Fever Status Research Articles

Long-term exposure to air pollution and greenness in association with respiratory emergency room visits and hospitalizations: The Life-GAP project.

Air pollution has been linked to respiratory diseases, while the effects of greenness remain inconclusive. We investigated the associations between exposure to particulate matter (PM2.5 and PM10), black carbon (BC), nitrogen dioxide (NO2), ozone (O3), and greenness (normalized difference vegetation index, NDVI) with respiratory emergency room visits and hospitalizations across seven Northern European centers in the European Community Respiratory Health Survey (ECRHS) study. We used modified mixed-effects Poisson regression to analyze associations of exposure in 1990, 2000 and mean exposure 1990-2000 with respiratory outcomes recorded duing ECRHS phases II and III. We assessed interactions of air pollution and greenness, and of atopic status (defined by nasal allergies and hay fever status) and greenness, on these outcomes. The analysis included 1,675 participants, resulting in 119 emergency visits and 48 hospitalizations. Increased PM2.5 by 5 μg/m³ was associated with higher relative risk (RR) of emergency visits (1990: RR 1.16, 95% CI: 1.00-1.35; 2000: RR 1.24, 95% CI: 0.98-1.57; 1990-2000: RR 1.17, 95% CI: 0.97-1.41) and hospitalizations (1990: RR 1.42, 95% CI: 1.00-2.01; 2000: RR 2.20, 95% CI: 1.43-3.38; 1990-2000: RR 1.44, 95% CI: 1.04-2.00). Similar trends were observed for PM10, BC, and NO2, with only PM10 showing significant associations with hospitalizations across all periods. No associations were found for O3. Greenness exposure was linked to more emergency visits in 2000 but to fewer hospitalizations in 1990. Significant interactions were observed between greenness and atopic status for emergency visits, and between NDVI with O3 and BC for some time windows. Long-term exposure to particulate matter was associated with increased emergency room visits and hospitalizations. Significant associations were observed for BC and NO2 with hospitalizations. No link was found with O3. Greenness indicated a lower risk of hospitalizations, but increased risks for emergency visits for those with atopic status.

Fever in the Trauma Bay: A Marker for Greater Risk of Adverse Outcomes.

Purpose: Previous work identified a sub-group of trauma patients at risk for bacteremia who presented with signs of infection, including fever. A majority were older adult falls who had early onset bacteremia. Hypothesis: Fever in the trauma bay is associated with a greater risk of adverse outcomes and identifies patients who might benefit from early initiation of interventions for sepsis. Methods: Trauma patients ≥18 years, drawn from a system-wide electronic medical record (EMR) (2017-2020), were included. Fever+ patients (temperature >38°C) were compared with Fever- patients (36°C-38°C). Multi-variable logistic regressions assessed the association of fever status with outcomes. The interaction between fever, age, and outcomes was assessed. Results: A total of 140,647 patients were included from 89 centers. Eight hundred ninety (0.6%) were Fever+ and had worse unadjusted outcomes. After adjustment, Fever+ patients had significantly greater mortality (adjusted odds ratios [aOR], 95% confidence interval: 1.05 [1.04-1.07]), intensive care unit use (1.08 [1.04-1.11]), and ventilator use (1.11 [1.09-1.13]). Fever+ status was associated with a significantly larger aOR of severe sepsis in older versus younger patients (≥65 y: 1.12 [1.11-1.13]; <65 y: 1.04 [1.03-1.05]). Fever+ status was also associated with a significantly larger aOR of bacteremia in older versus younger patients (≥65 y: 1.09 [1.08-1.10]; <65 y: 1.04 [1.03-1.05]). Implications: Although uncommon, fever at presentation is an ominous sign for trauma patients and portends significantly greater risks for bacteremia, sepsis, and mortality. These risks increase with age. These findings suggest older adults who present with fever warrant early aggressive intervention and may sustain injury as a consequence of debility from systemic infection.

Interaction Effects Between COVID-19 Outbreak and Fever on Mortality Among OHCA Patients Visiting Emergency Departments.

Background and Objectives: Fever in patients who have suffered an out-of-hospital cardiac arrest (OHCA) has been linked to poor clinical outcomes, as a fever can exacerbate neurological damage, increase metabolic demands, and trigger inflammatory responses. This study evaluates the impact of the COVID-19 outbreak and associated fevers on OHCA outcomes and examines how they can worsen patient prognosis. Materials and Methods: Our retrospective observational analysis used data from the National Emergency Department Information System (NEDIS), comprising adult OHCA patients at 402 EDs in Korea between 27 January and 31 December 2020 (COVID-19 pandemic period) and the corresponding period in 2019 (pre-COVID-19). The primary outcome was in-hospital mortality, with the COVID-19 outbreak as the main exposure variable and fever as an important interaction variable. We employed multilevel multivariate logistic regression with an interaction term (year of visit × fever) to examine the effects of COVID-19 and fever on mortality. Risk-adjusted mortality rates were calculated, and a difference-in-difference analysis evaluated the impact of COVID-19 on excess mortality by fever status. Results: During COVID-19, in-hospital mortality was higher among OHCA patients compared to the pre-pandemic period (adjusted OR 1.22, 95% CI 1.11-1.34), particularly among febrile patients (adjusted OR 1.40, 95% CI 1.24-1.59). Interaction analysis revealed that COVID-19 disproportionately increased mortality in febrile OHCA patients compared with non-febrile patients (difference-in-difference: 0.8%, 95% CI 0.2-1.5). Conclusions: Our study found that the COVID-19 pandemic significantly increased mortality among OHCA patients, with febrile patients experiencing disproportionately worse outcomes due to systemic delays and pandemic-related disruptions.

Severity of Acute Kawasaki Disease Can Be Predicted by Evaluating the Body Temperature at the Completion of an Initial Immunoglobulin Treatment.

Objective: We aimed to determine whether the severity of acute Kawasaki disease (KD) can be predicted based on whether a patient remains febrile or becomes afebrile immediately after the completion of initial immunoglobulin treatment (IVIG). Methods: This retrospective cohort study at a single institution involved 306 patients with KD. They were categorized into four groups according to their fever status at two specific time points (end of the initial IVIG treatment and 24-36 h later): Group F-F, patients who remained febrile at both time points; Group F-AF, patients who were febrile at the end of the initial IVIG treatment but became afebrile 24-36 h later; Group AF-F, patients who were afebrile at the end of the initial IVIG treatment but became febrile 24-36 h later; and Group AF-AF, patients who remained afebrile at both time points. The clinical characteristics of the groups were compared. Results: Group F-F (n = 38) showed a significantly higher incidence of CAAs compared to Group AF-F (n = 37), 55.3% vs. 0.0% (p < 0.0001), although both groups were classified as resistant to the initial IVIG. Conclusions: In Japanese patients with acute KD, the presence or absence of fever at the completion of initial IVIG treatment may serve as an early predictor of the occurrence of CAAs. An earlier secondary treatment may be warranted for patients who are in a febrile state immediately after the completion of the initial IVIG treatment. Future research should include a prospective cohort study with a larger number of KD cases across multiple institutions to analyze the effects of other contributing factors related to CAL formation.

Comparison of antimicrobial therapy termination in febrile and afebrile patients with acute cholangitis after drainage

The standard treatment duration for acute cholangitis (AC) involves a 4–7-day antimicrobial treatment post-biliary drainage; however, recent studies have suggested that a ≤ 2–3 days is sufficient. However, clinical practice frequently depends on body temperature as a criterion for discontinuing antimicrobial treatment. Therefore, in this study, we assessed whether patients with AC can achieve successful outcomes with a ≤ 7-day antimicrobial treatment, even with a fever, assuming the infection source is effectively controlled. We conducted a single-center retrospective study involving patients with AC, defined following the Tokyo Guidelines 2018 for any cause, who underwent successful biliary drainage and completed a ≤ 7-day antimicrobial treatment. Patients were categorized into the febrile and afebrile groups based on their body temperature within 24 h before completing antimicrobial treatment. The primary outcome was the clinical cure rate, defined as no initial presenting symptoms by day 14 post-biliary drainage without recurrence or death by day 30. The secondary outcome was a 3-month recurrence rate. Logistic regression with inverse probability of treatment weighting was used. Overall, 408 patients were selected, among whom 40 (9.8%) were febrile. The two groups showed no significant differences in the clinical cure and 3-month recurrence rates. Notably, the subgroups limited to patients with a ≤ 3-day antibiotic treatment duration also showed no differences in these outcomes. Therefore, our results suggest that discontinuing antibiotics within the initially planned treatment period was sufficient for successful drainage cases of AC, regardless of the patient's fever status during the 24 h leading up to termination.

Alterations in hematologic, coagulation, and inflammatory markers based on fever status in hospitalized COVID-19 patients: A retrospective study.

Laboratory markers like lymphopenia, thrombocytopenia, elevated D-dimer, and C-reactive protein (CRP) predict worse outcomes in coronavirus disease 2019 (COVID-19). However, a comprehensive analysis of hematologic and coagulation parameter alterations based on fever status is lacking. This retrospective study analyzed 300 COVID-19 patients hospitalized from March to December 2020. Demographic, clinical, and laboratory data were extracted from electronic medical records. Patients were stratified into fever (n = 200) and no fever (n = 100) groups. Hematologic, coagulation, and inflammatory markers were compared between groups using appropriate statistical tests. Multivariate regression identified independent predictors of fever. Fever was associated with leukocytosis, neutrophilia, lymphopenia, thrombocytopenia, elevated CRP, D-dimer, procalcitonin, interleukin-6, neutrophil to lymphocyte ratio (NLR), and ferritin compared to no fever (all P < 0.05). D-dimer (r = 0.42), CRP (r = 0.52), NLR (r = 0.48), and interleukin-6 (r = 0.46) demonstrated the strongest correlation with fever (P < 0.001). High D-dimer >1000 ng/mL (adjusted odds ratio 2.7), CRP >100 mg/L (3.1), lymphopenia <1.0 × 109/L (2.8), NLR >4 (2.9), and thrombocytopenia <150 × 109/L (2.7) were significant independent predictors of fever status (P < 0.005). These parameters had moderate sensitivity (40-60%) and high specificity (74-88%) for discriminating febrile patients with AUC of 0.85. Marked alterations in hematologic, coagulation, and inflammatory markers occur in COVID-19 based on fever. Routine laboratory parameters can facilitate diagnosis and risk stratification.

Antipyretic and Anti-inflammatory Effects of Sanchen Pediatric Antipyretic Paste

Objective:: This study aimed to investigate the antipyretic and anti-inflammatory effects and mechanisms of Sanchen Pediatric antipyretic Paste (SPAP). Methods:: Rats were randomly divided into 7 groups: negative control group, positive control group, positive treatment group, SPAP high-dose, medium-dose and low-dose groups, and blank substrate group. Except normal control group, rats in other groups were subcutaneously injected with 10% dry yeast suspension (10mL/kg) on the back to establish a fever model, and the normal group was given the same volume of saline. At the 4 h and 7 h after modeling, each treatment group was subjected to corresponding SPAP intervention. Anal temperature was measured every one hour after modeling for 10 consecutive times. The average temperature-rise curve, maximum temperature and body temperature response index (TRI) were calculated to evaluate the efficacy of SPAP. After the last temperature measurement, abdominal aortic blood was collected, and serum was separated from blood. The levels of IL-6, TNF-α and CRP in serum were determined by enzyme-linked immunosorbent assay. Results:: The body temperature of the positive control group was significantly increased (p &lt; 0.01) 4 hours after model establishment, and that of the SPAP groups significantly decreased (p &lt; 0.01) after 5 hours of the model establishment. The levels of Serum IL-6, TNF-α and CRP were significantly decreased (p &lt; 0.01) in a dose-dependent manner. Conclusion:: SPAP has an obvious antipyretic effect on fever caused by dry yeast in rats. One of its antipyretic mechanisms may be associated with inhibiting inflammatory reactions by reducing the production or accelerating the degradation of endogenous thermogenic cytokines, such as IL-6, TNF- α, and CRP.

Seroprevalence of Q fever (Coxiella burnetii) in sheep in the Kwahu West municipality, Eastern Region, Ghana

Query fever, also known as Q fever, is a zoonotic disease caused by Coxiella burnetii. It is a cause of abortion in livestock and presents as a febrile illness in humans. A correlation between the incidence of the disease in humans and abortion in goats and sheep farms has been reported in countries such as the Netherlands and Australia. In Ghana, the occurrence of Q fever in both livestock and humans has not been fully explored. This study sought to determine the seroprevalence of Q fever in livestock in Nkawkaw, in the Eastern Region of Ghana. Sera obtained from 92 sheep from 12 farms were tested using the indirect multi-species ELISA for the detection of anti-Coxiella burnetii antibodies. Animal demographics, farms’ proximity to human settlement and history of abortion in relation to the Q fever status were assessed.The overall prevalence of Q fever was 13.0 % [95 % CI 6.9–21.6] (12/92). Both sexes were equally affected, with a sex-specific prevalence of 13.0 % each. The farm-specific prevalence was 50 %. Abortions were reported on eight (8) of the 12 farms, and all farms were located less than 200 m from human habitation. Only proximity of farm to human settlement showed statistical significance. Q fever is prevalent in Nkawkaw and requires the attention of both animal and health authorities, using the One- Health approach to nip any future epidemics in its bud.

African swine fever antibody detection and status in pigs in Apa, Ohimini and Okpokwu local government areas of Benue State, Nigeria

Since African Swine Fever (ASF) is a notifiable, highly contagious, lethal haemorrhagic disease in domestic pigs. studies were undertaken to investigate the presence of antibody against African Swine Fever Virus (ASFV) among pig population in Apa, Ohimini and Okpokwu LGAs of Benue State, Nigeria . Eight, five, and seven serum were sampled from suspected pigs’ populations in Apa, Ohimini and Okpokwu Local Governments Areas of Benue state respectively. One serum sample from Ohimini tested positive (ie 20%) but none of the samples from Apa and Okpokwu LGAs tested positive for the test (ie 0%). Since pigs with demonstrable antibody are normally considered as chronic carriers of the virus because it is doubtful if true recovery ever occurred. Control measures such as use of quarantine , test and culling of animals that tested positive for ASF antibody with commensurable level of compensation.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; La peste porcine africaine (PPA) étant une maladie hémorragique à déclaration obligatoire, hautement contagieuse et mortelle chez les porcs domestiques. des études ont été entreprises pour étudier la présence d'anticorps contre le virus de la peste porcine africaine (VPPA) parmi la population porcine des LGA d'Apa, Ohimini et Okpokwu de l'État de Benue, au Nigéria. Huit, cinq et sept sérums ont été échantillonnés dans des populations de porcs suspectées respectivement dans les zones de gouvernement local d'Apa, d'Ohimini et d'Okpokwu, dans l'État de Benue. Un échantillon de sérum d'Ohimini s'est révélé positif (soit 20 %), mais aucun des échantillons des LGA d'Apa et d'Okpokwu n'a été testé positif (soit 0 %). Étant donné que les porcs présentant des anticorps démontrables sont normalement considérés comme des porteurs chroniques du virus, car il est douteux qu’une véritable guérison ne se soit jamais produite. Desmesures de contrôle telles que le recours à la quarantaine, les tests et l'abattage des animaux testés positifs aux anticorps anti-PPA avec un niveau de compensation proportionné.

Epidemiology and characteristics of emergency department utilization by patients with amyotrophic lateral sclerosis in Korea from 2016 to 2020: A nationwide study.

Patients with amyotrophic lateral sclerosis (ALS) inevitably visit the emergency department (ED) due to their increased risk of respiratory failure and mobility limitations. However, nationwide data on ED visits by patients with ALS are limited. This study investigated the characteristics of patients with ALS-related ED visits. We conducted a cross-sectional study from 2016 to 2020, utilizing a nationwide ED database. The total number of patients with ALS who visited the ED and their primary reasons for visiting/diagnoses were analyzed. In total, 6036 visits to the ED were made by patients with ALS. Of these, 41.8% arrived by ambulance and 27.7% spent >9 h in the ED. Following ED treatment, 57.4% were hospitalized, including 19.3% admitted to the intensive care unit (ICU) and 5.4% who died in the hospital. The primary reasons for ALS-related ED visits were dyspnea (35.2%), feeding tube problems (10.1%), fever (7.8%), and mental status changes (3.6%). The most common diagnoses were pneumonia (14.5%), respiratory failure (5.7%), dyspnea (5.5%), aspiration pneumonia (4.3%), and tracheostomy complications (3.4%). Reasons for ED visits for patients with ALS include acute respiratory distress, as well as concerns related to tube feeding and tracheostomy. To reduce the risk of patients with ALS requiring ED visits, it is essential to ensure the provision of timely respiratory support and high-quality home-based medical care teams that can support and address patients before their condition deteriorates.

Assessment of Dispensing Malpractice in Community Drug Retail Outlets in South Gondar Zone, Northwest Ethiopia: A Simulated Patient Experience.

Pharmacy professionals in community drug retail outlets, as the most accessible personnel for the community, are engaged in consultation and responding to health problems in addition to filling prescriptions. In doing so, different dispensing malpractices are observed and much is not known on the issue in Ethiopia. The study aimed at assessing dispensing malpractice at pharmacies, drug stores and drug vendors in South Gondar zone. A cross-sectional study design with a descriptive approach was applied from April 1 to June 30. The data was collected using the simulated patient method. Seven prescription-only medicines and a diarrheal case were requested during visit. All drug retail outlets in South Gondar zone that were in service during data collection were visited. Almost all prescription-only medications were dispensed without prescription at all community drug retail outlets. Of all the dispensaries, 19 (82.6%) provided a partial dosage regimen of amoxicillin. Presence of fever and pregnancy status were asked about by dispensers in only 8% and 20% of visits for diarrhea, respectively. Medication history was also rarely requested. Medication was dispensed in 80% of visits for diarrhea, all of which included antimicrobials. Oral rehydration salt was considered in only two (10%) dispensaries. Dispensing medications without a prescription is common in community drug retail outlets in South Gondar zone in Amhara Regional State. Our findings also showed that detailed assessments of patients' signs and symptoms are not performed properly by the dispensers to understand the diarrheal case. Training of pharmacy professionals and strict regulatory control are needed.

Risk Prediction for Rapidly Progressive Interstitial Lung Disease in Anti-MDA5-Positive Dermatomyositis: The CRAFT Model.

BACKGROUND Anti-melanoma differentiation-associated protein 5-positive dermatomyositis (MDA5⁺ DM) is characterized by a life-threatening complication of rapidly progressive interstitial lung disease (RP-ILD). Early prediction of RP-ILD can enhance diagnostic accuracy and therapeutic efficacy. This study was conducted to develop a nomogram model for predicting RP-ILD in patients with MDA5⁺ DM. MATERIAL AND METHODS We retrospectively analyzed 53 patients with MDA5⁺ DM, of whom 21 patients were diagnosed with RP-ILD between January 2018 and January 2021. Univariate analysis (t test, Mann-Whitney U test, chi-squared test, or Fisher's exact test) and receiver operating characteristic (ROC) analysis were used to select candidate variables. Multivariate logistic regression analysis was conducted to construct a prediction model, which was subsequently transformed into a nomogram. ROC analysis, calibration curve and decision curve analysis were performed to evaluate the model's performance. The bootstrapping method (resampling=500) was used for internal validation. RESULTS We successfully established a nomogram, called the CRAFT model, to predict RP-ILD in MDA5⁺ DM patients. The model included 4 variables, namely C-reactive protein-to-albumin ratio, red blood cell distribution width-coefficient of variation, fever status, and CD3⁺ T cells. The model presented high predictive power and a good performance in calibration curve and decision curve analysis. In addition, the model had a good predictive ability in internal validation. CONCLUSIONS The CRAFT model could help to predict RP-ILD in patients with MDA5⁺ DM.

Impact of Vacuum-Assisted Mini-Endoscopic Combined Intrarenal Surgery for Staghorn Stones: Analysis of Perioperative Factors of Postoperative Fever and Stone-Free Status.

Background and Objective: This retrospective cohort study aimed to evaluate the clinical outcomes of vacuum-assisted mini-endoscopic combined intrarenal surgery (vmECIRS) for staghorn stones. Patients and Methods: We analyzed a total of 61 cases treated with initial vmECIRS using 14F/16F ClearPetra® percutaneous sheaths for staghorn stones. We primarily measured complications and stone-free rates (SFRs) to evaluate the safety and efficiency of vmECIRS. In addition, pre- and intraoperative factors in patients who experienced postoperative fever >38°C and achieved an initial stone-free status were evaluated. Results: The percentages of staghorn stones were 36.1% and 63.9% for complete and partial stones, respectively. The median stone volume was 8.48 cm3. The median operation time was 117 minutes, and the mean number of procedures was 1.54. Regarding postoperative complications, postoperative fever >38°C was reported in 18 patients (29.5%). The initial and final SFRs were 50.8% and 91.8%, respectively. Among patients with emerging fever >38°C, positive urine culture was the only significant risk factor in the multivariate analysis (odds ratio [OR], 7.500; 95% confidence interval [CI], 1.772-31.751; p = 0.006). Moreover, for achieving initial stone-free status, body mass index and stone volume were significant risk factors in the multivariate analysis (OR, 0.872; 95% CI, 0.776-0.980; p = 0.021; and OR, 0.882; 95% CI, 0.784-0.994; p = 0.039, respectively). Conclusions: These findings suggest that vmECIRS is safe and effective for treatment of staghorn stones. Although current guidelines suggest that percutaneous nephrolithotomy is the gold standard surgical technique for staghorn stones, vmECIRS could also be a treatment strategy. The Clinical Trial Registration number (ID: 2022-05-17-1).

Autistic Regression Sequelae or Relapse for NMDA Receptor Antibody Encephalitis

Objective To highlight a pediatric presentation of autistic regression secondary to relapsing NMDA receptor antibody encephalitis (NMDARAE) post-HSV infection. Background It is reported that 30% of patients develop NMDA receptor antibodies (NMDARA) after HSV Encephalitis. Previous studies have demonstrated a significant association between prior HSV-1 infection and NMDARAE, a diagnosis often overlooked due to diverse neurological manifestations. Design/Methods NA. Results This case highlights a 5-year-old female presenting with fever and refractory status epilepticus, was diagnosed with HSV Encephalitis requiring prolonged hospitalization. At discharge she had insomnia, mutism, dyskinetic movements, atonic seizures, and developmental regression. At 3 months post-discharge EEG exhibited multiple generalized myoclonic, myoclonic tonic, and atonic seizures, MRI brain demonstrated right temporal lobe encephalomalacia with immunologic workup demonstrating positive serum and CSF NMDARA. She underwent treatment with intravenous steroids followed by plasmapheresis and then rituximab with an improved clinical response and seizure control at 6 months. At 9 months, she displayed behavioral changes with diagnosis of ADHD with autistic regression. Workup was positive for NMDARA in the CSF (18 months post-presentation) and EEG showed diffuse epileptiform discharges activated during sleep. She was treated with steroids followed by rituximab. At follow-up, she showed improved social interaction, sleep, and seizure control with persistence of some autistic and ADHD features. Conclusions About 90% of patients with NMDARE present with prominent behavioral manifestations, with challenges in differentiating from psychiatric diseases. Relapse is reported in 12-24% of cases and is associated with delayed treatment and the female gender. NMDARAE relapse post-HSV Encephalitis is underreported, especially cases demonstrating autistic regression, as in our case. In conclusion, given overlapping and subtle symptoms, it is crucial to recognize the varying presentations and early diagnosis of NMDARAE relapse for effective treatment and better outcome.

Streptococcus pneumoniae meningitis in a child with idiopathic nephrotic syndrome: a case report

BackgroundChildren with nephrotic syndrome are at increased risk of infections, including bacterial peritonitis, pneumonia, and cellulitis. However, bacterial meningitis, a potentially life-threatening complication, has not been highlighted as an infectious complication of nephrotic syndrome in recent reviews. We report a very subtle and unusual presentation of bacterial meningitis in a child with nephrotic syndrome, which without a high index of suspicion, would have been missed.Case presentationA 9-year-old African-American male with a history of steroid-dependent nephrotic syndrome presented to the nephrology clinic for routine follow-up. His medications included mycophenolate mofetil and alternate-day steroids. His only complaint was neck pain and stiffness that the mother attributed to muscle tightness relieved by massage. There was no history of fever, vomiting, headache, photophobia, or altered mental status. On physical examination, he was afebrile (99 °F), but had mild periorbital swelling and edema on lower extremities. He appeared ill and exhibited neck rigidity, and demonstrated reflex knee flexion when the neck was bent. Laboratory evaluation revealed leukocytosis, elevated C-reactive protein, hypoalbuminemia, and proteinuria. Cerebrospinal fluid suggested bacterial meningitis. The patient was treated with ceftriaxone and vancomycin. Both cerebrospinal and blood cultures grew Streptococcus pneumoniae; vancomycin was discontinued. The child completed a 2-week course of ceftriaxone and was discharged home.ConclusionsA high index of suspicion is necessary in children with nephrotic syndrome treated with corticosteroids, as symptoms may be masked, and thus, a life-threatening disease be missed. Bacterial meningitis should be highlighted as a serious infection complication in children with nephrotic syndrome.

Infrared Temperature Sensor for Use Among Sow Herds

Presently, the body temperature of farm animals must be monitored to prevent the occurrence or progression of any disease amongst the herds. We have employed infrared sensors (called “Inspect”) to detect the fever status of sows. Systemic architecture and data flow systems have also been designed for workers to use on small-scale pig farms. The body temperature of 100 gestating sows was determined with the use of a standard thermometer (inserted into the rectum), while our device was used on each part of the body of the sows. The valva or anus was found to be that location because of the high correlation that was observed between the two measurements (R=0.78). Moreover, regular, and systematic inspections were employed for a full year in 2019 on commercial pig farms that were home to at least 300 sows. The results indicated that the production indexes of the after period (2019) were better than those of the before period (2018), especially in terms of the health status of the animals with regard to mg/PCU. Consequently, it was determined that this system could detect abnormal signs in livestock before they could become a bigger problem.

Genetics and clinical phenotypes of epilepsy associated with chromosome 2q24.3 microdeletion

Objective: To summarize the genetics and clinical phenotypes of epilepsy children with 2q24.3 microdeletion. Methods: All the patients with 2q24.3 microdeletion were retrospectively collected at the Pediatric Department of Peking University First Hospital from March 2017 to July 2022. The features of clinical manifestations, electroencephalogram (EEG), and neuroimaging were analyzed. Results: There were 13 patients with 2q24.3 microdeletion were included. All 13 patients had de novo copy number variation (CNV) with a deletion size ranged 0.18-7.31 Mb. The main pathogenic genes in the region were SCN3A, SCN2A, TTC21B, SCN1A and SCN9A genes. Among the 13 patients, 7 were boys, and 6 were girls. The onset age of epilepsy was 3.3(2.5, 6.0) months. Multiple seizure types were observed, including focal seizures in 13 patients, generalized tonic-clonic seizures (GTCS) in 6 patients, myoclonic seizures in 3 patients, epileptic spasm in 2 patients, and tonic seizures in 2 patients. Seizures were fever sensitivity in 9 patients. Status epilepticus was observed in 6 patients. One case had normal mental motor development and 12 cases had different degrees of developmental delay. Six patients had craniofacial abnormality, 1 had six-finger deformity of the right thumb, and 1 had multiple system abnormalities. EEG showed focal discharge in 3 cases, multifocal discharges in 5 cases, multifocal and generalized discharges in 1 case. Brain magnetic resonance imaging (MRI) showed enlargement of subarachnoid spaces in the frontal and temporal region in 4 patients, enlargement of lateral ventricle in 4 patients and delayed myelination of white matter in 1 patient. Dravet syndrome was diagnosed in 5 cases. The age at the last follow-up were 2.5(1.4,5.5) years, 1 patient was seizure free longer than 1 year, and 12 patients still had seizures. Conclusions: The epilepsy associated with 2q24.3 microdeletion is mainly induced by the deletion of SCN3A, SCN2A and SCN1A genes. The seizure onset age of 2q24.3 microdeletion related epilepsy was in infancy. Multiple seizure types are observed and the common seizure types include focal seizures and GTCS. Most patients have fever sensitivity and status epilepticus. Most patients have developmental delay. The phenotype of patients with deletion of SCN3A and SCN2A gene is more severe than that of patients with deletion of SCN1A gene only.

Drug Induced Neuroleptic Malignant Syndrome: A Case Report

Neuroleptic malignant syndrome (NMS) causes fever, muscle rigidity, and impaired mental status. Drugs that influence central dopaminergic neurotransmission and almost all neuroleptics, including newer atypical antipsychotics, are also associated with it. While uncommon, NMS remains a critical differential diagnosis for patients with fever and mental status changes due to the requirement for prompt resuscitation to prevent morbidity and mortality. We present a case of a 21-year-old man with schizophrenia who attended the emergency room with generalized muscle rigidity, high-grade fever, and disturbed mental status for 12 days. His serum creatine phosphokinase was elevated (CPK). The computed tomography (CT) of the brain was normal, and the CSF was clear and cell-free. The patient was given muscle relaxants, dopamine agonists, and biperiden. After three days, rigidity, fever, and consciousness improved. A few cases of antipsychotic-induced NMS have been reported. Healthcare professionals should be aware of this fatal side effect.

Sintilimab combined with chidamide in the treatment of extranodal nature killer/T-cell lymphoma with secondary hemophagocytic lymphohistiocytosis: Two case reports and literature review

Rationale:Extranodal nature killer/T-cell lymphoma (ENKTL) failing in asparaginase-containing treatments is fatal, it has a higher mortality rate when accompanied by secondary hemophagocytic lymphohistiocytosis (HLH). The study reported 2 ENKTL-related HLH patients.Patient concerns:Patient 1 visited for nasal congestion and runny nose for 6 months then got a fever and serious myelosuppression after P-GEP (pegaspargase, gemcitabine, etoposide, and methylprednisolone) chemotherapy. Patient 2 complained of painless lymphadenectasis in the right neck for 4 months and experienced recurrent fever and poor performance status after 3 cycles of P-Gemox (pegaspargase, gemcitabine, and oxaliplatin) chemotherapy.Diagnoses:Patient 1 and patient 2 were diagnosed as ENKTL failing in asparaginase-based chemotherapy and involving secondary HLH.Interventions:The dose of chidamide was 20 mg twice a week for 2 weeks and sintilimab was 200 mg once every 3 weeks.Outcomes:ENKTL was relieved and the HLH was resolved after the therapy of sintilimab and chidamide. The patients had achieved durable survival without immune-related adverse events.Lessons:ENKTL-related HLH needs early diagnosis and treatment. The combined strategy of sintilimab plus chidamide help deal with HLH and solve ENKTL, it may be a useful treatment option for ENKTL-related HLH.

Bilateral Recurrent Laryngeal Nerve Paralysis Manifesting as Long COVID

Management with ventilation is used for severe cases of coronavirus disease 2019 (COVID-19). After extubation, recurrent laryngeal nerve paralysis due to various factors may occur. Almost all cases of paralysis develop unilaterally; however, bilateral recurrent laryngeal nerve paralysis occurs rarely. Such cases may be fatal due to upper air obstruction, and patients are forced to adhere to restrictions after a tracheotomy. The present case illustrates bilateral recurrent laryngeal nerve paralysis that occurred 48 hours after withdrawal from the ventilator. A 75-year-old woman with a history of hypertension came to our hospital with a history of fever and cough for five days. She was diagnosed with pneumonia due to COVID-19 via polymerase chain reaction using her saliva, and ground-glass opacity was found in both lung fields on chest X-ray and computed tomography (CT). Mechanical ventilation, steroids, remdesivir, and baricitinib were administered. The patient's fever and oxygenation status improved with these treatments, and she was weaned from the ventilator on the eighth day of hospitalization. She had no symptoms immediately. However, 48 hours after extubation, bilateral recurrent laryngeal nerve paralysis was suspected. Thus, oral intubation was immediately introduced and a tracheostomy was performed. Vocal cord movement disorders continued for eight weeks, and during that period, the patient displayed hoarseness and suffered from dysphagia. We considered that nerve disorders from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in addition to the compression by the endotracheal tube, caused bilateral recurrent laryngeal nerve paralysis. The neural injury by SARS-CoV-2 may prolong and manifest as "Long COVID."