First Day Of Illness Research Articles

Changes in Circulating Adipokine Levels in COVID-19 Patients.

Objective: The COVID-19 pandemic has posed significant global health challenges. Despite extensive research efforts, the inflammatory response triggered by SARS-CoV-2 remains to be further explored and understood. Our study aims to examine the changes in serum concentrations of pro-inflammatory adipokines-visfatin and leptin-in COVID-19 patients in relation to a healthy control group. Patients/Materials/Subjects and Methods: The study consisted of forty COVID-19 patients and twenty-four healthy patients in the control group. Two serum samples were collected: upon admission and on the seventh day of hospitalization. Concentrations of visfatin and leptin in the serum, alongside routine biochemical parameters, were measured using enzyme immunoassay or enzyme-linked immunosorbent assay kits. The Shapiro-Wilk test was used to assess normality. Differences between independent groups were compared using the Mann-Whitney U test and Kruskal-Wallis ANOVA. Correlations were evaluated with Spearman's rank correlation coefficient. Results: Our findings revealed significantly lower visfatin levels in COVID-19 patients compared to the control group upon admission (4.29 ng/mL, (3.0-6.88 ng/mL) vs. 37.16 ng/mL (24.74-50.12 ng/mL), p < 0.001 for visfatin 1 and 52.05 ng/mL, (31.2-69.66 ng/mL) vs. 37.16 ng/mL (24.74-50.12 ng/mL), p = 0.048 for visfatin 2). The visfatin level of COVID-19 patients returned to the normal levels, established in the control group. However, there was no significant difference in leptin levels between the two groups (p = 0.270 for leptin 1 and p = 0.129 for leptin 2). There was a positive correlation between BMI and leptin concentration (r = 0.66 and p = 0.00). Moreover, it was discovered that COVID-19 independently reduces visfatin levels during the first day of illness. Conclusions: The results of our research suggest that the onset of COVID-19 infection is correlated to visfatin levels. Association with leptin levels remains inconclusive. Further research is imperative to elucidate the intricate role of visfatin and leptin in SARS-CoV-2 infection and their potential as biomarkers for COVID-19 severity and prognosis.

Seizure Incidence among Children Hospitalized with COVID-19 during the Omicron Wave

Purpose: Since late 2019, coronavirus disease 2019 (COVID-19) has rapidly spread worldwide. Some children with COVID-19 present with seizures; in particular, studies have reported an increase in seizure episodes during the Omicron wave of the pandemic. This study was performed to describe the clinical characteristics of seizures among children hospitalized with COVID-19 before and during the Omicron wave.Methods: A retrospective cross-sectional study was conducted on all pediatric admissions for COVID-19 at Hospital Tunku Azizah from June 2021 to May 2022.Results: During this period, 1,586 children were admitted with COVID-19, of whom 111 (7.0%) experienced seizures. Patients with seizures were more likely to have a history of seizure (odds ratio [OR], 71.4; 95% confidence interval [CI], 23.7 to 215.2; &lt;i&gt;P&lt;/i&gt;&lt;0.001) and prior antiseizure medication use (OR, 55.1; 95% CI, 6.1 to 497.4; &lt;i&gt;P&lt;/i&gt;&lt;0.001). Most seizures (55.0%) occurred on the first day of illness, with 86.5% lasting less than 5 minutes. None of the children required intubation or admission to the pediatric intensive care unit, and all were discharged without complications. Between June 2021 and January 2022, the seizure rate varied from 1.3% to 3.4%; however, it increased to 18% in April 2022, coinciding with the period of Omicron variant predominance in Malaysia. Children admitted during the Omicron wave had significantly higher odds of experiencing seizures (OR, 7.89; 95% CI, 2.07 to 13.07; &lt;i&gt;P&lt;/i&gt;&lt;0.001) than children hospitalized prior to this wave.Conclusion: In conclusion, the study revealed a marked increase in seizures associated with pediatric COVID-19 cases during the Omicron wave.

Clinical aspects of diagnosis and prognosis of acute necrotic pancreatitis

Aim - to evaluate diagnostic markers of acute pancreatitis. Materials and methods. The study was conducted in the period from 2014 to 2023 and was based on the assessment of the severity of acute pancreatitis (AP) in 237 patients. All patients were divided due to the severity of AP. Mild AP was detected in 85 (35.86%), moderate - in 90 (37.97%), severe - in 44 (18.56%), critical - in 18 (7.59%) patients. Also, two study groups were formed: the Group 1 (patients with mild and moderate AP) and the Group 2 (severe and critical AP). Results. The level of procalcitonin in the blood was increased in 29 (12.23%) patients of the Group 2 (severe and critical AP) and was &gt;2.0 ng/ml. Among them in 25 (86.2%) patients early surgical treatment was perfomed and septic inflammation was detected in operating room. Typical ultrasound signs of AP were in 207 (87.34%) patients. Correlation roots between amylase and diastase on the first day of illness were: r=0,71 in the Group 1 and r=0.73 in the Group 2. Conclusions. The diagnosis of AP should be based on a comparative evaluation of the results of instrumental, laboratory tests and clinical symptoms. Levels of PCT, amylase, blood glucose, and urine diastase together with other clinical parameters helped to confirm the diagnosis of AP on admission to the hospital in 162 (92.57%) and 54 (87.09%) patients of the Group 1 and the Group 2. PCT should be used to predict complications and evaluate the efficiency of antibacterial therapy. The study was performed in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee for all participants. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Uji Diagnosis NS1, IgG dan IgM Dengue Metode Immunokromatografi dan Elisa

Dengue fever is a disease caused by the dengue virus (DENV). Detection of NS1 antigen can be useful for early confirmation of DENV infection. NS1 antigen can be detected from the first day of illness and lasts up to 9-10 days. Other supporting examinations are dengue virus IgG and IgM examinations. The purpose of this study was to review the sensitivity and specificity of the dengue virus NS1, IgG, and IgM tests through literature testing. This type of research is descriptive. The literature used is scientific journals which are the top journals searched using the google search engine and contains complete information and data related to the sensitivity and specificity of NS1, IgG, and IgM Dengue Virus examinations. Based on the review, it was found that the sensitivity of the NS1 antigen in the Rapid Immunochromatographic method was in the range of 48%-92% and specificity was 73%-100%, in the ELISA method the sensitivity range was 42%-84% and specificity was 89%-99%. In the examination of IgG and IgM antibodies using the Rapid Immunochromatography method, the sensitivity ranges from 6%-73% and specificity 36%-100%. Examination of IgG and IgM antibodies using the ELISA method obtained sensitivity in the range of 6%-58% and specificity 56%-100%. The results of the review conducted showed that the sensitivity of the NS1, IgG, and IgM tests for Dengue Virus with the Rapid Immunochromatography method was better than the ELISA method, but the specificity for the NS1, IgG, and IgM tests for Dengue Virus ELISA method was better than the Rapid Immunochromatography method. In addition, the Rapid Immunochromatography method of NS1 antigen examination showed higher accuracy than IgG and IgM antibodies in screening for dengue virus infection.

Role of Therapeutic Plasmapheresis in SARS-CoV-2 Induced Cytokine Release Syndrome: A Retrospective Cohort Study on COVID-19 Patients.

BackgroundCytokine release syndrome (CRS) significantly contributes to the pathophysiology and progression of COVID-19. It is speculated that therapeutic plasma exchange (TPE) can dampen CRS via elimination of pathogenic cytokines.ObjectivesThe study is intended to compare the outcomes of COVID-19 patients with CRS treated with TPE and standard care (SC) to their counterparts receiving SC alone.MethodologyA retrospective cohort study of severe COVID-19 confirmed patients presenting with CRS and admitted to the medical ICU was conducted between March and August 2021. Using case-control (CC) matching 1:1, 162 patients were selected and divided into two equal groups. The primary outcome was 28-day in-hospital survival analysis in severe COVID-19 patients with CRS. However, secondary outcomes included the effect of plasmapheresis on inflammatory markers, the need for mechanical ventilation, the rate of extubation, and the duration of survival.ResultsAfter CC matching, the study cohort had a mean age of 55.41 (range 56.41±11.56 in TP+SC and 54.42±8.94 in SC alone; p=0.22). There were 25.95% males and 74.05% females in both groups. The mean time from first day of illness to hospitalization was 6.53±2.18 days. The majority of patients with CRS had comorbid conditions (75.9%). Diabetes mellitus was the most common comorbidity (40.1%), followed by hypertension (25.3%), and chronic kidney disease (21%). Notable reduction in some inflammatory markers (D-dimers, LDH, CRP and serum ferritin) (p<0.0001) was observed in the group that received TPE+SC. Moreover, the patients in the plasmapheresis plus standard care group required relatively less mechanical ventilation as compared to the group receiving SC alone (46.9% vs 58.1%, respectively; p>0.05). The rate of extubation in the TP+SC group vs SC alone was 60.5% vs 44.7%, respectively (p>0.05). Similarly, the mortality percentages in both groups were 19.8% and 24.7%, respectively.ConclusionFor this particular group of matched patients with COVID-19-induced CRS, TPE+SC was linked with relatively better overall survival, early extubation, and earlier discharge compared to SC alone. As these results were not statistically significant, multi-centered randomized control trials are needed to further elaborate the role of therapeutic plasmapheresis in COVID-19 induced CRS.

Peculiarities clinical course of influenza in children and modern opportunities for specific prophylactics

Annotation. Timely detection of influenza cases and modern opportunities for prevention of the disease are becoming important in the season of increasing the incidence of respiratory diseases in a pandemic COVID-19.The aim was to study the clinical and laboratory features of influenza in children in the season 2021/2022, who were hospitalized in the departments of Vinnytsia City Hospital “Mother and Child Center” since December 2021 till February 2022, as well as to analyze the current possibilities of specific prevention of the disease. 30 children were examined to clarify the clinical course of influenza. To diagnose influenza A and B, children underwent a smear of the nasal mucosa. Immunochromatographic method was used, namely cito-test of LLC "Pharmaco - Ukraine". To rule out coronavirus infection, a rapid antigen test for the coronavirus "SARS-CoV-2 Rapid Antigen Test" was performed. An analysis of prophylactic vaccination cards №063/o was performed to study the coverage of influenza vaccination. It was found that preschool children predominated (17 people – 56.7%), while school-age children accounted for 43.3%. A quarter of children (26.6%) sought medical help on the first day of illness, half (56.6%) - on the second day and the rest (16.6%) – on the third day. The children with flu mostly complained of chills, headache, loss of appetite, aches in the joints and muscles, most children suffered from high body temperature, which lasted up to 3±0.8 days. The average temperature figures were 39.52±0.58ºC. Catarrhal phenomena were present in the biggest part of children (86.7%). It was revealed a clear lung sound and vesicular breath sound in a physical examination. There were no significant changes in the blood count in 70% of children. Children were prescribed special and symptomatic therapy. No one of the hospitalized children received specific influenza prophylaxis according to the prophylactic vaccination cards №063/o, although vaccination remains the best way to protect against influenza and is of great importance, especially in a pandemic COVID-19. Inactivated tetravalent vaccines present in Ukraine provide reliable protection against influenza and are completely safe.

Infección por COVID-19 y síntomas digestivos. Análisis de una población geriátrica ambulatoria

Introduction: Although the main symptomatology of COVID19 is respiratory, many patients present digestive symptoms, which can be used to guide earlier diagnosis, anticipating isolation measures and the establishment of treatment. Given that older subjects present more severe forms of COVID 19, even compromising their lives, these measures are more relevant among the elderly population. Methods: In the present study, 147 cases with SarsCov-2 infection identified in a nursing home during March and April 2020 were analyzed. Aims: To analyze cases with SarsCov-2 infection identified in a nursing home, as well as to describe the clinical presentation of symptoms and the evolution of the condition in these patients. The secondary objective is to demonstrate the importance of digestive symptoms in COVID-19. Results: In 71 patients (48.3%) data of COVID-19 infection were detected by PCR and/or rapid test for specific antibodies. 39.4% were asymptomatic. Of the positive patients, 72.1% were women and the mean age was 80.8 years (SD=16.7). The most frequent symptom was diarrhea (48.8%), followed by cough (41.9%) and fever (39.5%). Diarrhea was detected on the first day of illness in 90.4%. In 33.3% it was associated with other symptoms and in 16.6% it was isolated. The mean duration of the symptoms was 11.7 days. Hospital admission was required in 30.2% of patients. 16.2% died due to respiratory complications or sepsis. Conclusions: Gastrointestinal symptoms may be frequent in COVID-19 infection and may even be the first manifestation of the disease. This group of patients had a lower proportion of complications and case fatality than usual. However, the role of digestive symptoms in COVID-19 infection needs to be verified with larger studies.

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.

What's in an Eye?

What's in an Eye?

MO391RISK FACTORS OF ACUTE KIDNEY INJURY IN SEVERE ACUTE RESPIRATORY ILLNESS DURING CORONAVIRUS DISEASE 2019 PANDEMIC

Background and AimsAcute Kidney Injury (AKI) is associated with poor outcome in severe acute respiratory illness (SARI) during Coronavirus Disease 2019 (COVID 19) pandemic. This study aim at detetction of risk factors for AKI among patients admitted for SARI at our Center for COVID 19 screening.MethodRestrospective study by reviewing admission notes from March 2020 until December 2020 at our district center. Patient aged more than 18 year old who admitted for SARI as defined by World Health Organisation and AKI as defined by Kidney Disease Improving Global Outcome (KDIGO) guideline were included. Chronic kidney disease and End stage Renal Failure as defined by KDIGO were excluded.ResultsA total 230 ( 56%) patients out of 410 patients with SARI had AKI during hospitalisation. The mean age was 72 years old (SD 13.8), 130 (56.5%) were male and 100 ( 43.5%) were female. SARI patients with AKI took mean 5 days ( SD 0.9) to be admitted at our center from the first day of illness. The mean body mass index (BMI) was 27.2 kg/m2 . The mean arterial pressure was 52.1 ( SD 3.7) mmhg upon admission. The mean neutrophils lymphocytes ratio ( NLR ) was 22.4 (SD 2.4). The independant Risk factors for AKI in SARI are Male gender ( OR 0.95; 95% CI 0.35-2.6), smoking ( OR 0.72 ;95% CI 0.23- 2.3), ischaemic heart disease (OR 0.48; 95% CI 0.06-3.8), diabetes mellitus ( OR 1.15; 95% CI 0.39-3.38) and hypertension ( OR 1.58; 95% CI 0.58-4.25).ConclusionNon modifiable risk factors for AKI in SARI include male gender and advance age. The modifiable risk factors for AKI in SARI are over weight, smoking, ischemic heart disease, diabetes mellitus and hypertension. NLR play a role in predicting AKI among SARI patients. Delay hospitalisation and hypoperfusion predispose to AKI in SARI. Early recognition of risk factors is crucial in preventing deterioration of kidney function in SARI patients during the inital screening for COVID 19 infection.

Protecting health during COVID-19 and beyond: A global examination of paid sick leave design in 193 countries*

ABSTRACT Well-designed paid sick leave is critical to ensure workers stay home when sick to prevent the spread of SARS-CoV-2 and other infectious pathogens, both when the economy is open and during an economic shutdown. To assess whether paid sick leave is available in countries around the world, we created and analysed a database of legislative guarantees of paid leave for personal illness in 193 UN member states. Original labour and social security legislation and global information on social security systems for each country were obtained and analysed by a multilingual research team using a common coding framework. While strong models exist across low- middle- and high-income countries, critical gaps that jeopardise health and economic security remain. 27% of countries do not guarantee paid sick leave from the first day of illness, essential to encouraging workers to stay home when they are sick and prevent spread. 58% of countries do not have explicit provisions to ensure self-employed and gig economy workers have access to paid sick leave benefits. Comprehensive paid sick leave policies that cover all workers are urgently needed if we are to reduce the spread of COVID-19, and be ready to respond to threats from new pathogens.

Protecting Health During COVID-19 and Beyond: A Global Examination of Paid Sick Leave Design in 193 Countries

Background: Staying home when sick is essential to reducing the spread of COVID-19 and other infectious diseases. Well-designed paid sick leave is critical to ensuring workers stay home when sick both when the economy is open and during the economic shutdown. Methods: Legislative guarantees of paid sick leave were assessed across 193 countries to determine the extent to which countries guaranteed adequate paid sick leave to respond to the threats of COVID-19. Legislation was assessed for the availability of leave from the first day of illness, duration of paid leave, whether it ensured adequate wage replacement, how leave was provided, and whether coverage extended to workers in small businesses, self-employed workers, and part-time workers. Findings: While strong models exist at every income level, critical gaps that jeopardize health and economic security remain in paid sick leave policies. 27% of countries do not guarantee paid sick leave from the first day of illness, which is essential to encouraging workers to stay home when they are sick. 36% limit access to paid leave for workers who have recently changed jobs, 58% of countries do not have explicit provisions to ensure self-employed workers have access to paid sick leave benefits, and 66% do not have explicit provisions for part-time workers. Interpretation: Comprehensive paid sick leave policies that cover all workers are urgently needed if we are to reduce the spread of COVID-19, and be ready to respond to threats from new infections in the future as well as to the ongoing threat from recurring infections, such as seasonal influenza. Funding Statement: Funding for the data in this article was provided by the William & Flora Hewlett Foundation. Declaration of Interests: The authors declare no competing interests.

Dynamic changes of lymphocyte counts in adult patients with severe pandemic H1N1 influenza A

BackgroundLymphopenia has been observed in severe pandemic influenza A/H1N1 in developed countries. However, data from developing countries are rare and dynamic change of lymphocyte counts in severe pandemic influenza A/H1N1 is scarcely reported. This study aimed to observe change of lymphocyte counts in patients with severe pandemic influenza A/H1N1 and to investigate the correlation of lymphopenia and severe pandemic influenza A/H1N1. MethodsWe retrospectively analyzed the white blood cell counts and differentials and other clinical data in 21 hospitalized patients with severe pandemic influenza A/H1N1 confirmed by reverse-transcription PCR during 2009 and 2010. ResultsAll patients, except two cases with bacterial co-infections, had normal or reduced white blood cell counts. Seventeen (81.0%) patients had decreased lymphocyte proportions (<20%) and counts (<0.8×109/L), with the lowest value of 1.2% and 0.1×109/L respectively. A patient with nosocomial infection of influenza A/H1N1 showed that lymphopenia occurred on the first day of illness. Lymphocyte proportions and absolute counts returned to normal or slightly higher than normal in 16 of the 17 patients within 2–3weeks after the disease onset. ConclusionsLymphopenia along with other clinical parameters may be helpful in early differential diagnosis of severe pandemic influenza A/H1N1.

Mild encephalitis/encephalopathy with a reversible splenial lesion due to Plasmodium falciparum malaria: a case report

BackgroundNeurological complications from malaria cause significant morbidity and mortality. Severe cerebral malaria occurs as a result of intense sequestration of infected erythrocytes in the cerebral capillaries. However, the pathology of the reversible neurological symptoms remains unclear. We report the case of a patient with malaria who also had mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) causing transient neurological symptoms.Case presentationA 55-year-old Japanese man was admitted to our hospital with acute fever upon returning from Nigeria. Blood smears and PCR analysis revealed ring forms in the erythrocytes, indicative of Plasmodium falciparum infection. He presented with dysarthria, expressive aphasia, and truncal ataxia, all of which were suggestive of cerebellar ataxia. He had no other signs or symptoms of severe malaria. Artemether/lumefantrine was started on the first day of illness. Although the parasites were undetectable on day 3 of illness, his neurological symptoms persisted. Brain magnetic resonance imaging (MRI) demonstrated a high-signal lesion in the splenium of the corpus callosum on diffusion-weighted images along with a decreased apparent diffusion coefficient. The neurological symptoms gradually improved by day 12. Brain MRI on day 16 showed complete regression of the splenic lesion. Therefore, the patient was diagnosed with MERS due to malaria.ConclusionsMERS often causes transient headaches, seizures, and/or impaired consciousness. The symptoms are compatible with the reversible symptoms of cerebral malaria.

Early Intervention With Adrenocorticotropin for Acute Encephalopathy-Associated Epileptic Spasms: Report of Two Cases

Acute encephalopathy with biphasic seizures and reduced diffusion (AESD) is a leading cause of childhood-onset encephalopathy in Japan. Children with AESD frequently develop intractable epilepsy, whereas their treatment options remain to be determined. We present 2 unrelated girls, who developed AESD at 25 months (case 1) and 12 months of age (case 2). Both cases underwent intensive cares from the first day of illness, whereas severe neurological impairments were left on discharge. They showed repeated signs of epileptic spasms at 2 months (case 1) and 8 months (case 2) after the onset of AESD. Video-monitoring electroencephalograms (EEG) detected the recurrent attacks accompanying slow-wave bursts and transient suppressions of the precedent epileptiform discharges, as typically observed in epileptic spasms. Intramuscular injection of adrenocorticotropic hormone (ACTH, 0.0125 mg/kg/d) was introduced within 1 month from the onset of epileptic spasms and continued for 2 weeks. The ACTH treatment disrupted the paroxysmal activity in EEG, and it has relieved these patients from epileptic seizures for more than 1 year. This report illustrates the potential efficacy of ACTH for a group of children with epileptic spasms after AESD.

К РЕНТГЕНОЛОГИЧЕСКОЙ ОЦЕНКЕ СТЕПЕНИ ТЯЖЕСТИ СИНДРОМА ДЫХАТЕЛЬНЫХ РАССТРОЙСТВ У НОВОРОЖДЕННЫХ

В останні роки респіраторні розлади новонароджених стали приваблювати велику увагу дослідників, так як нерідко їх результатом є хронічна дихальна недостатність, бронхообструктивний синдром, бронхолегенева дисплазія у дітей більш старшого віку. Своєчасність оцінки стану органів дихання у новонароджених і особливо недоношених, а також наявність ознак морфологічної незрілості при синдромі дихальних розладів (СДР) вимагає широкого використання загальновідомих методів обстеження, зокрема це стосується своєчасного рентгенологічного обстеження.Мета дослідження – визначити рентгенологічні критерії ступеня тяжкості синдрому дихальних розладів (СДР) при пневмонії новонароджених.Матеріали і методи. Проведено клініко-рентгенологічне обстеження 100 новонароджених, з них 50 доношених новонароджених і 50 недоношених новонароджених із недоношеністю I і II ступенів.Результати досліджень та їх обговорення. Новонароджені діти, народжені з СДР, вимагають особливої уваги з перших днів хвороби і професійно грамотної лікарської тактики. При рентгенологічному обстеженні недоношених новонароджених із пневмонією спостерігали превалювання прояву ознак, властиві СДР. Ґрунтуючись на власних спостереженнях і аналізуючи наявну інформацію в літературі, а також узагальнюючи вивчені нами класифікації про рентгенологічні прояви стадій СДР, виділили наступний варіант рентгенологічної верифікації змін за ступенями залежно від тяжкості рентгенологічних проявів та вираження ознак, що бувають при запальному процесі на тлі незрілості легеневої тканини. I ступінь тяжкості: помірне зниження пневматизації, міліарна плямистість, обмежені слабоінтенсивні тіні, нодозно-ретикулярна сітка (розпливчаста), “повітряна бронхограма” помітна. II ступінь тяжкості: зниження пневматизації, грубі, безладно розкидані ділянки ущільнень легеневої тканини, нодозно-ретикулярна сітка, “повітряні бронхограми”. III ступінь тяжкості: виражене зниження пневматизації (“матове скло”), згладження легенево-діафрагмальної і легенево-серцевої межі (симптом “силуету”), “повітряні бронхограми”. IV ступінь тяжкості: “білі легені”. Уточнення лікарем-рентгенологом ступеня тяжкості СДР новонародженого при пневмонії дозволяє найбільш точно й об’єктивно оцінити стан тяжкості хворої дитини.Висновки. Результати рентгенологічних досліджень при пневмонії у новонароджених дітей дозволяють зробити висновок про необхідність проведення їх в неонатальному періоді. Рентгенологічний метод оцінки ступеня тяжкості СДР при пневмонії новонароджених дітей, особливо недоношених, і з синдромом затримки внутрішньоутробного розвитку зручний своєю неінвазивністю, мінімальним променевим навантаженням на обстежуваного, широким спектром показників і багатою інформацією морфологічних даних, що сприяє своєчасній корекції комплексного лікування, особливо при ризику СДР, економії використання лікарських препаратів, зменшенні розвитку постгіпоксичних ускладнень адаптаційного періоду.

THE BURDEN OF ROTAVIRUS GASTROENTERITIS, AS THE RATIONALE FOR ROUTINE VACCINATION

Rotavirus infection is the second after pneumococcal cause in the incidence of diseases and mortality in children under 5 years. That has defined the who’s recommendation for the introduction of vaccination against rotavirus infection in the vaccination schedules of all countries of the world. In our country that vaccination recommended for epidemic indications for introduction into the regional program. However, vaccination is carried out only in certain regions. One of the reasons for low uptake of this vaccine is the underestimation of the burden of disease.The aim the study.To assess the significance of rotavirus gastroenteritis in the structure of acute gastroenteritis in children under 5 years receiving treatment in outpatient clinics, to study the genetic diversity of rotaviruses, to compare the costs associated with the treatment of acute rotavirus and non-rotavirus gastroenteritis.Methods.Prospective, observational, epidemiological study. The inclusion of participants under the age of 5 years with the symptoms of acute gastroenteritis who meet the criteria of inclusion/exclusion. Examination, medical history, samples of faeces were carried out in the first day of treatment (day of inclusion in the study). Parents were given a questionnaire for 14 days. The severity of the disease was determined according to the scale of Vesicare, the disease dynamics was assessed by the answers of the questionnaire. Examination of feces samples was carried out centrally by PCR. Rotavirus positive samples were genotypically PCR and in case of detection of rare genotypes have been sequenced genomic RNA.Results.The study included 501 baby — boys — 286 (57,1%), girls — 215 (42,9%). The average age was 22.6 ± 15.2 months. 50 children (10.0 per cent) mentioned various background pathology, the others were deemed healthy. Rotavirus was diagnosed in 151 patients 31.4% (95% CI: 26.9 percent - 35.3 percent), which accounted 66,52% (151 of 227) among all cases with confirmed etiology. Genotyping was prevalent G1P [8] to 34.5%, and G4P[8] — 39,2%. Clinical manifestations in rotavirus gastroenteritis was more severe, severe course observed in 65.5% of cases in the comparison group -at 30.4%. Significantly more often than in the comparison group (Р χ2 &lt; 0,001) was observed vomiting (140cases из151 — 93,3%, compared to 239 of 336 -71,1%) and elevated temperature (146 of 151 — 97,3% compared with 254 of 336 — 75,6%). The average temperature was 38,5 ± 0,6 OS in the comparison group — 38,0 ± 2,2 OS, remained 3,1 ± 1,4 and 2.5 ± 1.2 day, respectively. The frequency of episodes of diarrhoea in the first day of illness was 6.4 ± 2.7 times, in comparison with 5.2 ± 2.8, duration of diarrhea was 6.3 ± 3.2 days and 4.5 ± 2.6 days. The costs for parents of patients with acute rotavirus gastroenteritis was (M ± SD) 2873.4 ± 2276.4 rubles, against 2007.4 ± 2150.4 rubles in the comparison group (t = 3.965; p= &lt; 0,001, as amended by Starlite for inequality of variances).Conclusion.The introduction of routine vaccination of children in the first year of life will reduce by more than a third of the number of appeals to medical institutions about intestinal infections and partially prevent the costs associated with the treatment of this pathology.

Aulus Cornelius Celsus and ‘empirical’ and ‘dogmatic’ medicine

Aulus Cornelius Celsus and ‘empirical’ and ‘dogmatic’ medicine

Poor Adherence to Lung-Protective Mechanical Ventilation in Pediatric Acute Respiratory Distress Syndrome.

To determine the frequency of low-tidal volume ventilation in pediatric acute respiratory distress syndrome and assess if any demographic or clinical factors improve low-tidal volume ventilation adherence. Descriptive post hoc analysis of four multicenter pediatric acute respiratory distress syndrome studies. Twenty-six academic PICU. Three hundred fifteen pediatric acute respiratory distress syndrome patients. All patients who received conventional mechanical ventilation at hours 0 and 24 of pediatric acute respiratory distress syndrome who had data to calculate ideal body weight were included. Two cutoff points for low-tidal volume ventilation were assessed: less than or equal to 6.5 mL/kg of ideal body weight and less than or equal to 8 mL/kg of ideal body weight. Of 555 patients, we excluded 240 for other respiratory support modes or missing data. The remaining 315 patients had a median PaO2-to-FIO2 ratio of 140 (interquartile range, 90-201), and there were no differences in demographics between those who did and did not receive low-tidal volume ventilation. With tidal volume cutoff of less than or equal to 6.5 mL/kg of ideal body weight, the adherence rate was 32% at hour 0 and 33% at hour 24. A low-tidal volume ventilation cutoff of tidal volume less than or equal to 8 mL/kg of ideal body weight resulted in an adherence rate of 58% at hour 0 and 60% at hour 24. Low-tidal volume ventilation use was no different by severity of pediatric acute respiratory distress syndrome nor did adherence improve over time. At hour 0, overweight children were less likely to receive low-tidal volume ventilation less than or equal to 6.5 mL/kg ideal body weight (11% overweight vs 38% nonoverweight; p = 0.02); no difference was noted by hour 24. Furthermore, in the overweight group, using admission weight instead of ideal body weight resulted in misclassification of up to 14% of patients as receiving low-tidal volume ventilation when they actually were not. Low-tidal volume ventilation is underused in the first 24 hours of pediatric acute respiratory distress syndrome. Age, Pediatric Risk of Mortality-III, and pediatric acute respiratory distress syndrome severity were not associated with improved low-tidal volume ventilation adherence nor did adherence improve over time. Overweight children were less likely to receive low-tidal volume ventilation strategies in the first day of illness.

First reported chikungunya fever outbreak in the republic of Congo, 2011.

BackgroundChikungunya is an Aedes -borne disease characterised by febrile arthralgia and responsible for massive outbreaks. We present a prospective clinical cohort study and a retrospective serological study relating to a CHIK outbreak, in the Republic of Congo in 2011.Methodology and FindingsWe analysed 317 suspected cases, of which 308 (97.2%) lived in the city of Brazzaville (66.6% in the South area). Amongst them, 37 (11.7%) were CHIKV+ve patients (i.e., biologically confirmed by a real-time RT-PCR assay), of whom 36 (97.3%) had fever, 22 (66.7%) myalgia and 32 (86.5%) arthralgia. All tested negative for dengue. The distribution of incident cases within Brazzaville districts was compared with CHIKV seroprevalence before the outbreak (34.4% in 517 blood donors), providing evidence for previous circulation of CHIKV. We applied a CHIK clinical score to 126 patients recruited within the two first day of illness (including 28 CHIKV+ves (22.2%)) with sensitivity (78.6%) and specificity (72.4%) values comparing with those of the referent study in Reunion Island. The negative predictive value was high (92%), but the positive predictive value (45%) indicate poor potential contribution to medical practice to identify CHIKV+ve patients in low prevalence outbreaks. However, the score allowed a slightly more accurate follow-up of the evolution of the outbreak than the criterion "fever+arthralgia". The complete sequencing of a Congolase isolate (Brazza_MRS1) demonstrated belonging to the East/Central/South African lineage and was further used for producing a robust genome-scale CHIKV phylogenetic analysis.Conclusions/SignificanceWe describe the first Chikungunya outbreak declared in the Republic of Congo. The seroprevalence study conducted amongst blood donors before outbreak provided evidence for previous CHIKV circulation. We suggest that a more systematic survey of the entomological situation and of arbovirus circulation is necessary in Central Africa for better understanding the environmental, microbiological and sociological determinants of emergence.