Moderate Fever Research Articles

Is It Safe to Take 650 mg of Paracetamol on a Regular Basis?

: The commonest medication to treat moderate to severe pain and fever in adults and children is paracetamol and it has been observed that there has been a rapid increase in the intake of paracetamol-650 since the COVID-19 pandemic and it has continued to date. This analgesic and antipyretic medication showed an increase of 150% in its consumption during the pandemic, simultaneously escalating its self-medication. Concerns have been expressed about the indirect advertising of prescription medications, their illogical use, and improper self-medication, which has resulted in overdose and certain serious side effects. Chronic pain and pyrexia are the most common symptoms witnessed during the COVID-19 pandemic. The intake of paracetamol-650 has also been increased as a prophylactic measure due to the widespread fear generated during COVID-19. The usage of paracetamol has been shifted from 500 mg to 650 mg for mild and moderate pain and fever during and after the end of the pandemic. This raises concerns about the misuse of paracetamol-650mg which may cause damage to the liver, stomach, and kidney chronically. So, this review article aims to generate awareness among the public and physicians about the rationale of paracetamol as an analgesic and antipyretic.

Curing of chronic hepatitis C combined with coronavirus disease 2019 in a couple over 85 years old: a case series study.

Data on the management of patients aged more than 85 years with chronic hepatitis C virus (HCV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequential infections are lacking. The current study described the management of an older couple aged more than 85 years with these above-mentioned two diseases treated with 12 weeks of sofosbuvir/velpatasvir (Epclusa®) and 5 days of nirmatrelvir/ritonavir (Paxlovid®) sequentially. The effectiveness and safety profiles were closely monitored during therapy and till 9 months posttreatment. In late March 2023, the husband with the main complaint of repeated gingival bleeding and asymptomatic wife were 86 and 85 years old, and had HCV RNA levels of 91,800 and 6,630,000 IU/mL, respectively. On the fourth day of sofosbuvir/velpatasvir treatment, the husband had a moderate headache, and the wife had severe headache and moderate fever and dizziness. We then found that their SARS-CoV-2 test results were positive. After careful consideration, the expert panel decided to treat the couple with oral nirmatrelvir/ritonavir (300 mg/100 mg, twice daily) beginning on the fifth day of sofosbuvir/velpatasvir treatment for 5 days. During the 5 days of nirmatrelvir/ritonavir treatment, the patient's symptoms and signs gradually improved, and the patient was negative for SARS-CoV-2 RNA on the fifth day of nirmatrelvir/ritonavir therapy. Meanwhile, the husband's HCV RNA was not detectable after one week of sofosbuvir/velpatasvir treatment till posttreatment month 9, and his ALT level was normal beginning at week 1 of sofosbuvir/velpatasvir treatment. Moreover, the wife's HCV RNA was not detectable after week 4 of sofosbuvir/velpatasvir treatment till posttreatment month 9. Notably, no other symptoms or signs occurred during the treatment or follow-up period, and other serum biochemical parameters remained stable until 9 months after the discontinuation of sofosbuvir/velpatasvir treatment. The older couple aged more than 85 years with chronic HCV and SARS-CoV-2 sequential infection were safely cured by the sofosbuvir/velpatasvir and nirmatrelvir/ritonavir sequential treatment. This study suggested that old age should not be a barrier to HCV/SARS-CoV-2 treatment. Given that the proportion of older HCV-infected patients is increasing, clinical trials of direct-acting antiviral agents should include older HCV-infected individuals.

The current pathogenicity and potential risk evaluation of Crimean-Congo hemorrhagic fever virus to cause mysterious "Disease X"-An updated literature review.

Crimean-Congo hemorrhagic fever (CCHF) is a severe and potentially lethal illness. Tick bites of the Hyalomma genus are the primary source of transmission of CCHF to humans. The virus responsible for CCHF is the CCHF virus (CCHFV). It is a single-stranded negative sensed RNA virus. The virus belongs to the Orthonairoviridae genus within the Nairoviridae family. It occurs in an extensive geographical area spanning the Middle East, western China, southern Asia, southeastern Europe, and much of Africa. The current study aimed to evaluate the pathogenicity and potential risk of CCHFV to cause a public health emergency of international concern. We searched updated relevant information from PubMed, Google Scholar, and Scopus databases using Crimean-Congo hemorrhagic fever, tick-borne virus, and Nairovirus as keywords. The case fatality rate (CFR) varies by region. It can be more than 30% in some cases. Three segments in the genome of CCHFV (L, M, and S) are different in size and function. It is unknown whether the pathogenicity of CCHFV varied based on the genomic diversity. CCHFV can be transmitted through tick bites, handling of infected ticks, contact with infected humans, contaminated body fluids, and so on. A wide range of severity is associated with CCHF, ranging from a moderate fever with no apparent cause to increased vascular permeability, failure of several organs, bleeding, and shock. Hospitals with high-level isolation units should be the first choice for treating CCHF patients. Individual safety equipment is crucial in healthcare to prevent the spread of the virus. In the farm environment, using integrated pest management techniques, minimizing activity in tick-infested regions, and dressing appropriately in long sleeves and pants will help to reduce the risk of CCHFV infection via tick bites. There are no approved vaccinations or therapeutics for CCHF except supportive therapeutic approaches. Therefore, scientists recommend early ribavirin therapy for cases of high-risk exposures.

Systematic analyses of the factors influencing sperm quality in patients with SARS-CoV-2 infection

To figure out how does SARS-CoV-2 affect sperm parameters and what influencing factors affect the recovery of sperm quality after infection? We conducted a prospective cohort study and initially included 122 men with SARS-CoV-2 infection. The longest time to track semen quality after infection is 112 days and 58 eligible patients were included in our study eventually. We subsequently exploited a linear mixed-effects model to statistically analyze their semen parameters at different time points before and after SARS-CoV-2 infection. Semen parameters were significantly reduced after SARS-CoV-2 infection, including total sperm count (211 [147; 347] to 167 [65.0; 258], P < 0.001), sperm concentration (69.0 [38.8; 97.0] to 51.0 [25.5; 71.5], P < 0.001), total sperm motility (57.5 [52.3; 65.0] to 51.0 [38.5; 56.8], P < 0.001), progressive motility (50.0 [46.2; 58.0] to 45.0 [31.5; 52.8], P < 0.001). The parameters displayed the greatest diminution within 30 days after SARS-CoV-2 infection, gradually recovered thereafter, and exhibited no significant difference after 90 days compared with prior to COVID-19 infection. In addition, the patients in the group with a low-grade fever showed a declining tendency in semen parameters, but not to a significant degree, whereas those men with a moderate or high fever produced a significant drop in the same parameters. Semen parameters were significantly reduced after SARS-CoV-2 infection, and fever severity during SARS-CoV-2 infection may constitute the main influencing factor in reducing semen parameters in patients after recovery, but the effect is reversible and the semen parameters gradually return to normal with the realization of a new spermatogenic cycle.

Characterization of a human H3N8 influenza virus

In 2022 and 2023, novel reassortant H3N8 influenza viruses infected three people, marking the first human infections with viruses of this subtype. Here, we generated one of these viruses (A/Henan/4-10CNIC/2022; hereafter called A/Henan/2022 virus) by using reverse genetics and characterized it. In intranasally infected mice, reverse genetics-generated A/Henan/2022 virus caused weight loss in all five animals (one of which had to be euthanized) and replicated efficiently in the respiratory tract. Intranasal infection of ferrets resulted in minor weight loss and moderate fever but no mortality. Reverse genetics-generated A/Henan/2022 virus replicated efficiently in the upper respiratory tract of ferrets but was not detected in the lungs. Virus transmission via respiratory droplets occurred in one of four pairs of ferrets. Deep-sequencing of nasal swab samples from inoculated and exposed ferrets revealed sequence polymorphisms in the haemagglutinin protein that may affect receptor-binding specificity. We also tested 90 human sera for neutralizing antibodies against reverse genetics-generated A/Henan/2022 virus and found that some of them possessed neutralizing antibody titres, especially sera from older donors with likely exposure to earlier human H3N2 viruses. Our data demonstrate that reverse genetics-generated A/Henan/2022 virus is a low pathogenic influenza virus (of avian influenza virus descent) with some antigenic resemblance to older human H3N2 viruses and limited respiratory droplet transmissibility in ferrets. This work was supported by the Japan Program for Infectious Diseases Research and Infrastructure (JP23wm0125002), and the Japan Initiative for World-leading Vaccine Research and Development Centers (JP233fa627001) from the Japan Agency for Medical Research and Development (AMED).

Metabolic engineering of Escherichia coli for production of acetaminophen from glucose based on high selectivity of N-acetyltransferase

Acetaminophen, also known as paracetamol, is one of the most commonly used medicines and is widely accepted as a safe and effective analgesic/antipyretic for mild to moderate pain and fever. Several efforts have been made on engineered E. coli for the biosynthesis of acetaminophen. However, the yield of de novo biosynthesis of acetaminophen from glucose still needs to be improved. In this study, we identified an N-acetyltransferase svNAT2 from Streptomyces venezuelae FBUA 1571with high substrate specificity for p-aminophenol. Subsequently, based on this N-acetyltransferase, we constructed a biosynthetic pathway for acetaminophen from glucose in E. coli. The results show that using high selectivity of N-acetyltransferase svNAT2 can effectively improve the production of acetaminophen. Subsequently, we further increased the acetaminophen production to 1268 mg/L by the increasing availability of erythrose-4-phosphate and phosphoenolpyruvate.

1384. Verbal Autopsy as a Tool to Identify Probable Cause of Death in People with Acute Febrile Illness in Zambia — January 2020-December 2022

Abstract Background Acute febrile illness (AFI) surveillance improves a country’s understanding of what diseases are circulating. However, fever as an entry point for patient identification casts a wide net that will likely capture non-infectious causes of AFI. We used mortality surveillance data to examine probable causes of death (CoD) potentially associated with AFI to expand our understanding of febrile illness in Zambia. Methods The Zambian Ministry of Health provided verbal autopsy (VA) data from 27 (of 117) districts representing ∼50% of Zambia’s population. The World Health Organization’s standardized tool for VA was used by hospital staff to interview relatives or close associates of deceased persons of all ages on clinical presentation and circumstances prior to death. The InterVA-5 validated computer algorithm provided a CoD. Using questionnaire data, we applied an AFI case definition based on common global AFI surveillance criteria: a febrile person with a fever duration of &amp;lt; 1-14 days and a mild, moderate, or severe fever classification (in lieu of a temperature cutoff). We analyzed the CoDs and SARS-CoV-2 infections among those that met our AFI case definition in R. Results From January 2020 to December 2022, 51,751 VAs were conducted on people over 28 days old–14,503 (28%) reported fever prior to death, of which 12,071 (23%) met our AFI case definition. Broadly, we found that 64% of those that met our AFI case definition had an infectious CoD, 32% had a non-communicable CoD, and 4% had other CoDs. Specifically, the most reported CoDs were acute respiratory infection (14%), diarrheal disease (11%), and HIV/AIDS (10%). A positive SARS-CoV-2 test was reported in 965 (8%) persons with AFI versus 1,876 (5%) without AFI (p&amp;lt; 0.001). Conclusion AFI-associated deaths were primarily attributable to infectious disease, as identified through VA. AFI is one approach for multi-pathogen surveillance that provides valuable insight into circulating diseases, including SARS-CoV-2, but findings are limited by which pathogens are targeted for testing. Mortality surveillance is a valuable supplementary data source when attempting to understand inconclusive findings in AFI surveillance and aids in a country’s understanding of common causes of febrile illness not captured through AFI surveillance diagnostics. Disclosures All Authors: No reported disclosures

A Cross-Sectional Study Exploring Mental Health among Patients Suffering from Dengue in Pakistani Tertiary Care Hospitals

Background. Dengue, known as “Tropical flu,” is a widespread disease that has recently become endemic in many Asian countries. Dengue disease still lacks research in many aspects, specifically the impact of patient factors and disease prognosis on mental health. This is a cross-sectional study that evaluated the impact of different patient factors on depression, stress, and anxiety in patients with acute dengue infection. Methods. An interview-based data were collected through a questionnaire containing patient sociodemographic parameters, clinical parameters, and DASS 21 questions. Independent sample T -test, one-way ANOVA test, and post hoc test were performed to determine the degree of association of psychological manifestations with clinical signs and symptoms considering a level of significance of p &lt; 0.05 . Results. The patients from 39 years to 49 years of age had a higher association with stress, depression, and anxiety. The participants at primary and matriculation level education had a higher association with dengue-associated anxiety. Among the three levels of fever, i.e., mild (&lt;102°F), moderate (102-103°F), and severe (&gt;103°F), the participants suffering from severe fever experienced more anxiety and so was those with intense pain and stress. Conclusions. According to the DASS-21 tool, patients with severe pain and high-degree fever during dengue had significant stress and anxiety symptoms, respectively, than the patients with mild or moderate pain and fever. Middle-aged patients with low literacy levels were also found to have significant associations with stress, anxiety, and depression. To our knowledge, this is one of the first studies in Pakistan that in-depth explored the impact of patient factors’ variability on psychological illnesses related to dengue. These findings may warrant practitioners to integrate timely psychological screening and care for dengue patients.

Safety and immunogenicity of heterologous boosting with orally administered aerosolized bivalent adenovirus type-5 vectored COVID-19 vaccine and B.1.1.529 variant adenovirus type-5 vectored COVID-19 vaccine in adults 18 years and older: a randomized, double blinded, parallel controlled trial

ABSTRACT Vaccination strategies that can induce a broad spectrum immune response are important to enhance protection against SARS-CoV-2 variants. We conducted a randomized, double-blind and parallel controlled trial to evaluate the safety and immunogenicity of the bivalent (5×1010viral particles) and B.1.1.529 variant (5×1010viral particles) adenovirus type-5 (Ad5) vectored COVID-19 vaccines administrated via inhalation. 451 eligible subjects aged 18 years and older who had been vaccinated with three doses inactivated COVID-19 vaccines were randomly assigned to inhale one dose of either B.1.1.529 variant Ad5 vectored COVID-19 vaccine (Ad5-nCoVO-IH group, N=150), bivalent Ad5 vectored COVID-19 vaccine (Ad5-nCoV/O-IH group, N=151), or Ad5 vectored COVID-19 vaccine (5×1010viral particles; Ad5-nCoV-IH group, N=150). Adverse reactions reported by 37 (24.67%) participants in the Ad5-nCoVO-IH group, 28 (18.54%) in the Ad5-nCoV/O-IH group, and 26 (17.33%) in the Ad5-nCoV-IH group with mainly mild to moderate dry mouth, oropharyngeal pain, headache, myalgia, cough, fever and fatigue. No serious adverse events related to the vaccine were reported. Investigational vaccines were immunogenic, with significant difference in the GMTs of neutralizing antibodies against Omicron BA.1 between Ad5-nCoV/O-IH (43.70) and Ad5-nCoV-IH (29.25) at 28 days after vaccination (P=0.0238). The seroconversion rates of neutralizing antibodies against BA.1 in Ad5-nCoVO-IH, Ad5-nCoV/O-IH, and Ad5-nCoV-IH groups were 56.00%, 59.60% and 48.67% with no significant difference among the groups. Overall, the investigational vaccines were demonstrated to be safe and well tolerated in adults, and was highly effective in inducing mucosal immunities in addition to humoral and cellular immune responses defending against SARS-CoV-2 variants. Trial registration: Chictr.org identifier: ChiCTR2200063996.

A UV Spectrophotometric method for simultaneous determination of Ibuprofen and Paracetamol concentration in suspensions

&#x0D; &#x0D; &#x0D; INTRODUCTION: Paracetamol is a standard antipyretic and analgesic which is widely used since the 19th century. Currently, paracetamol is the first-line treatment for pain management of different types. Ibuprofen, on the other hand, is an antipyretic and an analgesic. It is safe and has been used in the treatment of a number of conditions including mild to moderate pain, dysmenorrhea, inflammations and fever to name few.&#x0D; METHODS: This study aimed at developing and validating a simultaneous UV spectrophotometric method for analysis of ibuprofen and paracetamol in fixed-dose combination suspensions. The proposed method is based on the simultaneous equation principle, which involves measurement of absorbance at wavelengths of maximum absorbance for ibuprofen and paracetamol. The method was validated for linearity, accuracy, repeatability, intermediate precision and robustness as per USP and ICH guidelines.&#x0D; RESULTS: The two molecules showed wavelength of maximum absorbance at 222 nm and 243 nm for ibuprofen and paracetamol respectively, using phosphate buffer as a diluent. The method was also linear (R2≥0.995), precise (RSD ≤ 2), and robust with accuracy ranging between 98.1%-105% and 109.8 %- 134.9% for paracetamol and ibuprofen, in the range of 0.0032 – 0.0048 mg/ml for ibuprofen and 0.004-0.006 mg/ml for paracetamol, respectively.&#x0D; CONCLUSION: We have developed an accurate and robust method which can be used to analyze quantitatively paracetamol in suspensions which contain both paracetamol and ibuprofen. The limits of quantification of this method cover the concentration range recommended by the USP (80%- 120%), which justifies the application of the method in routine analysis.&#x0D; &#x0D; &#x0D;

Etiology and clinical features of infection-associated plastic bronchitis in children

ObjectiveTo investigate the etiological characteristics of plastic bronchitis (PB) caused by pulmonary infections in children and to identify any differences in the clinical features of PB cases caused by different pathogens.MethodWe collected data on children diagnosed with PB and admitted to the Respiratory Department at Soochow University Children’s Hospital between July 2021 and March 2023 utilizing electronic bronchoscopy. We analyzed clinical characteristics and the species of pathogens causing the illness in these children.ResultA total of 45 children were enrolled. The main clinical symptoms observed were cough (100%), fever (80%), shortness of breath (28.9%), and wheezing (20.0%). Pathogens were identified in 38 (84.4%) patients. Mycoplasma pneumoniae (MP) had the highest detection rate at 53.3%, followed by the Boca virus at 26.7%. MP-induced PB typically occurs in older children with an average age of 7.46 ± 2.36 years, with the main symptoms including high fever (85.7%) and local hyporespiration (42.9%). In contrast, Boca virus-induced PB tends to occur in younger children, with the main symptoms of moderate fever (54.5%), and wheezing (54.5%). The MP group exhibited a higher incidence of both internal and external pulmonary complications, including pleural effusion (42.9%), elevated aspartate aminotransferase (52.4%), lactic dehydrogenase (76.2%), and D-D dimer (90.5%). Conversely, the Boca virus group primarily showed pulmonary imaging of atelectasis (81.8%), with no pleural effusion. The average number of bronchoscopic interventions in the MP group was 2.24 ± 0.62, which was significantly higher than that required in the Boca virus group (1.55 ± 0.52). During the second bronchoscopy, 57.1% of children in the MP group still had visible mucus plugs, while none were observed in the Boca virus group.ConclusionMP and Boca virus are the primary pathogens responsible for PB among children. The clinical manifestations of PB typically vary significantly based on the pathogen causing the condition.

Paracetamol detection in environmental and pharmaceutical samples using multi-walled carbon nanotubes decorated with silver nanoparticles

Paracetamol (PA) treats mild to moderate pain and fever with a high relative safety factor when administered properly. However, PA overuse creates harmful metabolites and serious illnesses. Thus, PA must be continually monitored and measured in environmental, pharmaceutical, and biological samples. In this work, voltammetric sensing of PA using silver nanoparticles (AgNPs) and carboxylated multi-walled carbon nanotubes (AgNPs@HOOC-MWCNT) deposited on screen-printed carbon electrode (SPCE) has been demonstrated. The AgNPs were prepared through a simple reduction method with an average particle size of 46 nm. Both AgNPs and modified electrodes were characterized by ultraviolet–visible spectroscopy, Fourier transform infrared spectroscopy, Raman spectroscopy, scanning electron microscopy, and energy-dispersive X-ray analysis. The electrochemical behaviour of PA over the modified (AgNPs@HOOC-MWCNT@SPCE) was studied using cyclic voltammetry (CV). It has been demonstrated that a relatively small quantity of AgNPs results in a considerable improvement in the active surface area of the modified electrode and an increase in the oxidation current of PA. In addition, a computational study was performed to complement the experimental work. Using square wave voltammetry (SWV) under optimal conditions (pH 7.4 and 25 °C), AgNPs@HOOC-MWCNT@SPCE sensor shows an effective sensing potential with a limit of detection of 0.24 µM in the concentration range of 0.5 to 1000 µM. The reproducibility and repeatability studies and long-term stability for 60 days were illustrated. Ultimately, the practical applications of the proposed method for determining PA in environmental and pharmaceutical samples were demonstrated with satisfactory results.

Physical compatibility of ibuprofen and selected parenteral drugs during simulated y-site administration

Intravenous ibuprofen (IBF) is indicated for short-term acute moderate pain and fever management. Limited data concerning the compatibility of intravenous IBF and other parenteral medications makes it inconvenient to use in polypharmacy-required patients. The simultaneous administration of two incompatible drugs is a health- or even life-threatening medical error. This study was performed to evaluate the physical compatibility of two intravenous IBF doses (600 mg/100 mL, 400 mg/100 mL) during Y-site administration with common parenteral medications. Eight infusion fluids, seven ready-to-use solutions for infusion, and thirty concentrates or powders for solutions for infusion were examined. All these drugs, if relevant, were reconstituted and diluted following the manufacturer's instructions to achieve concentrations found most commonly in clinical practice. Samples were prepared by mixing IBFs and selected drug product solutions at the 1:1 volume ratio. All samples underwent visual inspection and determination of pH and turbidity before combining with IBF and in time points (0, 30, 60, and 120 minutes) after simulated Y-site administration with IBF. In the case of propofol, which is an emulsion for infusion, lipid droplet size, zeta potential, and polydispersity index were also determined. The incompatibilities were observed for IBF combinations with amiodarone, ciprofloxacin, clemastine, gentamicin, vinpocetine, and calcium chloride.

COVID-19 INFECTION IN PATIENTS WITH PROVEN HEART DISEASE

Objective: The COVID-19 pandemic remains a hot topic whose results are highly uncertain. This acute respiratory infection is mainly transmitted through respiratory droplets and contact routes. Frail patients such as those with severe heart disease are at higher risk of contracting moderate to severe forms of COVID-19 pneumonia. our goal was to determine the prevalence of COVID-19 in patients with proven heart failure and to give the result of this disease. Design and method: We collected data from the medical records of heart failure patients followed at the Medical and Cardiology Center over the past two years and looked for the onset of COVID-19 disease, risk factors for poor outcomes as well as the final outcome of the disease. Results: Out of 130 medical records, we recorded a total of 66 cases. The mean age of patients was 61.4 ± 17.8 years. The sex ratio was 0.81. LV systolic function was preserved in 47.7% of cases. COVID-19-related pneumonia was detected in 14.9% of cases; The clinical presentation was dominated by respiratory distress associated with moderate oxygen desaturation and fever. Forty-six patients (70.7%) were on renin-angiotensin-aldosterone inhibitors. Poor outcome factors were: BT systolic dysfunction (52.3%), atrial fibrillation (31.3%), pulmonary arterial hypertension (16.4%), impaired renal function (41.8%), impaired liver function (59.7%), and at least 10-fold increase in NT-Pro-BNP values (55.2%). In addition, LVH was observed in 32.8% of cases, complete LBBB in 13.4% of cases, and significant LV dilation in 55.2% of cases. There have been 8 deaths, including 5 related to COVID-19-related pneumonia. Survivors received long-term chest physiotherapy in addition to treatment for heart failure. Conclusions: Acute pneumonia due to COVID-19 can have a negative impact on the prognosis of heart disease. Thus, the factors of poor performance should encourage the isolation and/or treatment of these at-risk populations.

Causality of Salmonellosis and Antibiotic Resistance Assessment in Shirak Marz 2014-2022

Introduction Over the past eight years, salmonella infections in Armenia have shown an upward trend. To clarify the causality, epidemiological patterns and features, as well as to assess the resistance of pathogens to antibiotics, an epidemiological study and analysis of cases registered in the Shirak region were conducted. Methods Laboratory-confirmed cases of salmonellosis were studied by methods of retrospective epidemiological and computer statistical analysis. A 20-year regression analysis of salmonellosis infection was performed using Arc-GIS. In the period from 2014 to 2022, we collected samples of 384 cases of salmonellosis registered in 119 communities of the Shirak Marz. Classical methods revealed subtypes of the pathogen and sensitivity to antibiotics. Results During the study, out of 3257 cases of acute intestinal infection in 119 communities, Salmonella enteritidis was confirmed in 295(9.1%) of cases, and Salmonella typhimurium was confirmed in 89(2.7%). Among the respondents, the probability of infection in those who consume animal products is 4.3 times higher (RO=4.3) than in those who are not related to farm animal products: We found that the study expanded the areas of integrated risk associated with the breeding of farm animals. In 2014.in 2022, 48 diagnoses of salmonellosis of animal origin were confirmed in 7 communities, and in 2022 - 140 cases in 19 communities (the territorial risk increased by 2.9 times). Sensitivity to antibiotics is high- 52.6%, especially to Ceftriaxone, Ciprofloxacin, Doxycycline. Patients consume the meat, eggs and dairy products of their animals. They are given antibiotics for growth and disease treatment. 136 patients (35.4%) had moderate and severe intoxication 39 and high fever. Only 11.9% of patients with moderate and severe gastroenterocolitic poisoning and fever of 39 degrees or higher are treated with antibiotics. Of the patients, 73% are people aged 3 to 62 years. Gender peculiarities are not observed: 48% of patients are men, 52% are women. Conclusion The risk associated with the nutritional factor: RO=4.3. The number of cases of the disease increased by 2.9 times and the number of communities by 2.7 times compared to 2014, due to an increase in breeding of farm animals. A 3,5-4-year periodicity for Salmonelozis was identified. A negative result is the misuse of antibiotics in humans and animals, which also ensures the high sensitivity of the antibiotics used. Industry coordination requires a systematic approach and constant monitoring within One Health.

Comparison of epidemic characteristics and clinical manifestation of chickenpox between adults and children in Shandong Province from 2019 to 2021

Objective: To analyze the differences between adults and children in the epidemic characteristics and clinical manifestations of chickenpox and provide a reference for the prevention strategy adjustment of chickenpox. Methods: The incidence data of chickenpox surveillance in Shandong Province from January 2019 to December 2021 were collected. Descriptive epidemiological methods were used to analyze the distribution of cases, and the chi-square test was used to compare the differences in epidemiological characteristics and clinical manifestations of varicella cases between adults and children. Results: A total of 66 182 cases of chickenpox were reported from 2019 to 2021, including 24 085 cases of adults chickenpox, the male to female sex ratio was 1∶1 (12 032∶12 053), basically the same for men and women, and 42 097 cases of children chickenpox, with a gender ratio of 1.4∶1, the male to female ratio was 1.4∶1 (24 699∶17 398). Fever in chickenpox cases was mainly low and moderate, but the proportion of moderate fever with temperature between 38.1 and 39.0 ℃ in children cases (35.0%,14 744/42 097) was significantly higher than that in adults (32.0%,7 696/24 085). The number of herpes in chickenpox cases was mainly less than 50, but the proportion of severe cases with 100-200 herpes in children was higher than that in adults. The incidence rate of complications was 1.4% (333/24 085) in adults chickenpox, the incidence rate of complications was 1.7% (731/42 097) in children chickenpox. The incidence of encephalitis and pneumonia in children was higher than in adults, and the difference was statistically significant (P<0.05). The proportion of chickenpox cases was mainly outpatient, but the hospitalization rate of children cases was 14.4% (6 049/42 097), higher than that of adults, which was 10.7% (2 585/24 085). Conclusions: There were differences between adult chickenpox and child chickenpox in terms of epidemic and clinical manifestations; the symptoms of child chickenpox were more serious than adult chickenpox. However, the adult chickenpox population is generally susceptible and lacks immune strategy protection, which calls for more attention.

COVID-19 in early 2023: Structure, replication mechanism, variants of SARS-CoV-2, diagnostic tests, and vaccine & drug development studies.

Coronavirus Disease-19 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome-coronaviruses-2 (SARS-CoV-2), a highly pathogenic and transmissible coronavirus. Most cases of COVID-19 have mild to moderate symptoms, including cough, fever, myalgias, and headache. On the other hand, this coronavirus can lead to severe complications and death in some cases. Therefore, vaccination is the most effective tool to prevent and eradicate COVID-19 disease. Also, rapid and effective diagnostic tests are critical in identifying cases of COVID-19. The COVID-19 pandemic has a dynamic structure on the agenda and contains up-to-date developments. This article has comprehensively discussed the most up-to-date pandemic situation since it first appeared. For the first time, not only the structure, replication mechanism, and variants of SARS-CoV-2 (Alpha, Beta, Gamma, Omicron, Delta, Epsilon, Kappa, Mu, Eta, Zeta, Theta, lota, Lambda) but also all the details of the pandemic, such as how it came out, how it spread, current cases, what precautions should be taken, prevention strategies, the vaccines produced, the tests developed, and the drugs used are reviewed in every aspect. Herein, the comparison of diagnostic tests for SARS-CoV-2 in terms of procedure, accuracy, cost, and time has been presented. The mechanism, safety, efficacy, and effectiveness of COVID-19 vaccines against SARS-CoV-2 variants have been evaluated. Drug studies, therapeutic targets, various immunomodulators, and antiviral molecules applied to patients with COVID-19 have been reviewed.

Successful use of emapalumab in refractory hemophagocytic lymphohistiocytosis in a child with Chédiak–Higashi syndrome: a case report

BackgroundHemophagocytic lymphohistiocytosis is a life-threatening disease heralded by fever, cytopenia, hepatosplenomegaly, and multisystem organ failure. Its association with genetic mutations, infections, autoimmune disorders, and malignancies is widely reported.Case presentationA 3-year-old male Arab Saudi patient with insignificant past medical history and parental consanguinity presented with abdominal distension of moderate severity and persistent fever despite receiving antibiotics. This was accompanied by hepatosplenomegaly and silvery hair. The clinical and biochemical profiles were suggestive of Chédiak–Higashi syndrome with hemophagocytic lymphohistiocytosis. The patient received the hemophagocytic lymphohistiocytosis-2004 chemotherapy protocol and had multiple hospital admissions mainly due to infections and febrile neutropenia. After achieving the initial remission, the patient’s disease reactivated and did not respond to reinduction with the hemophagocytic lymphohistiocytosis-2004 protocol. Due to the disease reactivation and intolerance of conventional therapy, the patient commenced emapalumab. The patient was successfully salvaged and underwent an uneventful hematopoietic stem cell transplantation.ConclusionsNovel agents such as emapalumab can be helpful for the management of refractory, recurrent, or progressive disease, while avoiding the toxicities of conventional therapy. Due to a paucity of available data on emapalumab, additional data are needed to establish its role in hemophagocytic lymphohistiocytosis treatment.

Fever integrates antimicrobial defences, inflammation control, and tissue repair in a cold-blooded vertebrate

Multiple lines of evidence support the value of moderate fever to host survival, but the mechanisms involved remain unclear. This is difficult to establish in warm-blooded animal models, given the strict programmes controlling core body temperature and the physiological stress that results from their disruption. Thus, we took advantage of a cold-blooded teleost fish that offered natural kinetics for the induction and regulation of fever and a broad range of tolerated temperatures. A custom swim chamber, coupled to high-fidelity quantitative positional tracking, showed remarkable consistency in fish behaviours and defined the febrile window. Animals exerting fever engaged pyrogenic cytokine gene programmes in the central nervous system, increased efficiency of leukocyte recruitment into the immune challenge site, and markedly improved pathogen clearance in vivo, even when an infecting bacterium grew better at higher temperatures. Contrary to earlier speculations for global upregulation of immunity, we identified selectivity in the protective immune mechanisms activated through fever. Fever then inhibited inflammation and markedly improved wound repair. Artificial mechanical hyperthermia, often used as a model of fever, recapitulated some but not all benefits achieved through natural host-driven dynamic thermoregulation. Together, our results define fever as an integrative host response that regulates induction and resolution of acute inflammation, and demonstrate that this integrative strategy emerged prior to endothermy during evolution.

Improved understanding of the respiratory drive pathophysiology could lead to earlier spontaneous breathing in severe acute respiratory distress syndrome

Optimisation of the respiratory drive, as early as possible in the setting of severe acute respiratory distress syndrome (ARDS) and not its suppression, could be a new paradigm in the management of severe forms of ARDS. Severe ARDS is characterised by tachypnoea and hyperpnoea, a consequence of a high respiratory drive. Some patients require endotracheal intubation, controlled mechanical ventilation (CMV) and paralysis to prevent overt ventilatory failure and self-inflicted lung injury. Nevertheless, intubation, CMV and paralysis do not address per se the high respiratory drive, they only suppress it. Optimisation of the respiratory drive could be obtained by a multimodal approach that targets attenuation of fever, agitation, systemic and peripheral acidosis, inflammation, extravascular lung water and changes in carbon dioxide levels. The paradigm we present, based on pathophysiological considerations, is that as soon as these factors have been controlled, spontaneous breathing could resume because hypoxaemia is the least important input to the respiratory drive. Hypoxaemia could be handled by combining positive end-expiratory pressure (PEEP) to prevent early expiratory closure and low pressure support to minimise the work of breathing (WOB). ‘Cooperative’ sedation with alpha-2 agonists, supplemented with neuroleptics if required, is the pharmacological adjunct, administered immediately after intubation as the first-line sedation regimen during the multimodal approach. Given relative contraindications (hypovolaemia, auriculoventricular block, sick sinus syndrome), alpha-2 agonists can help attenuate or moderate fever, increased oxygen consumption VO2, agitation, high cardiac output, inflammation and acidosis. They may also help to preserve microcirculation, cognition and respiratory rhythm generation, thus promoting spontaneous breathing. Returning the physiology of respiratory, ventilatory, circulatory and autonomic systems to normal will support the paradigm of optimised respiratory drive favouring early spontaneous ventilation, at variance with deep sedation, extended paralysis, CMV and use of the prone position as therapeutic strategies in severe ARDS. GLOSSARY Glossary and Abbreviations_SDC, http://links.lww.com/EJAIC/A55