated with maternal fever during labor, the impact on the risk for maternal and/or neonatal sepsis is unknown. OBJECTIVES The aim of this systematic review was to investigate the effect of epidural-related intrapartum fever on maternal and neonatal outcomes. METHODS OVID MEDLINE, OVID Embase, the Cochrane Library, Cochrane Controlled Register of Trials, and clinical trial registries were searched for randomized controlled trials (RCT) and observational cohort studies from inception to November 2018. A total of 761 studies were identified with 100 eligible for full-text review. Only articles investigating the relationship between EA and maternal fever during labor were eligible for inclusion. Study quality was assessed using the Cochrane's Risk of Bias tool and National Institute of Health Quality Assessment Tool. Two meta-analyses - one each for the RCT and observational cohort groups - were performed using the random-effects model of Mantel-Haenszel to produce summary risk ratios (RR) with 95% CI. RESULTS Twelve RCTs and 16 observational cohort studies involving 579,157 parturients were included. RRs for maternal fever for the RCT and cohort analyses were 3.54 (95% CI 2.61-4.81) and 5.60 (95% CI 4.50-6.97), respectively. Meta-analyses of RR for maternal infection in both groups were infeasible given few occurrences. Meta-analysis of data from observational studies showed an increased risk for maternal antibiotic treatment in the epidural group (RR 2.60; 95% CI 1.31-5.17). For both analyses, neonates born to women with an epidural were not evaluated more often for suspected sepsis. Neither analysis reported an increased rate of neonatal bacteremia or neonatal antibiotic treatment after EA, although data precluded conclusiveness. CONCLUSION EA increases the risk of intrapartum fever and maternal antibiotic treatment. However, a definite conclusion on whether EA increases the risk for a proven maternal and/or neonatal bacteremia cannot be drawn due to the low quality of data. Further research on whether epidural-related intrapartum fever is of infectious origin or not is therefore needed.
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Affiliation(s)
- Sophie Jansen
- Department of Neonatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands,
| | - Enrico Lopriore
- Department of Neonatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Christiana Naaktgeboren
- University Medical Center Utrecht (UMCU), Department of Data Management and Research Support, Julius Center for Health Science and Primary Care, Utrecht, The Netherlands
| | - Marieke Sueters
- Department of Obstetrics and Gynecology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Jacqueline Limpens
- Medical Library, Research Support, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Elisabeth van Leeuwen
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center (UMC), Amsterdam, The Netherlands
| | - Vincent Bekker
- Department of Neonatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands.,Center for Infection and Immunity Amsterdam (CINIMA), Emma Children's Hospital, Amsterdam University Medical Center (UMC), Amsterdam, The Netherlands
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Piller S, Herzog D. The Burden Of Visits For Fever At A Paediatric Emergency Room: A Retrospective Study On Patients Presenting At The Cantons Hospital Of Fribourg, A Peripheral Public Hospital Of Switzerland. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2019; 10:147-152. [PMID: 31814793 PMCID: PMC6863118 DOI: 10.2147/phmt.s219759] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/23/2019] [Indexed: 11/23/2022]
Abstract
Introduction Fever is the chief complaint of up to one-third of all paediatric office visits in many places. The high number of consultations at our emergency department (ED) led us to hypothesise that this increase was due to febrile paediatric patients with lower urgency seeking medical advice. Methods We retrospectively analysed the number and characteristics of patients 3 months to 5 years of age consulting for a body temperature of 38.5°C or higher during the 6 winter months of 2011-2012. Results Twenty-four percent of all consultations were requested by the patients included in our group. None of the 835 patients had to be hospitalised, 95% of these patients had additional respiratory or gastrointestinal symptoms, 36.7% required antibiotic therapy, and 17.6% (laryngitis and lower respiratory tract infection (RTI)) required temporary respiratory support. A total of 56.2% of patients sought advice outside of the normal working hours. Conclusion The majority of patients had fever accompanied by additional symptoms justifying a medical consultation. However, most of these did not require the infrastructure of an ED for their health care problem and probably visited the ED because of the open hours.
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Affiliation(s)
- Sarah Piller
- Department of Paediatrics, Cantons Hospital of Fribourg, Fribourg, Switzerland
| | - Denise Herzog
- Department of Paediatrics, Cantons Hospital of Fribourg, Fribourg, Switzerland
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Nkoka O, Chuang TW, Chen YH. Multilevel Analysis of Factors Associated with Treatment-Seeking Behaviors among Caregivers with Febrile Children in Malawi. Am J Trop Med Hyg 2019; 100:1454-1465. [PMID: 30994089 PMCID: PMC6553897 DOI: 10.4269/ajtmh.18-0900] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/04/2019] [Indexed: 12/19/2022] Open
Abstract
Early diagnosis and treatment of childhood fever, an important sign of potentially serious infections such as malaria, is essential for controlling disease progression, and ultimately, preventing deaths. This study examined individual- and community-level factors associated with treatment-seeking behaviors and promptness in these behaviors among caregivers of febrile under-five children in Malawi. The 2015-2016 Malawi Demographic Health Survey was used to analyze a nationally representative sample of 4,133 under-five children who had fever within 2 weeks before the survey. A multilevel logistic regression model was used to examine the association between individual- and community-level factors and treatment-seeking behaviors. Approximately 67.3% of the caregivers reported seeking treatment for their febrile child, whereas only 46.3% reported promptly seeking treatment. Children from communities with moderate and high percentages of educated caregivers were more likely to be taken for treatment (adjusted odds ratio [aOR] = 1.26, 95% CI = 1.01-1.58 and aOR = 1.31, 95% CI = 1.02-1.70, respectively) than those from communities with a low percentage of educated caregivers. Children from communities with moderate and high percentages of caregivers complaining about the distance to a health facility were less likely to be taken for treatment (aOR = 0.74, 95% CI = 0.58-0.96 and aOR = 0.67, 95% CI = 0.51-0.88, respectively). At the individual level, having a cough in the last 2 weeks, region, religion, and having better health behaviors in other health dimensions were associated with fever treatment-seeking behaviors among Malawian caregivers. Programs aimed at improving treatment-seeking behaviors should consider these factors and the regional variations observed in this study.
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Affiliation(s)
- Owen Nkoka
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Ting-Wu Chuang
- Department of Molecular Parasitology and Tropical Diseases, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Hua Chen
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
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Faust SN, Le Roy M, Pancharoen C, Weber MAR, Cathie K, Behre U, Bernatoniene J, Snape MD, Helm K, Medina Pech CE, Henry O, Baccarini C, Povey M, Gillard P. Safety and immunogenicity of a varicella vaccine without human serum albumin (HSA) versus a HSA-containing formulation administered in the second year of life: a phase III, double-blind, randomized study. BMC Pediatr 2019; 19:50. [PMID: 30732648 PMCID: PMC6366055 DOI: 10.1186/s12887-019-1425-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/31/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND A new formulation of the live-attenuated varicella vaccine Varilrix (GSK) produced without human serum albumin (HSA) was developed to minimize a theoretical risk of transmission of infectious diseases. A previous study showed that the vaccine was immunologically non-inferior to the HSA-containing vaccine and well-tolerated in toddlers; low-grade fever was numerically higher in children receiving the vaccine without HSA, but the study lacked power to conclude on this difference. METHODS In this phase III, double-blind, multi-center study, healthy 12-23-month-olds were randomized (1:1) to receive two doses of the varicella vaccine without (Var-HSA group) or with HSA (Var + HSA group) at days 0 and 42. The primary objective compared safety of the vaccines in terms of incidence of fever > 39.0 °C in the 15-day period post-first vaccination. The objective was considered met if the upper limit of the 95% confidence interval for the between-group difference in the incidence of fever > 39.0 °C was ≤5% (Var-HSA group minus Var + HSA group). Safety, reactogenicity and immune responses were evaluated. RESULTS Six hundred fifteen children in the Var-HSA group and 616 in the Var + HSA group received ≥1 vaccination. Fever > 39.0 °C was reported in 3.9 and 5.2% of participants in the Var-HSA and Var + HSA groups, with a between-group difference of - 1.29 (95% confidence interval: - 3.72-1.08); therefore, the primary objective was achieved. Fever rates post-each dose and the incidence of solicited local and general adverse events (AEs) were comparable between groups. Unsolicited AEs were reported for 43.9 and 36.5% of children in the Var-HSA group and 45.8 and 36.0% of children in the Var + HSA group, during 43 days post-dose 1 and 2, respectively. Serious AEs occurred in 2.1% (group Var-HSA) and 2.4% (group Var + HSA) of children, throughout the study. In a sub-cohort of 364 children, all had anti-varicella-zoster virus antibody concentrations ≥50 mIU/mL post-dose 2; comparable geometric mean concentrations were observed between the groups. CONCLUSIONS The varicella vaccine formulated without HSA did not induce higher rates of fever during the 15 day-post-vaccination period, as compared with the original HSA-containing vaccine. The two vaccines displayed similar safety and immunogenicity profiles in toddlers. TRIAL REGISTRATION NCT02570126 , registered on 5 October 2015 (www.clinicaltrials.gov).
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Affiliation(s)
- Saul N Faust
- NIHR Southampton Clinical Research Facility, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.
| | | | - Chitsanu Pancharoen
- Department of Pediatrics and Center of Excellence for Pediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand
| | - Miguel Angel Rodriguez Weber
- Instituto Nacional de Pediatria, Insurgentes Sur 3700C Col. Insurgentes Cuicuilco, Coyoacan, 04530, Mexico City, Mexico
| | - Katrina Cathie
- NIHR Southampton Clinical Research Facility, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Ulrich Behre
- Private Practice, Hauptstrasse 240, 77694, Kehl, Germany
| | - Jolanta Bernatoniene
- Pediatric Infectious Disease Department, Education Centre Level 6, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8AE, UK
| | - Matthew D Snape
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Headington, Oxford, OX3 9DU, UK
| | - Klaus Helm
- Private practice, Paulinenstrasse 71a, 32756, Detmold, Germany
| | - Carlos Eduardo Medina Pech
- Medical Care and Research SA de CV, Calle 32 No. 217 Col. Garcia Gineres, 97070, Mérida, Yucatán, Mexico
| | - Ouzama Henry
- GSK, 14200 Shady Grove Rd, Rockville, MD, 20850, USA
| | - Carmen Baccarini
- GSK at the time of study conduct, 160 North Gulph Road, King of Prussia, PA, 19406, USA
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