Days Of Illness Research Articles

Monitoring of the Middle East Respiratory Syndrome Coronavirus Activity in a Secluded Herd of Camels Kept Under Field Conditions.

Background: Camel-to-human transmission of the Middle East Respiratory Syndrome coronavirus (MERS-CoV) was confirmed as a cause of primary infection in humans. There is a dearth of information regarding the behavior of the virus in camels and the mode of spread among them under natural conditions. The aim of this study was to monitor exposure of camels to the MERS-CoV under field conditions. Methods: From January 1 to November 30, 2015, a secluded herd of 20 pregnant female camels and their neonate calves was established. Nasal and rectal swabs were collected from calves daily for 90 days after birth, then weekly until the end of the study. Nasal and rectal samples were collected from the dams at outset and then weekly until the end of the study. The samples were tested with rtRT-PCR to detect the MERS-CoV RNA. Results: All purchased pregnant camels were MERS-CoV RNA negative at outset. Nineteen dams and 15 calves completed the study. Seven (46.7%) of the 15 calves developed a rise in rectal temperature (39-40°C), shivering, rhinitis, anorexia, and general weakness at a mean ± standard deviation of 18.9 ± 4.9 days of age and their MERS-CoV RNA test was positive on the first day of illness. Three of the seven infected calves died 14 ± 9.1 days postonset of illness at age 17, 14, and 46 days, respectively. The remaining four infected calves fully recovered and they were MERS-CoV RNA positive for 17.5 ± 8.8 days. Four (21.1%) of the 19 dams had positive tests; three dams had no clinical signs, whereas the fourth dam exhibited signs not compatible with MERS-CoV infection and died three days after the positive test, 33 days after parturition. All MERS-CoV infections occurred within 22 days. Conclusions: This study has expanded our understanding of the MERS-CoV epidemiology among camels, which is an important step forward to device effective preventive measures.

Early Fall in C-Reactive Protein (CRP) Level Predicts Response to Tocilizumab in Rapidly Progressing COVID-19: Experience in a Single-Arm Pakistani Center.

IntroductionThere are conflicting studies regarding the efficacy of tocilizumab use in coronavirus disease 2019 (COVID-19) disease. There is a special need to identify the parameters that could predict its response in early COVID-19 disease.ObjectiveTo report our experience with tocilizumab and correlate the magnitude of fall in c-reactive protein (CRP) as a predictor of its response to treatment in early COVID-19 disease.MethodsAll confirmed COVID-19 cases admitted to a tertiary healthcare hospital in Peshawar Pakistan, receiving ≥1 dose of intravenous tocilizumab, between March and September 2020 were included. Relevant clinical data of the patients were recorded and further divided into two categories based on the relative fall in CRP levels, 48 hours after tocilizumab administration. Adequate response (≥50% fall from baseline CRP), primary outcomes (fall in oxygen requirement and inflammatory biomarkers), and secondary outcome (all-cause mortality at day 28) were recorded. All outcomes were compared based on falls in CRP levels.ResultsA total of 27 patients were included. Males were 24 (88.8%) while females were three (11.1%). The mean age was 60.9±11.6 years. The mean day of illness at the time of tocilizumab administration was 4.26±3 days. After 48 hours of tocilizumab administration, 17 (62.9%) patients showed clinical improvement, with the mean SaO2/FiO2 ratio prior to treatment significantly increased (p<0.01). A significant reduction in CRP and ferritin levels was seen post-treatment (p <0.01 and p<0.01, respectively). Twenty (74.1%) patients demonstrated adequate response to tocilizumab while seven (25.9%) showed an inadequate response. Patients with adequate response had higher chances of improvement in oxygenation and lower in-hospital mortality (p-value 0.009 and 0.020, respectively).ConclusionsTocilizumab shows clinical improvement in a vast majority of patients. Being an early and sensitive predictor, a fall of ≥50% in CRP at 48 hours can be used to predict the overall response to tocilizumab as a guide to treatment.

MAIN INDICATORS OF THE OXIDANT-ANTIOXIDANT SYSTEM AND THEIR RELATIONSHIP WITH THE FORCE OF THE RESPIRATORY MUSCLES IN ADULT PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA

Background. Currently, pneumonia ranks 4-5 rate in the world in the structure of death causes after cardiovascular and cancer diseases, cerebrovascular pathology, injuries and poisonings.&#x0D; Objective. The aim of the study was to evaluate the indicators of the oxidative-antioxidant system and their relationship with the strength of the respiratory muscles in adult patients with community-acquired pneumonia.&#x0D; Methods. The study was carried out in the period 2017-2020 on the basis of the therapeutic department of the Municipal non-profit enterprise "City Clinical Multidisciplinary Hospital № 25" of Kharkiv City Council. The study involved 52 adult patients with CAP aged 18 to 80 years. The control group consisted of 20 apparently healthy humans. It was determinated the activity of malondialdehyde, catalase and superoxide dismutase, level of reduced glutathione, glutathione reductase and glutathione peroxidase. The assessment of the RM strength was investigated by recording the maximum static pressures at the level of the mouth and nose with “closed” airways using a MicroRPM apparatus on the 1st and 10th days of illness.&#x0D; Results. Dysfunction of expiratory respiratory muscles prevailed in patients with non-severe CAP, and inspiratory respiratory muscles in patients with severe CAP. Were established significant negative correlations of malondialdehyde with indicators of respiratory muscles strength and positive correlations with glutathione reductase, glutathione peroxidase, catalase, and superoxide dismutase.&#x0D; Conclusions. The presence of relationships between pro- and antioxidant indicators and respiratory muscles strength complements the concept of the body's systemic response on pulmonary inflammation – one of the markers of respiratory muscles dysfunction.&#x0D; KEYWORDS: community-acquired pneumonia, respiratory muscles, oxidative-antioxidant system.

Efficacy of Early Treatment With Favipiravir on Disease Progression Among High-Risk Patients With Coronavirus Disease 2019 (COVID-19): A Randomized, Open-Label Clinical Trial.

The role of favipiravir in preventing disease progression in coronavirus disease 2019 (COVID-19) remains uncertain. We aimed to determine its effect in preventing disease progression from nonhypoxia to hypoxia among high-risk COVID-19 patients. This was an open-label, randomized clinical trial conducted at 14 public hospitals across Malaysia (February-July 2021) among 500 symptomatic, RT-PCR-confirmed COVID-19 patients, aged ≥50 years with ≥1 comorbidity, and hospitalized within first 7 days of illness. Patients were randomized 1:1 to favipiravir plus standard care or standard care alone. Favipiravir was administered at 1800mg 2×/day on day 1 followed by 800mg 2×/day until day 5. The primary endpoint was rate of clinical progression from nonhypoxia to hypoxia. Secondary outcomes included rates of mechanical ventilation, intensive care unit (ICU) admission, and in-hospital mortality. Of 500 patients randomized (mean [SD] age, 62.5 [8.0] years; 258 women [51.6%]; 251 [50.2%] had COVID-19 pneumonia), 487 (97.4%) patients completed the trial. Clinical progression to hypoxia occurred in 46 (18.4%) patients on favipiravir plus standard care and 37 (14.8%) on standard care alone (OR, 1.30; 95% CI: .81-2.09; P = .28). All 3 prespecified secondary endpoints were similar between both groups. Mechanical ventilation occurred in 6 (2.4%) vs 5 (2.0%) (OR, 1.20; 95% CI: .36-4.23; P = .76), ICU admission in 13 (5.2%) vs 12 (4.8%) (OR, 1.09; 95% CI: .48-2.47; P = .84), and in-hospital mortality in 5 (2.0%) vs 0 (OR, 12.54; 95% CI: .76-207.84; P = .08) patients. Among COVID-19 patients at high risk of disease progression, early treatment with oral favipiravir did not prevent their disease progression from nonhypoxia to hypoxia. ClinicalTrials.gov (NCT04818320).

Analysis of long-term antibody response in COVID-19 patients by symptoms grade, gender, age, BMI, and medication.

The first aim of the study was to analyze the change in antibody titer at 15‐day intervals until 60 days postsymptom onset (PSO). The second aim was to analyze the relationship between antibody titer and symptom grade, gender, age, body mass index (BMI), medications, vitamin supplements, and herbal therapies. Blood samples were collected from 43 patients (5 mild, 21 moderate, 17 severe diseases), 18 women (41.9%), and 25 men (58.1%), on 15, 30, 45, and 60 days PSO after COVID‐19 infection. The serum antibody titers were determined by measuring the COVID‐19 immunoglobulin G (IgG) antibodies by enzyme‐linked immunoassay (ELISA). Associations between the duration of symptoms, demographic and clinical parameters, medications and vitamins used, and herbal therapies were evaluated by interviewing the participants. Within the first 15 days of illness, 81.4% of the patients were positive. From Day 45 PSO, seropositivity was 89.5%. The anti‐SARS‐CoV‐2 antibody titers were statistically higher in men than women at all times (p < 0.01). Antibody titer was higher in older participants compared to younger participants (p < 0.02). Plaquenil or favipiravir use did not affect antibody response (p > 0.05). Men had a higher fever (p = 0.006), shortness of breath (p = 0.004), and chest pain (p = 0.03) than women. We found powerful antibody response by 60 days PSO, as well as higher antibody response and severity of symptoms in the men gender. Data also showed that SARS‐CoV‐2 antibodies are higher in individuals with older age, whereas BMI, concomitant chronic disease, and medications had no effect on antibody titers.

Abstract 13032: Endothelial Cell Response to Intravenous Immunoglobulin, Infliximab and Atorvastatin Treatment During the Acute Phase of Kawasaki Disease

Introduction: Damage to coronary arteries (CA) during the acute phase of Kawasaki disease (KD) is linked to inflammatory cell infiltration, myofibroblast generation (EndMT: endothelial-mesenchymal transition), and endothelial cell (EC) dysfunction. To promote EC health, we performed a Phase I/IIa clinical trial (6-week course) of atorvastatin in patients with acute KD and coronary artery Z score &gt; 2.5. We demonstrated that atorvastatin was safe and well-tolerated. However, its effect on EC in KD has not been systematically studied. Hypothesis: Treatment with atorvastatin added to intravenous immunoglobulin (IVIG) and infliximab (IFX) promotes EC health in acute KD patients. Methods: We performed RNAseq on human umbilical vein ECs (HUVECs) incubated with pooled sera from KD patients (pre-treatment or subacute illness day 17-25) treated with IVIG and IFX with or without atorvastatin added to their initial treatment. Results: Differentially expressed genes (DEGs) from HUVECs incubated with sera pooled from 5 KD patients collected pre- and post-treatment (IVIG + IFX) that were suppressed by treatment included IL-8 , CCL2 and ICAM1 , molecules in the TNFα and IL1β pathways that have key roles in recruitment of inflammatory cells to EC. Subacute sera pooled from 5 patients treated with IVIG + IFX + atorvastatin induced expression of NOS3 , KLF2 and KLF4 , molecules that promote EC homeostasis and angiogenesis, and suppressed expression of TGFB2 and Dickkopf WNT signaling pathway inhibitor 1 ( DKK1 ), molecules in the TGFβ and WNT signaling pathways. These results were validated by RT-PCR on HUVECs incubated with independent individual sera from patients treated with/without atorvastatin. Conclusions: HUVECs incubated with pre- or post-treatment sera from KD patients showed upregulation of IL1 and TNFα pathway genes that were dramatically suppressed after treatment with IVIG and IFX. Incubation of HUVECs with post-treatment sera from patients who also received atorvastatin showed reduced expression of DKK1 and TGFB2 , suggesting reduced EndMT, and increased NOS3 and KLF4 , key mediators of EC homeostasis. These results suggest that atorvastatin improves EC health and may block KD-induced myofibroblast proliferation in the CA wall.

Criteria for the optimal use of interleukin-6 receptor blockers in patients with COVID-19

To determine the criteria for the optimal use of IL-6 receptor blockers in patients with COVID-19 community-acquired pneumonia based on predictors of adverse outcomes. The single-center, non-randomized prospective study included 190 patients with community-acquired pneumonia caused by coronavirus 2 between the beginning of March and the end of May 2020. Of these, 89 patients received tocilizumab and 101 patients received sarilumab. The study inclusion criterion for the patient was indications for initiating therapy with one of the inhibitors of IL-6 receptors (anti-IL-6R) according to the Interim guidelines (versions 4 and 5). The exclusion criterion was the need to re-prescribe genetically engineered biological therapy (GEBT). The severity of the patient's condition was assessed according to the early warning score (NEWS2), the volume of lung tissue lesions was assessed according to computed tomography (CT). Laboratory monitoring included counting the absolute (abs) number of lymphocytes, serum levels of C-reactive protein (CRP), interleukin 6 (IL-6), D-dimer, lactate dehydrogenase, fibrinogen. Statistical data processing was conducted by nonparametric methods using the IBM SPSS Statistics V-22 software. The phenotype of a patient with a negative outcome prognosis was described: a male patient over 50 years of age with aggravated premorbid background (with cardiovascular diseases, obesity and/or chronic renal disease), lung lesion CT 34, saturation less than 93% upon inhalation of atmospheric air, persisting for 2448 hours after GEBT. According to the blood test, lymphopenia was below 1000 U/L and CRP levels were above 50 mg/L. The laboratory parameters and clinical picture of the patient progressively worsened after 911 days of illness, regardless of the use of Anti-IL-6R. The features of patients monitoring when administering IL-6 receptor blockers have been determined. IL-6 receptor blockers should be administered to patients hospitalized with severe COVID-19 before the development of hyperinflammatory reactions. The optimal "therapeutic window" is 78 days of illness.

Two consecutive attacks of diarrhea in 15 COVID-19 patients: An antibiotic-associated one following the viral one

De los 971 pacientes admitidos en nuestra clínica por sospecha de COVID-19, 15 (1.5%) presentaron dos ataques de diarrea consecutivos. Uno de dichos pacientes (una mujer de 47 años) requirió admisión a la unidad de cuidados intensivos y ventilación mecánica. Murió el 11.o día de hospitalización (18 días de enfermedad). El primer ataque de diarrea en dichos pacientes ocurrió el 6.o (4.o -7.o) día de enfermedad, con una duración de 3 (3-5) días. El segundo ataque de diarrea se desarrolló 11 (8-12) días después del comienzo inicial de diarrea. A pesar de la tendencia existente, la diferencia en la duración de la diarrea y el número máximo de movimientos intestinales por día entre el primer y el segundo ataque no fue estadísticamente significativa (p = 0.130; p = 0.328). Tampoco existió diferencia significativa respecto a los resultados del conteo sanguíneo completo, las pruebas bioquímicas sanguíneas, ni los biomarcadores inflamatorios, entre los pacientes que presentaron un doble ataque de diarrea y los que no presentaron diarrea.

Prospects for the drug use based on common ivy for bronchopulmonary pathology in childhood

Respiratory diseases persistently lead in the structure of general morbidity in both children and adolescents. Acute respiratory infections are the most common among them. Interest of pediatricians to phytotherapy is not accidental and is due to the fact that it has a mild therapeutic effect, enhances the effectiveness of complex therapy, has few side effects. Of particular interest are herbal remedies containing ivy extract (Hedera helix), the active ingredients are mainly found in ivy leaves, they are biologically active substances: Triterpene saponins, glycosides, also contain carbohydrates, essential oils, steroids, phenolcarboxylic acids, coumarins, flavonoids, carotenoids, tocopherols (vitamin E), B and C vitamins, tannins, phytoncides. Ivy preparations are prescribed as an expectorant in the treatment of infectious and inflammatory diseases of the upper and lower respiratory tract due to their proven multidirectional effects: secretolytic, mucolytic, bronchospasmolytic. They also have anti-inflammatory, reparative, antioxidant effects.This article presents a clinical example of an officinal ivy-based preparation used in the treatment of a 3.5 year old patient diagnosed with acute respiratory viral infection. Temperature increased to 38 °C, runny nose; on the second day of illness the temperature remained subfebrile and a dry cough appeared. Nasal vasoconstrictor drops and oral acetylcysteine were prescribed, but there was no relief. On the third day of the illness, against the background of subfebrile temperature, the cough persisted, single dry rales were heard in the lungs, wheezing appeared during physical exertion. Acetylcysteine was withdrawn and replaced by ivy-based drops (16 drops 3 times a day orally after meals in a small amount of water). After 2 days the cough was moist, the sputum was easily expectorated, the wheezing in the lungs was almost gone, there was no more wheezing and the temperature was normal. By the sixth day of treatment the cough was gone and the girl had almost recovered. Nevertheless, Gedelix was continued for another 4 days. Prospective results and detailed study of the effects of herbal preparations on the basis of ivy extracts served as the basis for their recommendation as a complex therapy of cough in children.

Scrub typhus meningoencephalitis in children

Background: Scrub typhus is being reported from different parts of India. Meningitis or meningoencephalitis among various neurological complication seen in scrub typhus is not uncommon. Delay in diagnosis may cause higher mortality without prompt treatment. The aim of the study was to describe the various manifestations of scrub typhus meningoencephalitis and their outcome from eastern part of India. Subjects and Methods: A prospective observational study of scrub meningoencephalitis was carried out at Kalinga Institute of Medical Sciences, between October 2018 and August 2020. The diagnosis was made based on the compatible clinical features, positive Scrub Ig M by ELISA and cerebrospinal fluid lymphocytosis (&gt;5 cell/cmm), after excluding other causes of meningoencephalitis. Results: Twenty-seven (12.38%) cases of scrub meningoencephalitis were included in the study with male (66.6%) predominance. All had presented with fever of mean duration of 8.5 days of illness. Altered sensorium and seizure was observed in 70.5% and 62.9% of our patients along with two patients who had sixth cranial nerve palsy. Eschar was found in 25.9% of our children. The mean CSF cell count, protein and glucose were 25 cells/cmm,84.2 mg/dL and 62.9 mg/dL respectively with lymphocytosis in all cases. There was no mortality in this study. Conclusion: Meningoencephalitis is an important complication of scrub typhus in children. Unlike most viral encephalitis cases, it has a definite treatment with good outcome, if treated early.

Serological Diagnosis of Dengue.

A reliable and specific diagnosis is imperative in viral diagnosis, both for clinical management and surveillance, and to ensure that early treatment and control measures are carried out. The number of days of illness is important to choose the most appropriate method to be used and for the correct interpretation of the results obtained. Specific IgM is elicited after that period, indicating an active infection and usually lasts up to 3months. However, in DENV secondary infections, IgM levels may be significantly lower or undetectable. After 10-12days, a lifetime specific IgG is produced. Routinely, the laboratory diagnosis of DENV infections can be performed by viral isolation and/or detection of viral nucleic acid, serological assays for the detection of specific antibodies (IgM/IgG), antigen (NS1) and the detection of viral antigens in tissues, which are suitable during certain phases of the disease. For serological diagnosis, serum, plasma, or cerebrospinal fluid (CSF) samples may be investigated. If the test is carried out a few days after collection, the specimens can be stored at 4°C, since the immunoglobulins are stable in serum or plasma. If the storage period is extended, the material must be kept at -20°C or -70°C. In serology, several methods can be used to detect specific viral antigens and/or antibodies, produced by the host in response to DENV infection. Routinely, serological tests include the hemagglutination inhibition (HI) assay, the plaque reduction neutralizing test (PRNT), the gold standard assay for dengue immune response characterization, and ELISAs to detect IgM (MAC-ELISA) and IgG (IgG-ELISA).

Comparative Performance of Four Established Neonatal Disease Scoring Systems in Predicting In-Hospital Mortality and the Potential Role of Thromboelastometry.

Background: To compare the prognostic accuracy of the most commonly used indexes of mortality over time and evaluate the potential of adding thromboelastometry (ROTEM) results to these well-established clinical scores. Methods: The study population consisted of 473 consecutive term and preterm critically-ill neonates. On the first day of critical illness, modified Neonatal Multiple Organ Dysfunction (NEOMOD) scoring system, Score for Neonatal Acute Physiology (SNAP II), Perinatal extension of SNAP (SNAPPE), and SNAPPE II, were calculated and ROTEM standard extrinsically activated (EXTEM) assay was performed simultaneously. Time-to-event methodology for competing-risks was used to assess the performance of the aforementioned indexes in predicting in-hospital mortality over time. Time-dependent receiver operator characteristics curves for censored observation were compared across indexes. The addition of EXTEM parameters to each index was tested in terms of discrimination capacity. Results: The modified NEOMOD score performed similarly to SNAPPE. Both scores performed significantly better than SNAP II and SNAPPE II. Amplitude recorded at 10 min (A10) was the EXTEM parameter most strongly associated with mortality (A10 < 37 mm vs. ≥37 mm; sHR = 5.52; p < 0.001). Adding A10 to each index apparently increased the prognostic accuracy in the case of SNAP II and SNAPPE II. However, these increases did not reach statistical significance. Conclusion: Although the four existing indexes considered showed good to excellent prognostic capacity, modified NEOMOD and SNAPPE scores performed significantly better. Though larger studies are needed, adding A10 to well-established neonatal severity scores not including biomarkers of coagulopathy might improve their prediction of in-hospital mortality.

Features of the intestinal microbiota functional status in early-aged children with rotavirus infection

The aim is to assess the intestinal microflora functional and structural disorders in early-aged children in the dynamics of rotavirus infection by studying intestinal metabolites in faeces – short-chain fatty acids (SCFA).&#x0D; Materials and methods. The study included 60 breastfed children aged 1-24 months with rotavirus infection (the study group) and 30 healthy children, representative by age and sex (the comparison group). Determination of SCFA (acetate, propionate, butyrate) in faeces was carried out in all children of the study group three times in the dynamics of the disease (on the 3rd, 5th and 10th day) and in healthy children once.&#x0D; Results. The total concentration of SCFA in children with rotavirus infection was 3 and 2.2 times lower than in healthy children in the acute period of the disease (p&lt;0.01 on the 3rd and 5th day, respectively), increasing on the 10th day (p&lt;0.05), however, not reaching the normal level (p&lt;0.01). The decrease in the total pool of SCFA occurred due to all volatile acids (C2, C3, C4), the concentrations of which were lower than in healthy children (p&lt;0.01). Violation of the volatile acids ratio in their general pool was observed from the first days of rotavirus gastroenteritis in the form of an increase in the C2 relative concentration (p˂0.05) and a decrease in C3 and C4 profiles (p˂0.05). Correspondingly, a decrease in anaerobic index was noted. It was equal to 0.04 [0.01; 0.11] on the 3rd and 5th day of the disease, constituting only 1/5 of the healthy children values (p˂0,01), increasing on the 10th day to 0,09 [0,02; 0.17], however, remaining twice as lower than in children of the comparison group (p˂0,01).&#x0D; Conclusions. There is a violation of the intestinal microflora functional condition in early-aged children from the first days of rotavirus infection, which is expressed by depletion of the total pool of SCFA and concentrations of each of them, as well as structural disorders of intestinal microbiocinosis in the form of reducing its anaerobiosis. These changes are most pronounced during the first five days of rotavirus gastroenteritis and last up to 10th day of illness.

Virologic Features of Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Children.

Data on pediatric coronavirus disease 2019 (COVID-19) has lagged behind adults throughout the pandemic. An understanding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral dynamics in children would enable data-driven public health guidance. Respiratory swabs were collected from children with COVID-19. Viral load was quantified by reverse-transcription polymerase chain reaction (RT-PCR); viral culture was assessed by direct observation of cytopathic effects and semiquantitative viral titers. Correlations with age, symptom duration, and disease severity were analyzed. SARS-CoV-2 whole genome sequences were compared with contemporaneous sequences. One hundred ten children with COVID-19 (median age, 10 years [range, 2 weeks-21 years]) were included in this study. Age did not impact SARS-CoV-2 viral load. Children were most infectious within the first 5 days of illness, and severe disease did not correlate with increased viral loads. Pediatric SARS-CoV-2 sequences were representative of those in the community and novel variants were identified. Symptomatic and asymptomatic children can carry high quantities of live, replicating SARS-CoV-2, creating a potential reservoir for transmission and evolution of genetic variants. As guidance around social distancing and masking evolves following vaccine uptake in older populations, a clear understanding of SARS-CoV-2 infection dynamics in children is critical for rational development of public health policies and vaccination strategies to mitigate the impact of COVID-19.

Paediatric brought-in-dead at a tertiary health facility in South western Nigeria: Patterns and drivers

&#x0D; &#x0D; &#x0D; Background: ‘Brought- in-dead’ (BID) refers to the demise of an individual before presentation to a health facility. This study assessed the pattern of paediatric BID cases seen at a tertiary health facility in southwest Nigeria.&#x0D; Method: A cross-sectional, descriptive study was done at the Children Emergency Ward (CEW) of the hospital between January 2014 and December 2018. The patterns of BID cases and presumed causes of death were determined using a standardized checklist adapted from the WHO verbal autopsy instrument.&#x0D; Results: Ninety-eight BID cases were seen during the study, constituting 2.5% of total patients seen during the period. The median (IQR) age of cases was 24.0 (8.75 – 63.0) months and 72.4% were under-fives. Most had symptoms related to the haematologic (36.7%), respiratory (24.5%) or digestive (20.4%) systems. Severe anaemia 31(31.6%), gastroenteritis 19 (19.4) and aspiration 17 (17.3%) were the most common causes of death. The median (IQR) duration of illness before presentation was 3.0 (1.0 – 7.0) days but most presented from 4 – 7 days of illness. A significant relationship was found between the duration of illness and whether or not pre-hospital treatment was received (p &lt; 0.0001). Unprescribed drugs purchased over the counter were the most commonly used treatment in 79.1% of cases (p &lt; 0.0001).&#x0D; Conclusion: This study has highlighted the prevalence and pattern of paediatric BID in a tertiary health facility in southwest Nigeria and the factors that were associated with it. More efforts need to be geared towards community sensitization and pediatric health care to prevent factors drivingits menace.&#x0D; &#x0D; &#x0D;

Mortality in patients hospitalized with COVID-19 in northern Peru

Peru has one of the highest mortality rates due to COVID-19 in the world. To describe the clinical features, evolution and explore factors associated with mortality in patients with moderate to severe Covid-19. Prospective analytical study. The clinical, laboratory, imaging, and mortality data of patients admitted at a COVID service of the Santa Rosa de Piura Hospital were recorded from April to June 2020. Data from 391 patients with a median age of 60 years (70% women) was gathered. The time lapse between the onset of the disease and hospitalization was seven days. The most common alteration in the blood count was Neutrophilia in 78% of patients. The median PaO2/FiO2 ratio was 77. The distribution of tomographic patterns was Ground glass in 91% of patients, interstitial involvement in 57%, consolidation in 43%. Sixteen percent of patients had at least one complication, the most common was an increase in transaminases in 2%. Four percent were admitted to the intensive care unit and 53% died (94% during hospitalization and 5.8% during ICU stay). In the bivariate analysis, an association was found between a higher mortality and older age (p = 0.01), having fewer days of illness (p = 0.03), fewer days of hospital stay (p < 0.01), having at least one comorbidity (p = 0.02), lymphopenia (p = 0.02), neutrophilia (P = 0.03) and lower PaO2/ FiO2 ratio (p < 0.01). Fifty percent of these patients died. Age, rapid progression, having comorbidities and other laboratory alterations were associated with mortality.

AMANTADINE FOR POST-EXPOSURE PROPHYLAXIS IN COVID-19 IN WESTERN HONDURAS

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Low –to-middle-income countries (LMIC) have been struggling throughout the coronavirus disease 2019 (COVID-19) pandemic with overwhelmed hospital system and lack of access for novel therapeutics. Remdesivir, the only antiviral approved by the FDA for the treatment of COVID-19, needs to be given intravenously thus requiring admission to the hospital. This might not be feasible for health systems overwhelmed by the viral disease. Amantadine is a drug that has been utilized mainly for patients with neurological diseases, such as Parkinson’s disease. Although it is more commonly used for neurological diseases, it has also been reappropriated for viral illness like H1N1. There have been observational studies noting that patients who take amantadine regularly have not developed the disease and it has even been utilized a therapeutic in patients with known COVID-19 disease with apparent success. The need for cheap, outpatient medications for COVID-19 is paramount and amantadine seems to be a viable option. We sought to describe the characteristics of patients who took amantadine as a post-exposure prophylactic (PEP) medication. METHODS: We conducted a prospective, observational pilot study of patients who visited a covid clinic in a rural area of Western Honduras, from September 1st, 2020 to October 31st 2020. Patients were included if they were older than18 years of age, with mild disease symptoms and had a positive COVID-19 RT-PCR test. Patients included in the study received the A77 protocol, which consist of amantadine 100 mg bid in the first 7 days of disease for a period of 7 days. Oxygen Saturation, C-Reactive Protein(CRP) and Blood Count samples were measured each day while they were on the protocol. RESULTS: A total of 26 patients were enrolled in the A77 PEP protocol, with a median age of 51 years, 19 were male and 7 were female. The median time for protocol initiation was three days after symptoms first appeared. Average oxygen saturation was 95% on room air, the mean CRP level was 28 mg/L. Most patients had no comorbidities with only 2 having diabetes mellitus and one with systemic lupus erythematosus. Home oxygen supplementation was used in 5 patients in the protocol and only 1 patient was hospitalized. CONCLUSIONS: We enrolled 26 patients with mild, confirmed COVID-19 to A77 PEP protocol, with a median age of 51 years. Most of the patients started A77 on their third day of illness, and most maintained a SpO2 of 95% during the course of the trial, with only 5 patients requiring supplemental oxygen and one requiring hospitalization.Amantadine seemed to be an effective therapeutic avenue in preventing patients with COVID-19 to advance to moderate or severe disease. It also seemed to be effective in preventing admission to the hospital. Our findings echo similar studies of amantadine being an effective PEP for patients with COVID-19.We are limited by a small sample size and lack of control group, but our findings can be utilized as hypothesis generating for larger studies regarding the role of amantadine in PEP for COVID-19. CLINICAL IMPLICATIONS: Amantadine seems to be an effective PEP medication for patients with COVID-19, which can be crucial for LMIC struggling with the pandemic and acquisition vaccines. More rigorous studies are required to confirm its effectiveness. DISCLOSURES: No relevant relationships by Balduino Carcamo, source=Web Response No relevant relationships by Orlando Garner, source=Web Response No relevant relationships by Eleazar Montalvan, source=Web Response No relevant relationships by Maria Pineda, source=Web Response

Prediction of Coronary Artery Aneurysms in Children With Kawasaki Disease Before Starting Initial Treatment.

Background: Precisely predicting coronary artery aneurysms (CAAs) remains a clinical challenge. We aimed to investigate whether coronary dimensions adjusted for body surface area (Z scores) on baseline echocardiography and clinical variables before primary treatment could predict the presence of late CAAs.Methods: We conducted a retrospective study including children hospitalized for Kawasaki disease and received intravenous immunoglobulin within 10 days of illness. We defined late CAAs as a maximum Z score (Zmax) ≥2.5 of the left main, right, or left anterior descending coronary artery at 11–60 days of illness. Associations between late CAAs and clinical parameters and baseline maximum Z scores were analyzed.Results: Among the 314 included children, 31 (9.9%) had late CAAs. Male, higher C-reactive protein, and higher baseline Zmax were risk factors of late CAAs. Late CAAs were significantly associated with baseline Zmax ≥2.0 vs. <2.0 (25 [32.5%] vs. 6 [2.5%], P < 0.001). The odds ratio for late CAAs among the patients with baseline Zmax ≥2.0 vs. <2.0 was 18.5 (95% confidence interval, 7.23 to 47.41, P < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of baseline Zmax ≥2.0 for the presence of later CAAs were 80.6, 81.6, 32.5, and 97.5%, respectively.Conclusions: Findings from this study suggest that Zmax ≥2.0 of coronary arteries on baseline echocardiography may be used to predict children at a high risk of late CAAs and allow for targeted early intensification therapy.

Olfactory dysfunction in the scenario of COVID-19 pandemic in patients screened by the telemonitoring.

ABSTRACTObjective To assess the clinical and epidemiological profile of patients with olfactory dysfunction in the scenario of COVID-19 pandemic.Methods The study selected patients with loss of smell, previously screened by telemonitoring system of the Municipal Health Department of Goiânia (GO), Brazil, who agreed to answer a questionnaire about COVID-19 symptoms and findings of exams. The interviews were conducted by six otolaryngologists, who applied the specific questionnaire, over the phone.Results A total of 13,910 patients underwent telemonitoring, and 627 (4.51%) had olfactory loss complaints. Out of them, 330 were included in the survey. We observed a higher prevalence of altered smell in women (67%), and in patients aged under 50 years (86%). In most cases the manifestations had a sudden onset (70%), and in the first 5 days of illness (80%). The most prevalent associated symptom was a change in taste (89%), and only 2.7% of interviewed patients required hospitalization.Conclusion Anosmia in COVID-19 is more prevalent in females and individuals aged under 50 years. It is a relevant initial symptom predictive of the disease, together with dysgeusia.

A new scoring system for coronary artery abnormalities in Kawasaki disease.

BackgroundIn China, coronary artery abnormalities (CAAs) secondary to Kawasaki disease (KD) tend to have an increased occurrence. We hypothesize that Chinese children with KD may possess several unique CAA risks, and the predictive efficacy of multiple scoring systems in Chinese patients are still to be further studied.MethodsTwo hundred and three KD patients were recruited. Using multivariable analysis, independent predictors of CAAs were combined into a scoring system. Subsequently, CAA risks of our patients were evaluated by the newly established scoring system and eight other published scoring systems.ResultsSeventeen (8.37%) KD patients were identified as CAAs. The newly established scoring system contained the following 5 independent predictors: days of illness at initial treatment ≥7, redness and swelling of extremities, hematocrit ≤33%, percentage of monocytes ≥8.89%, and procalcitonin ≥0.5 ng/mL. The AUC value of newly established scoring system was 0.685 with a sensitivity of 41.18% and a specificity of 84.41%, higher than Harada score, Egami score, Kobayashi score, Sato score, San Diego score, Formosa score, and Tang score, whereas lower than Hua score.ConclusionsDays of illness at initial treatment ≥7 and procalcitonin are unique predictors of CAAs in newly established scoring system. Taking into account different identification criteria and analytical methodologies, there is still some heterogeneity among different scoring systems.Impact The newly established scoring system contains the five independent predictors.Days of illness at initial treatment ≥7 and PCT are unique predictors of CAAs in our study, compared with 8 other systems.The AUC value of newly established scoring system is 0.685, similar to Hua score.There is some heterogeneity among different scoring systems.