Higher Incidence Of Fever Research Articles

Comparative analysis of clinical profile, laboratory profile and outcome in COVID-19 patients with and without hypothyroidism.

Previous studies suggest that patients' thyroid status might directly impact the course of Coronavirus disease 2019 (COVID-19). The objective of the study was to determine the clinical profile of COVID-19 patients with hypothyroidism and compare it with that of COVID-19 patients without hypothyroidism. Retrospective observational study. The study was conducted in a tertiary healthcare centre in Tamil Nadu between May and June 2021. The study included 117 patients admitted with hypothyroidism and COVID-19 as well as 117 age and Gender matched COVID-19 patients without hypothyroidism. Data regarding the demography, comorbidities, presenting symptoms, method of diagnosis of COVID-19, computed tomography (CT) severity score, Interleukin 6 (IL-6), D-dimer, oxygen requirement, number of days in hospital and outcome were collected for both groups. Data analysis was conducted, and p<0.05 was considered statistically significant. The study comprised 234 patients over two months, from May to June 2021. Distribution of presenting symptoms showed that the hypothyroidism group presented with a higher incidence of fever (66.67%), loose stool (18.80%) and myalgia (7.69%). Results show that RTPCR+, O2 Requirement, death, D-dimer, IL-6, number of days admitted as well as CT-severity did not show any statistically significant differences (p>0.05) between both groups. The outcomes also showed that both groups reported four mortalities. The results of the study help conclude that the hypothyroidism status of a COVID-19 patient is not associated with higher severity of clinical symptoms, deranged laboratory values as well as mortality. None declared.

Association between Reactogenicity and Immunogenicity in a Vaccinated Cohort with Two mRNA SARS-CoV-2 Vaccines at a High-Complexity Reference Hospital: A Post Hoc Analysis on Immunology Aspects of a Prospective Cohort Study

Enhancing our comprehension of mRNA vaccines may facilitate the future design of novel vaccines aimed at augmenting immune protection while minimising reactogenic responses. Before this design is carried out, it is important to determine whether adaptive immunity correlates with the reactogenicity profile of vaccines. We studied a large cohort that was vaccinated with mRNA vaccines to answer this question. This was an observational study with real-world data. Reactogenicity data were obtained from the VigilVacCOVID study. Immunogenicity (humoral and cellular) data were retrieved from health records. One main population (n = 215) and two subpopulations were defined (subpopulation 1, n = 3563; subpopulation 2, n = 597). Sensitivity analyses were performed with subpopulations 1 and 2 to explore the consistency of results. We analysed the association of the intensity and types of adverse reactions with the development and quantity of elicited antibody titres. As an exploratory analysis in subpopulation 1, we assessed the association between reactogenicity and cellular immunogenicity. A higher incidence of fever, malaise, and myalgia including severe cases was significantly associated with the development and quantity of positive antibody titres. No significant findings were observed with cellular immunity. We observed a positive association between immunogenicity and reactogenicity. These findings can be relevant for the future development of our understanding of how mRNA vaccines function.

Distinguishing Kikuchi-Fujimoto disease from lymphoma in patients by clinical and PET/CT features.

To develop a scheme for distinguishing Kikuchi-Fujimoto disease (KFD) from lymphoma in patients presenting enlarged lymph nodes (LNs) predominantly on the upper side of the diaphragm. From November 2015 to August 2023, 32 KFD patients and 38 lymphoma patients were pathologically confirmed and enrolled in this retrospectively study. Clinical and 18F-fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT) features were collected. When comparing those PET/CT parameters, we set 5 models with different research objects: (1) all affected LNs; (2) the 5 largest affected LNs in terms of maximum diameter; (3) the 5 largest affected LNs in terms of maximum standard uptake values (SUVmax); (4) the largest affected LNs in terms of maximum diameter; (5) the largest affected LNs in terms of SUVmax. Compared to lymphoma patients, KFD patients were younger; and with higher incidence of fever, arthralgia, abnormal serum white blood cell, lactate dehydrogenase (LDH) and splenomegaly; lower incidence of affected LNs perinodal infiltration, necrosis and conglomeration; more affected LNs in Head and Neck nodes (particularly in level II) and Axillary in KFD (P ˂ .05). PET/CT parameters presented as various difference in each model. Finally, 11 clinical and PET/CT features (age ≤ 34, with fever, arthralgia, abnormal white blood cell, abnormal LDH, and without node necrosis and node conglomeration have a score of 2 each; splenomegaly, perinodal infiltration, median maximum diameter ≤ 20.5 and median SUVmax ≤ 7.1 of affected LNs in model 2 have score of 1 each) were selected as scheme items for distinguishing KFD from lymphoma. Individuals who have a total score > 8, meet the criteria for KFD. Sensitivity and specificity were high: 86.8% (95% CI: 71.9%, 95.5%) and 96.9% (95% CI: 83.7%, 99.5%), AUC = 0.975 (95% CI: 90.5%, 99.6%), respectively. It can effectively distinguish KFD from lymphoma by clinical and PET/CT parameters.

Assessment of Gastrointestinal Manifestations and Predictive Factors Associated with Their Occurrence in Kawasaki Disease Patients: A Cross-Sectional Study

Background: Kawasaki disease is an idiopathic febrile systemic vasculitis, recognized as the leading cause of acquired heart disease in pediatric patients. Gastrointestinal manifestations can lead to delayed treatment, underscoring the importance of identifying and predicting factors associated with these manifestations to enable timely intervention. Objectives: The primary objective of this study was to identify the aforementioned factors. Methods: This retrospective study collected demographic information, medical history, physical examination findings, and laboratory results of 359 children suspected of having Kawasaki disease and referred to Mofid Children’s Hospital between 2013 and 2022. The study assessed the frequency of gastrointestinal manifestations and their association with physical examination findings and laboratory data. Results: A total of 359 patients were included in the study, comprising 153 males and 206 females. The mean age of participants was 2.8 ± 2.6 years. Abdominal pain was the most common clinical manifestation, reported in 39% of patients. Elevated levels of aspartate aminotransferase (AST) were observed in 38.1% of patients, while 30.2% showed elevated alanine aminotransferase (ALT) levels, and 10.5% exhibited direct hyperbilirubinemia. Patients with elevated ALT and AST levels had a higher incidence of abdominal pain, nausea/vomiting, and anorexia. Moreover, patients with positive findings of red blood cell (RBC) and white blood cell (WBC) in their stool examination had a higher incidence of fever and abdominal pain. Conclusions: Based on our statistical analysis, elevated AST and ALT levels, hyperbilirubinemia, and positive stool findings of RBC and WBC appear to be predictive factors for gastrointestinal manifestations in Kawasaki disease.

Lower Gastrointestinal Bleed in Children: Safety, Utility, and Yield of Colonoscopy: an Experience from a Large Tertiary Referral Endoscopy Center

Abstract Objective: There is paucity of data on lower gastrointestinal bleed (LGIB) in the pediatric population. We aimed to retrospectively review the endoscopy findings in patients younger than 18 years, presenting with lower gastrointestinal (GI) bleed and undergoing colonoscopy. Materials and Methods: Retrospective review of the endoscopy database at the department of gastroenterology at a tertiary care center from Western India was conducted between June 2017 until December 2021. Patients ≤18 years with LGIB, who underwent colonoscopy within 7 days of onset of bleed, were included in the study. Demographic details, endoscopic findings, and complications were noted. Results: In all, 55 patients were included in study (65% males; median age: 13 years [range: 1–18 years]). The most common endoscopic findings were polyps in 26 (47.2%) patients, colitis in 15 (27.2%) patients, solitary rectal ulcer syndrome (SRUS) in 6 (11.3%) patients, and hemorrhoids in 3 (5.4%) patients. Five (9%) patients had normal colonoscopy in whom the cause remained unidentified on further evaluation. However, no repeat episode was documented on a follow-up of 30 days. The most common location of a polyp was the rectum (64%). Two patients had multiple polyps (2 each). All the patients underwent a successful polypectomy. Pathology reported juvenile polyps in 25 biopsies. Four were diagnosed as inflammatory bowel disease (IBD), while 11 had acute infective colitis. Patients with infectious colitis as compared to IBD had higher incidence of fever (55 vs. 0%) and lesser incidence of previous similar events (22 vs. 66%). Those with polyps were younger than those without polyps (9.1 vs. 14.3 years; p = 0.000). Polyps were significantly more common in boys (84%; 22/26; p = 0.014) than in girls. No complications occurred in this cohort of patients. Conclusions: Polyps are the most common cause of LGIB in patients ≤18 years, followed by colitis. Polyps were more common in younger males.

Does the drainage of irrigation through the ureteral access sheath have an impact on the results of primary retrograde intrarenal surgery?

Purpose: One of the risk factors associated with post-operative fever and infections is the amount of fluid absorbed by the kidney. We conducted a prospective study to analyse the effects of irrigation fluid inflow and outflow on post-operative complications and stone-free rate. Material and methods: We did a prospective study on all primary retrograde intrarenal surgery (RIRS) cases performed at our hospital between JAN 2020 and JAN 2023. The fluid draining out of the access sheath was collected in a measuring container until the flexible scope was inside the access sheath. The amount of fluid retained by the body was measured by calculating the difference between the quantity of irrigation fluid utilised and the output from the access sheath. Results: A total of 566 patients were included in the study. The retained volume of more than 100 ml was associated with more pain (0.0/426 vs 49/140, p &lt; 0.001), a higher incidence of fever (7/426 vs 22/140, p &lt; 0.001), a higher incidence of high-grade complications (G4A 0 vs 4), and a higher incidence of residual stones (11/426 vs 49/140, p &lt; 0.001). Conclusion: The outflow from the access sheath is a crucial factor that can significantly impact the outcome of RIRS. Level of evidence: Not applicable

Cytokine Release Syndrome in Patients Treated With Chimeric Antigen Receptor T-cell Therapy: A Retrospective Study Analyzing Risks, Outcomes, and Healthcare Burden.

Background Chimeric antigen receptor T-cell (CAR-T) therapy has emerged as a promising immunotherapy for various malignancies. However, its use is associated with challenges, including cytokine release syndrome (CRS), a potentially severe complication. This retrospective study aims to analyze the risks, outcomes, and healthcare burden of CRS in patients undergoing CAR-T therapy. Method Data from the 2020 National Inpatient Sample (NIS) were utilized, comprising 415 CAR-T-related hospitalizations. They were categorized into those with CRS (n = 68) and those without CRS (n = 347). Baseline characteristics, including age, gender, race, income, insurance status, and comorbidities, were compared. Outcomes of interest included in-hospital mortality, length of stay (LOS), total hospital charges, and access to complications, associations, and interventions. Statistical analyses, including multivariable models, were employed to assess associations. Results Hospitalizations with CRS did not exhibit significant differences in age, gender, race, income, or insurance status compared to those without CRS. The multivariable analysis showed no statistically significant difference in mortality (adjusted odds ratio (aOR) = 2.48, 95% confidence interval (CI): 0.71 to 8.69, p = 0.151), LOS (coefficient = -2.1 days, 95% CI: -5.43 to 1.21, p = 0.207), or total hospital charges (coefficient = $207,456, 95% CI: $6119 to $421,031, p = 0.057) between the two groups. The CRS group had a higher incidence of fever (aOR = 1.91, 95% CI: 1.15 to 3.17, p = 0.014), acute respiratory failure (aOR = 2.10, 95% CI: 1.01 to 4.40,p= 0.049), and the need for intubation/mechanical ventilation (aOR = 2.59, 95% CI: 1.14 to 5.88, p = 0.024). Hemophagocytic lymphohistiocytosis (HLH) was significantly associated with CRS (aOR = 6.72, 95% CI: 2.03 to 22.18, p = 0.002). Conclusion While the development of CRS in CAR-T-treated patients did not significantly increase mortality, LOS, or total hospital charges, it was associated with specific risks and outcomes, including fever, respiratory failure, and HLH. This study emphasizes the importance of vigilance in recognizing and managing CRS in CAR-T therapy to optimize patient outcomes. The findings contribute valuable insights to guide clinical decision-making in the context of CAR-T therapy.

The impact of normal serum complement levels on the disease classification and clinical characteristics in systemic lupus erythematosus

BackgroundSome patients have normal levels of complement during the diagnosis of systemic lupus erythematosus (SLE), although decreased serum levels of complement are a hallmark of the active phase of the disease. This study investigated the clinical characteristics, impact on the classification of SLE, and the prognosis of patients with SLE who had normal serum complement levels at initial diagnosis (N-com).MethodsWe evaluated 21 patients with N-com and 96 patients with hypocomplementemia at the initial diagnosis of SLE (H-com). The classification rates among the American College of Rheumatology (ACR) 1997, Systemic Lupus International Collaborating Clinics (SLICC) 2012, European League Against Rheumatism (EULAR)/ACR 2019 criteria, and clinical and immunological involvements were compared between SLE patients with N-com and H-com. Relapse and organ damage based on the SLICC/ACR damage index were also evaluated.ResultsThe classification rates of SLE were not significantly different in the ACR, SLICC, and EULAR/ACR criteria between the N-com and H-com groups. Patients with N-com had no significant differences in the classification rates among the three criteria, whereas patients with H-com had lower classification rates in the ACR criteria than in the SLICC criteria. A lower incidence of renal manifestation, less positivity for anti-dsDNA antibody, and a higher incidence of fever were observed in patients with N-com than in those with H-com. The occurrence of relapse and organ damage was not significantly different between patients with N-com and H-com.ConclusionPatients with N-com were less involved in renal manifestation and anti-dsDNA antibody positivity but had a higher incidence of fever than those with H-com, while having no disadvantage in SLE classification processes. Serum complement levels at the initial diagnosis of SLE may not predict prognosis.

Vitamin D Levels in Pediatric Patients Undergoing Chemotherapy

Background: Vitamin D has important roles in bone health, immune function, metabolic regulation, and cancer. Children with cancer may be especially vulnerable to fluctuating Vitamin D levels due to their disease itself, chemotherapy, and limited nutrition and sun exposure. However, most US-based literature addresses only childhood cancer survivors after therapy concluded, so it remains unclear if children with cancer are at risk of vitamin D deficiency during treatment. Methods: This study investigated (i) if children with cancer are vitamin D deficient compared to matched controls, (ii) if their vitamin D levels worsen throughout the course of their cancer treatment, and (iii) if vitamin D levels correlate with the number of fever episodes or fever severity score, as surrogate for infectious disease, in cancer patients. The serum levels of 25-hydroxycholecalciferol vitamin D (25OHD) were assessed at baseline (T1, both cancer and control groups) and 3-4 months and 6-8 months later (T2 and T3, cancer group only). Any incidence of fever experienced in patients with cancer during the study period was recorded and a previously-validated fever severity score was calculated for each episode. Results: This prospective cohort study enrolled 47 cancer-affected children (<21 yr) expected to receive chemotherapy for at least 6 months and 53 age-and-ethnicity-matched controls. Analysis showed participants were 8.6 ± 5.2 yr, with BMI of 19.1 ± 5.0 kg/m2. Most participants were male (63.6%) and Hispanic (52.5%). The cancer and control groups were comparable in terms of age, gender, ethnicity, BMI, and 25OHD at baseline (all p>0.05). Of note, a few cancer patients missed some of their planned draws due to COVID-19 related precautions. The level of 25OHD did not differ between the cancer and control groups at T1, with or without controlling for age, gender, BMI, and season of measurement (both p > 0.05). The 25OHD level among patients with cancer was significantly different for different seasons (p = 0.0047). Levels of 25OHD significantly increased over time among children with cancer (p = 0.0040). However, when patients' age, gender, ethnicity, BMI, and season were controlled for, it was found that the 25OHD level did not change over time (p = 0.1817). Among the cancer patients, the concentrations of 25OHD did not significantly correlate with the number of fever episodes and fever severity scores (all p>0.05). Conclusion: 25OHD levels were not lower in patients with cancer compared to their matched controls even when adjusting for variables associated with vitamin D deficiency. When controlling for these variables, the levels of 25OHD did not change significantly over time in children with cancer. Finally, lower 25OHD did not correlate with a higher incidence of fever or higher fever score, as a surrogate marker for infectious disease. Our findings dispute previous studies suggesting that children with cancer are at higher risk of vitamin D deficiency and that lower levels of vitamin D correlate with incidence or severity of infectious disease, when using fever as a surrogate marker. Larger studies are needed to better understand the role of vitamin D status in children with cancer.

An exploratory clinical study of the efficacy and safety of tumor-infiltrating lymphocytes in the treatment of metastatic osteosarcoma

Objective: To explore the safety and efficacy of tumor-infiltrating lymphocytes (TILs) extracted from tumor tissue in patients with pulmonary metastasis of osteosarcoma, the TILs were amplified in vitro to reach clinical dosage and reinfused to the patients combined with high-dose interleukin 2 (IL-2). Methods: Twelve subjects with pathologically diagnosed osteosarcoma were enrolled from December 2019 to June 20, 2021 in Shanghai General Hospital. All subjects progressed with metastasis after standard chemotherapy and failed multiple lines of treatments. Fresh tumor tissue was obtained from the metastatic site and extracted and amplified by Good Manufacturing Practice (GMP) workshop to produce TILs to clinical treatment dosage (109-1011). High-dose IL-2 (100 000-200 000 U/kg) was administered immediately after autogenous TILs infusion to promote the activation, proliferation and antitumor cytolytic activity in vivo. Adverse events (AE) were graded according to Common Terminology Criteria for Adverse Events (CTCAE) standard and tumor response was assessed according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. Results: One patient did not receive treatment due to failure in isolating TILs, total of 11 patients received a single re-infusion of autologous TILs. There were 10 males and 1 female with a median age of 19.9 years (12-33 years). Six of these patients received higher dose levels of 1.0×1010 TILs. The 11 patients were followed-up for 1 to 13 months and tolerated well. The most common adverse events reported were fever (10/11), constipation (3/11) and elevated gamma-glutamyl transferase (GGT) (3/11). The high incidence of fever was due to the IL-2 infusion. All patients experienced a transient drop in lymphocyte count and leukopenia leading to non-myeloid ablative lymphocyte clearance. The AE included grade 4 hematologic toxicity, including 8 cases of lymphocytopenia, 2 cases of neutropenia and 1 case of thrombocytopenia. No AE of neurotoxicity occurred. Of all the 11 patients, 9 patients got stable disease (SD) and 2 patients had progressive disease (PD). The disease control rate was 9/11. The median duration of SD was more than 4 months, and the maximum tumor volume decreased by close to 20%. Patient number 9 had sustained SD status for more than 6 months. Conclusions: TILs with in vitro expansion ability could be isolated from tumor tissues of advanced osteosarcoma patients. TILs amplified and reinfused in vitro have anti-osteosarcoma activity.

Clinical Characteristics and Short-Term Prognosis of Children With Antibody-Mediated Autoimmune Encephalitis: A Single-Center Cohort Study.

BackgroundThe incidence and prevalence of autoimmune encephalitis (AE) is gradually increasing in pediatric patients (between the ages of 3 months and 16 years). The aim of this retrospective observational study was to investigate the clinical characteristics and short-term prognosis of children with antibody-mediated AE at Hunan Children's Hospital.MethodsAntibody analysis of blood and/or cerebrospinal fluid was performed in suspected AE patients admitted to the Department of Neurology, Hunan Children's Hospital from June 2014 to June 2021. Ultimately, 103 patients were diagnosed with antibody-mediated AE and were enrolled in this study. Clinical data and corresponding demographic, clinical characteristics, laboratory and imaging data, treatment, and prognosis data were collected and analyzed.ResultsIn our study, 103 AE patients with antibody-positive were identified. The main subtype of AE in our cohort was anti-NMDAR encephalitis. Few patients have anti-CASPR2 encephalitis, anti-GABABR encephalitis, or anti-LGI1 encephalitis. In our AE patients, the most common clinical manifestations were behavioral symptoms, seizures, and involuntary movements, with seizures being the most common initial symptom. All patients underwent brain magnetic resonance imaging (MRI) and electroencephalography (EEG). Forty-five (43.7%) patients had abnormal MRI findings. And 96 (93.2%) patients had abnormal EEG results. All 103 patients were given first-line immunotherapy, 21 of which were also treated with the combination of the second-line immunotherapy. All surviving patients were followed up for at least 6 months. Seventy-seven patients recovered completely, 23 had sequelae of different degrees, and 3 died. Eight patients had one or more relapses during the follow-up period.ConclusionsAE is a treatable disease that can occur in children of all ages. The mortality rate is low, as most patients have a good response to immune therapy. Compared with the older children, infants and young children (≤ 3 years old) with anti-NMDAR encephalitis have a higher incidence of fever and status epilepticus, more severe condition, higher PICU admission rate and worse prognosis. AE patients with high maximum mRS scores and PICU admissions may require second-line immunotherapy.

STUDY OF EFFECTS OF SPONTANEOUS DELIVERY OF PLACENTA VERSUS MANUAL REMOVAL OF PLACENTA DURING CESAREAN SECTION AT TERTIARY CARE CENTRE

Objectives: The aim of the study was to compare the effects of manual removal of placenta and spontaneous delivery of placenta during cesarean section. Methods: This was a hospital-based prospective comparative study conducted in the Department of Obstetrics and Gynecology, Jhalawar Medical College, Jhalawar. 400 antenatal women at term and singleton pregnancy posted for cesarean section from October 2018 to September 2019 for 1 year duration. The study populations were divided into two groups (200 each). Group A in whom placenta deliver spontaneously and Group B in whom placenta was removed manually. Comparison was done in term of blood loss, fever, endometritis, and delayed complications. Results: The manual removal of placenta associated with greater blood loss (p&lt;0.0001, statistically significant), the greater fall in hemoglobin (p&lt;0.0001, statistically significant). Manual removal of placenta was associated with leukocytosis (p=0.0009), higher incidence of fever, post-operative uterine tenderness, and sub involution of uterus (p&lt;0.05 statistically significant). This is reflected by increased incidence of endometritis with manual removal (p=0.001, Significant). The overall time taken between delivery of baby to delivery of placenta was significantly lesser in manual removal method (p&lt;0.0001). Conclusion: Manual method seems to decrease the time interval between delivery of baby and that of placenta. Manual removal of placenta does more harm than benefit by increasing the incidence of fall in hemoglobin and delayed complication.

Childhood Hypertension: An Observational Study from a Tertiary Care Centre, Gujarat, India

Introduction: Childhood hypertension is an underestimated problem in India and other developing countries. It often leads to Hypertension in adult. Hypertensive children, although usually asymptomatic, already manifest evidence of target organ damage. Many of hypertensive children have left ventricular hypertrophy and increased carotid intima-media thickness, a marker of early atherosclerosis. Hypertensive children are very prone to develop target organ damage like retinopathy, renal damage, cardiac complications if remains undiagnosed and untreated for long. Other risk factors like cardiovascular disease, diabetes mellitus and hyperlipidaemia must also be looked for in hypertensive children. Aim: To study the prevalence, clinical profile, aetiology and to analyse various management protocol, complications, and early outcomes of hypertension in hospitalised children aged between 5-10 years. Materials and Methods: This was a prospective, observational analytical study conducted in the Department of Paediatrics of a Tertiary Care Centre at Ahmedabad, Gujarat, India, from 1st October 2017 to 30th September 2019. Blood pressure was measured by mercury sphygmomanometer using auscultatory method in all admitted patients in Paediatrics Department between the age of 5-10 years as a part of vital monitoring. A total of 103 patients having average systolic blood pressure and/or diastolic blood pressure greater than or equal to 95th percentile for that age, sex and height on three or more occasions were included in the study and their comprehensive details were recorded in prestructured proforma. The outcome was recorded as data in excel sheet and arranged in tables. Results: The prevalence of hypertension was 0.96%. The mean age of the study population was 8 years, and the male:female ratio was 1.09:1. Vomiting was the most common presenting complaint followed by fever and puffiness of eyes. A higher incidence of fever on presentation was due to the associated infective pathology of Central Nervous System (CNS). Pallor was the most common finding on general examination. Neurological deficit was observed in patients with hypertensive encephalopathy and stroke. Overall, 21 (20.38%) patients were in stage 2 hypertension, amounting to hypertensive emergencies, 48 (46.6%) patients with hypertension had an underlying renal disorder, followed by CNS disorder in 47 (45.6%). Amlodipine (26.21%) was the most common drug used in hypertensive patients. Most common complication of the present study was hypertensive retinopathy seen in 14 patients (13.59%). Conclusion: In hospitalised patients, the prevalence of hypertension was 0.96% with a male preponderance. On admission, the most prevalent complaints were vomiting and fever; pallor and puffiness of eyes were the most common general examination findings, and ascites was the most common systemic examination result. The most common secondary cause of hypertension was renal disease, with acute glomerulonephritis as most prevalent

COVID-19 induced telogen effluvium.

COVID‐19 is a febrile, infectious illness that has previously been associated with telogen effluvium (TE). However, to date, no study has been conducted to determine the incidence of TE in those who have had COVID‐19. To assess the frequency of TE in post‐COVID‐19 patients and the correlation between the development of TE and the severity of COVID‐19, to understand whether emotional stress or medications are responsible for the development of TE. Totally 204 patients with a history of SARS‐CoV‐2 infection in the last 3 months were included in the study. The diagnosis of TE was made by history of excessive hair shedding, hair pull test, diffuse or bitemporal thinning, and absence of anisotrichosis in trichoscopy. Patients who did not have any TE cause other than COVID‐19 and whose hair loss started after COVID‐19 were considered as “COVID‐19 associated TE (CATE).” We found TE in 75 (36.7%) cases and androgenetic alopecia (AGA) in 85 (41.7%) cases. CATE was present in 27.9% of cases and developed on average 53.76 (± 23.772) days after COVID‐19 real‐time reverse transcription polymerase chain reaction (RT‐PCR) positivity. The proportion of patients with CATE was numerically higher in hospitalized patients compared to outpatients (31.7% vs. 24.3%; p = 0.238); and significantly higher in women compared to men (42.3% vs. 6.2%; p < 0.001), in patients with hypertension compared to those without hypertension (40.4% vs. 23.1%; p = 0.014), and in patients who had respiratory symptoms compared to those who had not (31.7% vs. 14.0%; p = 0.021). The patients with and without CATE were similar in terms of stress level and usage of COVID‐19 medications. Patients with AGA had a higher rate of hospitalization (69.4% vs. 35.3%; p < 0.001) and a higher incidence of fever (69.4% vs. 54.6%; p = 0.033) during COVID‐19, compared to those without. TE developed in approximately one‐quarter of people who have had COVID‐19, and our study is the first to detect it. The time to onset of CATE, which was 7–8 weeks after the SARS‐CoV‐2 RT‐PCR positivity, was not much different from post‐infectious TE. Patients with severe COVID‐19 seem to be more prone to develop TE. The presence of AGA is associated with a more severe COVID‐19. During the pandemic, clinicians should consider a previous SARS‐CoV‐2 infection in patients presenting with hair loss.

Diagnostic accuracy of oral thermometry for fever detection in adult patients: literature review and meta-analysis.

To synthesise the evidence on the accuracy and precision of oral thermometry in adult patients, as well as on its sensitivity and specificity for fever detection. Oral thermometry has long been used in various clinical settings thanks to its rapid, safe and convenient measurements, which are easy to obtain and minimally prone to operator errors. Literature review and meta-analysis that adhered to the PRISMA statement. By using key terms, literature searches were conducted in CINAHL, PubMed, Web of Science, Scopus and Cochrane Library. Method-comparison studies, which were published from January 1990 to December 2020 in English-language, peer-reviewed journals, compared oral temperature measurements with invasive thermometry ones, and were conducted on patients ≥18years, were included. Methodological quality of selected studies was evaluated with QUADAS-2. Sixteen articles were selected for inclusion. Risk of bias was assessed as low in most of them. Quantitative synthesis indicated that pooled mean oral temperature was lower than core temperature by .07℃, with 95% limits of agreement ranging between -.22℃ and .08℃. Pooled sensitivity and specificity for fever detection (defined as core temperature ≥38℃ in most studies) were .53 (95% confidence interval, .39-.66) and .98 (95% confidence interval, .97-.99), respectively. Sensitivity analysis indicated larger temperature underestimation in case rectal temperature was used as reference standard. Despite its satisfactory accuracy, precision and specificity, oral thermometry has low sensitivity for fever detection, which entails a high number of false-negative readings and uncertainty for excluding fever in patients found to be non-febrile. Oral thermometry cannot be recommended for replacing invasive thermometry methods in hospitalised adult patients, considering the high incidence of fever in them and possible negative effects of missing fever for patient diagnosis and outcomes.

Surgical reconstruction of the right ventricular outflow tract-The clock is still ticking.

Surgical reconstruction of the right ventricular outflow tract-The clock is still ticking.

High incidence of fever in patients after biointegral pulmonic valved conduit implantation.

To describe our short- and medium-term outcomes using the BioIntegral pulmonic conduit. Between August 2018 and September 2019, the BioIntegral pulmonic valved conduit was used for right ventricular outflow tract reconstruction in 48 patients. The data were retrospectively retrieved from the patient charts. The median age at surgery was 36 months (interquartile range [IQR] = 18-62 months). The diagnoses were pulmonary atresia-ventricular septal defectin 28 patients, absent pulmonary valve in four patients, truncus arteriosus in six patients, TGA-VSD-PS in five patients, conduit stenosis in three patients, and left venticular outflow tract obstruction requiring a Ross operation in two patients. In the postoperative short-term follow-up, 15 patients out of 48 had a high fever. Of these, 12 patients had concomitantly elevated C-reactive protein levels. There were no patients with blood culture positivity. The median postoperative length of hospital stay was 14 days (IQR = 8-21 days). The overall mortality was 4% in two patients, one died of right ventricular failure and multiple organ failure and one died of pulmonary embolism. The two patients who died were not among the 15 patients with fever. However, four patients with fever underwent balloon angioplasty for conduit restenosis in their medium-term follow-up. There was a high incidence of fever and adverse outcomes in the short-term postoperative follow-up of patients in whom the BioIntegral pulmonic valved conduit was implanted. Caution is advisable in using these conduits until there is convincing evidence about the sterilization and storage standards of these grafts.

Molecular Epidemiology and Clinical Features of Enteroviruses-Associated Hand, Foot, and Mouth Disease and Herpangina Outbreak in Zunyi, China, 2019.

Background: Hand, foot and mouth disease (HFMD) and herpangina (HA), two of the most common childhood infectious diseases, are associated with enteroviruses (EVs) infection. The aim of this study was to identify the molecular epidemiology of enterovirus causing HFMD/HA in Zunyi, China, during 2019, and to describe the clinical features of the cases.Methods: We collected the information on demographic and clinical characteristics, laboratory data of laboratory-confirmed EVs associated HFMD/HA cases in Zunyi Medical University Third Affiliated Hospital between March 1 and July 31, 2019. EV types were determined by either one-step real time RT-PCR or partial VP1 gene sequencing and sequence alignment. Phylogenetic analysis of CVA6, CVA2, and CVA5 were established based on the partial VP1 gene sequences by neighbor-joining method. Differences in clinical characteristics and laboratory results of the cases were compared among patients infected with the most prevalent EV types.Results: From 1 March to 31 July 2019, 1,377 EVs associated HFMD/HA inpatients were confirmed. Of them, 4 (0.3%, 4/1,377) were EV-A71-associated cases, 84 (6.1%, 84/1,377) were CVA16-associated cases, and 1,289 (93.6%, 1,289/1,377) were non-EV-A71/CVA16-associated cases. Of the randomly selected 372 non-EV-A71/CVA16 cases, EV types have been successfully determined in 273 cases including 166 HFMD and 107 HA cases. For HFMD cases, the three most common types were CVA6 (80.7%, 134/166), CVA2 (5.4%, 9/166) and CVA5 (3.0%, 5/166); similarly, for HA cases, the three most prevalent serotypes were CVA6 (36.5%, 39/107), CVA2 (21.5%, 23/107) and CVA5 (18.7%, 20/107). Phylogenetic analysis showed that subclade D of CVA5, and subclade E of CVA6 and CVA2 were predominant in Zunyi during the outbreak in 2019. Compared with the cases caused by CVA16, the incidence of high fever and severe infection associated with CVA2, CVA5, and CVA6 was higher.Conclusions: The recent HFMD/HA outbreak in Zunyi is due to a larger incidence of CVA6, CVA2, and CVA5. Novel diagnostic reagents and vaccines against these types would be important to monitor and control EV infections.

Temporary Trends in Fever following Transcatheter Aortic Valve Implantation

Objectives: Fever following transcatheter aortic valve implantation (TAVI) is a common phenomenon, attributed mostly to inflammatory response which may impact outcome. Systemic inflammatory response may be triggered by multiple factors, most associated with the TAVI procedure itself. However, there are no data regarding the incidence of fever following TAVI in contemporary era with newer generation devices. Our primary objective was to measure temporal trends in fever incidence and features following TAVI. Methods: We analyzed a retrospective cohort of 802 consecutive patients who underwent TAVI at our institution between November 2008 and February 2018. We identified and characterized all patients who developed fever (>38.0°C from any cause) within the first 72 h following the procedure and analyzed incidence and characteristics stratified into 3 time frames: 2008–2014, 2014–2016, and 2016–2018. Results: Following TAVI, 190 (23.7%) patients developed fever (mean age 82.3 ± 5.2 years, 64.2% female). An infectious etiology was evident in only 32.1% of cases. The frequency decreased gradually and significantly across timeframes (32.8, 23.6, and 14.5%, respectively, p < 0.001). In a multivariate regression analysis, 1st generation CoreValve (HR 1.91; CI 95% 1.2–3.04, p = 0.006) was found to be associated with higher incidence of fever in addition to female gender, vascular complications, transfemoral access, and reduced GFR. Conclusions: Fever incidence post TAVI decreased significantly throughout the last decade. The higher rate of fever in the early years of TAVI was likely associated with first-generation devices, vascular complications, and reduced GFR.

Rapid COVID-19 Screening Based on Self-Reported Symptoms: Psychometric Assessment and Validation of the EPICOVID19 Short Diagnostic Scale.

BackgroundConfirmed COVID-19 cases have been registered in more than 200 countries, and as of July 28, 2020, over 16 million cases have been reported to the World Health Organization. This study was conducted during the epidemic peak of COVID-19 in Italy. The early identification of individuals with suspected COVID-19 is critical in immediately quarantining such individuals. Although surveys are widely used for identifying COVID-19 cases, outcomes, and associated risks, no validated epidemiological tool exists for surveying SARS-CoV-2 infection in the general population.ObjectiveWe evaluated the capability of self-reported symptoms in discriminating COVID-19 to identify individuals who need to undergo instrumental measurements. We defined and validated a method for identifying a cutoff score.MethodsOur study is phase II of the EPICOVID19 Italian national survey, which launched in April 2020 and included a convenience sample of 201,121 adults who completed the EPICOVID19 questionnaire. The Phase II questionnaire, which focused on the results of nasopharyngeal swab (NPS) and serological tests, was mailed to all subjects who previously underwent NPS tests.ResultsOf 2703 subjects who completed the Phase II questionnaire, 694 (25.7%) were NPS positive. Of the 472 subjects who underwent the immunoglobulin G (IgG) test and 421 who underwent the immunoglobulin M test, 22.9% (108/472) and 11.6% (49/421) tested positive, respectively. Compared to NPS-negative subjects, NPS-positive subjects had a higher incidence of fever (421/694, 60.7% vs 391/2009, 19.5%; P<.001), loss of taste and smell (365/694, 52.6% vs 239/2009, 11.9%; P<.001), and cough (352/694, 50.7% vs 580/2009, 28.9%; P<.001). With regard to subjects who underwent serological tests, IgG-positive subjects had a higher incidence of fever (65/108, 60.2% vs 43/364, 11.8%; P<.001) and pain in muscles/bones/joints (73/108, 67.6% vs 71/364, 19.5%; P<.001) than IgG-negative subjects. An analysis of self-reported COVID-19 symptom items revealed a 1-factor solution, the EPICOVID19 diagnostic scale. The following optimal scores were identified: 1.03 for respiratory problems, 1.07 for chest pain, 0.97 for loss of taste and smell 0.97, and 1.05 for tachycardia (ie, heart palpitations). These were the most important symptoms. For adults aged 18-84 years, the cutoff score was 2.56 (sensitivity: 76.56%; specificity: 68.24%) for NPS-positive subjects and 2.59 (sensitivity: 80.37%; specificity: 80.17%) for IgG-positive subjects. For subjects aged ≥60 years, the cutoff score was 1.28, and accuracy based on the presence of IgG antibodies improved (sensitivity: 88.00%; specificity: 89.58%).ConclusionsWe developed a short diagnostic scale to detect subjects with symptoms that were potentially associated with COVID-19 from a wide population. Our results support the potential of self-reported symptoms in identifying individuals who require immediate clinical evaluations. Although these results come from the Italian pandemic period, this short diagnostic scale could be optimized and tested as a screening tool for future similar pandemics.