Acute Fever Research Articles

CD12 Citalopram-induced drug reaction with eosinophilia and systemic reaction confirmed by patch testing

Abstract A 46-year-old man was referred for investigation of an acute widespread rash and fever that started 4 weeks after commencing citalopram. Clinical and histological features were consistent with drug reaction with eosinophilia and systemic reaction (DRESS). He was not on any other medication, had no known allergies and had not previously taken a selective serotonin reuptake inhibitor (SSRI). Six months after resolution, he was patch tested to the extended British Baseline Series and citalopram (crushed tablet in 50% petrolatum). Readings on days 2 (D2) and 4 (D4) were positive for citalopram (D2 ++ and D4 +++). To investigate possible crossreactivity, he was subsequently patch tested to fluoxetine, paroxetine and sertraline (crushed tablets in 50% petrolatum), which showed a positive reaction to paroxetine [D2 (–) and D4 (+)]. Patch tests to citalopram and paroxetine were negative with no irritancy in a normal volunteer. SSRIs are extensively and increasingly used for depression and other mental health problems; 45 000 000 UK prescriptions were issued in the last financial year. Despite such widespread use, cutaneous adverse drug reactions (CADRs) appear to be rare. From 1998 to 2022, the Medicines and Healthcare products Regulatory Agency recorded 16 586 adverse reactions to citalopram, of which only 1077 (6.5%) were cutaneous. Various rashes have been reported to arise from SSRI treatment, ranging from maculopapular eruptions to toxic epidermolysis necrolysis/Stevens–Johnson syndrome. There have been isolated reports of DRESS from fluoxetine, sertraline and escitalopram (the S-enantiomer of citalopram). To our knowledge, this is the first reported case of citalopram-induced DRESS. The sensitivity and specificity of patch tests in the diagnosis of delayed CADR varies according to the drug and rash. We have found case reports of positive patch tests to sertraline and paroxetine following maculopapular exanthems. Our findings highlight a diagnostic role for patch tests with an extemporaneous preparation in SSRI-induced DRESS. SSRIs have diverse chemical structures, and we speculate that patch tests may be of benefit in identifying a safer alternative should further SSRI treatment be needed.

Automatically Identifying Sickness Behavior in Grazing Lambs with an Acceleration Sensor

Acute disease of grazing animals can lead to alterations in behavioral patterns. Relatively recent advances in accelerometer technology have resulted in commercial products, which can be used to remotely detect changes in animals’ behavior, the pattern and extent of which may provide an indicator of disease challenge and animal health status. The objective of this study was to determine if changes in behavior during use of a lipopolysaccharide (LPS) challenge model can be detected using ear-mounted accelerometers in grazing lambs. LPS infusion elevated rectal temperatures from 39.31 °C to 39.95 °C, indicating successful establishment of an acute fever response for comparison with groups (p < 0.001). For each of the five recorded behaviors, time spent eating, ruminating, not active, active, and highly active, the accelerometers were able to detect an effect of LPS challenge. Compared with the control, there were significant effects of LPS infusion by hour interaction on durations of eating (−6.71 min/h, p < 0.001), inactive behavior (+16.00 min/h, p < 0.001), active behavior (−8.39 min/h, p < 0.001), and highly active behavior (−2.90 min/h, p < 0.001) with a trend for rumination time (−1.41 min/h, p = 0.075) in lambs after a single LPS infusion. Results suggest that current sensors have the capability to correctly identify behaviors of grazing lambs, raising the possibility of detecting changes in animals’ health status.

Sweet syndrome induced by SARS-CoV-2 vaccines: A systematic review of patient-report studies

ABSTRACT Since COVID-19 became a global pandemic in 2020, the development and application of SARS-CoV-2 vaccines has become an important task to prevent the spread of the epidemic. In addition to the safety and efficacy of COVID-19 vaccines, the adverse reactions caused by vaccines in a small number of people also deserve our attention. We aimed to discuss and analyze the possible causes of Sweet syndrome caused by the COVID-19 vaccine by integrating the effective information from 16 patients and combining it with the latest views on the innate immune mechanism. We searched the PubMed and Embase databases for published patient reports on the occurrence or recurrence of Sweet syndrome after COVID-19 vaccination. We summarized the basic information of the patients, the type of vaccination, the presence of underlying diseases, and the clinical manifestations, clinical treatment and prognosis of the patients. The results were reported in narrative methods and were sorted into tables. We initially identified 53 studies. 16 articles were included through full-text screening. Based on the table we compiled, we generally concluded that the first dose of any type of COVID-19 vaccine was more likely to cause Sweet syndrome than subsequent doses. Sweet syndrome may occur after COVID-19 vaccination. Clinicians should consider Sweet syndrome in addition to common adverse reactions such as anaphylaxis and infection when a patient presents with acute fever accompanied by nodular erythema, pustules, and edematous plaques after COVID-19 vaccination.

Copula based trivariate spatial modeling of childhood illnesses in Western African countries

Acute respiratory infections (ARI), diarrhea, and fever are three common childhood illnesses, especially in sub-Saharan Africa. This study investigates the marginal and pairwise correlated effects of these diseases across Western African countries in a single analytical framework. Using data from nationally representative cross-sectional Demographic and Health Surveys, the study analyzed specific and correlated effects of each pair of childhood morbidity from ARI, diarrhea, and fever using copula regression models in fourteen contiguous Western African countries. Data concerning childhood demographic and socio-economic conditions were used as covariates. In this cross-sectional analysis of 152,125 children aged 0–59 months, the prevalence of ARI was 6.9%, diarrhea, 13.8%, and fever 19.6%. The results showed a positive correlation and geographical variation in the prevalence of the three illnesses across the study region. The estimated correlation and 95% confidence interval between diarrhea and fever is 0.431(0.300,0.539); diarrhea and ARI is 0.270(0.096,0.422); and fever and ARI is 0.502(0.350,0.614). The marginal and correlated spatial random effects reveal within-country spatial dependence. Source of water and access to electricity was significantly associated with any of the three illnesses, while television, birth order, and gender were associated with diarrhea or fever. The place of residence and access to newspapers were associated with fever or ARI. There was an increased likelihood of childhood ARI, diarrhea, and fever, which peaked at about ten months but decreased substantially thereafter. Mother’s age was associated with a reduced likelihood of the three illnesses. The maps generated could be resourceful for area-specific policy-making to speed up mitigation processes.

Phase I clinical trial using a unique immunotherapeutic combination of MUC1-targeted CAR-T cells with PD-1-knockout in the treatment of patients with advanced esophageal cancer.

e16061 Background: Combining CAR-T with programmed cell death-1 (PD-1) inhibition may be a more efficacious approach for treatment of solid tumors. This clinical study was designed to assess the safety and tolerability of PD-1 knockout MUC1-Targeted CAR-T engineered Cells to treat advanced esophageal cancer. Methods: Patients with advanced esophageal cancer were recruited according to the criteria in NCT03706326. PD-1 gene knockout (KO) MUC1-targeted CAR-T cells were prepared by constructing MUC1-specific CARs using the SM3 scFv in patient-derived T-cells, and PD-1 gene KO was achieved in these CAR positive T cells using the CRISPR-Cas9 system. Efficiency and validation were confirmed by sequencing and flow cytometry. MUC1-CAR+/PD-1- KO engineered T cells at a starting dose of 5x107 were infused over 60 min. The dose was escalated to 5x109 cells. Following treatment, the safety and tolerability of dose of the therapeutic cells were assessed using CTCAE v4.0. Patients’ general condition, levels of lymphocytes, IL-6, hs-CRP, PCT, CYFRA21, NSE(E), and SCC were monitored at regular intervals. Circulating CART cells were checked regularly. Tumor size were examined by MRI/CT scans. Efficacy was also assessed. Results: A total of 9 patients (aged 48 to 80) diagnosed with esophageal cancer/esophageal squamous cell carcinoma (IIIb to IV), were included in this study. All participants received at least one cycle of CART cell treatment. Among the 9 treated patients, 4 received 1 cycle, other 5 received 2, 3, 4, 7 and 10 cycles, respectively. The most common adverse events (AE) were acute fever (8 patients, 38.0-40.5 C◦), chills (5 patients, occurred in the subsequent cycle of infusion), skin rash (4 patient). No grade 3-5 AEs were found, and no cytokine release syndrome (CRS) was observed. Of the 9 assessed patients, 6 had stable disease (SD) while 3 had progressive disease. All patients had significant symptom improvements after infusion. Circulating CART cells gradually declined after infusion; the number dropped down to approximately 25% in 4 months after one cycle treatment indicating the necessity of receiving more cycles. Patients who received multiple cycles of infusion showed long-term and steady SD status. Two patients who received a multiple cycle of CAR-T cells had an overall survival (OS) of 24 months. Conclusions: Our data suggests that the treatment of patients with advanced esophageal cancer with PD-1 disrupted MUC1-targeted CAR-T cells is safe and well-tolerated by all patients. No CRS and other serious EAs were observed throughout the study. The efficacy of this unique combined therapy is currently being assessed. Our limited data indicate that the OS of the patients extended significantly in the treated patients. Two out of 6 patients with an OS of greater than 24 months, an outstanding clinical outcome. Clinical trial information: NCT03706326 .

Nivolumab plus ipilimumab (N+I) in patients (pts) with ovarian cancer (OC) with BRCA1/2 mutation (mut): Results from the Targeted Agent and Profiling Utilization Registry (TAPUR) study.

5548 Background: TAPUR is a phase II basket study evaluating antitumor activity of commercially available targeted agents in pts with advanced cancers with genomic alterations. Results in a cohort of pts with OC with BRCA1/2 mut treated with N+I are reported. Methods: Eligible pts had advanced OC, measurable disease, ECOG performance status (PS) 0-2, adequate organ function, and no standard treatment (tx) options. Genomic testing was done in CLIA-certified, CAP-accredited labs. PD-L1 status was not routinely reported. Pts received I at 3 mg/kg every 3 wks for 4 doses with N at 1 mg/kg IV every 3 weeks (wks) for 4 doses. N alone was then continued at 240 mg every 2 wks or 480 mg every 4 wks until disease progression. Primary endpoint was disease control (DC) per investigator defined as complete or partial (PR) response per RECIST v. 1.1, or stable disease of at least 16+ wks duration (SD16+). CA-125 levels were not routinely reported. Simon 2-stage design tested the null DC rate of 15% vs. 35% (power = 0.85; α = 0.10). If ≥2 of 10 pts in stage 1 have DC, 18 more pts are enrolled; otherwise, the cohort is closed. If ≥7 of 28 pts have DC, the null DC rate is rejected. P-value calculated based on 2-stage design. Secondary endpoints were progression-free survival (PFS), overall survival (OS), and safety. Results: 33 pts with OC and BRCA1 (n=20), BRCA2 (n=10), or both mut (n=3) were enrolled from Sept 2017 to Oct 2019. 6 pts were not evaluable for efficacy analysis; 1 pt was found to be ineligible after enrolling, 5 pts discontinued tx before the post-baseline tumor evaluation due to an adverse or serious adverse event (SAE). Table shows demographics and efficacy outcomes. 6 pts with PR were observed for an OR rate of 22% (95% CI: 9% to 42%) and a DC rate of 27% (90% CI: 13% to 36%); the null hypothesis of a 15% DC rate was not rejected (p=0.17). 3 pts with PR had BRCA1 mut only, 2 pts had BRCA2 mut only and 1 pt had both BRCA1 and BRCA2 mut. Of the 6 pts with PR, 4 had microsatellite (MS) stable (MSS) tumors and MS status was not reported in 2. Of the 4 with MSS, 3 had a tumor mutational burden (TMB) ≤ 10 mutations per megabase and 1 had TMB of 11. 11 pts had at least 1 tx-related SAE, including acute kidney injury, ALT/AST increase, colitis, dehydration, diarrhea, E. coli, electrolyte disorder, fever, nausea/vomiting and pneumonitis. Conclusions: N+I did not meet prespecified criteria to declare a signal of activity in pts with OC and BRCA1/2 mut. However, given 22% of pts had PR (2 with >1 year duration) in this heavily pretreated cohort, additional study may be warranted to further evaluate efficacy. Clinical trial information: NCT02693535 . [Table: see text]

Impaired Psychomotor Speed Functions in Patients Who Recovered from Acute Lassa Fever Infection: A 30-Days Follow-Up Study

Impaired Psychomotor Speed Functions in Patients Who Recovered from Acute Lassa Fever Infection: A 30-Days Follow-Up Study

Aetiology of Acute Undifferentiated Fever Among Children Under the Age of Five in Vietnam: A Prospective Study

BackgroundTo investigate the aetiology of acute undifferentiated fever (AUF) among children under the age of five in Vietnam.MethodsThis 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.Results286 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.ConclusionReal-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.

Typhoid Fever: Azithromycin vs. Ceftriaxone for the Treatment of Mild to Moderate Cases in Children

Background: Typhoid fever is a bacterial infection that can spread throughout the body, affecting many organs. Without prompt treatment, it can cause serious complications and can be fatal. It's caused by a bacterium called Salmonella typhi, In areas where there are few carriers of the typhoid bacterium, the disease is uncommon. It's also unusual to find places with sanitary water treatment and waste management systems. Nowadays both Azithromycin and Ceftriaxone are used for the treatment of mild to moderate cases in children.
 Objective: To assess the outcome of treatment of Acute Typhoid Fever with Azithromycin vs Ceftriaxone in Children with no other complication.
 Methods: This comparative study was carried out at tertiary hospital from January 2019 to January 2020. Where 200 patients coming to the hospital were initially screened in the outpatient department. During the study period, all children 5-18 years of age who, according to the outpatient department physician, had a diagnosis of typhoid fever were admitted to hospital. After admission to the ward, Among 200 patients, 100 patients treated with azithromycin (7 days of 10 mg/kg/day (maximum dose, 500 mg/day) and 100 patients treated with ceftriaxone were cured (P > .05).
 Results: During the study, majority belong to 5-10 years age group and 45% live in semipucca building followed by 60% drink Supply water without boiling and 80% cases were accustomed to solely home made food and outside of food. Clinical characteristics of azithromycin and ceftriaxone recipients who had typhoid fever and for whom blood cultures were positive where in azithromycin group mean duration of hospital stay was 9.8 days followed by 100 cases showed salmonella typhi positive.
 Whereas in Ceftriaxone group mean duration of hospital stay was 9.0 days followed by 100 cases showed positivity in salmonella typhi positive. In azithromycin group 90% were cured by day 7 followed by 86% were cured microbiologically, plus no relapse cases were found.
 Whereas in ceftriaxone case 80% were cured by day 7 followed by 78% were cured microbiologically, plus 5 relapse cases were found.
 Conclusion: Oral azithromycin given once daily appears to be beneficial in the treatment of uncomplicated typhoid fever in children. If these findings are verified, the agent could be a viable therapeutic option for typhoid fever, especially in developing nations where medical resources are limited.

Acute encephalomyelitis in a 52-year-old male post messenger ribonucleic acid severe acute respiratory syndrome coronavirus 2 vaccination: a case report

BackgroundAcute disseminated encephalomyelitis is a well-known, but rare, side effect of some vaccines, or symptom following a febrile illness.CaseA 69-year-old, otherwise healthy Hispanic male presented with acute fever, confusion, and later progressive weakness after receiving the first dose of the mRNA-1273 (Moderna) severe acute respiratory syndrome coronavirus 2 vaccine. Considering the progressive deterioration of the patient, despite being on multiple immunosuppressive agents, a brain biopsy was obtained, which revealed nonspecific meningoencephalitis.ConclusionIn this case, we highlight the need for a regulatory framework to assist clinicians and patients with coverage of treatment for acute disseminated encephalomyelitis. The use of intravenous immunoglobulin in conjunction with glucocorticoids seems to be an effective treatment option.

γδ T cells mediate protective immune responses following an insect virus-based Chikungunya virus chimera vaccine

Abstract Chikungunya virus (CHIKV) is a re-emerging alphavirus that causes acute chikungunya fever (CHIKF) which often is accompanied by severe and persistent arthralgia. There are currently no licensed human vaccines against CHIKV. Eilat virus (EILV), a mosquito-specific alphavirus, replicates well in mosquito cells, but not in vertebrate cells. EILV/CHIKV is a chimeric CHIKV vaccine candidate that contains the nonstructural proteins of EILV and the structural proteins of CHIKV. This chimera vaccine candidate has been shown to protect against wild-type (WT) CHIKV challenge in mice and non-human primates (NHPs), yet the immune mechanism of the vaccine-induced host protection remains unknown. γδ T cells are known to react to WT CHIKV infection by controlling CHIKV inflammation, cell infiltration, and tissue damage. We found that γδ T cells are expanded following vaccination with EILV/CHIKV. TCRδ −/−mice, which are deficient of γδ T cells, exhibited a reduced CD8 +T cell effector function response at different timepoints compared to WT mice. This reduced CD8 +T cell response was also observed 7 days post WT CHIKV infection in the vaccinated mice. A significant reduction of CHIKV-specific IgM titers was also observed 7 days post WT CHIKV challenge in the vaccinated mice. Lastly, we noted that the vaccinated TCRδ −/−mice had higher levels of viremia than vaccinate WT mice following challenge with WT CHIKV. Overall, our results suggest that γδ T cells contribute to the host protection by promoting vaccine induced CD8 +T cell and antibody responses against CHIKV infection.

Structural conservation of Lassa virus glycoproteins and recognition by neutralizing antibodies

Lassa fever is an acute hemorrhagic fever caused by the zoonotic Lassa virus (LASV). The LASV glycoprotein complex (GPC) mediates viral entry and is the sole target for neutralizing antibodies. Immunogen design is complicated by the metastable nature of recombinant GPCs and the antigenic differences among phylogenetically distinct LASV lineages. Despite the sequence diversity of the GPC, structures of most lineages are lacking. We present the development and characterization of prefusion-stabilized, trimeric GPCs of LASV lineages II, V, and VII, revealing structural conservation despite sequence diversity. High-resolution structures and biophysical characterization of the GPC in complex with GP1-A-specific antibodies suggest their neutralization mechanisms. Finally, we present the isolation and characterization of a trimer-preferring neutralizing antibody belonging to the GPC-B competition group with an epitope that spans adjacent protomers and includes the fusion peptide. Our work provides molecular detail information on LASV antigenic diversity and will guide efforts to design pan-LASV vaccines.

Caroli Syndrome Associated with Polycystic Kidney Disease: A Case Report

Introduction: Caroli disease is a fibrocystic liver disease characterized by congenital nonobstructive cystic dilatation of the intrahepatic bile ducts. Its association with congenital hepatic fibrosis defines Caroli syndrome. The more common Caroli syndrome is associated with cystic renal dilatations in 60-80% of patients with polycystic kidney disease and Cacchi-Ricci disease as the most frequently noted renal anomalies. Objective: We want to define this uncommon entity and to describe the radiological characteristics which can, in the absence of their knowledge, be a source of confusion for the radiologist and pose problems of diagnostic delay. Case Report: The patient was a male infant, 1 year and 10 months old, with a history of 2 episodes of urinary tract infections at the age of 3 months and 6 months, and a 13-year-old sister with polycystic hepatorenal disease. The patient was admitted to the pediatric emergency department for acute fever associated with fluid diarrhea evolving for 3 days and irritability and crying at the time of urination. A cytobacteriological examination of the urine showed a turbid appearance of the urine with isolation of Escherichia Coli on culture. Abdominal ultrasound revealed bilateral nephromegaly, with diffuse microcystic hyperechogenicity of medullary pyramids generating multiple comet tail images with a "sponge kidney" appearance as well as a homogeneous splenomegaly and a normal sized liver of heterogeneous echostructure with cystic dilatation of the intrahepatic bile ducts which are centered by hyperechoic punctuations realizing the "Dot Sign". The individualization of this sign at an early age associated with splenomegaly allowed the diagnosis of a Caroli syndrome. While the diffuse medullary hyperechogenicity in the kidney allowed to evoke its association with polycystic kidney disease, especially the recessive one. Discussion and Conclusion: Caroli syndrome is a rare entity of autosomal recessive transmission. ..........

A Bivalent Bacterium-like Particles-Based Vaccine Induced Potent Immune Responses against the Sudan Virus and Ebola Virus in Mice

Ebola virus disease (EVD) is an acute viral hemorrhagic fever disease causing thousands of deaths. The large Ebola outbreak in 2014–2016 posed significant threats to global public health, requiring the development of multiple medical measures for disease control. Sudan virus (SUDV) and Zaire virus (EBOV) are responsible for severe disease and occasional deadly outbreaks in West Africa and Middle Africa. This study shows that bivalent bacterium-like particles (BLPs)-based vaccine, SUDV-EBOV BLPs (S/ZBLP + 2 + P), generated by mixing SUDV-BLPs and EBOV-BLPs at a 1 : 1 ratio, is immunogenic in mice. The SUDV-EBOV BLPs induced potent immune responses against SUDV and EBOV and elicited both T-helper 1 (Th1) and T-helper 2 (Th2) immune responses. The results indicated that SUDV-EBOV BLPs-based vaccine has the potential to be a promising candidate against SUDV and EBOV infections and provide a strategy to develop universal vaccines for EVD.

Focussed Assessment with Sonography in acute Lassa Fever (FASLa): Development of a point-of-care protocol and description of common ultrasound findings

Managing Lassa fever (LF) patients is challenging because of the complexity of this life-threatening infectious disease, the necessary isolation measures, and the limited resources in countries where it is endemic. Point-of-care ultrasonography (POCUS) is a promising low-cost imaging technique that may help in guiding the management of patients. We conducted this observational study at the Irrua Specialist Teaching Hospital in Nigeria. We developed a POCUS protocol, trained local physicians who applied the protocol to LF patients and recorded and interpreted the clips. These were then independently re-evaluated by an external expert, and associations with clinical, laboratory and virological data were analyzed. We developed the POCUS protocol based on existing literature and expert opinion and trained two clinicians, who then used POCUS to examine 46 patients. We observed at least one pathological finding in 29 (63%) patients. Ascites was found in 14 (30%), pericardial effusion in 10 (22%), pleural effusion in 5 (11%), and polyserositis in 7 (15%) patients, respectively. Eight patients (17%) showed hyperechoic kidneys. Seven patients succumbed to the disease while 39 patients survived, resulting in a fatality rate of 15%. Pleural effusions and hyper-echoic kidneys were associated with increased mortality. In acute LF, a newly established POCUS protocol readily identified a high prevalence of clinically relevant pathological findings. The assessment by POCUS required minimal resources and training; the detected pathologies such as pleural effusions and kidney injury may help to guide the clinical management of the most at-risk LF patients.

Fulminant colitis due to Clostridium Difficile in a patient with a history of liver transplantation: a severe life-threatening complication.

Clostridium difficile´s fulminant colitis is characterized by the development of severe acute inflammation of the colon, associated with systemic toxicity. Fulminant colitis is the most serious form of acute colitis with a mortality of up to 80%. We present the case of a 45-year-old man who presented to the emergency department with acute abdominal pain, diarrhea and fever. Computed tomography showed circumferential diffuse parietal thickening of the colon, including the rectum, associated with striation of the surrounding tissues and ganglionic formations. In the following hours the patient evolved with worsening of the general condition, increased inotropic requirements and lactic acidosis. Emergency laparotomy was decided and total colectomy was performed. Fulminant Clostridium difficile colitis is a potentially deadly disease. The lability of the pathology in many occasions forces quick decision making, therefore fulminant colitis represents a medical surgical emergency being time crucial.

Neurological features related to influenza virus in the pediatric population: a 3-year monocentric retrospective study.

Various neurological manifestations can be associated with influenza virus. Certain entities led to a poor prognosis, but in most cases, symptoms improved within a few days. The severity of the neurological manifestations correlated with previous neurological or metabolic disorders. • Influenza viruses are well known pathogens with a seasonal epidemic evolution, particularly affecting children. These viruses cause acute fever with respiratory symptoms, associated with myalgia and headaches. Neurological presentation in influenza-virus infection is a well-established possibility as influenza virus is considered to be responsible for 27 to 36% of childhood encephalitis. Some specific and severe entity as acute necrotizing encephalitis, cytotoxic lesion of the corpus callosum, or Hemiconvulsion-hemiplegia-epilepsy syndrome are well described. • In a French monocentric cohort of 37 children with influenza-related neurologic manifestations, the majority of these manifestations, including seizure, drowsiness, motor deficiency, hallucination… are self limiting and do not lead to after-effects. In rare cases (4/37), they may reveal severe encephalitis requiring rapid and appropriate treatment. Otherwise, comparison of a group of 14 children with underlying neurological or metabolic disorder with a group of 23 children free of any significant disorder show that the severity of the neurological manifestations was largely related to previous neurological or metabolic disorders highlighting the importance of vaccination in this population.

The Impacts of SARS-2 and Its Variants on Human Health and How They Cause it

Began from the end of 2019, the SARS-CoV-2 outbreaks in Wuhan, China, this unknown virus are first been recognized and it continues to devastate millions worldwide. As more individual has been infected, Covid-19 has been considered an international public health event and research on its pathogenesis and impacts are necessary. Some research has already shown that the virus can also infect multi organs including human gut enterocytes and the respiratory tract and brings both short-term and long-term effects to humans, the more research has shown the varying immediate symptoms of Covid-19 including acute respiratory distress (ARDS), fever, cytokines storm and long-term risk with the impacts on heart, male reproductive system, neurological and psychological health, and other mysterious risks. In this article, multiple journals and review articles have been researched and managed into long-term and short-term sections, the result shows that Covid-19 has significant impacts on humans for both chronical and instant manifestations.

Clinical predictors of early surgical intervention in patients with venomous snakebites

BackgroundVenomous snakebites induce tissue destruction and secondary infection; however, the optimal timing of surgical intervention for these complications remains unknown. This study assessed the clinical predictors of early surgical intervention in patients with snakebites.MethodsThis retrospective study included 63 patients (45 men and 18 women) with venomous snakebites. In addition to the snake species, the demographics, affected body parts, clinical characteristics, and ultrasound findings of the patients in the surgical (32 patients) and nonsurgical (31 patients) groups were analyzed and compared.ResultsA higher incidence of acute compartment syndrome, local ecchymosis, skin necrosis, bullae, blisters, and fever was found in the surgical group than in the nonsurgical group, and ultrasound findings of the absence of Doppler flow were more frequently noted in the surgical group than in the nonsurgical group. After adjustment using a multivariate logistic regression model, only advanced age, Naja atra bite, local ecchymosis, and bulla or blister formation remained significant factors for surgical intervention. Furthermore, comparison of the outcomes of patients who received early (≤ 24 h) and late (> 24 h) surgical intervention revealed that the duration of continuous negative pressure wound therapy (6 vs. 15 days; P = 0.006), duration of hospital stay (13 vs. 26 days; P = 0.002), and duration of outpatient follow-up (15 vs. 36 days; P < 0.001) were significantly lower in patients who received early surgical intervention. The final reconstructive surgery was simple among the patients who received surgical intervention within 24 h of being bitten (P = 0.028).ConclusionIn patients with snakebites, advanced age, high-risk clinical manifestations (e.g., local ecchymosis and bulla or blister formation), and Naja atra envenomation are predictors of surgical intervention within 24 h.

Spatial distribution of common childhood illnesses, healthcare utilisation and associated factors in Ethiopia: Evidence from 2016 Ethiopian Demographic and Health Survey.

Childhood illnesses, such as acute respiratory illness, fever, and diarrhoea, continue to be public health problems in low-income countries. Detecting spatial variations of common childhood illnesses and service utilisation is essential for identifying inequities and call for targeted actions. This study aimed to assess the geographical distribution and associated factors for common childhood illnesses and service utilisation across Ethiopia based on the 2016 Demographic and Health Survey. The sample was selected using a two-stage stratified sampling process. A total of 10,417 children under five years were included in this analysis. We linked data on their common illnesses during the last two weeks and healthcare utilisation were linked to Global Positioning System (GPS) information of their local area. The spatial data were created in ArcGIS10.1 for each study cluster. We applied a spatial autocorrelation model with Moran's index to determine the spatial clustering of the prevalence of childhood illnesses and healthcare utilisation. Ordinary Least Square (OLS) analysis was done to assess the association between selected explanatory variables and sick child health services utilisation. Hot and cold spot clusters for high or low utilisation were identified using Getis-Ord Gi*. Kriging interpolation was done to predict sick child healthcare utilisation in areas where study samples were not drawn. All statistical analyses were performed using Excel, STATA, and ArcGIS. Overall, 23% (95CI: 21, 25) of children under five years had some illness during the last two weeks before the survey. Of these, 38% (95%CI: 34, 41) sought care from an appropriate provider. Illnesses and service utilisation were not randomly distributed across the country with a Moran's index 0.111, Z-score 6.22, P<0.001, and Moran's index = 0.0804, Z-score 4.498, P< 0.001, respectively. Wealth and reported distance to health facilities were associated with service utilisation. Prevalence of common childhood illnesses was higher in the North, while service utilisation was more likely to be on a low level in the Eastern, South-western, and the Northern parts of the country. Our study provided evidence of geographic clustering of common childhood illnesses and health service utilisation when the child was sick. Areas with low service utilisation for childhood illnesses need priority, including actions to counteract barriers such as poverty and long distances to services.