Peak Fever Research Articles

Association of Prenatal Maternal Fever and Neonatal Umbilical Artery Blood-Gas Analysis: Evidence from a Tertiary Center at China

Background: Neonatal umbilical artery blood-gas analysis is a diagnostic procedure performed shortly after birth to assess the acid-base balance, oxygenation, and metabolic status of a newborn infant. This retrospective study aimed to investigate the association of prenatal maternal fever with neonatal umbilical artery blood-gas analysis. Methods: A retrospective analysis was conducted on data from 333 parturients and their newborns. Demographic characteristics, clinical information, and neonatal umbilical artery blood gas analysis data were analyzed to evaluate the association between prenatal maternal fever and neonatal blood-gas analysis. Pregnant women with fever (≥38.0 °C) during labor were compared with those without fever. Neonatal umbilical artery blood gas parameters were assessed in relation to the degree and duration of maternal fever. Results: The incidence of the adverse delivery outcome of parturients with high prenatal fever and long duration of fever was significantly higher than that of the low fever, short-term fever, and normal parturients (p < 0.05). The pH of neonatal umbilical veins in the high fever groups was reduced compared with the control group (p < 0.05). Lactic acid (Lac) of neonatal umbilical vein in the low fever and high fever groups was enhanced compared with the control group (p < 0.05). The pH of neonatal umbilical veins in the short-term fever and long-term fever groups was elevated compared with the control group (p < 0.05). The umbilical artery pH and base excess (BE) were positively correlated with maternal peak fever temperature (r = 0.20, r = 0.22, p < 0.05). The umbilical Lac was negatively correlated with maternal peak fever temperature (r = –0.22, p < 0.05). Moreover, the umbilical artery pH and BE were positively correlated with maternal duration of fever (r = 0.29, r = 0.21, p < 0.05). The umbilical artery Lac was negatively correlated with maternal duration of fever (r = –0.25, p < 0.05). Conclusions: The findings suggested that maternal fever during labor was associated with alterations in neonatal umbilical artery blood gas analysis. Understanding the influence of prenatal fever on delivery outcomes is crucial for optimizing maternal and neonatal health.

Escroto agudo en el lactante

Acute scrotum consists of testicular pain associated with local inflammatory signs and is very unsual in neonates and infants. We present a case of a 2-month-old infant with right scrotal swelling and erythema of 48 hours' evolution. Peak fever in the emergency department. On examination, the teste was painful on palpation, with cremasteric reflex present. Testicular ultrasound showed right orchiepididymitis with associated hydrocele. Laboratory tests show leukocytosis, neutrophilia and minimal elevation of acute phase reactants. Urine culture isolated Escherichia coli. He received antibiotherapy for 2 weeks with good evolution. Orchiepididymitis is an acute inflammation of the testicle and epididymis, and it is a very rare pathology in neonates and infants. Haematogenous dissemination is the most frequent cause in this age group, with E. coli being the most frequently isolated germ. Therefore, in neonates and infants with orchiepididymitis, considering the risk of associated bacteraemia, it is essential to optimize the diagnosis by including a complete sepsis study together with Doppler ultrasound and the early initiation of empirical antibiotherapy.

A-320 Validation of a Multi-Analyte Immunoassay for Distinguishing Bacterial Versus Viral Infections in a Pediatric Cohort

Abstract Background Clinical presentation of viral and bacterial infections or co-infections overlaps significantly. Pathogen identification is the gold standard for appropriate treatment. Recently, FDA approved a multivariate index test called MeMed-BV on the MedKey analyzer that distinguishes viral and bacterial infections based on a score derived from the differential expression of 3 host proteins. Here, we sought to validate the MeMed-BV immunoassay on the MedKey analyzer in our pediatric hospital, following guidelines from the Clinical and Laboratory Standards Institute. Methods The analytical performance of MeMed-BV was evaluated by precision (intra- and inter-assay), accuracy (sensitivity and specificity) and interference studies. A retrospective cohort study (n = 60) was conducted to assess the diagnostic accuracy using plasma samples from pediatric patients with acute febrile illness who visited the emergency department of the Texas Children's Hospital, Houston, TX, for whom a C-reactive protein test was requested. The following inclusion criteria were employed: 1) age ≤18 years during the clinical encounter; 2) peak fever >37.5°C with the onset of symptoms such as cough, sore throat, abdominal pain or nausea and vomiting; 3) duration of symptoms ≤7 days; and 4) a positive nucleic acid amplification test (for virus) or abnormal blood culture (for bacteria). Patients with 1) active malignancy, 2) congenital immunodeficiency, 3) active immunosuppressive or immunomodulatory therapy and 4) human immunodeficiency virus or hepatitis B/C virus infection were excluded. Clinical performance was evaluated by blinded adjudication from our emergency room physicians. Results MeMed-BV showed acceptable intra- and inter-assay precision with a range of <3 score units in both the high-score bacterial and the low-score viral samples. Accuracy studies revealed a sensitivity of 94% and specificity of 88% for identifying bacterial infections or co-infections. Our MeMed-BV results showed an excellent agreement (R = 0.998) with the manufacturer's laboratory data and compared well with ELISA studies. Gross hemolysis and icterus did not affect the assay, but gross lipemia showed a considerable bias in samples with a moderate likelihood of viral infection. Importantly, the MeMed-BV score performed better than routinely measured infection-related biomarkers like white blood cell counts, procalcitonin and C-reactive protein in classifying bacterial infections. Furthermore, it is important to note that the score but not individual levels of the biomarkers, should be used to discriminate between bacterial and viral infections. Conclusion MeMed-BV score on the MedKey analyzer demonstrated acceptable analytical performance and is reliable for distinguishing viral and bacterial infections or co-infections in pediatric patients. Future studies are warranted to examine the clinical utility, especially with respect to reducing the need for blood cultures and reducing the time to treatment for the patient.

Differential clinical characteristics and performance of home antigen tests between parents and children after household transmission of SARS-CoV-2 during the Omicron variant pandemic

ObjectivesThe SARS-CoV-2 Omicron variant pandemic struck Taiwan in April 2022. Rapid antigen tests (RATs) play an important role in providing rapid results during a pandemic. However, self-collected samples by the children's caregivers without the supervision of medical personnel raise some concerns. MethodsThis study was performed to investigate household transmission, clinical characteristics, and antigen performance in a special COVID-19 family clinic in a children's hospital. The performance of at-home RATs was evaluated based on reverse transcription-polymerase chain reaction. ResultsWe included 627 patients in our study between May 11 and June 10, 2022. The COVID-19 full vaccination rate was significantly higher in adults (98.5%) than in children (5.9%, P <0.001). The transmission rate was significantly higher in children (91.3%) than in adults (76.6%, P <0.001). Infected children had more incidents of fever (82.4% vs 22.4%, P <0.001) and a higher peak fever than adults. Based on the reverse transcription-polymerase chain reaction, the negative predictive rate of the home RAT was only 38.7% (95% confidence interval: 31.9-46.0%) in children. The cycle threshold value of those with false-negative antigen tests was significantly lower in children. ConclusionChildren had a higher transmission rate, more fever, and higher peak fever than adults. Home RAT has a suboptimal negative predictive rate in children.

Markers of infection and inflammation are associated with post-thrombectomy mortality in acute stroke

ObjectiveWe explored the relationship between markers of infection and inflammation and mortality in patients with acute ischemic stroke who underwent thrombectomy. MethodsWe performed retrospective chart review of stroke patients who underwent thrombectomy at two tertiary academic centers between December 2018 and November 2020. Associations between discharge mortality, WBC count, neutrophil percentage, fever, culture data, and antibiotic treatment were analyzed using the Wilcoxon rank sum test, Student’s t-test, and Fisher’s exact test. Independent predictors of mortality were identified with multivariable analysis. Analyses were repeated excluding COVID-positive patients. ResultsOf 248 patients who underwent thrombectomy, 41 (17 %) died prior to discharge. Mortality was associated with admission WBC count (11 [8–14] vs. 9 [7–12], p = 0.0093), admission neutrophil percentage (78 % ± 11 vs. 71 % ± 14, p = 0.0003), peak WBC count (17 [13–22] vs. 12 [9–15], p < 0.0001), fever (71 % vs. 27 %, p < 0.0001), positive culture (44 % vs. 15 %, p < 0.0001), and days treated with antibiotics (3 [1–7] vs. 1 [0–4], p < 0.0001). After controlling for age, admission NIHSS and post-thrombectomy ASPECTS score, mortality was associated with admission WBC count (OR 13, CI 1.32–142, p = 0.027), neutrophil percentage (OR 1.03, CI 1.0–1.07, p = 0.045), peak WBC count (OR 301, CI 24–5008, p < 0.0001), fever (OR 24.2, CI 1.77–332, p < 0.0001), and positive cultures (OR 4.24, CI 1.87–9.62, p = 0.0006). After excluding COVID-positive patients (n = 14), peak WBC count, fever and positive culture remained independent predictors of mortality. ConclusionMarkers of infection and inflammation are associated with discharge mortality after thrombectomy. Further study is warranted to investigate the causal relationship of these markers with clinical outcome.

Clinical characteristics of 68 children with atypical hand, foot, and mouth disease caused by coxsackievirus A6: a single-center retrospective analysis.

BackgroundHand, foot, and mouth disease (HFMD) caused by coxsackievirus A6 (CV-A6) has become prevalent in many parts of the world. It is commonly referred to as atypical HFMD which more likely to present as bullous lesions. Compared with traditional HFMD, its misdiagnosis rate is relatively high, which brings difficulties to clinical diagnosis. We retrospectively analyze the clinical characteristics of children with HFMD with bullous lesions caused by CV-A6.MethodsThe study included 68 children with atypical HFMD caused by CV-A6 who were hospitalized from 2018 to 2020. Data of the children including age, sex, month of HFMD onset, the morphologies and distribution of rashes, the details of fever, the presence or absence of onychomadesis, and laboratory test results were analyzed and compared between an infant group (<1 year), a toddler group (1–<3 years), and a preschool group (3–<6 years).ResultsOf the 68 children, 67 were younger than 5 years old, with a male to female ratio of 1.62:1. The disease peaked in the period from June to September. With 75.0% of the infant group had more than three kinds of rashes; 95.0% of the preschool group had rashes in more than five locations. These differences were statistically significant (P<0.05). All children had fever. The peak fever in the toddler group was lower (P=0.033). No critical cases were observed in any of the groups. Of the 61 children who were successfully followed up, 68.9% developed onychomadesis within 2–3 weeks. The proportion of cases with abnormal liver function was 83.3%, 41.7%, and 10.0% in the infant, toddler, and preschool groups (P<0.001). The proportion of cases with increased serum creatine kinase MB isoenzyme (CK-MB) were significantly higher in the toddler group (P<0.05).ConclusionsAtypical HFMD caused by CV-A6 infection usually occurred in children under 5 years old. The morphologies of the rashes in the infant group changed more, while the rashes in the preschool group was more widely distributed. The incidence of critical cases was low. More than half of the cases can develop onychomadesis in the recovery period. Organ damage was relatively mild in the preschool group.

Seasonality of Child Growth: High Temperatures Coincide with Growth Faltering among Young Children in Burkina Faso

ObjectivesSeasonal cycles in climatic factors such as temperature and precipitation affect the drivers of child growth and contribute to seasonal fluctuations in undernutrition. Current growth seasonality models are limited by categorical definitions of seasons that rely on assumptions about their timing and fail to consider their magnitude. In this study, we disentangle the relationship between climatic factors and growth indicators, using harmonic regression models to determine how child growth is related to peaks in temperature, precipitation, and vegetation. MethodsLongitudinal anthropometric data collected between August 2014-December 2016 from 5,039 Burkinabè children measured monthly from age 6–28 months were linked with remotely sensed daily precipitation, vegetation, and maximum air temperature. Using harmonic regression models, we compared the magnitude and timing of seasonal peaks in climatic factors and morbidity with that of nadirs in growth velocity (cm/month, kg/month). ResultsLength and weight velocity were slowest twice a year, coinciding both times with the highest temperatures, as rains start and end, and with peak fever and diarrhea incidence. ConclusionsOur results suggest that child health and development are more affected by high temperatures than by other aspects of climatic seasonality such as rainfall. Pathogens causing diarrheal disease and fever thrive and have more opportunities to infect children while temperatures are high, and precipitation is low. Emerging shifts in climatic conditions will pose challenges to optimal growth, highlighting the importance of programmatic and policy-level changes that optimize timing of nutrition interventions and address environmental growth-limiting conditions. Funding SourcesUnited States Agency for International Development.

Risk factors of furazolidone-associated fever.

Furazolidone is a synthetic nitrofuran with a broad spectrum of antimicrobial action and has been widely used in the treatment of Helicobacter pylori (H. pylori) infection. However, its safety profile has not been clarified. Moreover, the drug fever associated with its use is frequently misdiagnosed. The aim of this study was to explore the risk factors of furazolidone-associated fever to increase awareness and stimulate further research on this topic. This was a retrospective case-control study of patients referred to a specialist clinic for furazolidone-containing quadruple regimens for H. pylori infection at a tertiary care hospital located in Eastern China between July 2018 and September 2018. We evaluated adult patients who received furazolidone treatment for Helicobacter pylori infection. The exclusion criteria were as follows: (1) patients were pregnant or breastfeeding; (2) patients received furazolidone treatment not for Helicobacter pylori infection; (3) patients had taken antibiotics or any acid suppressant or non-steroidal anti-inflammatory drug in the last 4 weeks; (4) patients had chronic hepatic, renal, or pulmonary disease. Pertinent information was retrieved from medical records and telephone follow-up. All statistical analysis was performed in SPSS version 22.0. A total of 1499 patients received furazolidone and met the overall inclusion criterion. Of these 1499 patients, 27 (1.80%) developed drug fever. The mean time between initiation of furazolidone and the onset of fever is 11.00 ± 1.84 days, and the median peak fever was 38.87 ± 0.57°C. We found no differences in age and past drug allergy between the non-fever and fever groups. Through multiple logistic regression analysis, we found two variables as independent risk factors for furazolidone-associated fever, including gender (OR, 3.16; 95% CI, 1.26-7.91; P = 0.014) and clarithromycin (OR, 4.83; 95% CI, 2.17-10.79; P<0.001). This retrospective cohort study identified two risk factors for furazolidone-associated fever, which were female and clarithromycin. We also analyzed the characteristics of drug fever during anti-Helicobacter pylori therapy. However, the underlying mechanisms are uncertain and require further research.

Bibliometric analysis of the global literature productivity of adult-onset Still's disease (2011-2020).

Adult-onset Still's disease is a nonfamilial, or sporadic, systemic autoinflammatory disorder accompanied by peak fever ≥ 39°C, arthralgia or arthritis, skin rashes, leukocytosis (≥ 10,000cells/mm3) with neutrophils ≥ 80%, and other clinical symptoms. This study aimed to analyze the quantity and quality of publications, and to exhibit the current global status and trend of adult-onset Still's disease research. Searched with the search term 'Adult onset Still disease' on the Web of Science for time limited to 2011-2020. Original articles and reviews were selected. A total of 537 articles were retrieved from 44 countries, of which 13 met the criteria of major active countries. High-income countries contributed 378 articles (70.39%). The number of articles annually increased significantly in the 10-year period (P < 0.001). China (n = 90, 16.76%), Japan (n = 79, 14.71%), Italy (n = 59, 10.99%), the United States (n = 52, 9.68%) and South Korea (n = 45, 8.38%) are the five most productive countries. Adjusted by population, Italy led the top list, followed by South Korea and Israel. According to gross domestic product analysis, Italy ranked first, followed by Portugal and Turkey. A significant correlation was detected between average citations and AAS (P = 0.002), MRC (P < 0.001). From 2011 to 2020, the number of global articles was increasing rapidly. Most papers came from high-income countries. The relationship between the bibliometric and altmetric analyses are basically consistent, therefore the two can prove/complement each other.

What is the role of chest X-ray imaging in the acute management of children with sickle cell disease?

Children with sickle cell disease (SCD) frequently present to hospital acutely unwell and are often exposed to diagnostic chest X-rays (CXRs). Little evidence exists to determine when CXRs are clinically useful. Using electronic hospital records, we audited CXR use in children aged 0-18 who presented to hospital over the past 10years in both an inpatient and emergency department setting. From a total of 915 first CXRs, only 28·2% of CXRs (n=258) had clinically significant findings that altered management or final diagnosis. Of these abnormalities, consolidation represented 52·3%, effusion 8·9%, cardiomegaly 8·4% and sickle cell-related bone changes 6·3%. Indications for CXR of respiratory distress (OR=3·74, 95% CI 2·28-6·13), hypoxia (OR=1·86, 95% CI 1·50-2·31) and cough (OR=1·64, 95% CI 1·33-2·02), were more likely to have significant CXR findings. Patients who had higher peak fever (38·4°C vs. 37·4°C, P=0·001), higher peak CRP (156·4 vs. 46·1, P<0·001) and higher WCC (20·2 vs. 13·6, P<0·001) were more likely to have clinically significant abnormalities on CXR. We found a decision tool using either hypoxia, cough, respiratory distress, T>38°C, CRP>50 or WCC>15×109 /l as indications for CXR, to have a sensitivity of 88% (with 95% CI 0·78-0·95) and specificity of 46% (95% CI 0·43-0·50) for clinically significant findings.

The Two-Step Approach to Haploidentical Hematopoietic Stem Cell Transplantation (HI HSCT): 15 Years of Transplants in Patients 19-78 Years Old

Background/Methods: The two-step approach to HI HSCT was developed in 2005 with the first patient treated on clinical trial in early 2006. In this approach, after myeloablative [MA- 12 Gy total body irradiation (TBI)], reduced intensity (RIC- fludarabine, 2 Gy TBI and cytarabine, OR thiotepa, OR busulfan), or nonmyeloablative (NMA-fludarabine and 2 Gy TBI) conditioning, patients receive a fixed dose of unmanipulated donor lymphocytes (DLI) containing 2 x 108/kg CD3+ cells (Step 1). Two days later, cyclophosphamide (CY) 60 mg/kg/day x 2 is infused for bidirectional T cell tolerization. One day after the completion of CY, a CD34-selected stem cell product is infused (Step 2). All patients receive tacrolimus and mycophenolate mofetil starting at d-1. The two-step approach avoids stem cell exposure to CY, allows a growth factor-naïve fixed dose of donor T-cells to be infused increasing uniformity for outcomes analysis, and permits easier manipulation of both T-cell and CD34 cell dosing. In later protocols, the timing of the DLI after conditioning and the CD34 cell dose have been manipulated with the goal of reducing relapse, and age-based comorbidity and performance status indices were added to eligibility criteria to reduce non-relapse mortality (NRM). Results: We analyzed all 283 patients treated on a two-step HI HSCT clinical trial at our institution. The median follow-up is 63 (range 1-165) months. Diagnoses were AML (n=118), MDS (n=43), myeloproliferative disorder (n=7), CMML (n=3), B-ALL (n=21), Ph+ ALL (n=15), multiple myeloma (n=14), T cell ALL (n=9), aggressive lymphoma (n=15), CLL (n=8), Hodgkin (n=7), aplastic anemia (n=5), and lymphoma-other (n=18). Patients had high (45%), intermediate (43%), very high (5%), and low (4%) risk disease per the Revised Disease Risk Index. Median age of the group is 58 (19-78) years and 21% of patients were &amp;gt;age 65. Conditioning was MA in 56%, RIC in 37%, and NMA in 7%. All patients received 2 x 108/kg CD3+ cells in step 1 of the HSCT except for 1 early patient who received 1.7 x 108/kg CD3+ cells. Median CD34 cell dose was 6.3 (range 1.0-20.0) x 106/kg, median non-CY-exposed T cells in the CD34 product was 2.88 (range 0.33-50.0) x 103/kg. Patients developed a haploimmunostorm manifested by high grade fever, diarrhea and rash within 24 hours of receiving DLI. These symptoms effectively resolved after the administration of CY. Median peak fever of patients during the haploimmunostorm was 103.6 (range 98.6-106.1). No patients died as a consequence of the haploimmunostorm. Cumulative incidence (CI) of donor engraftment was 97%. Median time to neutrophil and platelet engraftment was 11 (8-21) days and 17 (10-173) days respectively. All results at 2 years: CI of relapse and NRM were 25% each. CI grades 2-4 and 3-4 acute GVHD were 39% and 7% respectively, and CI chronic GVHD was 15%. Probability of survival (OS) was 55% in the total cohort and 34% in patients &amp;gt;65 years. In patients with AML which represented the largest subgroup of patients, OS was 51% in the total cohort and 40% in patients &amp;gt; 65. Conclusion: HI HSCT using the two-step approach is an effective treatment for a variety of hematologic malignancies and dyscrasias. Despite older age, over 1/3 of patients &amp;gt;65 years were alive 2 years after HI-HSCT. Disclosures Flomenberg: Tevogen: Consultancy, Honoraria.

HSCT Engraftment Kinetics: Differences in Chimerism between Haploidentical (HI) and Matched Related (MR) Transplant Recipients (HSCT) after the 2 Step Approach

Cyclophosphamide (CY) toleration has been associated with low rates of graft versus host disease (GVHD) and non-relapse mortality after both HI and MR HSCT. At Jefferson, both recipient types undergo a 2 step approach to HSCT in which after myeloablative (MYA) or reduced intensity (RIC) conditioning, patients receive a fixed dose of 2 x 108/kg donor CD3+ T cells (DLI), followed 2 days later by CY daily x 2 for bidirectional tolerization. A CD34-selected stem cell product containing < 5 x 104/kg untolerized CD3 cells is infused 24 hours after CY. Mycophenolate mofetil and tacrolimus are started on day-1 for GVHD prophylaxis. The consistency of cell doses, conditioning, and GVHD prophylaxis in the approach provides an optimal platform for comparing patient outcomes. Because tolerance induction and sustained engraftment in CY-based HSCT approaches depends on elimination of donor and host alloreactive T cells, we hypothesized that engraftment in this model would be different between HI and MR recipients based on the lower proliferation of alloreactive T cells in major histocompatibility (MHC) MR versus HI donor-recipient pairs.Data for 292 consecutive patients (232 HI, 60 MR) treated on a 2-step trial were evaluated for incorporation into this analysis. To be included, patients were required to be in remission for 3 months post HSCT and have available d+28 and d+90 peripheral blood T cell chimerism data. Seven HI patients with graft rejection, 5/232 with early (2%-all MYA) and 2/232 with late (0.1%-1 MYA and 1 RIC), were not included in the analysis. No MR patients developed graft rejection. Days to ANC > 500 cells x 103/ul, CD3/4 and CD3/8 counts at d+28 and d+90, peak fever after DLI infusion as a rough measure of alloreactivity, and number of patients requiring post HSCT donor lymphocytes for mixed chimerism were also examined. Independent samples T test was used for chimerism and peak fever comparisons.The final study group contained 201 patients treated on a 2 step MYA [12 Gy total body irradiation (TBI)] or RIC (fludarabine/TBI based) regimen. Patients had various hematological malignancies and 6 had aplastic anemia. Data is contained in the table.Mean T cell chimerism was higher in HI versus MR recipients at d+28 and d+90 (p= 0.001 both time points). In 3 MR recipients, donor T cell chimerism was < 70% through d+90. Four (9%) MR versus no HI recipients received post HSCT DLI for mixed chimerism in the absence of recurrent disease. Chimerism differences did not affect time to myeloid engraftment or lymphoid reconstitution. While higher median peak temperatures after DLI were observed in HI versus MR recipients, some patients in the latter population were also highly febrile. Those MR recipients with higher fevers had a higher mean donor engraftment percentage at d+28 than those with lower fevers, but the difference was not significant (96.61% vs 93.95%, p=0.193).The data presented here supports the concept that MHC mismatching in HI HSCT is associated with a higher frequency of alloreactive T cells in the DLI which more efficiently eliminate residual host lymphocytes prior to CY administration resulting in more complete donor lymphoid chimerism. Interestingly, further support for this notion was provided by the MR recipient data where higher fevers, a surrogate for more robust immunologic activation, translated into the more rapid achievement of full donor chimerism. This finding was potentially due to higher alloreactivity between some MR recipient/donor pairs from non-MHC polymorphisms. Persistence of small numbers of host lymphocytes, which have also been rendered tolerant by CY administration, does not, in and of itself, lead to graft failure/rejection. However, concerns that low degree of chimerism might contribute to higher risk of relapse led to administration of post-transplant DLIs to push donor lymphoid chimerism closer to 100%. The impact if any, of delayed complete chimerism on GVHD and relapse requires further evaluation and may dictate changes to the 2 step regimen for the MR group. [Display omitted] DisclosuresPorcu:Innate Pharma: Consultancy.

Aktivitas Antipiretik Ekstrak Etanol Buah Belimbing Wuluh (Averrhoa bilimbi) pada Tikus Putih Jantan (ANTIPYRETIC ACTIVITY OF ETHANOL EXTRACT OF BELIMBING WULUH (AVERRHOA BILIMBI) IN MALE WHITE RAT)

The experiment was conducted to study the activity of ethanol extract of belimbing wuluh (EEBW) as antipyretic. Fever induction was done by using difteri pertusis tetanus (DPT) vaccine intramuscularly at a dose of 0.1 mL/100 g BW. Male white rat strain spraque dawley with range of weight by 200 to 300 g was used in this research.Fifteen experimental rats were used to explore the specific time of fever (time of early fever and time of peak fever) which were divided in 2 treatments, i.e. 10 experimental rats with DPT vaccine injection and 5 experimental rats without DPT vaccine injection as control.Fourty experimental rats were used to study effectivity of EEBW as antipyretic which were grouped with factorial randomized design with 4 x 2 and 5 replications. The first factor was various substance administered which consisted of aquadest (control), EEBW 0.88 g/kg BW, EEBW 1.75 g/kg BW, and aspirin 0.004 g/kg BW.The second factor was time of fever detection, i.e. time of early stage fever and time of peak fever. The variable was measured with rectal temperature of the experimental rats by using digital thermometer (correction factor 0.01oC) every 30 minutes. The data were analyzed with t-student dan general linear model (GLM). Increasing of rectal temperature of experimental rats with DPT injection began at 30 minutes post-DPT injection (time of early stage fever) and reached time of peak fever at 210 minutes post-DPT injection. Ethanol extract of belimbing wuluh at dose of 1.75 g/kg BW administered at early fever lowered rectal temperature of the experimental rats compared to the other groups. It was concluded that the administration of EEBW at dose of 1.75 g/kg BW was effective combination in dose and time administration as an antipyretic.

The risk of subsequent epilepsy in children with febrile seizure after 5 years of age

PurposeDespite their age-dependent definition, febrile seizures (FS) may be observed in people of almost any age. The risk of developing unprovoked seizures after an FS is well defined. However, there are limited data about FS starting or persisting after 5 years of age. In the present study, we evaluated patients who developed FS after 5 years of age. MethodBetween 2010 and 2014, we prospectively enrolled all patients with FS. We collected demographic and clinical features, radiologic images, electroencephalograms (EEGs), and results of psychomotor development tests and treatment data of the patients. The patients were grouped into two groups. Group 1 consisted of patients who had the first FS after 5 years of age, and group 2 consisted of patients in whom FS persisted after 5 years of age. Fisher’s exact test and Pearson’s chi-square test were used to analyse the study data and derive conclusions. ResultsSixty-four patients were enrolled, and afebrile seizure was observed in 12 (18.8%) of them. Nine (14%) patients were diagnosed to have epilepsy in their follow-up examination. Subsequent epilepsy occurrence was independent of gender, mean age, medical history of the patient, family history of epilepsy, presence of afebrile seizure, type of seizure, type of FS, duration of seizure, semiology of seizure, peak fever and EEG and magnetic resonance imaging (MRI) findings in our total cohort. There were no statistical differences between the groups with regard to the occurrence of subsequent afebrile seizure or epilepsy (p>0.5). ConclusionClose follow-up is important in patients with FS after the age of 5 years. These seizures are generally benign, but tend to recur and increase the risk of development of epilepsy in the patient. Further studies with a larger cohort are warranted to clarify risk factors and incidence of epilepsy in these patients.

Peripheral Leukocyte Migration in Ferrets in Response to Infection with Seasonal Influenza Virus.

In order to better understand inflammation associated with influenza virus infection, we measured cell trafficking, via flow cytometry, to various tissues in the ferret model following infection with an A(H3N2) human seasonal influenza virus (A/Perth/16/2009). Changes in immune cells were observed in the blood, bronchoalveolar lavage fluid, and spleen, as well as lymph nodes associated with the site of infection or distant from the respiratory system. Nevertheless clinical symptoms were mild, with circulating leukocytes exhibiting rapid, dynamic, and profound changes in response to infection. Each of the biological compartments examined responded differently to influenza infection. Two days after infection, when infected ferrets showed peak fever, a marked, transient lymphopenia and granulocytosis were apparent in all infected animals. Both draining and distal lymph nodes demonstrated significant accumulation of T cells, B cells, and granulocytes at days 2 and 5 post-infection. CD8+ T cells significantly increased in spleen at days 2 and 5 post-infection; CD4+ T cells, B cells and granulocytes significantly increased at day 5. We interpret our findings as showing that lymphocytes exit the peripheral blood and differentially home to lymph nodes and tissues based on cell type and proximity to the site of infection. Monitoring leukocyte homing and trafficking will aid in providing a more detailed view of the inflammatory impact of influenza virus infection.

Human temperatures for syndromic surveillance in the emergency department: data from the autumn wave of the 2009 swine flu (H1N1) pandemic and a seasonal influenza outbreak.

BackgroundThe emergency department (ED) increasingly acts as a gateway to the evaluation and treatment of acute illnesses. Consequently, it has also become a key testing ground for systems that monitor and identify outbreaks of disease. Here, we describe a new technology that automatically collects body temperatures during triage. The technology was tested in an ED as an approach to monitoring diseases that cause fever, such as seasonal flu and some pandemics.MethodsTemporal artery thermometers that log temperature measurements were placed in a Boston ED and used for initial triage vital signs. Time-stamped measurements were collected from the thermometers to investigate the performance a real-time system would offer. The data were summarized in terms of rates of fever (temperatures ≥100.4 °F [≥38.0 °C]) and were qualitatively compared with regional disease surveillance programs in Massachusetts.ResultsFrom September 2009 through August 2011, 71,865 body temperatures were collected and included in our analysis, 2073 (2.6 %) of which were fevers. The period of study included the autumn–winter wave of the 2009–2010 H1N1 (swine flu) pandemic, during which the weekly incidence of fever reached a maximum of 5.6 %, as well as the 2010–2011 seasonal flu outbreak, during which the maximum weekly incidence of fever was 6.6 %. The periods of peak fever rates corresponded with the periods of regionally elevated flu activity.ConclusionsTemperature measurements were monitored at triage in the ED over a period of 2 years. The resulting data showed promise as a potential surveillance tool for febrile disease that could complement current disease surveillance systems. Because temperature can easily be measured by non-experts, it might also be suitable for monitoring febrile disease activity in schools, workplaces, and transportation hubs, where many traditional syndromic indicators are impractical. However, the system’s validity and generalizability should be evaluated in additional years and settings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12873-016-0080-7) contains supplementary material, which is available to authorized users.

Impact of Perihemorrhagic Edema on Short-Term Outcome After Intracerebral Hemorrhage.

Intracerebral hemorrhage (ICH) is a devastating disease with ICH volume being the main predictor of poor outcome. The prognostic role of perihemorrhagic edema (PHE) is still unclear; however, available data are mainly derived from analyses during the first days after symptom onset. As PHE growth may continue up to 14days after ICH, we evaluated PHE over a longer period of time and investigated its impact on short-term clinical outcome. In this monocentric retrospective cohort study, patients with spontaneous supratentorial ICH were identified from our institutional data base. Different time points of CT scans were merged to time clusters for better comparison (day 1, 2-3, 4-6, 7-9, 10-12). Absolute volumes of ICH and PHE were obtained using a validated semiautomatic volumetric algorithm. Clinical outcome at discharge was assessed using the modified Rankin Scale (0-3=favorable, 4-6=poor). 220 patients (83 with favorable, 137 with poor outcome) were included in the final analysis. Mean ICH volume on admission was 22.8 [standard deviation (SD) 24.6] cm(3). Mean absolute PHE volume on admission was 22.5 (SD 20.8) cm(3) and increased to a mean peak volume of 38.1 (SD 31.4) cm(3) during 6.7 (SD 4.1) days on average. Besides GCS on admission, functional status before ICH, peak hematoma volume, lobar localization and fever burden, and high peak PHE volume predicted poor outcome at discharge [OR 0.977 (95% CI 0.957-0.998)] in the multivariable analysis. PHE may have a negative impact on short-term functional outcome after ICH and therefore represent a possible treatment target.

Clinical characteristics and treatment-related biomarkers associated with response to high-dose interleukin-2 in metastatic melanoma and renal cell carcinoma: retrospective analysis of an academic community hospital's experience.

BackgroundImmunotherapy in the treatment of metastatic melanoma and renal cell carcinoma can produce durable therapeutic responses, which may improve survival. We aimed to identify clinical characteristics and biomarkers associated with response to high-dose interleukin-2 therapy (IL-2) in patients with metastatic melanoma and renal cell carcinoma treated at an academic community hospital.Patients/MethodsWe retrospectively analyzed clinical variables and biomarkers of 50 consecutive metastatic melanoma or renal cell carcinoma patients treated at our institution with IL-2 during 2004 – 2012. We evaluated clinical characteristics: metastatic sites of disease, prior therapies, number of IL-2 doses per cycle, response duration, autoimmune phenomena, and peak fever, as well as laboratory biomarkers: baseline LDH, platelet nadir, and baseline and highest absolute lymphocyte count (ALC). Survival outcomes were calculated using Kaplan-Meier curves.ResultsVariables differing between responders (clinical benefit group) and non-responders (no clinical benefit group) in metastatic melanoma included platelet nadir during treatment (p = 0.015), autoimmune phenomena (p = 0.049), and in renal cell carcinoma, platelet nadir (p = 0.026). There were no significant differences between number of doses of IL-2 received per cycle and response in either cancer subtype. Clinical benefit occurred in 25% of patients (9/36) when IL-2 was given as first-line therapy. Median overall survival for the clinical benefit group from the initiation of IL-2 to death or last follow-up was 61 months versus 17 months for the no clinical benefit group (p < 0.001) for metastatic melanoma. In renal cell carcinoma overall survival for clinical benefit patients was 48 months versus 17 months. No treatment-related deaths occurred.ConclusionsHigh-dose IL-2 can be safely administered by an experienced team in a non–intensive care oncology unit. The clinical benefit group developed autoimmune phenomena (melanoma patients), lower platelet nadir, and on average, received the same number of IL-2 doses as the no clinical benefit group, suggesting a response relationship to the patient’s baseline immune status. Further investigation of immune predictors of response may be useful to select appropriate patients for this therapy.

Clinical and microbiological characteristics of spontaneous acute prostatitis and transrectal prostate biopsy-related acute prostatitis: Is transrectal prostate biopsy-related acute prostatitis a distinct acute prostatitis category?

This study aimed to compare the clinical and microbiological characteristics between acute bacterial prostatitis and transrectal biopsy-related acute prostatitis. We retrospectively reviewed the records of 135 patients hospitalized for acute prostatitis in three urological centers between 2004 and 2013. Acute bacterial prostatitis was diagnosed according to typical symptoms, findings of physical examination, and laboratory test results. Clinical variables, laboratory test results, and anti-microbial susceptibility results were reviewed. Patients were classified into the spontaneous acute prostatitis group (S-ABP) or biopsy-related acute prostatitis (Bx-ABP) for comparison of their clinical, laboratory, and microbiological findings. The mean age of all patients was 61.7 ± 12.9 years. Compared with S-ABP patients, Bx-ABP patients were significantly older, had larger prostate volumes, higher PSA values, higher peak fever temperatures, and higher incidence of septicemia and antibiotic-resistant bacteria. Overall, of the 135 patients, 57.8% had positive bacterial urine and/or blood cultures. Bx-ABP patients had a higher incidence of bacterial (urine and/or blood) positive cultures compared to S-ABP patients (66.7% versus 55.6%). Escherichia coli was the predominant organism in both groups, but it was more common in Bx-ABP (88.9%) than in S-ABP (66.7%). Extended spectrum beta-lactamase -producing bacteria accounted for 64.7% of culture-positive patients in the Bx-ABP group compared to 13.3% in the S-ABP group. Bx-ABP patients showed a higher incidence of septicemia and antibiotic-resistant bacteria than S-ABP patients. These results have important implications for the management and antimicrobial treatment of Bx-ABP, which may well deserve to be considered a distinct prostatitis category.

P-019 Sweetʼs Syndrome as an Extraintestinal Ulcerative Retocolitis Manifestation

Inflammatory Bowel Diseases (IBD) are associated with a variety of extraintestinal manifestations and can virtually affect every organ. The incidence of cutaneous manifestations occurs in the range from 2% to 34% of the cases and are presented as erythema nodosum, pyoderma gangrenosum and Sweet's Syndrome (SS). The Sweet's syndrome (SS) is a rare form with strong predilection for females (87%), colonic involvement (100%) and other extra-intestinal findings (77%). It also has association with the disease activity from 67% to 80% of the cases. It is characterized by the appearance of erythema, erythematous papules or painful but not itchy nodules with preferential involvement of the face, neck and upper limbs, accompanied by fever, neutrophilia and neutrophilic infiltrate in the upper dermis. Diagnostic criteria are clinical and histopathological as proposed by Su and Liu in 1987 which remain valid today. The most effective treatment is immunosuppressive therapy, most commonly with systemic corticosteroids at doses ranging from 40 and 80 mg/day of Prednisone with good efficacy. Case report and literature review. This current report documents the rare extra-intestinal manifestation developed by a male patient of 47 years old, a former smoker, accompanied at the Inflammatory Bowel Diseases Clinic of the Faculty of Medicine of Botucatu (FMB) for UC—pancolitis, of difficult control. The pathology report showed colitis in intense activity with microabscesses and crypts, and a merge of them. Cutaneous effects began 10 months after diagnosis, with the appearance of erythematous papules on target with central umbilication, some of them resembling pustules and tendency to central ulceration on the face, trunk and limbs for 2 days (Fig. 1). She also reported a peak fever and was admitted to hospital with leukocytosis, at the expense of neutrophilia and elevated inflammatory activity tests. A performed skin biopsy showed an inflammatory infiltrate of predominantly neutrophilic nature in the dermis without leukocytoclastic vasculitis. With a confirmed diagnosis of Sweet's Syndrome she started steroids treatment (40 mg/day of Prednisone) and a significant improvement of the skin condition was obtained after a month of onset. After 3 months of therapy at weaning of steroids (Prednisone 20 mg/day), there was only a slight erythema and some secondary acneiform eruptions to the medication with no additional active lesions (Fig. 2). The patient remains under follow-up with no recurrence of the condition. The completion of well documented and internationally accepted clinical criteria was the real milestone to confirm the diagnosis of patient's cutaneous condition which was only ratified by the excellent response to treatment with corticosteroids. Finally, when IBD is mentioned the importance of a detailed clinical follow-up is recognized regardless of the organ and multi-professionalism involved for clinical suspicion of rare manifestations as this one described in this patient.