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Sample records for acute infectious illness

  1. Infectious Etiologies of Acute Febrile Illness among Patients Seeking Health Care in South-Central Cambodia

    PubMed Central

    Kasper, Matthew R.; Blair, Patrick J.; Touch, Sok; Sokhal, Buth; Yasuda, Chadwick Y.; Williams, Maya; Richards, Allen L.; Burgess, Timothy H.; Wierzba, Thomas F.; Putnam, Shannon D.

    2012-01-01

    The agents of human febrile illness can vary by region and country suggesting that diagnosis, treatment, and control programs need to be based on a methodical evaluation of area-specific etiologies. From December 2006 to December 2009, 9,997 individuals presenting with acute febrile illness at nine health care clinics in south-central Cambodia were enrolled in a study to elucidate the etiologies. Upon enrollment, respiratory specimens, whole blood, and serum were collected. Testing was performed for viral, bacterial, and parasitic pathogens. Etiologies were identified in 38.0% of patients. Influenza was the most frequent pathogen, followed by dengue, malaria, and bacterial pathogens isolated from blood culture. In addition, 3.5% of enrolled patients were infected with more than one pathogen. Our data provide the first systematic assessment of the etiologies of acute febrile illness in south-central Cambodia. Data from syndromic-based surveillance studies can help guide public health responses in developing nations. PMID:22302857

  2. Hospital-Based Surveillance for Infectious Etiologies Among Patients with Acute Febrile Illness in Georgia, 2008-2011.

    PubMed

    Kuchuloria, Tinatin; Imnadze, Paata; Mamuchishvili, Nana; Chokheli, Maiko; Tsertsvadze, Tengiz; Endeladze, Marina; Mshvidobadze, Ketevan; Gatserelia, Lana; Makhviladze, Manana; Kanashvili, Marine; Mikautadze, Teona; Nanuashvili, Alexander; Kiknavelidze, Khatuni; Kokaia, Nora; Makharadze, Manana; Clark, Danielle V; Bautista, Christian T; Farrell, Margaret; Fadeel, Moustafa Abdel; Maksoud, Mohamed Abdel; Pimentel, Guillermo; House, Brent; Hepburn, Matthew J; Rivard, Robert G

    2016-01-01

    Information on the infectious causes of undifferentiated acute febrile illness (AFI) in Georgia is essential for effective treatment and prevention. In May 2008, a hospital-based AFI surveillance was initiated at six hospitals in Georgia. Patients aged ≥ 4 years with fever ≥ 38°C for ≥ 48 hours were eligible for surveillance. Blood culture and serologic testing were conducted for Leptospira spp., Brucella spp., West Nile virus (WNV), Crimean-Congo hemorrhagic fever virus, Coxiella burnetii, tick-borne encephalitis virus (TBEV), hantavirus, Salmonella enterica serovar Typhi (S. Typhi), and Rickettsia typhi. Of 537 subjects enrolled, 70% were outpatients, 54% were males, and the mean age was 37 years. Patients reported having fatigue (89%), rigors (87%), sweating (83%), pain in joints (49%), and sleep disturbances (42%). Thirty-nine (7%) patients were seropositive for R. typhi, 37 (7%) for Brucella spp., 36 (7%) for TBEV, 12 (2%) for Leptospira spp., 10 (2%) for C. burnetii, and three (0.6%) for S. Typhi. None of the febrile patients tested positive for WNV antibodies. Of the patients, 73% were negative for all pathogens. Our results indicate that most of the targeted pathogens are present in Georgia, and highlight the importance of enhancing laboratory capacity for these infectious diseases. PMID:26438032

  3. Correlates of illness severity in infectious mononucleosis

    PubMed Central

    Odame, John; Robinson, Joan; Khodai-Booran, Nasser; Yeung, Simon; Mazzulli, Tony; Stephens, Derek; Allen, Upton D

    2014-01-01

    INTRODUCTION: Understanding the spectrum and frequencies of Epstein-Barr virus (EBV) complications and markers of illness severity in immunocompetent patients with primary EBV infection will inform management of patients with EBV-related illnesses. OBJECTIVES: To determine the clinical and laboratory correlates of illness severity among infants, children and youth with infectious mononucleosis (IM). METHODS: Study subjects with confirmed IM were prospectively enrolled. Illness severity was assessed at baseline and at six weeks using a scoring tool. Peripheral blood viral loads served as a measure of viral burden. RESULTS: Among 32 children and young adults with IM, the median age was 16 years (range two to 24 years). The predominant clinical findings were lymphadenopathy (23 of 32 [72%]), pharyngitis (16 of 32 [50%]), fever (nine of 32 [28%]) and splenomegaly (six of 32 [19%]). With respect to symptoms or signs that persisted to at least six weeks after illness onset, the predominant complaint was lymphadenopathy in 35% of subjects available for reassessment. Deranged liver function tests were present at presentation in up to 44% of subjects. Patients with the highest viral loads at presentation had significantly higher illness severity scores associated with fatigue (P=0.02). Other than the scores associated with fatigue, viral load values were not significantly correlated with the illness severity scores at baseline and at six weeks. CONCLUSION: In IM, viral loads are not necessarily correlated with illness severity, with the exception of fatigue. EBV-related hepatitis is common in IM, confirming the status of this virus as a relatively common cause of transient hepatitis in children and youth. This entity is not necessarily a marker of disease severity. PMID:25371691

  4. Immunological reason for chronic ill health after infectious mononucleosis.

    PubMed Central

    Hamblin, T J; Hussain, J; Akbar, A N; Tang, Y C; Smith, J L; Jones, D B

    1983-01-01

    In a group of patients who suffered from chronic ill health after an attack of acute infectious mononucleosis a disorder of T cell regulation was found. By means of cytochemical reactions the staining pattern associated with T suppressor cells was found in a greater percentage and that associated with T helper cells in a smaller percentage than in normal subjects. In a few patients this finding was confirmed in a functional suppressor assay. The patients were unwell for at least a year but most later made a complete recovery, which was associated with return to normal of the lymphocyte subsets. PMID:6222781

  5. Effectiveness of probiotics on the duration of illness in healthy children and adults who develop common acute respiratory infectious conditions: a systematic review and meta-analysis.

    PubMed

    King, Sarah; Glanville, Julie; Sanders, Mary Ellen; Fitzgerald, Anita; Varley, Danielle

    2014-07-14

    Recent systematic reviews have reported a positive, although modest, effect of probiotics in terms of preventing common cold symptoms. In this systematic review, the effect of probiotics, specifically Lactobacillus and Bifidobacterium strains, on the duration of acute respiratory infections in otherwise healthy children and adults was evaluated. To identify relevant trials, eight databases, including MEDLINE, Embase, the Cochrane Database of Systematic Reviews (CDSR), the Cochrane Central Register of Controlled Trials (CENTRAL), the Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment (HTA), Science Citation Index (SCI) and OAISTER, were searched from inception to 20 July 2012. Details regarding unpublished studies/databases were also obtained from probiotic manufacturers. Study selection, data extraction and quality assessment were carried out by two reviewers. Risk of bias was assessed using criteria adapted from those published by the Centre for Reviews and Dissemination. In this review, twenty randomised controlled trials (RCT) were included, of which twelve were considered to have a low risk of bias. Meta-analysis revealed significantly fewer numbers of days of illness per person (standardised mean difference (SMD) - 0·31 (95% CI - 0·41, - 0·11), I²= 3%), shorter illness episodes by almost a day (weighted mean difference - 0·77 (95% CI - 1·50, - 0·04), I²= 80%) (without an increase in the number of illness episodes), and fewer numbers of days absent from day care/school/work (SMD - 0·17 (95% CI - 0·31, - 0·03), I²= 67%) in participants who received a probiotic intervention than in those who had taken a placebo. Reasons for heterogeneity between the studies were explored in subgroup analysis, but could not be explained, suggesting that the effect sizes found may differ between the population groups. This systematic review provides evidence from a number of good-quality RCT that probiotics reduce the duration of illness in

  6. Acalculous Acute Cholecystitis in Previously Healthy Children: General Overview and Analysis of Pediatric Infectious Cases

    PubMed Central

    Poddighe, Dimitri; Tresoldi, Matteo; Licari, Amelia; Marseglia, Gian Luigi

    2015-01-01

    Acute acalculous cholecystitis (AAC) is an inflammation of the gallbladder, which does not appear to be associated with the presence of gallstones. AAC is estimated to represent more than 50% of cases of acute cholecystitis in the pediatric population. Although this pathology was initially described in critically ill patients, actually most pediatric cases have been observed during several infectious diseases. Particularly, here we reviewed pediatric infectious acute acalculous cholecystitis and analyzed the pathophysiological and clinical aspects of bacterial and viral forms. PMID:26640715

  7. The Association between Mental Health and Acute Infectious Illness among a National Sample of 18- To 24-Year-Old College Students

    ERIC Educational Resources Information Center

    Adams, Troy B.; Wharton, Christopher M.; Quilter, Lyndsay; Hirsch, Tiffany

    2008-01-01

    Poor mental health is associated with physical illness, but this association is poorly characterized among college students. Objective and Participants: Using American College Health Association-National College Health Assessment data, the authors characterized poor mental health (depression, anxiety, negative affect) and examined the relationship…

  8. Serum immunoreactive trypsin concentrations in infectious and non-infectious illnesses and in juvenile diabetes.

    PubMed Central

    Gamble, D R; Moffatt, A; Marks, V

    1979-01-01

    Serum immunoreactive trypsin (SIT) concentrations were measured in 244 patients with infectious illnesses and in 281 children with diabetes of recent onset. Results were compared with reference ranges established in 107 patients with non-infectious, non-diabetic illnesses, in whom SIT concentrations were found to increase with advancing age. Reduced or undetectable concentrations of SIT were associated with diabetes in children and with a few cases of severe childhood infection. Increased SIT concentrations were associated with virologically confirmed cases of infection with mumps and Coxsackie B virus infection, and with clinical diagnoses of mumps, PUO, and meningitis in children, and with Bornholm disease, cardiac infection, and respiratory infection in adults. It is suggested that silent invasion of the exocrine pancreas with elevation of the SIT concentration may accompany infection by Coxsackie B, mumps, and, possibly, other viruses. PMID:512051

  9. [Medication in infectious acute diarrhea in children].

    PubMed

    Cézard, J-P; Bellaiche, M; Viala, J; Hugot, J-P

    2007-10-01

    Acute infectious diarrhea in children remain still a frequent cause of morbidity. 50 % of them are due to rotavirus. Oral rehydration therapy and early realimentation have drastically reduced their mortality and morbidity. Beside oral or eventually IV rehydration therapy no medication has proven its efficacy based on the main HMO criteria (reduction of over 30 % of the stool output) except racecadotril and loperamide which is contre-indicated for the last one in children less than 2 years old. Other medications such as silicates or some probiotics have shown efficacy on diarrhea duration or stool consistency but not on stool output. They have so no formal indication in infectious diarrhea and should be considered as "comfort" treatment. Antibiotics, beside their indication in shigella, cholera and amibiasis could be used in invasive diarrhea in some debilating conditions or infants less than 3 months. PMID:17961811

  10. Acute kidney injury due to decompression illness.

    PubMed

    Viecelli, Andrea; Jamboti, Jagadish; Waring, Andrew; Banham, Neil; Ferrari, Paolo

    2014-08-01

    Decompression illness is a rare but serious complication of diving caused by intravascular or extravascular gas bubble formation. We report the first case of acute kidney injury in a 27-year-old diver following three rapid ascents. He presented with transient neurological symptoms and abdominal pain followed by rapidly progressive acute kidney injury (creatinine peak 1210 µmol/L) due to arterial air emboli. He received supportive care and 100% oxygen followed by hyperbaric therapy and recovered fully. Arterial air emboli caused by rapid decompression can affect multiple organs including the kidneys. Early transfer to a hyperbaric unit is important as complications may present delayed. PMID:25852912

  11. Acute kidney injury due to decompression illness

    PubMed Central

    Viecelli, Andrea; Jamboti, Jagadish; Waring, Andrew; Banham, Neil; Ferrari, Paolo

    2014-01-01

    Decompression illness is a rare but serious complication of diving caused by intravascular or extravascular gas bubble formation. We report the first case of acute kidney injury in a 27-year-old diver following three rapid ascents. He presented with transient neurological symptoms and abdominal pain followed by rapidly progressive acute kidney injury (creatinine peak 1210 µmol/L) due to arterial air emboli. He received supportive care and 100% oxygen followed by hyperbaric therapy and recovered fully. Arterial air emboli caused by rapid decompression can affect multiple organs including the kidneys. Early transfer to a hyperbaric unit is important as complications may present delayed. PMID:25852912

  12. FGF23 in Acute and Chronic Illness

    PubMed Central

    Schnedl, Christian; Fahrleitner-Pammer, Astrid; Pietschmann, Peter; Amrein, Karin

    2015-01-01

    FGF23 is a bone-derived phosphaturic hormone that may become a useful biomarker for the identification of high-risk patients in chronic but also acute disease. It rises early in chronic kidney disease and is strongly and independently associated with excess morbidity and mortality. Emerging data suggest that FGF23 is also elevated in different scenarios of acute illness. In this review, we give an overview on the role of this interesting disease marker and potential and proven interventional strategies and discuss a blueprint for future research. PMID:26491212

  13. Distinct Features of Nonthyroidal Illness in Critically Ill Patients With Infectious Diseases

    PubMed Central

    Lee, Woo Kyung; Hwang, Sena; Kim, Daham; Lee, Seul Gi; Jeong, Seonhyang; Seol, Mi-Youn; Kim, Hyunji; Ku, Cheol Ryong; Shin, Dong Yeop; Chung, Woong Youn; Lee, Eun Jig; Lee, Jandee; Jo, Young Suk

    2016-01-01

    Abstract Nonthyroidal illness (NTI), often observed in critically ill patients, arises through diverse alterations in the hypothalamus-pituitary-thyroid (HPT) axis. However, the causal relationship between underlying disease and NTI diversity in critically ill patients is poorly understood. The aim of this study was to examine NTI severity and adverse outcomes in critically ill patients with respect to their underlying disease(s). The medical records of 616 patients admitted to the intensive care unit (ICU) between January 2009 and October 2014 were retrospectively reviewed. Patients with known diseases or taking medications that affect thyroid function were excluded. All-cause mortality (ACM) and length of stay (LOS) in the ICU were assessed as adverse outcomes. The enrolled patients (n = 213) were divided into the following 4 groups according to the severity of NTI at the nadir of their thyroid function test (TFT): normal (n = 11, 5.2%), mild NTI (n = 113, 53.1%), moderate NTI (n = 78, 36.6%), and severe NTI (n = 11, 5.2%). There was no significant difference between the groups in terms of age and gender. NTI severity showed a significantly strong association with ACM (P < 0.0001) and a significant positive association with LOS in the ICU (P = 0.031). After adjusting for age, gender, and current medications affecting TFT, increasing NTI severity led to increased ACM (odds ratio = 3.101; 95% confidence interval = 1.711–5.618; P < 0.0001). Notably, the prevalence of moderate-to-severe NTI was markedly higher in patients with infectious disease than in those with noninfectious disease (P = 0.012). Consistent with this, serum C-reactive protein levels were higher in patients with moderate-to-severe NTI (P = 0.016). NTI severity is associated with increased ACM, LOS, and underlying infectious disease. Future studies will focus on the biological and clinical implications of infectious disease on the HPT axis. PMID

  14. Nutritional demands in acute and chronic illness.

    PubMed

    Richardson, Rosemary A; Davidson, H Isobel M

    2003-11-01

    Common to both acute and chronic disease are disturbances in energy homeostasis, which are evidenced by quantitative and qualitative changes in dietary intake and increased energy expenditure. Negative energy balance results in loss of fat and lean tissue. The management of patients with metabolically-active disease appears to be simple; it would involve the provision of sufficient energy to promote tissue accretion. However, two fundamental issues serve to prevent nutritional demands in disease being met. The determination of appropriate energy requirements relies on predictive formulae. While equations have been developed for critically-ill populations, accurate energy prescribing in the acute setting is uncommon. Only 25-32% of the patients have energy intakes within 10% of their requirements. Clearly, the variation in energy expenditure has led to difficulties in accurately defining the energy needs of the individual. Second, the acute inflammatory response initiated by the host can have profound effects on ingestive behaviour, but this area is poorly understood by practising clinicians. For example, nutritional targets have been set for specific disease states, i.e. pancreatitis 105-147 kJ (25-35 kcal)/kg; chronic liver disease 147-168 kJ (35-40 kcal)/kg, but given the alterations in gut physiology that accompany the acute-phase response, targets are unlikely to be met. In cancer cachexia attenuation of the inflammatory response using eicosapentaenoic acid results in improved nutritional intake and status. This strategy poses an attractive proposition in the quest to define nutritional support as a clinically-effective treatment modality in other disorders. PMID:15018475

  15. Acute kidney injury in critically ill cancer patients: an update.

    PubMed

    Lameire, Norbert; Vanholder, Raymond; Van Biesen, Wim; Benoit, Dominique

    2016-01-01

    Patients with cancer represent a growing group among actual ICU admissions (up to 20 %). Due to their increased susceptibility to infectious and noninfectious complications related to the underlying cancer itself or its treatment, these patients frequently develop acute kidney injury (AKI). A wide variety of definitions for AKI are still used in the cancer literature, despite existing guidelines on definitions and staging of AKI. Alternative diagnostic investigations such as Cystatin C and urinary biomarkers are discussed briefly. This review summarizes the literature between 2010 and 2015 on epidemiology and prognosis of AKI in this population. Overall, the causes of AKI in the setting of malignancy are similar to those in other clinical settings, including preexisting chronic kidney disease. In addition, nephrotoxicity induced by the anticancer treatments including the more recently introduced targeted therapies is increasingly observed. However, data are sometimes difficult to interpret because they are often presented from the oncological rather than from the nephrological point of view. Because the development of the acute tumor lysis syndrome is one of the major causes of AKI in patients with a high tumor burden or a high cell turnover, the diagnosis, risk factors, and preventive measures of the syndrome will be discussed. Finally, we will briefly discuss renal replacement therapy modalities and the emergence of chronic kidney disease in the growing subgroup of critically ill post-AKI survivors. PMID:27480256

  16. Acute high-altitude illness: a clinically orientated review

    PubMed Central

    Smedley, Tom

    2013-01-01

    Acute high-altitude illness is an encompassing term for the range of pathology that the unacclimatised individual can develop at increased altitude. This includes acute mountain sickness, high-altitude cerebral oedema and high-altitude pulmonary oedema. These conditions represent an increasing clinical problem as more individuals are exposed to the hypobaric hypoxic environment of high altitude for both work and leisure. In this review of acute high-altitude illness, the epidemiology, risk factors and pathophysiology are explored, before their prevention and treatment are discussed. Appropriate ascent rate remains the most effective acute high-altitude illness prevention, with pharmacological prophylaxis indicated in selected individuals. Descent is the definitive treatment for acute high-altitude illness, with the adjuncts of oxygen and specific drug therapies. PMID:26516505

  17. Undiagnosed Acute Viral Febrile Illnesses, Sierra Leone

    PubMed Central

    Rossi, Cynthia A.; Khan, Sheik H.; Goba, Augustine; Fair, Joseph N.

    2014-01-01

    Sierra Leone in West Africa is in a Lassa fever–hyperendemic region that also includes Guinea and Liberia. Each year, suspected Lassa fever cases result in submission of ≈500–700 samples to the Kenema Government Hospital Lassa Diagnostic Laboratory in eastern Sierra Leone. Generally only 30%–40% of samples tested are positive for Lassa virus (LASV) antigen and/or LASV-specific IgM; thus, 60%–70% of these patients have acute diseases of unknown origin. To investigate what other arthropod-borne and hemorrhagic fever viral diseases might cause serious illness in this region and mimic Lassa fever, we tested patient serum samples that were negative for malaria parasites and LASV. Using IgM-capture ELISAs, we evaluated samples for antibodies to arthropod-borne and other hemorrhagic fever viruses. Approximately 25% of LASV-negative patients had IgM to dengue, West Nile, yellow fever, Rift Valley fever, chikungunya, Ebola, and Marburg viruses but not to Crimean-Congo hemorrhagic fever virus. PMID:24959946

  18. Ills in the pipeline: emerging infectious diseases and wildlife

    USGS Publications Warehouse

    Sleeman, Jonathan; Gillin, Colin

    2012-01-01

    In the recent film Contagion, a medical thriller released in fall 2011, the fictitious MEV-1 virus—passed from bat to pig to humans—spreads across the globe as easily as the common cold, killing millions of humans and causing mass hysteria as medical researchers race to find a cure. Though it's Hollywood hyperbole, the film holds a kernel of truth: Researchers believe that the close proximity of Malaysian hog farms to forested areas—the natural habitat for fruit bats—allowed the previously unknown Nipah virus to spill from bats into pigs and subsequently into people, resulting in more than 100 human deaths (Epstein et al. 2006). There is no doubt that in recent times we have seen an unprecedented number of emerging infectious diseases, defined by the Institute for Medicine as new, reemerging, or drug-resistant infections whose incidence has increased or whose incidence threatens to increase in the near future. Many of these have a wildlife origin (Taylor et al. 2001). While this jump may be due, in part, to increased vigilance and reporting, there is a general consensus that current global conditions are creating a situation that is very favorable to the transmission of microbes that cause diseases. (For reviews, see Daszak et al. 2001 and Keesing et al. 2010). Likewise, it's increasingly important that wildlife professionals become aware of how and why new infectious diseases spread and what, if anything, can be done to minimize impacts on wildlife.

  19. [Acute oliguric renal failure and haemolytic anaemia following infectious mononucleosis].

    PubMed

    Brkovic, Natasa; Jørgensen, Kit Riegels; Rosenbæk, Jeppe Bakkestrøm; Pedersen, Erling Bjerregaard

    2015-11-01

    A 19-year-old man was admitted to hospital due to fatigue, nausea, abdominal pain and faint. He was pale and icteric, awake with sufficient respiration and circulation. He had infectious mononucleosis complicated with acute oliguric renal failure and severe haemolytic anaemia with a positive Coombs test. He had a cold agglutinin syndrome. The treatment comprised intermittent haemodialysis, plasmapheresis and heating. He recovered completely after two months. PMID:26573947

  20. Headache in the presentation of noncephalic acute illness

    PubMed Central

    Tzadok, Tomer; Toledano, Ronen; Fuchs, Lior; Bartal, Carmi; Novack, Victor; Ifergane, Gal

    2015-01-01

    Background: Headache is a frequent symptom of many systemic diseases that do not involve cranial structures. In this observational study, we assessed factors associated with headache in the acute presentation of systemic conditions in a nonsurgical emergency department (ED). Methods: Consecutive patients, admitted to Soroka University Medical Center ED due to noncephalic illness, were prospectively surveyed using a structured questionnaire focused on the prevalence and characteristics of headache symptoms. Medical data were extracted from the patient's charts. Results: Between 1 and 6/2012, 194 patients aged 64.69 ± 19.52 years, were evaluated. Headache was reported by 83 (42.7%) patients and was more common among patients with febrile illness (77.5% vs. 22.5%, P < 0.001). Respiratory illness and level of O2 saturation were not associated with headache. Headache in the presentation of a noncephalic illness was associated with younger age (58 vs. 69, P < 0.001) and with suffering from a primary headache disorder (48.2% vs. 10.8%, P < 0.001). Headache was also associated with higher body temperature and lower platelets count. Conclusions: Headache is a common symptom in acute noncephalic conditions and was found to be associated with younger age and febrile disease on presentation. Patients who present with primary headache disorders are more prone to have headache during acute illness. Acute obstructive respiratory disease, hypercarbia or hypoxemia were not associated with headache. PMID:26752891

  1. Rifaximin for the treatment of acute infectious diarrhea.

    PubMed

    Hong, Kyoung Sup; Kim, Joo Sung

    2011-07-01

    Rifaximin is a nonabsorbable rifamycin derivative with an excellent safety profile and a broad spectrum of antimicrobial activity against a variety of enteropathogens causing acute infectious diarrhea. After oral ingestion, its bioavailability is known to be less than 0.4%, and it has a low potential for significant drug interactions. In the treatment of travelers' diarrhea caused by noninvasive diarrheagenic Escherichia coli, it has been demonstrated that rifaximin significantly shortens the duration of diarrhea and has an efficacy similar to that of ciprofloxacin. Moreover, according to two randomized placebo-controlled trials, prophylactic treatment with rifaximin reduced the risk of developing travelers' diarrhea by more than 50% compared with the placebo group. For the treatment of acute diarrhea unrelated to travel, a short course of rifaximin significantly reduced the duration of diarrhea, and its overall efficacy was comparable to that of ciprofloxacin. The discrepancy between the in vitro and in vivoantimicrobial activities of rifaximin, however, and the clinical implication of the rapid appearance of bacterial resistance, must be further elucidated. In conclusion, this gut-selective antibiotic seems to be a promising option for the treatment of acute infectious diarrhea secondary to noninvasive E. coli and also appears to be effective in chemoprophylaxis for travelers' diarrhea. PMID:21765867

  2. Rifaximin for the treatment of acute infectious diarrhea

    PubMed Central

    Hong, Kyoung Sup; Kim, Joo Sung

    2011-01-01

    Rifaximin is a nonabsorbable rifamycin derivative with an excellent safety profile and a broad spectrum of antimicrobial activity against a variety of enteropathogens causing acute infectious diarrhea. After oral ingestion, its bioavailability is known to be less than 0.4%, and it has a low potential for significant drug interactions. In the treatment of travelers’ diarrhea caused by noninvasive diarrheagenic Escherichia coli, it has been demonstrated that rifaximin significantly shortens the duration of diarrhea and has an efficacy similar to that of ciprofloxacin. Moreover, according to two randomized placebo-controlled trials, prophylactic treatment with rifaximin reduced the risk of developing travelers’ diarrhea by more than 50% compared with the placebo group. For the treatment of acute diarrhea unrelated to travel, a short course of rifaximin significantly reduced the duration of diarrhea, and its overall efficacy was comparable to that of ciprofloxacin. The discrepancy between the in vitro and in vivoantimicrobial activities of rifaximin, however, and the clinical implication of the rapid appearance of bacterial resistance, must be further elucidated. In conclusion, this gut-selective antibiotic seems to be a promising option for the treatment of acute infectious diarrhea secondary to noninvasive E. coli and also appears to be effective in chemoprophylaxis for travelers’ diarrhea. PMID:21765867

  3. Proteomic Changes of Alveolar Lining Fluid in Illnesses Associated with Exposure to Inhaled Non-Infectious Microbial Particles

    PubMed Central

    Teirilä, Laura; Karvala, Kirsi; Ahonen, Niina; Riska, Henrik; Pietinalho, Anne; Tuominen, Päivi; Piirilä, Päivi

    2014-01-01

    Background Hyperresponsiveness to inhaled non-infectious microbial particles (NIMPs) has been associated with illnesses in the airways. Hypersensitivity pneumonitis (HP) is considered to be the prototype for these NIMPs-related diseases; however, there is no consensus on the definitions or diagnostic criteria for HP and the spectrum of related illnesses. Methods and Findings In order to identify the possible diagnostic markers for illnesses associated with NIMPs in alveolar lining fluid, we performed a proteomic analysis using a two-dimensional difference gel electrophoresis on bronchoalveolar lavage (BAL) fluid from patients with exposure to NIMPs in the context of damp building-related illness (DBRI) or conditions on the borderline to acute HP, designated here as agricultural type of microbial exposure (AME). Samples from patients with HP and sarcoidosis (SARC) were included for reference. Results were compared to results of healthy subjects (CTR). Western blot was used for validation of potential marker proteins from BAL fluid and plasma. Protein expression patterns suggest a close similarity between AME and HP, while DBRI was similar to CTR. However, in DBRI the levels of the inflammation associated molecules galectin-3 and alpha-1-antitrypsin were increased. A novel finding emerging from this study was the increases of semenogelin levels in BAL fluid from patients with AME, HP and SARC. Histone 4 levels were increased in AME, HP and SARC. Elevated plasma levels of histone 2B were detected in HP and SARC, suggesting it to be a potential blood indicator for inflammatory diseases of the lungs. Conclusions In this study, the proteomic changes in bronchoalveolar lavage of DBRI patients were distinct from other NIMP exposure associated lung diseases, while changes in AME overlapped those observed for HP patient samples. Some of the proteins identified in this study, semenogelin and histone 4, could function as diagnostic markers for differential diagnosis between

  4. Sleep Disturbances in Acutely Ill Patients with Cancer.

    PubMed

    Matthews, Ellyn E; Tanner, J Mark; Dumont, Natalie A

    2016-06-01

    Intensive care units may place acutely ill patients with cancer at additional risk for sleep loss and associated negative effects. Research suggests that communication about sleep in patients with cancer is suboptimal and sleep problems are not regularly assessed or adequately treated throughout the cancer trajectory. However, many sleep problems and fatigue can be managed effectively. This article synthesizes the current literature regarding the prevalence, cause, and risk factors that contribute to sleep disturbance in the context of acute cancer care. It describes the consequences of poor sleep and discusses appropriate assessment and treatment options. PMID:27215362

  5. The central role of hypothalamic inflammation in the acute illness response and cachexia.

    PubMed

    Burfeind, Kevin G; Michaelis, Katherine A; Marks, Daniel L

    2016-06-01

    When challenged with a variety of inflammatory threats, multiple systems across the body undergo physiological responses to promote defense and survival. The constellation of fever, anorexia, and fatigue is known as the acute illness response, and represents an adaptive behavioral and physiological reaction to stimuli such as infection. On the other end of the spectrum, cachexia is a deadly and clinically challenging syndrome involving anorexia, fatigue, and muscle wasting. Both of these processes are governed by inflammatory mediators including cytokines, chemokines, and immune cells. Though the effects of cachexia can be partially explained by direct effects of disease processes on wasting tissues, a growing body of evidence shows the central nervous system (CNS) also plays an essential mechanistic role in cachexia. In the context of inflammatory stress, the hypothalamus integrates signals from peripheral systems, which it translates into neuroendocrine perturbations, altered neuronal signaling, and global metabolic derangements. Therefore, we will discuss how hypothalamic inflammation is an essential driver of both the acute illness response and cachexia, and why this organ is uniquely equipped to generate and maintain chronic inflammation. First, we will focus on the role of the hypothalamus in acute responses to dietary and infectious stimuli. Next, we will discuss the role of cytokines in driving homeostatic disequilibrium, resulting in muscle wasting, anorexia, and weight loss. Finally, we will address mechanisms and mediators of chronic hypothalamic inflammation, including endothelial cells, chemokines, and peripheral leukocytes. PMID:26541482

  6. Managing the acutely ill adult with sickle cell disease.

    PubMed

    Brown, Marvelle

    Sickle cell disease (SCD) is an autosomal recessively inherited condition, affecting the structure of the haemoglobin. SCD is a long-term chronic condition which is manifested by periods of acute painful sickling crisis, known as vaso-occlusive crisis (VOC) and is the cause of 90% of sickle cell-related hospital admissions. SCD is one of the most common genetic conditions worldwide and in the UK there are approximately 12,500 people living with it (Streetly et al,1997; Howard et al, 2008), making it more common than cystic fibrosis, yet there still remains many challenges in managing these patients when they become acutely ill. Lack of awareness and understanding of the illness, concerns regarding addiction and limited attention to the psycho-social implications of the illness, leads to less than effective care for this patient group when they are hospitalized. The aims of this article are to outline the pathophysiology of SCD, identify the causes of VOC and discuss the key principles of nursing management for patients experiencing a VOC. PMID:22306637

  7. Descriptive epidemiology of infectious gastrointestinal illnesses in Sydney, Australia, 2007–2010

    PubMed Central

    Fletcher, Stephanie; Sibbritt, David; Stark, Damien; Harkness, John; Rawlinson, William; Andresen, David; Van Hal, Sebastian; Merif, Juan

    2015-01-01

    Objective There is a lack of information about the prevalence of gastrointestinal illnesses in Australia. Current disease surveillance systems capture only a few pathogens. The aim of this study is to describe the epidemiology of infectious gastrointestinal illnesses in Sydney, Australia. Methods A retrospective cross-sectional study of patients with gastrointestinal symptoms who visited tertiary public hospitals in Sydney was conducted between 2007 and 2010. Patients with diarrhoea or loose stools with an enteric pathogen detected were identified. Demographic, clinical and potential risk factor data were collected from their medical records. Measures of association, descriptive and inferential statistics were analysed. Results In total, 1722 patients were included in this study. Campylobacter (22.0%) and Clostridium difficile (19.2%) were the most frequently detected pathogens. Stratified analysis showed that rotavirus (22.4%), norovirus (20.7%) and adenovirus (18.1%) mainly affected children under 5 years; older children (5–12 years) were frequently infected with Campylobacter spp. (29.8%) and non-typhoid Salmonella spp. (24.4%); infections with C. difficile increased with age.Campylobacter and non-typhoid Salmonella spp. showed increased incidence in summer months (December to February), while rotavirus infections peaked in the cooler months (June to November). Discussion This study revealed that gastrointestinal illness remains a major public health issue in Sydney. Improvement of current disease surveillance and prevention and control measures are required. This study emphasizes the importance of laboratory diagnosis of enteric infections and the need for better clinical data collection to improve management of disease risk factors in the community. PMID:26798556

  8. Update: outbreak of acute febrile illness among athletes participating in Eco-Challenge-Sabah 2000--Borneo, Malaysia, 2000.

    PubMed

    2001-01-19

    During September 7-11, 2000, CDC was notified by the Idaho Department of Health, the Los Angeles County Department of Health Services, and the GeoSentinel Global Surveillance Network of at least 20 cases of acute febrile illness in three countries; all ill patients had participated in the Eco-Challenge-Sabah 2000 multisport expedition race in Borneo, Malaysia, during August 21-September 3, 2000. Participants included athletes from 29 U.S. states and 26 countries. This report updates the ongoing investigation of this outbreak through December 2, which suggests that Leptospira were the cause of illness and that water from the Segama River was the primary source of infection. Participants in adventure sports and exotic tourism should be aware of potential exposure to unusual and emerging infectious agents. PMID:11215718

  9. A case of acute infectious mononucleosis presenting with very high ferritin

    PubMed Central

    Thoufeeq, Muhammed Hameed; Ali Khan, Shahul Leyakath; Jain, Sanjiv Kumar; Al-Shakerchi, Hasanain; Hussain, Munem

    2007-01-01

    Hepatitis is an important but uncommon manifestation of acute Epstein Barr infection. Infectious mononucleosis is usually a disease of young adults. We report a case of infectious mononucleosis in a 72-year old jaundiced gentleman with ferritin level of 2438 that normalised on clinical improvement. PMID:17278235

  10. Progress in Pediatrics in 2012: choices in allergy, endocrinology, gastroenterology, hematology, infectious diseases, neurology, nutrition and respiratory tract illnesses.

    PubMed

    Caffarelli, Carlo; Santamaria, Francesca; Vottero, Alessandra; Bernasconi, Sergio

    2013-01-01

    In this review, we summarize the progresses in allergy, endocrinology, gastroenterology, hematology, infectious diseases, neurology, nutrition and respiratory tract illnesses that have been published in The Italian Journal of Pediatrics in 2012. The induction of Treg activity by probiotics might be effective for promoting tolerance towards food allergens. Nasal cytology is useful in patients with rhinitis for diagnosing chronic non-allergic non-infectious diseases. Atopic eczema is associated both with an aberrant skin matrix and impaired systemic immune response. Therefore, isolated topical treatment may have suboptimal effect. Diagnostic work-up of exercise-induced anaphylaxis, including exercise challenge test, is necessary to reach a diagnosis. Studies may support a role for nutrition on prevention of asthma and cardiovascular diseases. Clinicians need to early identify adolescent menstrual abnormalities to minimize sequelae, and to promote health information. In Multiple Endocrine Neoplasia type 2B investigations include acetylcholinesterase study of rectal mucosa followed by the molecular analysis of RET mutation. Low adherence to gluten-free diet and osteopenia are common problems in children with diabetes mellitus type 1 and celiac disease. In infantile colic, laboratory tests are usually unnecessary and the treatment is based on reassurance. Prevalence of obesity and stunting is elucidated by several studies. Evidences are growing that dietetic measures are needed to prevent obesity in children with acute leukemia. Treatment studies for infectious diseases show promise for probiotics along with standard triple therapy in children with Helicobacter pilori infection, while zinc has no effect on pneumonia. Educational programs about the proper management of the febrile child are warranted. A new hour-specific total serum bilirubin nomogram has been shown to be able to predict newborns without hyperbilirubinemia after 48 to 72 hours of life. Newborns with

  11. Pediatric Acute Q Fever Mimics Other Common Childhood Illnesses

    PubMed Central

    Bart, Ingeborg Y.; Schabos, Yvonne; van Hout, Roeland W. N. M.; Leenders, Alexander C. A. P.; de Vries, Esther

    2014-01-01

    Knowledge of Q fever has increased over the last decades, but research has mainly focused on adults. Data in children are scarce, and current knowledge is mostly based on case reports. The aim of this study was to determine predictors for acute Q fever in children in the general population. We retrospectively studied all children tested for Coxiella burnetii by serology and/or PCR upon request of their general practitioner in the regional laboratory for Medical Microbiology of the Jeroen Bosch during the Q fever outbreak in the Netherlands between 2007 and 2011. A total of 1061 patients was analyzed. Influenza-like illness and respiratory tract infection were the most common presentations of acute Q fever, mimicking other common childhood illnesses. None of the reported symptoms was significantly related to a positive test outcome and therefore presenting signs or symptoms have no predictive value in diagnosing Q-fever in children. Only diagnostic tests are reliable. As the infection generally follows a mild and uncomplicated course, we question if the difficulty of recognizing pediatric Q fever is a problem worth solving. PMID:24520412

  12. From data patterns to mechanistic models in acute critical illness.

    PubMed

    Aerts, Jean-Marie; Haddad, Wassim M; An, Gary; Vodovotz, Yoram

    2014-08-01

    The complexity of the physiologic and inflammatory response in acute critical illness has stymied the accurate diagnosis and development of therapies. The Society for Complex Acute Illness was formed a decade ago with the goal of leveraging multiple complex systems approaches to address this unmet need. Two main paths of development have characterized the society's approach: (i) data pattern analysis, either defining the diagnostic/prognostic utility of complexity metrics of physiologic signals or multivariate analyses of molecular and genetic data and (ii) mechanistic mathematical and computational modeling, all being performed with an explicit translational goal. Here, we summarize the progress to date on each of these approaches, along with pitfalls inherent in the use of each approach alone. We suggest that the next decade holds the potential to merge these approaches, connecting patient diagnosis to treatment via mechanism-based dynamical system modeling and feedback control and allowing extrapolation from physiologic signals to biomarkers to novel drug candidates. As a predicate example, we focus on the role of data-driven and mechanistic models in neuroscience and the impact that merging these modeling approaches can have on general anesthesia. PMID:24768566

  13. [Colorectal carcinoma as a cause of acute abdominal illness].

    PubMed

    Lipská, L; Visokai, V; Bergmann, P; Trubac, M; Cech, P; Strupová, L; Levý, M

    2008-01-01

    Colorectal carcinoma (KCR) is the commonest malignancy in male patients and the second commonest in female patients in the Czech Republic. During 1990-2006, 1162 patients with colorectal carcinomas were operated in the FTNsP (Faculty Thomayer Hospital) Surgical Clinic. 212 patients aged between 39 to 94 y.o.a.(the median of 70 y.o.a) were managed urgently for acute abdominal illness. In this group of urgently managed patients, the mortality rate was 17% and the morbidity rate was 38%. Future prospects of any colorectal carcinoma patient with acute abdominal illness depend on the procedure's radicality, which is limited by the overall patient's condition. The preoperative care aims to improve the patient's overall condition to such a degree, to allow for surgery fulfilling principles of oncosurgical radicality. According to this report's data, such urgent surgical procedures do not result in increased mortality or morbidity rates, compared to these in planned procedures, and show the best results in this patient group. PMID:18432070

  14. Pediatric acute Q fever mimics other common childhood illnesses.

    PubMed

    Bart, Ingeborg Y; Schabos, Yvonne; van Hout, Roeland W N M; Leenders, Alexander C A P; de Vries, Esther

    2014-01-01

    Knowledge of Q fever has increased over the last decades, but research has mainly focused on adults. Data in children are scarce, and current knowledge is mostly based on case reports. The aim of this study was to determine predictors for acute Q fever in children in the general population. We retrospectively studied all children tested for Coxiella burnetii by serology and/or PCR upon request of their general practitioner in the regional laboratory for Medical Microbiology of the Jeroen Bosch during the Q fever outbreak in the Netherlands between 2007 and 2011. A total of 1061 patients was analyzed. Influenza-like illness and respiratory tract infection were the most common presentations of acute Q fever, mimicking other common childhood illnesses. None of the reported symptoms was significantly related to a positive test outcome and therefore presenting signs or symptoms have no predictive value in diagnosing Q-fever in children. Only diagnostic tests are reliable. As the infection generally follows a mild and uncomplicated course, we question if the difficulty of recognizing pediatric Q fever is a problem worth solving. PMID:24520412

  15. Asthmatics with exacerbation during acute respiratory illness exhibit unique transcriptional signatures within the nasal mucosa

    PubMed Central

    2014-01-01

    Background Acute respiratory illness is the leading cause of asthma exacerbations yet the mechanisms underlying this association remain unclear. To address the deficiencies in our understanding of the molecular events characterizing acute respiratory illness-induced asthma exacerbations, we undertook a transcriptional profiling study of the nasal mucosa over the course of acute respiratory illness amongst individuals with a history of asthma, allergic rhinitis and no underlying respiratory disease. Methods Transcriptional profiling experiments were performed using the Agilent Whole Human Genome 4X44K array platform. Time point-based microarray and principal component analyses were conducted to identify and distinguish acute respiratory illness-associated transcriptional profiles over the course of our study. Gene enrichment analysis was conducted to identify biological processes over-represented within each acute respiratory illness-associated profile, and gene expression was subsequently confirmed by quantitative polymerase chain reaction. Results We found that acute respiratory illness is characterized by dynamic, time-specific transcriptional profiles whose magnitudes of expression are influenced by underlying respiratory disease and the mucosal repair signature evoked during acute respiratory illness. Most strikingly, we report that people with asthma who experience acute respiratory illness-induced exacerbations are characterized by a reduced but prolonged inflammatory immune response, inadequate activation of mucosal repair, and the expression of a newly described exacerbation-specific transcriptional signature. Conclusion Findings from our study represent a significant contribution towards clarifying the complex molecular interactions that typify acute respiratory illness-induced asthma exacerbations. PMID:24433494

  16. Hyperglycemia and acute kidney injury in critically ill children

    PubMed Central

    Gordillo, Roberto; Ahluwalia, Tania; Woroniecki, Robert

    2016-01-01

    Background Hyperglycemia and acute kidney injury (AKI) are common in critically ill children and have been associated with higher morbidity and mortality. The incidence of AKI in children is difficult to estimate because of the lack of a standard definition for AKI. The pediatric RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease) criteria can be used to define AKI in children. Various biomarkers in urine and blood have been studied to detect AKI in critically ill children. However, it is not clear whether hyperglycemia is associated with AKI. Our objective was to evaluate the effect of hyperglycemia on kidney function and its effect on neutrophil gelatinase-associated lipocalin (NGAL) in children. Methods We studied retrospective and prospective cohorts of pediatric critically ill subjects admitted to the pediatric intensive care unit (PICU). We analyzed data from admission that included estimated glomerular filtration rate, plasma and urine NGAL, serum glucose and peak glycemia (highest glycemia during PICU admission), and length of hospital and PICU stay from two different institutions. Results We found that the prevalence of hyperglycemia was 89% in the retrospective cohort and 86% in the prospective cohort, P=0.99. AKI was associated with peak glycemia, P=0.03. There was a statistically significant correlation between peak glycemia and hospital and PICU stays, P=<0.001 and P<0.001, respectively. Urine NGAL and plasma NGAL were not statistically different in subjects with and without hyperglycemia, P=0.99 and P=0.85, respectively. Subjects on vasopressors had lower estimated glomerular filtration rate and higher glycemia, P=0.01 and P=0.04, respectively. Conclusion We conclude that in critically ill children, hyperglycemia is associated with AKI and longer PICU stays. PMID:27601931

  17. Severe Acute Respiratory Illness (SARI) Surveillance in Louisiana, 2013-2014.

    PubMed

    Hand, Julie P; Serrano, Jose; Johnson, Jenna I; Jespersen, Megan; Ratard, Raoult C

    2015-01-01

    The objectives of this article are to describe the severe acute respiratory illness (SARI) surveillance implemented in Louisiana during the 2013-2014 influenza season, present the epidemiology of reported SARI cases, and identify ways to improve this system by incorporating formal SARI surveillance into the influenza surveillance program. Of the 212 SARI cases, 181 (85%) had at least one underlying medical condition, 54 (25.7%) had two conditions, 43 (20.3%) had three conditions, and 25 (11.8%) reported four or more. The most common four underlying conditions were: obesity (43.4%), chronic cardiac conditions (39.6%), diabetes (29.7%), and chronic pulmonary conditions (26.9%). While obesity was the most reported underlying condition, it was three times more likely to be reported in less than 65 years old rather than those >65. Continuation of SARI data collection in future seasons will allow comparisons regarding severity, populations affected, and identify risk factors most commonly associated with severe illness. Reporting of SARI cases also increased influenza-associated adult mortality reporting to the Office of Public Health's Office of Infectious Diseases Epidemiology (ID Epi). Though all influenza-associated mortality is reportable in Louisiana, adult mortality was reported rarely prior to the 2013-2014 season. PMID:27159455

  18. [Acute infectious (not Clostridium difficile-associated) diarrhea in the elderly].

    PubMed

    Van Dessel, C; Flamaing, J; Hiele, M

    2005-11-01

    Acute diarrhoea, non-antibiotic associated, is a common problem and a significant cause of morbidity and mortality in old age. In most cases diarrhoea has an infectious etiology. A number of different micro organisms can cause infectious diarrhoea. Most frequent are viral infections with a benign evolution. Rehydration is the only important therapeutic measure. Infections with bacteria are less common, antibiotics should be prescribed only in severe cases, and when there is suspicion of invasive infections by enteropathogenic bacteria. PMID:16350530

  19. The Use of Acute Peritoneal Dialysis in Critically Ill Newborns

    PubMed Central

    Ustyol, Lokman; Peker, Erdal; Demir, Nihat; Agengin, Kemal; Tuncer, Oguz

    2016-01-01

    Background To evaluate the efficacy, complications, and mortality rate of acute peritoneal dialysis (APD) in critically ill newborns. Material/Methods The study included 31 newborns treated in our center between May 2012 and December 2014. Results The mean birth weight, duration of peritoneal dialysis, and gestational age of the patients were determined as 2155.2±032.2 g (580–3900 g), 4 days (1–20 days), and 34 weeks (24–40 weeks), respectively. The main reasons for APD were sepsis (35.5%), postoperative cardiac surgery (16%), hypoxic ischemic encephalopathy (13%), salting of the newborn (9.7%), congenital metabolic disorders (6.1%), congenital renal diseases (6.5%), nonimmune hydrops fetalis (6.5%), and acute kidney injury (AKI) due to severe dehydration (3.2%). APD-related complications were observed in 48.4% of the patients. The complications encountered were catheter leakages in nine patients, catheter obstruction in three patients, peritonitis in two patients, and intestinal perforation in one patient. The general mortality rate was 54.8%, however, the mortality rate in premature newborns was 81.3%. Conclusions APD can be an effective, simple, safe, and important therapy for renal replacement in many neonatal diseases and it can be an appropriate treatment, where necessary, for newborns. Although it may cause some complications, they are not common. However, it should be used carefully, especially in premature newborns who are vulnerable and have a high mortality risk. The recommendation of APD therapy in such cases needs to be verified by further studies in larger patient populations. PMID:27121012

  20. Intention to Receive Influenza Vaccine After an Acute Respiratory Illness

    PubMed Central

    Nowalk, Mary Patricia; Balasubramani, G. K.; Schaffer, Mallory; Lieberman, Rhett H.; Eng, Heather; Kyle, Shakala; Wisniewski, Stephen; Zimmerman, Richard K.; Middleton, Donald B.

    2015-01-01

    Objective To determine the effects of symptoms and presence of confirmed influenza on intention to receive an influenza vaccine, specifically in patients recovering from a medically-attended acute (≤ 7 days’ duration) respiratory illness (ARI). Methods During the 2013–2014 influenza season, individuals seeking outpatient care for an ARI that included cough were tested for influenza using reverse transcription polymerase chain reaction assays (PCR) and completed surveys. Children (6 months–18 years) and adults (≥ 18 years) were grouped by their combined current season’s influenza vaccination status (vaccinated/not vaccinated) and their vaccination intentions for next season (intend/do not intend). Results Forty-one percent (323/786) were unvaccinated at enrollment, of whom nearly half (151/323) intended to be vaccinated next season. When adjusting for demographic, health and other factors, unvaccinated individuals who intended to be vaccinated next season were approximately 1.5 times more likely to have PCR-confirmed influenza compared with vaccinated individuals who intended to be vaccinated next season. Conclusion The combined experience of not being vaccinated against influenza and seeking medical attention for an ARI seemed to influence approximately one-half of unvaccinated participants to consider influenza vaccination for next season. PMID:26018106

  1. Acute gastrointestinal illness in two Inuit communities: burden of illness in Rigolet and Iqaluit, Canada.

    PubMed

    Harper, S L; Edge, V L; Ford, J; Thomas, M K; Pearl, D L; Shirley, J; McEwen, S A

    2015-10-01

    Food- and waterborne disease is thought to be high in some Canadian Indigenous communities; however, the burden of acute gastrointestinal illness (AGI) is not well understood due to limited availability and quality of surveillance data. This study estimated the burden of community-level self-reported AGI in the Inuit communities of Rigolet, Nunatsiavut, and Iqaluit, Nunavut, Canada. Cross-sectional retrospective surveys captured information on AGI and potential environmental risk factors. Multivariable logistic regression models identified potential AGI risk factors. The annual incidence of AGI ranged from 2·9-3·9 cases/person per year in Rigolet and Iqaluit. In Rigolet, increased spending on obtaining country foods, a homeless person in the house, not visiting a cabin recently, exposure to puppies, and alternative sources of drinking water were associated with increased odds of AGI. In Iqaluit, eating country fish often, exposure to cats, employment status of the person responsible for food preparation, not washing the countertop with soap after preparing meat, a homeless person in the house, and overcrowding were associated with increased odds of AGI. The results highlight the need for systematic data collection to better understand and support previously anecdotal indications of high AGI incidence, as well as insights into unique AGI environmental risk factors in Indigenous populations. PMID:25697261

  2. Zuclopenthixol acetate for acute schizophrenia and similar serious mental illnesses

    PubMed Central

    Jayakody, Kaushadh; Gibson, Roger Carl; Kumar, Ajit; Gunadasa, Shalmini

    2014-01-01

    Background Medication used for acute aggression in psychiatry must have rapid onset of effect, low frequency of administration and low levels of adverse effects. Zuclopenthixol acetate is said to have these properties. Objectives To estimate the clinical effects of zuclopenthixol acetate for the management of acute aggression or violence thought to be due to serious mental illnesses, in comparison to other drugs used to treat similar conditions. Search methods We searched the Cochrane Schizophrenia’s Group Trials Register (July 2011). We supplemented this by citation searching and personal contact with authors and relevant pharmaceutical companies. Selection criteria All randomised clinical trials involving people thought to have serious mental illnesses comparing zuclopenthixol acetate with other drugs. Data collection and analysis Two review authors extracted and cross-checked data independently. We calculated fixed-effect relative risks (RR) and 95% confidence intervals (CI) for dichotomous data. We analysed by intention-to-treat. We used mean differences (MD) for continuous variables. Main results We found no data for the primary outcome, tranquillisation. Compared with haloperidol, zuclopenthixol acetate was no more sedating at two hours (n = 40, 1 RCT, RR 0.60, 95% CI 0.27 to 1.34). People given zuclopenthixol acetate were not at reduced risk of being given supplementary antipsychotics (n = 134, 3 RCTs, RR 1.49, 95% CI 0.97 to 2.30) although additional use of benzodiazepines was less (n = 50, 1 RCT, RR 0.03, 95% CI 0.00 to 0.47). People given zuclopenthixol acetate had fewer injections over seven days compared with those allocated to haloperidol IM (n = 70, 1 RCT, RR 0.39, 95% CI 0.18 to 0.84, NNT 4, CI 3 to 14). We found no data on more episodes of aggression or harm to self or others. One trial (n = 148) reported no significant difference in adverse effects for people receiving zuclopenthixol acetate compared with those allocated haloperidol at one, three

  3. Analysis of infectious complications and timing for emergency liver transplantation in autoimmune acute liver failure.

    PubMed

    Fujiwara, Keiichi; Yasui, Shin; Yonemitsu, Yutaka; Arai, Makoto; Kanda, Tatsuo; Fukuda, Yoshihiro; Nakano, Masayuki; Oda, Shigeto; Yokosuka, Osamu

    2016-04-01

    Highlight Fujiwara and colleagues reveal that the critical point for switching to liver transplantation without infectious complications in autoimmune acute liver failure is two weeks after the start of corticosteroid treatment. It is crucial to evaluate corticosteroid efficacy and, if no improvement is seen, to perform liver transplantation by that time. PMID:26808231

  4. Pharmacological Prophylaxis for Venous Thromboembolism Among Hospitalized Patients With Acute Medical Illness: An Electronic Medical Records Study.

    PubMed

    Rosenman, Marc; Liu, Xianchen; Phatak, Hemant; Qi, Rong; Teal, Evgenia; Nisi, Daniel; Liu, Larry Z; Ramacciotti, Eduardo

    2016-01-01

    Patients hospitalized with acute medical illness have an elevated risk of venous thromboembolism (VTE). American College of Chest Physicians guidelines list various chronic illnesses, sepsis, advanced age, history of VTE, and immobility as risk factors and recommend prophylactic anticoagulation using fondaparinux, low-molecular weight heparin, or low-dose unfractionated heparin. The objectives of this study were to examine pharmacological prophylaxis against VTE among hospitalized medically ill patients and to assess demographic and clinical correlates related to VTE prophylaxis. A retrospective (1999-2010) electronic medical records study included patients aged 40 years and older hospitalized for at least 3 days, with significant medical illness or with a VTE hospitalization 30-365 days before admission. Each patient's first qualifying hospitalization was analyzed. Exclusions were if VTE treatment was started within 1 day of admission, or if warfarin (and not heparin or enoxaparin) was used. Prophylaxis was defined if the first inpatient dose of subcutaneous heparin or enoxaparin was at prophylaxis levels (lower than treatment levels). Multivariable logistic regression was used to examine factors associated with VTE prophylaxis. Among 12,980 patients, 22.1% received prophylaxis (11.8% with enoxaparin, 10.3% with heparin). VTE prophylaxis was positively associated with year of hospitalization, subcutaneous heparin in the month before admission, aspirin, self-pay status, age, and sepsis. VTE prophylaxis was negatively associated with smoking, alcohol, warfarin in the past 30 days, and primary diagnoses of stroke, infectious disease, or inflammatory bowel disease. Pharmacological VTE prophylaxis has increased significantly over the past 12 years but is still largely underused in patients hospitalized with acute medical illness. Multiple demographic, behavioral, and clinical factors are associated with inpatient VTE prophylaxis. PMID:26720163

  5. Risk of viral acute gastrointestinal illness from non-disinfected drinking water distribution systems

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Acute gastrointestinal illness (AGI) resulting from pathogens directly entering the piping of drinking water distribution systems is insufficiently understood. Here, we estimate AGI incidence attributable to virus intrusions into non-disinfecting municipal distribution systems. Viruses were enumerat...

  6. Drug Use during Acute Illness in Tigray Region, Northern Ethiopia: A Household Study

    PubMed Central

    Wondimu, Abrham; Molla, Fantahun; Abrha, Solomon; Mohammed, Jemal; Demeke, Birhanu; Eticha, Tadele; Assen, Admassu; Melkam, Wondim; Gebre-Samuel, Naod; Berhe, Derbew Fikadu; Tadese, Ebisa; Endris, Kedir

    2015-01-01

    Background Drug use study in the community enables health authorities to understand pattern of drug utilization and its related aspects. This, in turn, can help to develop rational drug policies to be harmonized in accordance to the need of the community. Objective The aim of this study was to assess drug use during acute illness by the general population in Tigray region, Northern Ethiopia. Method A community based cross-sectional study was undertaken in April 2013 in Tigray Region, Ethiopia. A total of 1034 households were interviewed in the study. A multi-stage sampling technique was used to select households. Data were collected using a pre-tested structured questionnaire. Data were analyzed using descriptive statistics and bivariate and multivariate logistic regression model. Results Out of 1000 households, 210(21%) reported an episode of acute illness. The prevalence of acute illnesses in rural areas 126(25%) (AOR = 1.83, 95% CI: 1.21–2.76) was significantly higher than that of urban areas 84(17%). Cough, runny nose, sore throat, earache, fever and headache added up to 155(52%) of all reported symptoms of acute illnesses. The majority of the patients 162 (77%) took modern medications for the managements of their diseases. Half 105(50%) of the consumed medications were antibiotics. The large proportions 173(83%) of medicines for acute illness were taken orally. The greater proportions 150(93%) of medications were prescribed by health professionals. Thirty-four households (21%) reported treatment discontinuation. Conclusion The prevalence of acute illnesses in this study was found to be 21%. Acute illnesses were more common in rural areas than urban areas. Antibiotics were the most frequently used drugs for acute illnesses. PMID:26658645

  7. Complement levels in acute infectious hepatitis and serum hepatitis

    PubMed Central

    Kosmidis, J. C.; Leader-Williams, Lesley K.

    1972-01-01

    The level of the third component of complement was measured in serial specimens of serum taken from thirty-one patients with acute viral hepatitis. Fourteen of the thirty-one patients were positive for the hepatitis-associated antigen. A characteristic fluctuation was observed in twenty-nine of the thirty-one patients. This consisted of an initial fall of the level of C3, followed by an increase to a higher than normal level and then a gradual return to normal. No difference was observed between the patients who were positive and those who were negative for the hepatitis-associated antigen. These results support the view that immune complexes play a significant role in the pathogenesis of acute viral hepatitis. PMID:4624985

  8. Acute occupational disinfectant-related illness among youth, 1993-1998.

    PubMed Central

    Brevard, Theresa A; Calvert, Geoffrey M; Blondell, Jerome M; Mehler, Louise N

    2003-01-01

    Working youths face many safety and health risks. Among these risks are those posed by disinfectant exposures. In this study we describe acute occupational disinfectant-related illness among youth. Data on U.S. children younger than 18 years with acute occupational disinfectant-related illnesses between 1993 and 1998 were collected from the Toxic Exposure Surveillance System and from the California Department of Pesticide Regulation. We analyzed data from persons with exposures who met the case definition for acute occupational disinfectant-related illness. The case definition required onset of new adverse health effects that were both temporally related to a disinfectant exposure and consistent with the known toxicology of the disinfectant. We calculated incidence rates of acute occupational disinfectant-related illness among youths 15-17 years old and incidence rate ratios to compare these rates with those of adults 25-44 years old. We found 307 children with disinfectant-related illnesses. The average annual incidence rate was 16.8/billion hours worked with a relative risk compared with adults of 4.14 (95% confidence interval, 3.66-4.68). Most illnesses were of mild severity (78%). There were no fatalities. Hypochlorites (e.g., bleach) were responsible for 45% of the illnesses. Among the 206 cases where the responsible disinfectant's U.S. Environmental Protection Agency toxicity category was known, 80% were in category I (highest toxicity level). These findings suggest the need for greater efforts to prevent adolescent acute occupational disinfectant-related illness. This may require strengthening regulations and enforcement as well as increased educational efforts directed at employers, youths, parents, school officials, and physicians. Better mechanisms for reporting and tracking chemical illnesses among working adolescents are also needed. PMID:14527846

  9. Clinical Research in Acute Fatal Illness: Lessons From Extracorporeal Membrane Oxygenation.

    PubMed

    Bartlett, Robert H

    2016-08-01

    Clinical research to evaluate the effectiveness of life support systems in acute fatal illness has unique problems of logistics, ethics, and consent. There have been 10 prospective comparative trials of extracorporeal membrane oxygenation in acute fatal respiratory failure, utilizing different study designs. The trial designs were prospective controlled randomized, prospective adaptive randomized, sequential, and matched pairs. The trials were reviewed with regard to logistics, ethics, consent, statistical methods, economics, and impact. The matched pairs method is the best study design for evaluation of life support systems in acute fatal illness. PMID:25223826

  10. Challenges in the Etiology and Diagnosis of Acute Febrile Illness in Children in Low- and Middle-Income Countries.

    PubMed

    Iroh Tam, Pui-Ying; Obaro, Stephen K; Storch, Gregory

    2016-06-01

    Acute febrile illness is a common cause of hospital admission, and its associated infectious causes contribute to substantial morbidity and death among children worldwide, especially in low- and middle-income countries. Declining transmission of malaria in many regions, combined with the increasing use of rapid diagnostic tests for malaria, has led to the increasing recognition of leptospirosis, rickettsioses, respiratory viruses, and arboviruses as etiologic agents of fevers. However, clinical discrimination between these etiologies can be difficult. Overtreatment with antimalarial drugs is common, even in the setting of a negative test result, as is overtreatment with empiric antibacterial drugs. Viral etiologies remain underrecognized and poorly investigated. More-sensitive diagnostics have led to additional dilemmas in discriminating whether a positive test result reflects a causative pathogen. Here, we review and summarize the current epidemiology and focus particularly on children and the challenges for future research. PMID:27059657

  11. Chikungunya as a Cause of Acute Febrile Illness in Southern Sri Lanka

    PubMed Central

    Reller, Megan E.; Akoroda, Ufuoma; Nagahawatte, Ajith; Devasiri, Vasantha; Kodikaarachchi, Wasantha; Strouse, John J.; Chua, Robert; Hou, Yan'an; Chow, Angelia; Sessions, October M.; Østbye, Truls; Gubler, Duane J.; Woods, Christopher W.; Bodinayake, Champica

    2013-01-01

    Background Chikungunya virus (CHIKV) re-emerged in Sri Lanka in late 2006 after a 40-year hiatus. We sought to identify and characterize acute chikungunya infection (CHIK) in patients presenting with acute undifferentiated febrile illness in unstudied rural and semi-urban southern Sri Lanka in 2007. Methodology/Principal Findings We enrolled febrile patients ≥ 2 years of age, collected uniform epidemiologic and clinical data, and obtained serum samples for serology, virus isolation, and real-time reverse-transcriptase PCR (RT-PCR). Serology on paired acute and convalescent samples identified acute chikungunya infection in 3.5% (28/797) patients without acute dengue virus (DENV) infection, 64.3% (18/28) of which were confirmed by viral isolation and/or real-time RT-PCR. No CHIKV/DENV co-infections were detected among 54 patients with confirmed acute DENV. Sequencing of the E1 coding region of six temporally distinct CHIKV isolates (April through October 2007) showed that all isolates posessed the E1-226A residue and were most closely related to Sri Lankan and Indian isolates from the same time period. Except for more frequent and persistent musculoskeletal symptoms, acute chikungunya infections mimicked DENV and other acute febrile illnesses. Only 12/797 (1.5%) patients had serological evidence of past chikungunya infection. Conclusions/Significance Our findings suggest CHIKV is a prominent cause of non-specific acute febrile illness in southern Sri Lanka. PMID:24312651

  12. [Post-infectious functional gastrointestinal disorders: from the acute episode to chronicity].

    PubMed

    Mearin, Fermín; Balboa, Agustín

    2011-01-01

    Functional gastrointestinal disorders (FGID) form a major part of gastroenterology practice. Several studies have reported the development of post-infectious irritable bowel syndrome (PI-IBS) after acute gastroenteritis (AGE). Non-gastrointestinal (GI) infections may increase the risk of developing IBS. There are also data showing that a GI infection may trigger functional dyspepsia (PI-FD). The possible development of PI-IBS or PI-FD depends on factors related to both the infection and the host. Microinflammation has been found in patients with post-infectious FGID. Studies performed in animal models show that infection and acute inflammation permanently change gastrointestinal motility and sensitivity. The role of AGE in the development of FGID is important not only because this entity provides an excellent natural model for pathogenic study but also because it provides an opportunity for preventive action. PMID:21641686

  13. Ulcerative colitis presenting as acute infectious gastroenteritis with a paralytic ileus

    PubMed Central

    Schoenmaker, Suzanne Gerdien; Tjon a Ten, Walther E

    2012-01-01

    A 15-year-old girl who presented with signs of acute infectious gastroenteritis, just as two members of her family is described. As the patient did not improve, a sigmoidoscopy was performed and the diagnosis of ulcerative colitis (UC) was made. Our hypothesis is that an infection triggered the development of UC. Her paralytic ileus was probably triggered by the increased nitric oxide produced in the macrophages and smooth muscles of the inflamed bowel. PMID:22605860

  14. Anti-NMDAR encephalitis, a mimicker of acute infectious encephalitis and a review of the literature

    PubMed Central

    Wong, Darren; Fries, Bettina

    2014-01-01

    Anti-N-methyl-d-aspartate receptor encephalitis has become an increasingly recognized etiology of acute psychosis in young patients. The diverse constellation of symptoms allows for misdiagnosis as an infectious, psychological, or toxicological entity resulting in delays in treatment with increasing morbidity. We describe a case of anti-NMDAR encephalitis that was a particular challenge to diagnose. Practitioners should maintain a high index of suspicion for anti-NMDAR and related neuroautoimmune syndromes, especially in young patients that present with acute mental status decline or dyskinesia. PMID:26839775

  15. Postdischarge mortality in children with acute infectious diseases: derivation of postdischarge mortality prediction models

    PubMed Central

    Wiens, M O; Kumbakumba, E; Larson, C P; Ansermino, J M; Singer, J; Kissoon, N; Wong, H; Ndamira, A; Kabakyenga, J; Kiwanuka, J; Zhou, G

    2015-01-01

    Objectives To derive a model of paediatric postdischarge mortality following acute infectious illness. Design Prospective cohort study. Setting 2 hospitals in South-western Uganda. Participants 1307 children of 6 months to 5 years of age were admitted with a proven or suspected infection. 1242 children were discharged alive and followed up 6 months following discharge. The 6-month follow-up rate was 98.3%. Interventions None. Primary and secondary outcome measures The primary outcome was postdischarge mortality within 6 months following the initial hospital discharge. Results 64 children died during admission (5.0%) and 61 died within 6 months of discharge (4.9%). Of those who died following discharge, 31 (51%) occurred within the first 30 days. The final adjusted model for the prediction of postdischarge mortality included the variables mid-upper arm circumference (OR 0.95, 95% CI 0.94 to 0.97, per 1 mm increase), time since last hospitalisation (OR 0.76, 95% CI 0.61 to 0.93, for each increased period of no hospitalisation), oxygen saturation (OR 0.96, 95% CI 0.93 to 0·99, per 1% increase), abnormal Blantyre Coma Scale score (OR 2.39, 95% CI 1·18 to 4.83), and HIV-positive status (OR 2.98, 95% CI 1.36 to 6.53). This model produced a receiver operating characteristic curve with an area under the curve of 0.82. With sensitivity of 80%, our model had a specificity of 66%. Approximately 35% of children would be identified as high risk (11.1% mortality risk) and the remaining would be classified as low risk (1.4% mortality risk), in a similar cohort. Conclusions Mortality following discharge is a poorly recognised contributor to child mortality. Identification of at-risk children is critical in developing postdischarge interventions. A simple prediction tool that uses 5 easily collected variables can be used to identify children at high risk of death after discharge. Improved discharge planning and care could be provided for high-risk children. PMID

  16. Two episodes of acute illness in a machine shop

    SciTech Connect

    Sinks, T.; Kerndt, P.R.; Wallingford, K.M.

    1989-08-01

    Following an explosion in a machine shop and temporary plant closure, on the day the plant returned to full operations a degreaser malfunctioned. Workers in the assembly room were exposed to trichloroethylene levels later estimated to have exceeded 220 ppm (OSHA PEL 100 ppm). The plant was evacuated and the degreaser taken out of operation. Blood testing for carbon monoxide (CO) on five employees found carboxyhemoglobin levels in excess of normal. The plant reopened the following morning. Over the next two weeks, 15 employees were seen by the plant nurses for similar complaints; although all returned to work, their carboxyhemoglobin levels, later found to be inaccurate, were reported by a local medical clinic to range from 13.7 to 20.0 percent. At the end of the second week, another outbreak of illness occurred, but carboxyhemoglobin, trichloroethylene, fluorocarbons, and methylene chloride were not elevated in all 17 persons tested; plant-wide monitoring for CO found no elevated levels. During the first outbreak of illness, cases were 2.26 times as likely to have entered the assembly room as noncases. During the second outbreak, cases were no more likely than noncases to have entered the assembly room. We believe the explosion, earlier toxic exposures and illness, and the misleading blood test results led to plant-wide anxiety which culminated in a collective stress reaction and the second outbreak. An open meeting with all employees, informing them of our findings, provided reassurance and no further episodes of illness occurred in this workforce.

  17. Initial Sequential Organ Failure Assessment score versus Simplified Acute Physiology score to analyze multiple organ dysfunction in infectious diseases in Intensive Care Unit

    PubMed Central

    Nair, Remyasri; Bhandary, Nithish M.; D’Souza, Ashton D.

    2016-01-01

    Aims: To investigate initial Sequential Organ Failure Assessment (SOFA) score of patients in Intensive Care Unit (ICU), who were diagnosed with infectious disease, as an indicator of multiple organ dysfunction and to examine if initial SOFA score is a better mortality predictor compared to Simplified Acute Physiology Score (SAPS). Materials and Methods: Hospital-based study done in medical ICU, from June to September 2014 with a sample size of 48. Patients aged 18 years and above, diagnosed with infectious disease were included. Patients with history of chronic illness (renal/hepatic/pulmonary/  cardiovascular), diabetes, hypertension, chronic obstructive pulmonary disease, heart disease, those on immunosuppressive therapy/chemoradiotherapy for malignancy and patients in immunocompromised state were excluded. Blood investigations were obtained. Six organ dysfunctions were assessed using initial SOFA score and graded from 0 to 4. SAPS was calculated as the sum of points assigned to each of the 17 variables (12 physiological, age, type of admission, and three underlying diseases). The outcome measure was survival status at ICU discharge. Results: We categorized infectious diseases into dengue fever, leptospirosis, malaria, respiratory tract infections, and others which included undiagnosed febrile illness, meningitis, urinary tract infection and gastroenteritis. Initial SOFA score was both sensitive and specific; SAPS lacked sensitivity. We found no significant association between age and survival status. Both SAPS and initial SOFA score were found to be statistically significant as mortality predictors. There is significant association of initial SOFA score in analyzing organ dysfunction in infectious diseases (P < 0.001). SAPS showed no statistical significance. There was statistically significant (P = 0.015) percentage of nonsurvivors with moderate and severe dysfunction, based on SOFA score. Nonsurvivors had higher SAPS but was not statistically significant (P

  18. The economic impact of the insured patients with severe chronic and acute illnesses: a qualitative approach

    PubMed Central

    Aji, Budi; Yamamoto, Shelby Suzanne; Sauerborn, Rainer

    2014-01-01

    Background Little research has focused on the economic hardship among the insured with severe illnesses and high treatment costs, in particular, the consequence of poorer insurance coverage for high-cost illnesses. Therefore, we presented the case for identifying the experiences of insured patients with severe chronic and acute illnesses. This study identified a qualitative understanding of the economic impact of severe chronic and acute illnesses and household strategies to deal with high treatment costs. Design Interviews were conducted with 19 insured households of three different health insurance programs with a family member that had been hospitalized for severe chronic or acute illnesses in either Banyumas or Margono Sukarjo hospitals in Banyumas, Central Java, Indonesia. A thematic analysis was applied to guide the interpretation of the data. Results Insured households with a family member that had been hospitalized for severe chronic and acute illnesses were greatly affected by the high treatment costs. Four major issues emerged from this qualitative study: insured patients are still burdened with high out-of-pocket payments, households adopt various strategies to cope with the high cost of treatments, households experience financial hardships, and positive and negative perceptions of the insured regarding their health insurance coverage for acute and chronic illnesses. Conclusions Askes and Jamsostek patients faced financial burdens from high cost sharing for hospital amenities, non-covered drugs, and treatments and other indirect costs. Meanwhile, Jamkesmas beneficiaries faced no financial burden for related medical services but were rather burdened with indirect costs for the carers. Households relied on internal resources to cover hospital bills as the first strategy, which included the mobilization of savings, sale of assets, and borrowing of money. External support was tapped secondarily and included financial support from extended family members

  19. Infectious Events Prior to Chemotherapy Initiation in Children with Acute Myeloid Leukemia

    PubMed Central

    Portwine, Carol; Mitchell, David; Johnston, Donna; Gillmeister, Biljana; Ethier, Marie-Chantal; Yanofsky, Rochelle; Dix, David; Cellot, Sonia; Lewis, Victor; Price, Victoria; Silva, Mariana; Zelcer, Shayna; Bowes, Lynette; Michon, Bruno; Stobart, Kent; Brossard, Josee; Beyene, Joseph; Sung, Lillian

    2013-01-01

    Background The primary objective was to describe infectious complications in children with acute myeloid leukemia from presentation to the healthcare system to initiation of chemotherapy and to describe how these infections differ depending on neutropenia. Methods We conducted a retrospective, population-based cohort study that included children and adolescents with acute myeloid leukemia diagnosed and treated at 15 Canadian centers. We evaluated infections that occurred between presentation to the healthcare system (for symptoms that led to the diagnosis of acute myeloid leukemia) until initiation of chemotherapy. Results Among 328 children, 92 (28.0%) were neutropenic at presentation. Eleven (3.4%) had sterile-site microbiologically documented infection and four had bacteremia (only one Gram negative). Infection rate was not influenced by neutropenia. No child died from an infectious cause prior to chemotherapy initiation. Conclusion It may be reasonable to withhold empiric antibiotics in febrile non-neutropenic children with newly diagnosed acute myeloid leukemia until initiation of chemotherapy as long as they appear well without a clinical focus of infection. Future work could examine biomarkers or a clinical score to identify children presenting with leukemia and fever who are more likely to have an invasive infection. PMID:23637925

  20. Incidence of high altitude illnesses among unacclimatized persons who acutely ascended to Tibet.

    PubMed

    Ren, Yusheng; Fu, Zhongming; Shen, Weimin; Jiang, Ping; He, Yanlin; Peng, Shaojun; Wu, Zonggui; Cui, Bo

    2010-01-01

    High altitude illnesses pose health threats to unwary travelers after their acute ascent to high altitude locations. The incidence of high altitude illnesses among unacclimatized persons who acutely ascend to Tibet has not been previously reported. In the present study, we surveyed the incidence of high altitude illness among 3628 unacclimatized persons who had no previous high altitude experience and who traveled to Tibet by air to an altitude of 3600 m. These subjects were asked to answer questions in a written questionnaire about symptoms associated with high altitude illnesses that occurred within 2 weeks of their first arrival, their severity, and possible contributing factors. Physical examination and appropriate laboratory tests were also performed for hospitalized subjects. We found that 2063 respondents had mild acute mountain sickness with an incidence of 57.2%, and 249 (12.07%) of them were hospitalized for treatment. The incidence of high altitude pulmonary edema was 1.9%, while no case of high altitude cerebral edema was found. Additionally, there was no report of death. Psychological stresses and excessive physical exertions possibly contributed to the onset of HAPE. Acute mountain sickness is common among unacclimatized persons after their acute ascent to Tibet. The incidence of HAPE and HACE, however, is very low among them. PMID:20367487

  1. Polyclonal proliferation of activated suppressor/cytotoxic T cells with transient depression of natural killer cell function in acute infectious mononucleosis.

    PubMed Central

    Williams, M L; Loughran, T P; Kidd, P G; Starkebaum, G A

    1989-01-01

    In acute infectious mononucleosis large numbers of atypical lymphocytes proliferate in response to B cells infected with Epstein-Barr virus, generally resulting in a self-limited illness. Although both T-cells and NK cells are known to be involved, the precise origin of the large granular lymphocytes in this disorder is incompletely understood. Using two-colour immunofluorescent flow cytometry, we sequentially examined the phenotype of selected T cell and NK cell subsets from nine patients with infectious mononucleosis. In parallel, we determined whether these lymphocytes utilized a restricted repertoire of the T cell receptor gene and also measured their NK activity. Our results show that in acute infectious mononucleosis there was a greater than three-fold increase in T lymphocytes with the phenotype CD2+, CD3+, CD8+ and DR+. A modest increase in Leu7(HNK1)+ and CD4+ T cells was also seen. In addition, there was a three-fold increase in cells coexpressing CD3- and CD16+, the phenotype reported to represent most NK cells. In spite of this latter finding, however, a marked decrease in NK function was found at the time of diagnosis, gradually returning to normal by day 28. Finally, Southern blot analysis of DNA from patient lymphocytes showed polyclonal rearrangements of the T cell receptor beta chain gene. These studies indicate that the proliferation of activated suppressor/cytotoxic T lymphocytes in acute infectious mononucleosis is polyclonal and is associated with transient depression of NK function. Images Fig. 2 PMID:2527653

  2. Management of Acute Alcohol Withdrawal Syndrome in Critically Ill Patients.

    PubMed

    Dixit, Deepali; Endicott, Jeffrey; Burry, Lisa; Ramos, Liz; Yeung, Siu Yan Amy; Devabhakthuni, Sandeep; Chan, Claire; Tobia, Anthony; Bulloch, Marilyn N

    2016-07-01

    Approximately 16-31% of patients in the intensive care unit (ICU) have an alcohol use disorder and are at risk for developing alcohol withdrawal syndrome (AWS). Patients admitted to the ICU with AWS have an increased hospital and ICU length of stay, longer duration of mechanical ventilation, higher costs, and increased mortality compared with those admitted without an alcohol-related disorder. Despite the high prevalence of AWS among ICU patients, no guidelines for the recognition or management of AWS or delirium tremens in the critically ill currently exist, leading to tremendous variability in clinical practice. Goals of care should include immediate management of dehydration, nutritional deficits, and electrolyte derangements; relief of withdrawal symptoms; prevention of progression of symptoms; and treatment of comorbid illnesses. Symptom-triggered treatment of AWS with γ-aminobutyric acid receptor agonists is the cornerstone of therapy. Benzodiazepines (BZDs) are most studied and are often the preferred first-line agents due to their efficacy and safety profile. However, controversy still exists as to who should receive treatment, how to administer BZDs, and which BZD to use. Although most patients with AWS respond to usual doses of BZDs, ICU clinicians are challenged with managing BZD-resistant patients. Recent literature has shown that using an early multimodal approach to managing BZD-resistant patients appears beneficial in rapidly improving symptoms. This review highlights the results of recent promising studies published between 2011 and 2015 evaluating adjunctive therapies for BZD-resistant alcohol withdrawal such as antiepileptics, baclofen, dexmedetomidine, ethanol, ketamine, phenobarbital, propofol, and ketamine. We provide guidance on the places in therapy for select agents for management of critically ill patients in the presence of AWS. PMID:27196747

  3. Infectious Mononucleosis

    PubMed Central

    Dunmire, Samantha K.; Hogquist, Kristin A.; Balfour, Henry H.

    2015-01-01

    Infectious mononucleosis is a clinical entity characterized by sore throat, cervical lymph node enlargement, fatigue and fever most often seen in adolescents and young adults and lasting several weeks. It can be caused by a number of pathogens, but this chapter only discusses infectious mononucleosis due to primary Epstein-Barr virus (EBV) infection. EBV is a γ-herpesvirus that infects at least 90% of the population worldwide. The virus is spread by intimate oral contact among teenagers and young adults. How preadolescents acquire the virus is not known. A typical clinical picture with a positive heterophile test is usually sufficient to make the diagnosis, but heterophile antibodies are not specific and do not develop in some patients. EBV-specific antibody profiles are the best choice for staging EBV infection. In addition to causing acute illness, there can also be long-term consequences as the result of acquisition of the virus. Several EBV related illnesses occur including certain cancers and autoimmune diseases, as well as complications of primary immunodeficiency in persons with the certain genetic mutations. A major obstacle to understanding these sequelae has been the lack of an efficient animal model for EBV infection, although progress in primate and mouse models has recently been made. Key future challenges are to develop protective vaccines and effective treatment regimens. PMID:26424648

  4. Diminishing willingness to pay per quality-adjusted life year: valuing acute foodborne illness.

    PubMed

    Haninger, Kevin; Hammitt, James K

    2011-09-01

    We design and conduct a stated-preference survey to estimate willingness to pay (WTP) to reduce foodborne risk of acute illness and to test whether WTP is proportional to the corresponding gain in expected quality-adjusted life years (QALYs). If QALYs measure utility for health, then economic theory requires WTP to be nearly proportional to changes in both health quality and duration of illness and WTP could be estimated by multiplying the expected change in QALYs by an appropriate monetary value. WTP is elicited using double-bounded, dichotomous-choice questions in which respondents (randomly selected from the U.S. general adult population, n = 2,858) decide whether to purchase a more expensive food to reduce the risk of foodborne illness. Health risks vary by baseline probability of illness, reduction in probability, duration and severity of illness, and conditional probability of mortality. The expected gain in QALYs is calculated using respondent-assessed decrements in health-related quality of life if ill combined with the duration of illness and reduction in probability specified in the survey. We find sharply diminishing marginal WTP for severity and duration of illness prevented. Our results suggest that individuals do not have a constant rate of WTP per QALY, which implies that WTP cannot be accurately estimated by multiplying the change in QALYs by an appropriate monetary value. PMID:21488924

  5. Serious Mental Illness and Acute Hospital Readmission in Diabetic Patientsa

    PubMed Central

    Albrecht, Jennifer S.; Hirshon, Jon Mark; Goldberg, Richard; Langenberg, Patricia; Day, Hannah R.; Morgan, Daniel J.; Comer, Angela C.; Harris, Anthony D.; Furuno, Jon P.

    2013-01-01

    Patients with serious mental illness (SMI), particularly those with other chronic illnesses, may be vulnerable to unplanned hospital readmission. We hypothesized that SMI would be associated with increased 30-day hospital readmission in a cohort of adult patients with comorbid diabetes admitted to a tertiary-care facility from 2005–2009. SMI was defined by ICD-9 discharge diagnosis codes for schizophrenia, schizo-affective, bipolar, manic, or major depressive disorders, or other psychosis. The primary outcome was 30-day readmission to the index hospital. Among 26,878 eligible admissions, prevalence of SMI was 6% and incidence of 30-day hospital admission was 16%. Among patients aged <35 years, SMI was significantly associated with decreased odds of 30-day hospital readmission (OR 0.39, 95% CI: 0.17, 0.91). However, among patients ≥35 years, SMI was not significantly associated with 30-day hospital readmission (OR 1.11, 95%CI: 0.86, 1.42). SMI may not be associated with increased odds of 30-day hospital readmission in this population. PMID:22539798

  6. Parents' help-seeking behaviours during acute childhood illness at home: A contribution to explanatory theory.

    PubMed

    Neill, Sarah J; Jones, Caroline H D; Lakhanpaul, Monica; Roland, Damian T; Thompson, Matthew J

    2016-03-01

    Uncertainty and anxiety surround parents' decisions to seek medical help for an acutely ill child. Consultation rates for children are rising, yet little is known about factors that influence parents' help-seeking behaviours. We used focus groups and interviews to examine how 27 parents of children under five years, from a range of socioeconomic groups in the East Midlands of England, use information to make decisions during acute childhood illness at home. This article reports findings elucidating factors that influence help-seeking behaviours. Parents reported that decision-making during acute childhood illness was influenced by a range of personal, social and health service factors. Principal among these was parents' concern to do the right thing for their child. Their ability to assess the severity of the illness was influenced by knowledge and experience of childhood illness. When parents were unable to access their general practitioner (GP), feared criticism from or had lost trust in their GP, some parents reported using services elsewhere such as Accident and Emergency. These findings contribute to explanatory theory concerning parents' help-seeking behaviours. Professional and political solutions have not reduced demand; therefore, collaborative approaches involving the public and professionals are now needed to improve parents' access to information. PMID:25296933

  7. Respiratory Viral Testing and Influenza Antiviral Prescriptions During Hospitalization for Acute Respiratory Illnesses

    PubMed Central

    Rolfes, Melissa A.; Yousey-Hindes, Kimberly M.; Meek, James I.; Fry, Alicia M.; Chaves, Sandra S.

    2016-01-01

    We examined respiratory viral testing and influenza antiviral prescriptions at a US tertiary care hospital. During the 2010–11 to 2012–13 influenza seasons, antiviral prescriptions among acute respiratory illness (ARI) hospitalizations were associated with viral testing (rate ratio = 15.0), and empiric prescriptions were rare (<1% of ARI hospitalizations). PMID:26885545

  8. Emergency room visits for acute gastrointestinal illness following flooding: A case-crossover study

    EPA Science Inventory

    Climate change may alter the frequency of precipitation and flooding which can increase fecal-oral transmission of acute gastrointestinal illness (AGI) through contact with contaminated items or water. Few studies have quantified the risk associated with flood events in the Unite...

  9. Parents' difficulties and information needs in coping with acute illness in preschool children: a qualitative study.

    PubMed Central

    Kai, J.

    1996-01-01

    OBJECTIVES: To identify and explore difficulties parents experience with acute illness in young children and the information they seek to help them. DESIGN: Qualitative study using semi-structured one t one and group interviews with parents of preschool children. SETTING: Disadvantaged inner city community. SUBJECTS: 95 parents of preschool children. RESULTS: Parents felt disempowered when dealing with acute illness in their children because of difficulties making sense of the illness. Central to parents' difficulties were their experiences of inadequate information sharing by their general practitioners and variations in their doctors' decisions and behaviour. Disparity between parents' beliefs and expectations about illness and treatment and professionals' behaviour further frustrated parents' attempts to understand illness. Parents expressed a need for a range of accessible and specific information to support them through their negotiation of children's illness. CONCLUSIONS: Communication with parents requires greater recognition of parents' difficulties. Professionals have considerable potential to empower parents by sharing more information and skills. Such information should be consistent and address parents' concerns, beliefs, and expressed needs if this potential is to be realised. PMID:8892421

  10. Can nutrition support interfere with recovery from acute critical illness?

    PubMed

    Schulman, Rifka C; Mechanick, Jeffrey I

    2013-01-01

    Malnutrition, following critical illness-related metabolic and immune neuroendocrine derangements, is exacerbated by energy and protein deficits beginning early in the intensive care unit (ICU) stay. While nutrition support is an important component of ICU care, adverse effects can occur. Underfeeding, due to insufficient energy and/or protein is associated with poor patient outcomes. Overfeeding carbohydrates, lipids, and/or protein can result in hyperglycemia, hypertriglyceridemia, hepatic dysfunction, and/or azotemia. Individualization of the nutritional prescription with clinical monitoring and repeated adjustment is necessary to avoid harm. Appropriate use of tight glycemic control protocols in combination with nutrition support can prevent hyperglycemia, while minimizing glycemic variability and hypoglycemic events. While the enteral route is favored for nutrition support, early supplemental parenteral nutrition should be considered in selected high-risk patients. Thus, risk stratification of patients upon admission to the ICU can be helpful to design individualized nutritional prescriptions maximizing benefit while avoiding potential interference with recovery. PMID:23075588

  11. Dyschloremia Is a Risk Factor for the Development of Acute Kidney Injury in Critically Ill Patients

    PubMed Central

    Shao, Min; Li, Guangxi; Sarvottam, Kumar; Wang, Shengyu; Thongprayoon, Charat; Dong, Yue; Gajic, Ognjen

    2016-01-01

    Introduction Dyschloremia is common in critically ill patients, although its impact has not been well studied. We investigated the epidemiology of dyschloremia and its associations with the incidence of acute kidney injury and other intensive care unit outcomes. Material and Methods This is a single-center, retrospective cohort study at Mayo Clinic Hospital—Rochester. All adult patients admitted to intensive care units from January 1st, 2006, through December 30th, 2012 were included. Patients with known acute kidney injury and chronic kidney disease stage 5 before intensive care unit admission were excluded. We evaluated the association of dyschloremia with ICU outcomes, after adjustments for the effect of age, gender, Charlson comorbidity index and severity of illness score. Results A total of 6,025 patients were enrolled in the final analysis following the implementation of eligibility criteria. From the cohort, 1,970 patients (33%) developed acute kidney injury. Of the total patients enrolled, 4,174 had a baseline serum chloride. In this group, 1,530 (37%) had hypochloremia, and 257 (6%) were hyperchloremic. The incidence of acute kidney injury was higher in hypochloremic and hyperchloremic patients compared to those with a normal serum chloride level (43% vs.30% and 34% vs. 30%, respectively; P < .001). Baseline serum chloride was lower in the acute kidney injury group vs. the non-acute kidney injury group [100 mmol/L (96–104) vs. 102 mmol/L (98–105), P < .0001]. In a multivariable logistic regression model, baseline serum chloride of ≤94 mmol/L found to be independently associated with the risk of acute kidney injury (OR 1.7, 95% CI 1.1–2.6; P = .01). Discussion Dyschloremia is common in critically ill patients, and severe hypochloremia is independently associated with an increased risk of development of acute kidney injury. PMID:27490461

  12. Working as a doctor when acutely ill: comments made by doctors responding to United Kingdom surveys

    PubMed Central

    Smith, Fay; Goldacre, Michael J

    2016-01-01

    Summary Objectives We undertook multi-purpose surveys of doctors who qualified in the United Kingdom between 1993 and 2012. Doctors were asked specific questions about their careers and were asked to comment about any aspect of their training or work. We report doctors’ comments about working whilst acutely ill. Design Self-completed questionnaire surveys. Setting United Kingdom. Participants Nine cohorts of doctors, comprising all United Kingdom medical qualifiers of 1993, 1996, 1999, 2000, 2002, 2005, 2008, 2009 and 2012. Main outcome measures Comments made by doctors about working when ill, in surveys one, five and 10 years after graduation. Results The response rate, overall, was 57.4% (38,613/67,224 doctors). Free-text comments were provided by 30.7% (11,859/38,613). Three-hundred and twenty one doctors (2.7% of those who wrote comments) wrote about working when feeling acutely ill. Working with Exhaustion/fatigue was the most frequent topic raised (195 doctors), followed by problems with Taking time off for illness (112), and general comments on Physical/mental health problems (66). Other topics raised included Support from others, Leaving or adapting/coping with the situation, Bullying, the Doctor’s ability to care for patients and Death/bereavement. Arrangements for cover due to illness were regarded as insufficient by some respondents; some wrote that doctors were expected to work harder and longer to cover for colleagues absent because of illness. Conclusions We recommend that employers ensure that it is not unduly difficult for doctors to take time off work when ill, and that employers review their strategies for covering ill doctors who are off work. PMID:27066264

  13. Air pollution and acute respiratory illness in five German communities

    SciTech Connect

    Schwartz, J. ); Spix, C.; Wichmann, H.E. ); Malin, E. )

    1991-10-01

    To assess the impact of short-term exposure to air pollution on respiratory illness in children, the authors recruited pediatricians and hospitals in five German cities to report daily counts of children's visits for croup symptoms and obstructive bronchitis. Data were collected for at least 2 years in each location. These symptoms are predominantly found in very young children, with the croup reporting peaking at 2 years of age and obstructive bronchitis at 1 year. A total of 6,330 cases of croup and 4,755 cases of obstructive bronchitis were observed during the study. The distributions of these events were quite skewed and were modeled as a Poisson process. To focus the analysis on short-term correlations and avoid seasonal confounding, biannual, annual (seasonal), and six shorter term cycles were controlled for in the regression models. After controlling for short-term weather factors, total suspended particulate matter (TSP) and nitrogen dioxide (NO{sub 2}) were associated with croup cases. An increase in TSAP levels from 10 {mu}g/m{sup 3} to 70 {mu}g/m{sup 3} was associated with a 27% increase in cases of croup; the same increase in NO{sub 2} levels resulted in a 28% increase in cases. No pollutant was associated with daily cases of obstructive bronchitis.

  14. Progress in pediatrics in 2013: choices in allergology, endocrinology, gastroenterology, hypertension, infectious diseases, neonatology, neurology, nutrition and respiratory tract illnesses.

    PubMed

    Caffarelli, Carlo; Santamaria, Francesca; Vottero, Alessandra; Dascola, Carlotta Povesi; Mirra, Virginia; Sperli, Francesco; Bernasconi, Sergio

    2014-01-01

    This review will provide new information related to pathophysiology and management of specific diseases that have been addressed by selected articles published in the Italian Journal of Pediatrics in 2013, focusing on allergology, endocrinology, gastroenterology, hypertension, infectious diseases, neonatology, neurology, nutrition and respiratory tract illnesses in children. Recommendations for interpretation of skin prick test to foods in atopic eczema, management of allergic conjunctivitis, hypertension and breastfeeding in women treated with antiepileptic drugs and healthy breakfast have been reported. Epidemiological studies have given emphasis to high incidence of autoimmune disorders in patients with Turner syndrome, increasing prevalence of celiac disease, frequency of hypertension in adolescents, incidence and risk factor for retinopathy of prematurity. Advances in prevention include elucidation of the role of probiotics in reducing occurrence of allergies and feeding intolerance, and events of foetal life that influence later onset of diseases. Mechanistic studies suggested a role for vitamin D deficiency in asthma and type 1 diabetes and for reactivation of Varicella-Zoster virus in aseptic meningitis. Regarding diagnosis, a new mean for the diagnosis of hyperbilirubinaemia in newborns, a score for recognition of impaired nutritional status and growth and criteria for early Dyke-Davidoff-Masson Syndrome have been suggested. New therapeutic approaches consist of use of etanercept for reducing insulin dose in type 1 diabetes, probiotics in atopic eczema, and melatonin in viral infections. PMID:25015124

  15. A new surveillance system for undiagnosed serious infectious illness for the London 2012 Olympic and Paralympic Games.

    PubMed

    Heinsbroek, E; Said, B; Kirkbride, H

    2012-01-01

    A new surveillance system was developed to detect possible new or emerging infections presenting as undiagnosed serious infectious illness (USII) for use during the London 2012 Olympic and Paralympic Games. Designated clinicians in sentinel adult and paediatric intensive care units (ICU/ PICUs) reported USII using an online reporting tool or provided a weekly nil notification. Reported cases were investigated for epidemiological links. A pilot study was undertaken for six months between January and July 2011 to evaluate the feasibility and acceptability of the system. In this six-month period, 5 adults and 13 children were reported by six participating units (3 ICUs, 3 PICUs). Of these 18 patients, 12 were reported within four days after admission to an ICU/PICU. Nine patients were subsequently diagnosed and were thus excluded from the surveillance. Therefore, only nine cases of USII were reported. No clustering was identified.On the basis of the pilot study, we conclude that the system is able to detect cases of USII and is feasible and acceptable to users. USII surveillance has been extended to a total of 19 sentinel units in London and the south-east of England during the London 2012 Olympic and Paralympic Games. PMID:22874459

  16. Physiology in Medicine: A physiologic approach to prevention and treatment of acute high-altitude illnesses.

    PubMed

    Luks, Andrew M

    2015-03-01

    With the growing interest in adventure travel and the increasing ease and affordability of air, rail, and road-based transportation, increasing numbers of individuals are traveling to high altitude. The decline in barometric pressure and ambient oxygen tensions in this environment trigger a series of physiologic responses across organ systems and over a varying time frame that help the individual acclimatize to the low oxygen conditions but occasionally lead to maladaptive responses and one or several forms of acute altitude illness. The goal of this Physiology in Medicine article is to provide information that providers can use when counseling patients who present to primary care or travel medicine clinics seeking advice about how to prevent these problems. After discussing the primary physiologic responses to acute hypoxia from the organ to the molecular level in normal individuals, the review describes the main forms of acute altitude illness--acute mountain sickness, high-altitude cerebral edema, and high-altitude pulmonary edema--and the basic approaches to their prevention and treatment of these problems, with an emphasis throughout on the physiologic basis for the development of these illnesses and their management. PMID:25539941

  17. A patient-centered research agenda for the care of the acutely ill older patient.

    PubMed

    Wald, Heidi L; Leykum, Luci K; Mattison, Melissa L P; Vasilevskis, Eduard E; Meltzer, David O

    2015-05-01

    Hospitalists and others acute-care providers are limited by gaps in evidence addressing the needs of the acutely ill older adult population. The Society of Hospital Medicine sponsored the Acute Care of Older Patients Priority Setting Partnership to develop a research agenda focused on bridging this gap. Informed by the Patient-Centered Outcomes Research Institute framework for identification and prioritization of research areas, we adapted a methodology developed by the James Lind Alliance to engage diverse stakeholders in the research agenda setting process. The work of the Partnership proceeded through 4 steps: convening, consulting, collating, and prioritizing. First, the steering committee convened a partnership of 18 stakeholder organizations in May 2013. Next, stakeholder organizations surveyed members to identify important unanswered questions in the acute care of older persons, receiving 1299 responses from 580 individuals. Finally, an extensive and structured process of collation and prioritization resulted in a final list of 10 research questions in the following areas: advanced-care planning, care transitions, delirium, dementia, depression, medications, models of care, physical function, surgery, and training. With the changing demographics of the hospitalized population, a workforce with limited geriatrics training, and gaps in evidence to inform clinical decision making for acutely ill older patients, the identified research questions deserve the highest priority in directing future research efforts to improve care for the older hospitalized patient and enrich training. PMID:25877486

  18. A patient-centered research agenda for the care of the acutely ill older patient

    PubMed Central

    Wald, Heidi L.; Leykum, Luci K.; Mattison, Melissa L. P.; Vasilevskis, Eduard E.; Meltzer, David O.

    2015-01-01

    Hospitalists and others acute care providers are limited by gaps in evidence addressing the needs of the acutely ill older adult population. The Society of Hospital Medicine (SHM) sponsored the Acute Care of Older Patients (ACOP) Priority Setting Partnership to develop a research agenda focused on bridging this gap. Informed by the Patient-Centered Outcomes Research Institute (PCORI) framework for identification and prioritization of research areas, we adapted a methodology developed by the James Lind Alliance to engage diverse stakeholders in the research agenda setting process. The work of the Partnership proceeded through four steps: convening, consulting, collating, and prioritizing. First, the steering committee convened a Partnership of 18 stakeholder organizations in May 2013. Next, stakeholder organizations surveyed members to identify important unanswered questions in the acute care of older persons, receiving 1299 responses from 580 individuals. Finally, an extensive and structured process of collation and prioritization resulted in a final list of ten research questions in the following areas: advanced care planning, care transitions, delirium, dementia, depression, medications, models of care, physical function, surgery, and training. With the changing demographics of the hospitalized population, a workforce with limited geriatrics training, and gaps in evidence to inform clinical decision-making for acutely ill older patients, the identified research questions deserve the highest priority in directing future research efforts to improve care for the older hospitalized patient and enrich training. PMID:25877486

  19. Forearm and upper-arm oscillometric blood pressure comparison in acutely ill adults.

    PubMed

    Schell, Kathleen; Morse, Kate; Waterhouse, Julie K

    2010-04-01

    When patients' upper arms are not accessible and/or when cuffs do not fit large upper arms, the forearm site is often used for blood pressure (BP) measurement. The purpose of this study is to compare forearm and upper-arm BPs in 70 acutely ill adults, admitted to a community hospital's 14-bed ICU. Using Philips oscillometric monitors, three repeated measures of forearm and upper-arm BPs are obtained with head of bed flat and with head of bed elevated at 30 degrees. Arms are resting on the bed. Paired t tests show statistically significant differences in systolic BPs, diastolic BPs, and mean arterial pressures in the supine and head-elevated positions. Bland-Altman analyses indicate that forearm and upper-arm oscillometric BPs are not interchangeable in acutely ill adults. PMID:20581399

  20. Infectious dengue vesicles derived from CD61+ cells in acute patient plasma exhibited a diaphanous appearance

    PubMed Central

    Hsu, Alan Yi-Hui; Wu, Shang-Rung; Tsai, Jih-Jin; Chen, Po-Lin; Chen, Ya-Ping; Chen, Tsai-Yun; Lo, Yu-Chih; Ho, Tzu-Chuan; Lee, Meed; Chen, Min-Ting; Chiu, Yen-Chi; Perng, Guey Chuen

    2015-01-01

    The levels of neutralizing antibody to a pathogen are an effective indicator to predict efficacy of a vaccine in trial. And yet not all the trial vaccines are in line with the theory. Using dengue virus (DENV) to investigate the viral morphology affecting the predictive value, we evaluated the viral morphology in acute dengue plasma compared to that of Vero cells derived DENV. The virions in plasma were infectious and heterogeneous in shape with a “sunny-side up egg” appearance, viral RNA was enclosed with CD61+ cell-derived membrane interspersed by the viral envelope protein, defined as dengue vesicles. The unique viral features were also observed from ex vivo infected human bone marrow. Dengue vesicles were less efficiently neutralized by convalescent patient serum, compared to virions produced from Vero cells. Our results exhibit a reason why potencies of protective immunity fail in vivo and significantly impact dengue vaccine and drug development. PMID:26657027

  1. Is albumin administration in the acutely ill associated with increased mortality? Results of the SOAP study

    PubMed Central

    Vincent, Jean-Louis; Sakr, Yasser; Reinhart, Konrad; Sprung, Charles L; Gerlach, Herwig; Ranieri, V Marco

    2005-01-01

    Introduction Albumin administration in the critically ill has been the subject of some controversy. We investigated the use of albumin solutions in European intensive care units (ICUs) and its relationship to outcome. Methods In a cohort, multicenter, observational study, all patients admitted to one of the participating ICUs between 1 May and 15 May 2002 were followed up until death, hospital discharge, or for 60 days. Patients were classified according to whether or not they received albumin at any time during their ICU stay. Results Of 3,147 admitted patients, 354 (11.2%) received albumin and 2,793 (88.8%) did not. Patients who received albumin were more likely to have cancer or liver cirrhosis, to be surgical admissions, and to have sepsis. They had a longer length of ICU stay and a higher mortality rate, but were also more severely ill, as manifested by higher simplified acute physiology score (SAPS) II and sequential organ failure assessment (SOFA) scores than the other patients. A Cox proportional hazard model indicated that albumin administration was significantly associated with decreased 30-day survival. Moreover, in 339 pairs matched according to a propensity score, ICU and hospital mortality rates were higher in the patients who had received albumin than in those who had not (34.8 versus 20.9% and 41.3 versus 27.7%, respectively, both p < 0.001). Conclusion Albumin administration was associated with decreased survival in this population of acutely ill patients. Further prospective randomized controlled trials are needed to examine the effects of albumin administration in sub-groups of acutely ill patients. PMID:16356223

  2. Unsuspected Leptospirosis Is a Cause of Acute Febrile Illness in Nicaragua

    PubMed Central

    Reller, Megan E.; Wunder, Elsio A.; Miles, Jeremy J.; Flom, Judith E.; Mayorga, Orlando; Woods, Christopher W.; Ko, Albert I.; Dumler, J. Stephen; Matute, Armando J.

    2014-01-01

    Background Epidemic severe leptospirosis was recognized in Nicaragua in 1995, but unrecognized epidemic and endemic disease remains unstudied. Methodology/Principal Findings To determine the burden of and risk factors associated with symptomatic leptospirosis in Nicaragua, we prospectively studied patients presenting with fever at a large teaching hospital. Epidemiologic and clinical features were systematically recorded, and paired sera tested by IgM-ELISA to identify patients with probable and possible acute leptospirosis. Microscopic Agglutination Test and PCR were used to confirm acute leptospirosis. Among 704 patients with paired sera tested by MAT, 44 had acute leptospirosis. Patients with acute leptospirosis were more likely to present during rainy months and to report rural residence and fresh water exposure. The sensitivity of clinical impression and acute-phase IgM detected by ELISA were poor. Conclusions/Significance Leptospirosis is a common (6.3%) but unrecognized cause of acute febrile illness in Nicaragua. Rapid point-of-care tests to support early diagnosis and treatment as well as tests to support population-based studies to delineate the epidemiology, incidence, and clinical spectrum of leptospirosis, both ideally pathogen-based, are needed. PMID:25058149

  3. Access to medicines for acute illness in middle income countries in Central America

    PubMed Central

    Emmerick, Isabel Cristina Martins; Luiza, Vera Lucia; Camacho, Luiz Antonio Bastos; Ross-Degnan, Dennis

    2013-01-01

    OBJECTIVE To analyze the main predictors of access to medicines for persons who experienced acute health conditions. METHODS This was a cross-sectional analytic study, based on data from household surveys. We examined the predictors of: (1) seeking care for acute illness in the formal health care system and (2) obtaining all medicines sought for the acute condition. RESULTS The significant predictors of seeking health care for acute illnesses were urban geographic location, head of household with secondary school education or above, age under 15, severity of illness perceived by the respondent, and having health insurance. The most important predictor of obtaining full access to medicines was seeking care in the formal health care system. People who sought care in the formal system were three times more likely to receive all the medicines sought (OR 3.0, 95%CI 2.3;4.0). For those who sought care in the formal health system, the strongest predictors of full access to medicines were seeking care in the private sector, having secondary school education or above, and positive perceptions of quality of health care and medicines in public sector health facilities. For patients who did not seek care in the formal health system, full access to medicines was more likely in Honduras or Nicaragua than in Guatemala. Urban geographic location, higher economic status, and male gender were also significant predictors. CONCLUSIONS A substantial part of the population in these three countries sought and obtained medicines outside of the formal health care system, which may compromise quality of care and pose a risk to patients. Determinants of full access to medicines inside and outside the formal health care system differ, and thus may require different strategies to improve access to medicines.  PMID:24626545

  4. On the dynamics of acute EBV infection and the pathogenesis of infectious mononucleosis

    PubMed Central

    Hadinoto, Vey; Shapiro, Michael; Greenough, Thomas C.; Sullivan, John L.; Luzuriaga, Katherine

    2008-01-01

    Memory B cells latently infected with Epstein-Barr virus (mBLats) in the blood disappear rapidly on presentation with acute symptomatic primary infection (acute infectious mononucleosis [AIM]). They undergo a simple exponential decay (average half-life: 7.5 ± 3.7 days) similar to that of normal memory B cells. The cytotoxic T lymphocyte (CTL) response to immediate early (IE) lytic antigens (CTLIEs) also decays over this time period, but no such correlation was observed for the CTL response to lytic or latent antigens or to the levels of virions shed into saliva. We have estimated the average half-life of CTLIEs to be 73 (± 23) days. We propose that cycles of infection and reactivation occur in the initial stages of infection that produce high levels of mBLats in the circulation. Eventually the immune response arises and minimizes these cycles leaving the high levels of mBLats in the blood to decay through simple memory B-cell homeostasis mechanisms. This triggers the cells to reactivate the virus whereupon most are killed by CTLIEs before they can release virus and infect new cells. The release of antigens caused by this large-scale destruction of infected cells may trigger the symptoms of AIM and be a cofactor in other AIM-associated diseases. PMID:17991806

  5. Suppressor T cell clones from patients with acute Epstein-Barr virus-induced infectious mononucleosis.

    PubMed Central

    Wang, F; Blaese, R M; Zoon, K C; Tosato, G

    1987-01-01

    Suppression and/or cytotoxicity are believed to play an important role in the defense against Epstein-Barr virus (EBV) infection. To analyze the role of suppressor T cells in relation to EBV, we sought to clone and study these T cells. Analysis of 152 T cell clones derived from the peripheral blood of two patients with acute EBV-induced infectious mononucleosis (IM) yielded 11 highly suppressive clones that had no cytotoxic activity for the natural killer sensitive K562 cell line, an autologous EBV-infected cell line, or an allogeneic EBV-infected B cell line. Four of six suppressor T cell clones also profoundly inhibited EBV-induced immunoglobulin production, and five of five clones delayed the outgrowth of immortalized cells. These results indicate that during acute IM, suppressor T cells capable of inhibiting B cell activation in the absence of cytotoxicity can be identified, and may play a key role in the control of EBV infection. Images PMID:3025263

  6. Viral Hemorrhagic Fever Cases in the Country of Georgia: Acute Febrile Illness Surveillance Study Results

    PubMed Central

    Kuchuloria, Tinatin; Imnadze, Paata; Chokheli, Maiko; Tsertsvadze, Tengiz; Endeladze, Marina; Mshvidobadze, Ketevan; Clark, Danielle V.; Bautista, Christian T.; Fadeel, Moustafa Abdel; Pimentel, Guillermo; House, Brent; Hepburn, Matthew J.; Wölfel, Silke; Wölfel, Roman; Rivard, Robert G.

    2014-01-01

    Minimal information is available on the incidence of Crimean–Congo hemorrhagic fever (CCHF) virus and hantavirus infections in Georgia. From 2008 to 2011, 537 patients with fever ≥ 38°C for ≥ 48 hours without a diagnosis were enrolled into a sentinel surveillance study to investigate the incidence of nine pathogens, including CCHF virus and hantavirus. Of 14 patients with a hemorrhagic fever syndrome, 3 patients tested positive for CCHF virus immunoglobulin M (IgM) antibodies. Two of the patients enrolled in the study had acute renal failure. These 2 of 537 enrolled patients were the only patients in the study positive for hantavirus IgM antibodies. These results suggest that CCHF virus and hantavirus are contributing causes of acute febrile syndromes of infectious origin in Georgia. These findings support introduction of critical diagnostic approaches and confirm the need for additional surveillance in Georgia. PMID:24891463

  7. Effects of acute critical illnesses on the performance of interferon-gamma release assay

    PubMed Central

    Huang, Chun-Ta; Ruan, Sheng-Yuan; Tsai, Yi-Ju; Kuo, Ping-Hung; Ku, Shih-Chi; Lee, Pei-Lin; Kuo, Lu-Cheng; Hsu, Chia-Lin; Huang, Chun-Kai; Yang, Ching-Yao; Chien, Ying-Chun; Wang, Jann-Yuan; Yu, Chong-Jen

    2016-01-01

    Performance of interferon-gamma release assays (IGRAs) is influenced by preanalytical, laboratory and host factors. The data regarding how critical illnesses influence IGRA results are limited. This study aimed to investigate IGRA performance among critically ill patients. Patients admitted to intensive care unit (ICU) were prospectively enrolled, and underwent QuantiFERON-TB Gold In-Tube testing on admission and discharge. The associations between patient factors and IGRA results were explored. In total, 118 patients were included. IGRA results on admission were positive, negative and indeterminate for 10(9%), 36(31%) and 72(61%) patients. All indeterminate results were due to a low mitogen response. Indeterminate results were associated with higher disease severity and lower serum albumin levels. Ninety(76%) patients survived to ICU discharge and had repeat IGRA testing 13.3 ± 10.1 days after first ones. Of those, 43(48%) had indeterminate results, and no IGRA conversion or reversion was observed. The majority (35/51, 69%) of ICU survivors with initial indeterminate results still had indeterminates on follow-up testing. Acute critical illnesses exert a significant impact on IGRA performance and a high proportion of indeterminate results was seen in ICU patients. This study highlights limitation of IGRAs in the critically ill and judicious selection of patients to be tested should be considered. PMID:26804487

  8. Effects of acute critical illnesses on the performance of interferon-gamma release assay.

    PubMed

    Huang, Chun-Ta; Ruan, Sheng-Yuan; Tsai, Yi-Ju; Kuo, Ping-Hung; Ku, Shih-Chi; Lee, Pei-Lin; Kuo, Lu-Cheng; Hsu, Chia-Lin; Huang, Chun-Kai; Yang, Ching-Yao; Chien, Ying-Chun; Wang, Jann-Yuan; Yu, Chong-Jen

    2016-01-01

    Performance of interferon-gamma release assays (IGRAs) is influenced by preanalytical, laboratory and host factors. The data regarding how critical illnesses influence IGRA results are limited. This study aimed to investigate IGRA performance among critically ill patients. Patients admitted to intensive care unit (ICU) were prospectively enrolled, and underwent QuantiFERON-TB Gold In-Tube testing on admission and discharge. The associations between patient factors and IGRA results were explored. In total, 118 patients were included. IGRA results on admission were positive, negative and indeterminate for 10 (9%), 36 (31%) and 72 (61%) patients. All indeterminate results were due to a low mitogen response. Indeterminate results were associated with higher disease severity and lower serum albumin levels. Ninety (76%) patients survived to ICU discharge and had repeat IGRA testing 13.3 ± 10.1 days after first ones. Of those, 43 (48%) had indeterminate results, and no IGRA conversion or reversion was observed. The majority (35/51, 69%) of ICU survivors with initial indeterminate results still had indeterminates on follow-up testing. Acute critical illnesses exert a significant impact on IGRA performance and a high proportion of indeterminate results was seen in ICU patients. This study highlights limitation of IGRAs in the critically ill and judicious selection of patients to be tested should be considered. PMID:26804487

  9. Acute Monocytic Leukemia Masquerading Behçet's Disease-Like Illness at Onset in an Elderly Female

    PubMed Central

    Koba, Shigeru; Sekioka, Toshio; Takeda, Sorou; Miyagawa-Hayashino, Aya; Nishimura, Keisuke

    2016-01-01

    A previously healthy 74-year-old Japanese female was hospitalized with fever and high C-reactive protein. She developed palatal herpangina-like aphthous ulcers, localized intestinal wall thickening, terminal ileum ulcers, and an erythematous acneiform rash; thus Behçet's disease-like illness was suspected. Significant peripheral blood acute monocytosis developed during her hospitalization and acute monocytic leukemia (FAB M5b) with normal karyotype was diagnosed. By immunostaining, the infiltrating cells in the skin and the terminal ileum were identified as monocytic leukemic cells. This case exhibited a unique initial presentation of Behçet's disease-like illness associated with acute monocytic leukemia. PMID:27610252

  10. Acute Monocytic Leukemia Masquerading Behçet's Disease-Like Illness at Onset in an Elderly Female.

    PubMed

    Koba, Shigeru; Sekioka, Toshio; Takeda, Sorou; Miyagawa-Hayashino, Aya; Nishimura, Keisuke; Imashuku, Shinsaku

    2016-01-01

    A previously healthy 74-year-old Japanese female was hospitalized with fever and high C-reactive protein. She developed palatal herpangina-like aphthous ulcers, localized intestinal wall thickening, terminal ileum ulcers, and an erythematous acneiform rash; thus Behçet's disease-like illness was suspected. Significant peripheral blood acute monocytosis developed during her hospitalization and acute monocytic leukemia (FAB M5b) with normal karyotype was diagnosed. By immunostaining, the infiltrating cells in the skin and the terminal ileum were identified as monocytic leukemic cells. This case exhibited a unique initial presentation of Behçet's disease-like illness associated with acute monocytic leukemia. PMID:27610252

  11. Plasticity of the Systemic Inflammatory Response to Acute Infection during Critical Illness: Development of the Riboleukogram

    PubMed Central

    Burykin, Anton; Ruan, Jianhua; Li, Qing; Schierding, William; Lin, Nan; Dixon, David; Zhang, Weixiong; Coopersmith, Craig M.; Dunne, W. Michael; Colonna, Marco; Ghosh, Bijoy K.; Cobb, J. Perren

    2008-01-01

    Background Diagnosis of acute infection in the critically ill remains a challenge. We hypothesized that circulating leukocyte transcriptional profiles can be used to monitor the host response to and recovery from infection complicating critical illness. Methodology/Principal Findings A translational research approach was employed. Fifteen mice underwent intratracheal injections of live P. aeruginosa, P. aeruginosa endotoxin, live S. pneumoniae, or normal saline. At 24 hours after injury, GeneChip microarray analysis of circulating buffy coat RNA identified 219 genes that distinguished between the pulmonary insults and differences in 7-day mortality. Similarly, buffy coat microarray expression profiles were generated from 27 mechanically ventilated patients every two days for up to three weeks. Significant heterogeneity of VAP microarray profiles was observed secondary to patient ethnicity, age, and gender, yet 85 genes were identified with consistent changes in abundance during the seven days bracketing the diagnosis of VAP. Principal components analysis of these 85 genes appeared to differentiate between the responses of subjects who did versus those who did not develop VAP, as defined by a general trajectory (riboleukogram) for the onset and resolution of VAP. As patients recovered from critical illness complicated by acute infection, the riboleukograms converged, consistent with an immune attractor. Conclusions/Significance Here we present the culmination of a mouse pneumonia study, demonstrating for the first time that disease trajectories derived from microarray expression profiles can be used to quantitatively track the clinical course of acute disease and identify a state of immune recovery. These data suggest that the onset of an infection-specific transcriptional program may precede the clinical diagnosis of pneumonia in patients. Moreover, riboleukograms may help explain variance in the host response due to differences in ethnic background, gender, and

  12. Efficacy of Rifaximin Compared with Ciprofloxacin for the Treatment of Acute Infectious Diarrhea: A Randomized Controlled Multicenter Study

    PubMed Central

    Hong, Kyoung Sup; Kim, You Sun; Han, Dong Soo; Choi, Chang Hwan; Jang, Byung-Ik; Park, Young-Sook; Lee, Kang-Moon; Lee, Soo Teik; Kim, Hyun-Soo

    2010-01-01

    Background/Aims Ciprofloxacin has been widely prescribed for acute infectious diarrhea. However, the resistance to this drug is increasing. Rifaximin is a novel but poorly absorbed rifamycin derivative. This study evaluated and compared the efficacies of rifaximin and ciprofloxacin for the treatment of acute infectious diarrhea. Methods We performed a randomized controlled multicenter study in Korea. Patients with acute diarrhea were enrolled and randomized to receive rifaximin or ciprofloxacin for 3 days. The primary efficacy endpoint was the time to last unformed stool (TLUS). Secondary endpoints were enteric wellness (reduction of at least 50% in the number of unformed stools during 24-hour postenrollment intervals), general wellness (subjective feeling of improvement), and proportion of patients with treatment failure. Results Intent-to-treat analysis (n=143) showed no significant difference between the rifaximin and ciprofloxacin groups in the mean TLUS (36.1 hours vs 43.6 hours, p=0.163), enteric wellness (49% vs 57%, p=0.428), general wellness (67% vs 78%, p=0.189), or treatment failure rate (9% vs 12%, p=0.841). The adverse events did not differ significantly between the two groups. Conclusions These results suggest that rifaximin is as safe and effective as ciprofloxacin in the treatment of acute infectious diarrhea. PMID:20981213

  13. Surviving Critical Illness: The Acute Respiratory Distress Syndrome as Experienced by Patients and Their Caregivers

    PubMed Central

    Cox, Christopher E.; Docherty, Sharron L.; Brandon, Debra H.; Whaley, Christie; Attix, Deborah K.; Clay, Alison S.; Dore, Daniel V.; Hough, Catherine L.; White, Douglas B.; Tulsky, James A.

    2009-01-01

    Objective Survivors of the acute respiratory distress syndrome (ARDS), a systemic critical illness, often report poor quality of life based on responses to standardized questionnaires. However, the experiences of ARDS survivors have not been reported. Our objective was to characterize the effects of critical illness in the daily lives and functioning of ARDS survivors. Design, Setting, and Patients We recruited consecutively 31 ARDS survivors and their informal caregivers from medical and surgical intensive care units of an academic medical center and a community hospital. Eight patients died before completing interviews. We conducted semi-structured interviews with 23 ARDS survivors and 24 caregivers three to nine months after ICU admission, stopping enrollment after thematic saturation was reached. Transcripts were analyzed using Colaizzi’s qualitative methodology to identify significant ways in which survivors’ critical illness experience impacted their lives. Measurements and Main Results Participants related five key elements of experience as survivors of ARDS: pervasive memories of critical care, day to day impact of new disability, critical illness defining the sense of self, relationship strain and change, and ability to cope with disability. Survivors described remarkable disability that persisted for months. Caregivers’ interviews revealed substantial strain from caregiving responsibilities, as well as frequent symptom minimization by patients. Conclusions The diverse and unique experiences of ARDS survivors reflect the global impact of severe critical illness. We have identified symptom domains important to ARDS patients that are not well represented in existing health outcomes measures. These insights may aid the development of targeted interventions to enhance recovery and return of function after ARDS. PMID:19865004

  14. Acute gastrointestinal illness following a prolonged community-wide water emergency.

    PubMed

    Gargano, J W; Freeland, A L; Morrison, M A; Stevens, K; Zajac, L; Wolkon, A; Hightower, A; Miller, M D; Brunkard, J M

    2015-10-01

    The drinking water infrastructure in the United States is ageing; extreme weather events place additional stress on water systems that can lead to interruptions in the delivery of safe drinking water. We investigated the association between household exposures to water service problems and acute gastrointestinal illness (AGI) and acute respiratory illness (ARI) in Alabama communities that experienced a freeze-related community-wide water emergency. Following the water emergency, investigators conducted a household survey. Logistic regression models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for self-reported AGI and ARI by water exposures. AGI was higher in households that lost water service for ⩾7 days (aPR 2·4, 95% CI 1·1-5·2) and experienced low water pressure for ⩾7 days (aPR 3·6, 95% CI 1·4-9·0) compared to households that experienced normal service and pressure; prevalence of AGI increased with increasing duration of water service interruptions. Investments in the ageing drinking water infrastructure are needed to prevent future low-pressure events and to maintain uninterrupted access to the fundamental public health protection provided by safe water supplies. Households and communities need to increase their awareness of and preparedness for water emergencies to mitigate adverse health impacts. PMID:25608522

  15. Gastroesophageal Reflux Disease Increases Infant Acute Respiratory Illness Severity, but not Childhood Asthma.

    PubMed

    Valet, Robert S; Carroll, Kecia N; Gebretsadik, Tebeb; Minton, Patricia A; Woodward, Kimberly B; Liu, Zhouwen; Hartert, Tina V

    2014-03-01

    It is unknown whether gastroesophageal reflux disease (GERD) during infancy affects infant bronchiolitis severity or childhood asthma inception. Four hundred thirty-two infants presenting with acute respiratory illness due to bronchiolitis or upper respiratory infection were studied. The primary exposure was the parental report of a previous GERD diagnosis. Outcomes included bronchiolitis severity at initial presentation and childhood asthma diagnosis at age 4. Infants with parentally reported GERD had a higher bronchiolitis severity score (range=0-12, clinically significant difference=0.5), indicating more severe disease, than infants without reported GERD (median 5.5 [interquartile range 3.5-9.0] among those with reported GERD versus 4.0 [1.0-7.0] among those without, P=0.005). This association persisted after adjusting for infant age, race, gender, and secondhand smoke exposure by a propensity score (adjusted odds ratio [OR] 1.99, 95% confidence interval [CI] 1.14-3.46, P=0.02). The parental report of GERD during infancy was not associated with the parental report of asthma diagnosis at age 4. GERD during infancy may contribute to acute respiratory illness severity, but is not associated with asthma diagnosis at age 4. Future prospective studies are needed to confirm these findings. PMID:24669353

  16. Validating a decision tree for serious infection: diagnostic accuracy in acutely ill children in ambulatory care

    PubMed Central

    Verbakel, Jan Y; Lemiengre, Marieke B; De Burghgraeve, Tine; De Sutter, An; Aertgeerts, Bert; Bullens, Dominique M A; Shinkins, Bethany; Van den Bruel, Ann; Buntinx, Frank

    2015-01-01

    Objective Acute infection is the most common presentation of children in primary care with only few having a serious infection (eg, sepsis, meningitis, pneumonia). To avoid complications or death, early recognition and adequate referral are essential. Clinical prediction rules have the potential to improve diagnostic decision-making for rare but serious conditions. In this study, we aimed to validate a recently developed decision tree in a new but similar population. Design Diagnostic accuracy study validating a clinical prediction rule. Setting and participants Acutely ill children presenting to ambulatory care in Flanders, Belgium, consisting of general practice and paediatric assessment in outpatient clinics or the emergency department. Intervention Physicians were asked to score the decision tree in every child. Primary outcome measures The outcome of interest was hospital admission for at least 24 h with a serious infection within 5 days after initial presentation. We report the diagnostic accuracy of the decision tree in sensitivity, specificity, likelihood ratios and predictive values. Results In total, 8962 acute illness episodes were included, of which 283 lead to admission to hospital with a serious infection. Sensitivity of the decision tree was 100% (95% CI 71.5% to 100%) at a specificity of 83.6% (95% CI 82.3% to 84.9%) in the general practitioner setting with 17% of children testing positive. In the paediatric outpatient and emergency department setting, sensitivities were below 92%, with specificities below 44.8%. Conclusions In an independent validation cohort, this clinical prediction rule has shown to be extremely sensitive to identify children at risk of hospital admission for a serious infection in general practice, making it suitable for ruling out. Trial registration number NCT02024282. PMID:26254472

  17. Septic versus non-septic acute kidney injury in critically ill patients: characteristics and clinical outcomes

    PubMed Central

    Cruz, Marília Galvão; Dantas, João Gabriel Athayde de Oliveira; Levi, Talita Machado; Rocha, Mário de Seixas; de Souza, Sérgio Pinto; Boa-Sorte, Ney; de Moura, Carlos Geraldo Guerreiro; Cruz, Constança Margarida Sampaio

    2014-01-01

    Objective This study aimed to describe and compare the characteristics and clinical outcomes of patients with septic and non-septic acute kidney injury. Methods This study evaluated an open cohort of 117 critically ill patients with acute kidney injury who were consecutively admitted to an intensive care unit, excluding patients with a history of advanced-stage chronic kidney disease, kidney transplantation, hospitalization or death in a period shorter than 24 hours. The presence of sepsis and in-hospital death were the exposure and primary variables in this study, respectively. A confounding analysis was performed using logistic regression. Results No significant differences were found between the mean ages of the groups with septic and non-septic acute kidney injury [65.30±21.27 years versus 66.35±12.82 years, respectively; p=0.75]. In the septic and non-septic acute kidney injury groups, a predominance of females (57.4% versus 52.4%, respectively; p=0.49) and Afro-descendants (81.5% versus 76.2%, respectively; p=0.49) was observed. Compared with the non-septic patients, the patients with sepsis had a higher mean Acute Physiology and Chronic Health Evaluation II score [21.73±7.26 versus 15.75±5.98; p<0.001)] and a higher mean water balance (p=0.001). Arterial hypertension (p=0.01) and heart failure (p<0.001) were more common in the non-septic patients. Septic acute kidney injury was associated with a greater number of patients who required dialysis (p=0.001) and a greater number of deaths (p<0.001); however, renal function recovery was more common in this group (p=0.01). Sepsis (OR: 3.88; 95%CI: 1.51-10.00) and an Acute Physiology and Chronic Health Evaluation II score >18.5 (OR: 9.77; 95%CI: 3.73-25.58) were associated with death in the multivariate analysis. Conclusion Sepsis was an independent predictor of death. Significant differences were found between the characteristics and clinical outcomes of patients with septic versus non-septic acute kidney

  18. Acute illness associated with use of pest strips - seven U.S. States and Canada, 2000-2013.

    PubMed

    Tsai, Rebecca J; Sievert, Jennifer; Prado, Joanne; Buhl, Kaci; Stone, Dave L; Forrester, Mathias; Higgins, Shelia; Mitchell, Yvette; Schwartz, Abby; Calvert, Geoffrey M

    2014-01-17

    Dichlorvos-impregnated resin strips (DDVP pest strips) are among the few organophosphate products still available for indoor residential use. The residential uses for most other organophosphate products, including most DDVP products, were canceled because they posed unreasonable risks to children. DDVP pest strips act by inhibiting acetylcholinesterase activity in the brain and nerves of insect pests and are designed to gradually release DDVP vapor for up to 4 months. Acute illnesses in humans associated with nonlethal acute exposures usually resolve completely, but recovery is not always rapid. To assess the frequency of acute illnesses associated with DDVP pest strips, cases from 2000 through June 2013 were sought from the 12 states that participate in the Sentinel Event Notification System for Occupational Risks (SENSOR)-Pesticides Program, the National Pesticide Information Center (NPIC), and Health Canada.* A total of 31 acute DDVP pest strip-related illness cases were identified in seven U.S. states and Canada. The majority of these illnesses resulted from use of the product in commonly occupied living areas (e.g., kitchens and bedrooms), in violation of label directions. Although 26 of the 31 cases involved mild health effects of short duration, five persons had moderate health effects. Illnesses caused by excess exposure to DDVP pest strips can be reduced by educating the public about the proper usage of DDVP pest strips and with improvements in label directions. PMID:24430101

  19. Arboviral Etiologies of Acute Febrile Illnesses in Western South America, 2000–2007

    PubMed Central

    Forshey, Brett M.; Guevara, Carolina; Laguna-Torres, V. Alberto; Cespedes, Manuel; Vargas, Jorge; Gianella, Alberto; Vallejo, Efrain; Madrid, César; Aguayo, Nicolas; Gotuzzo, Eduardo; Suarez, Victor; Morales, Ana Maria; Beingolea, Luis; Reyes, Nora; Perez, Juan; Negrete, Monica; Rocha, Claudio; Morrison, Amy C.; Russell, Kevin L.; J. Blair, Patrick; Olson, James G.; Kochel, Tadeusz J.

    2010-01-01

    Background Arthropod-borne viruses (arboviruses) are among the most common agents of human febrile illness worldwide and the most important emerging pathogens, causing multiple notable epidemics of human disease over recent decades. Despite the public health relevance, little is know about the geographic distribution, relative impact, and risk factors for arbovirus infection in many regions of the world. Our objectives were to describe the arboviruses associated with acute undifferentiated febrile illness in participating clinics in four countries in South America and to provide detailed epidemiological analysis of arbovirus infection in Iquitos, Peru, where more extensive monitoring was conducted. Methodology/Findings A clinic-based syndromic surveillance system was implemented in 13 locations in Ecuador, Peru, Bolivia, and Paraguay. Serum samples and demographic information were collected from febrile participants reporting to local health clinics or hospitals. Acute-phase sera were tested for viral infection by immunofluorescence assay or RT-PCR, while acute- and convalescent-phase sera were tested for pathogen-specific IgM by ELISA. Between May 2000 and December 2007, 20,880 participants were included in the study, with evidence for recent arbovirus infection detected for 6,793 (32.5%). Dengue viruses (Flavivirus) were the most common arbovirus infections, totaling 26.0% of febrile episodes, with DENV-3 as the most common serotype. Alphavirus (Venezuelan equine encephalitis virus [VEEV] and Mayaro virus [MAYV]) and Orthobunyavirus (Oropouche virus [OROV], Group C viruses, and Guaroa virus) infections were both observed in approximately 3% of febrile episodes. In Iquitos, risk factors for VEEV and MAYV infection included being male and reporting to a rural (vs urban) clinic. In contrast, OROV infection was similar between sexes and type of clinic. Conclusions/Significance Our data provide a better understanding of the geographic range of arboviruses in South

  20. Awake video-assisted thoracic surgery in acute infectious pulmonary destruction

    PubMed Central

    Egorov, Vladimir; Deynega, Igor; Ionov, Pavel

    2015-01-01

    Background Many of thoracic minimally invasive interventions have been proven to be possible without general anesthesia. This article presents results of video-assisted thoracic surgery (VATS) application under local anesthesia in patients with lung abscesses and discusses its indications in detail. Methods The study involved prospective analysis of treatment outcomes for all acute infectious pulmonary destruction (AIPD) patients undergoing VATS under local anesthesia and sedation since January 1, 2010, till December 31, 2013. Patients with pulmonary destruction cavity at periphery of large size (>5 cm) underwent non-intubated video abscessoscopy (NIVAS). Patients with pyopneumothorax (lung abscess penetration into pleural cavity) underwent non-intubated video thoracoscopy (NIVTS). Indications for NIVAS and NIVTS were as follows: cavity debridement and washing, necrotic sequestra removal, adhesion split, biopsy. All interventions were done under local anesthesia and sedation without trachea intubation and epidural anesthesia. Results Sixty-five enrolled patients had 42 NIVAS and 32 NIVTS interventions, nine patients underwent two surgeries. None of the patients required trachea intubation or epidural anesthesia. In none of our cases with conversion to thoracotomy was required. Post-surgical complications developed after 11 interventions (13%): subcutaneous emphysema (five cases), chest wall phlegmon (three cases), pulmonary bleeding (two cases), and pneumothorax (one case). One patient died due to the main disease progression. In 50 patients NIVAS and NIVTS were done within 5 to 8 days after abscess/pleural cavity draining, while in other 15 patients—immediately prior to draining; both pulmonary bleeding episodes and all cases of chest wall phlegmon took place in the latter group. Conclusions NIVAS and NIVTS under local anesthesia and sedation are well tolerated by patients, safe and should be used more often in AIPD cases. Timing of NIVAS and NIVTS procedures

  1. Infectious disease.

    PubMed

    Jaworski, Carrie A; Donohue, Brian; Kluetz, Joshua

    2011-07-01

    Athletes are susceptible to the same infections as the general population. However, special considerations often need to be taken into account when dealing with an athlete who has contracted an infectious disease. Health care providers need to consider how even common illnesses can affect an athlete's performance, the communicability of the illness to team members, and precautions/contraindications related to athletic participation. Recent advances in the prevention, diagnosis, and/or management of frequently encountered illnesses, as well as certain conditions that warrant special attention in the athletic setting, are discussed in detail. PMID:21658549

  2. The association of the kynurenine pathway of tryptophan metabolism with acute brain dysfunction during critical illness*

    PubMed Central

    Adams Wilson, Jessica R.; Morandi, Alessandro; Girard, Timothy D.; Thompson, Jennifer L.; Boomershine, Chad S.; Shintani, Ayumi K.; Ely, E. Wesley; Pandharipande, Pratik P.

    2013-01-01

    Objectives Plasma tryptophan levels are associated with delirium in critically ill patients. Although tryptophan has been linked to the pathogenesis of other neurocognitive diseases through metabolism to neurotoxins via the kynurenine pathway, a role for kynurenine pathway activity in intensive care unit brain dysfunction (delirium and coma) remains unknown. This study examined the association between kynurenine pathway activity as determined by plasma kynurenine concentrations and kynurenine/tryptophan ratios and presence or absence of acute brain dysfunction (defined as delirium/coma-free days) in intensive care unit patients. Design, Setting, and Patients This was a prospective cohort study that utilized patient data and blood samples from the Maximizing Efficacy of Targeted Sedation and Reducing Neurologic Dysfunction trial, which compared sedation with dexmedetomidine vs. lorazepam in mechanically ventilated patients. Measurements and Main Results Baseline plasma kynurenine and tryptophan concentrations were measured using high-performance liquid chromatography with or without tandem mass spectrometry. Delirium was assessed daily using the Confusion Assessment Method for the Intensive Care Unit. Linear regression examined associations between kynurenine pathway activity and delirium/coma-free days after adjusting for sedative exposure, age, and severity of illness. Among 84 patients studied, median age was 60 yrs and Acute Physiology and Chronic Health Evaluation II score was 28.5. Elevated plasma kynurenine and kynurenine/tryptophan ratio were both independently associated with significantly fewer delirium/coma-free days (i.e., fewer days without acute brain dysfunction). Specifically, patients with plasma kynurenine or kynurenine/tryptophan ratios at the 75th percentile of our population had an average of 1.8 (95% confidence interval 0.6–3.1) and 2.1 (95% confidence interval 1.0–3.2) fewer delirium/coma-free days than those patients with values at the 25

  3. There is need for antigen-based rapid diagnostic tests to identify common acute tropical illnesses.

    PubMed

    Wilde, Henry; Suankratay, Chusana

    2007-01-01

    Enteric fever, typhus, leptospirosis, dengue, melioidosis, and tuberculous meningitis present urgent diagnostic problems that require experience and clinical judgment to make early evidence-based management decisions. Basic and applied research dealing with reliable antigen-based diagnostics has been published and confirmed for several of these infections. This should have initiated commercial production but has not. Established international firms see little profit in such diagnostic kits since they would be used in poor countries with little prospects for return of investment capital. We attempt to illustrate this issue, using common causes of acute febrile illnesses in the Southeast Asian region. We believe that rapid diagnostic technology could prevent significant delay in starting appropriate therapy, reduce hospital expenses, and even save lives. PMID:17617848

  4. Hydroclimatic variables and acute gastro-intestinal illness in British Columbia, Canada: A time series analysis

    NASA Astrophysics Data System (ADS)

    Galway, L. P.; Allen, D. M.; Parkes, M. W.; Li, L.; Takaro, T. K.

    2015-02-01

    Using epidemiologic time series analysis, we examine associations between three hydroclimatic variables (temperature, precipitation, and streamflow) and waterborne acute gastro-intestinal illness (AGI) in two communities in the province of British Columbia (BC), Canada. The communities were selected to represent the major hydroclimatic regimes that characterize BC: rainfall-dominated and snowfall dominated. Our results show that the number of monthly cases of AGI increased with increasing temperature, precipitation, and streamflow in the same month in the context of a rainfall-dominated regime, and with increasing streamflow in the previous month in the context of a snowfall-dominated regime. These results suggest that hydroclimatology plays a role in driving the occurrence and variability of AGI in these settings. Further, this study highlights that the nature and magnitude of the effects of hydroclimatic variability on AGI are different in the context of a snowfall-dominated regime versus a rainfall-dominated regimes. We conclude by proposing that the watershed may be an appropriate context for enhancing our understanding of the complex linkages between hydroclimatic variability and waterborne illness in the context of a changing climate.

  5. Utility of the Tourniquet Test and the White Blood Cell Count to Differentiate Dengue among Acute Febrile Illnesses in the Emergency Room

    PubMed Central

    Gregory, Christopher J.; Lorenzi, Olga D.; Colón, Lisandra; Sepúlveda García, Arleene; Santiago, Luis M.; Cruz Rivera, Ramón; Cuyar Bermúdez, Liv Jossette; Ortiz Báez, Fernando; Vázquez Aponte, Delanor; Tomashek, Kay M.; Gutierrez, Jorge; Alvarado, Luisa

    2011-01-01

    Dengue often presents with non-specific clinical signs, and given the current paucity of accurate, rapid diagnostic laboratory tests, identifying easily obtainable bedside markers of dengue remains a priority. Previous studies in febrile Asian children have suggested that the combination of a positive tourniquet test (TT) and leucopenia can distinguish dengue from other febrile illnesses, but little data exists on the usefulness of these tests in adults or in the Americas. We evaluated the diagnostic accuracy of the TT and leucopenia (white blood cell count <5000/mm3) in identifying dengue as part of an acute febrile illness (AFI) surveillance study conducted in the Emergency Department of Saint Luke's Hospital in Ponce, Puerto Rico. From September to December 2009, 284 patients presenting to the ED with fever for 2–7 days and no identified source were enrolled. Participants were tested for influenza, dengue, leptospirosis and enteroviruses. Thirty-three (12%) patients were confirmed as having dengue; 2 had dengue co-infection with influenza and leptospirosis, respectively. An infectious etiology was determined for 141 others (136 influenza, 3 enterovirus, 2 urinary tract infections), and 110 patients had no infectious etiology identified. Fifty-two percent of laboratory-positive dengue cases had a positive TT versus 18% of patients without dengue (P<0.001), 87% of dengue cases compared to 28% of non-dengue cases had leucopenia (P<0.001). The presence of either a positive TT or leucopenia correctly identified 94% of dengue patients. The specificity and positive predictive values of these tests was significantly higher in the subset of patients without pandemic influenza A H1N1, suggesting improved discriminatory performance of these tests in the absence of concurrent dengue and influenza outbreaks. However, even during simultaneous AFI outbreaks, the absence of leucopenia combined with a negative tourniquet test may be useful to rule out dengue. PMID:22163057

  6. Seasonal variation of acute gastro-intestinal illness by hydroclimatic regime and drinking water source: a retrospective population-based study.

    PubMed

    Galway, Lindsay P; Allen, Diana M; Parkes, Margot W; Takaro, Tim K

    2014-03-01

    Acute gastro-intestinal illness (AGI) is a major cause of mortality and morbidity worldwide and an important public health problem. Despite the fact that AGI is currently responsible for a huge burden of disease throughout the world, important knowledge gaps exist in terms of its epidemiology. Specifically, an understanding of seasonality and those factors driving seasonal variation remain elusive. This paper aims to assess variation in the incidence of AGI in British Columbia (BC), Canada over an 11-year study period. We assessed variation in AGI dynamics in general, and disaggregated by hydroclimatic regime and drinking water source. We used several different visual and statistical techniques to describe and characterize seasonal and annual patterns in AGI incidence over time. Our results consistently illustrate marked seasonal patterns; seasonality remains when the dataset is disaggregated by hydroclimatic regime and drinking water source; however, differences in the magnitude and timing of the peaks and troughs are noted. We conclude that systematic descriptions of infectious illness dynamics over time is a valuable tool for informing disease prevention strategies and generating hypotheses to guide future research in an era of global environmental change. PMID:24642439

  7. Acute Muscular Sarcocystosis: an international investigation among ill travelers returning from Tioman Island, Malaysia, 2011 and 2012

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Two provider-based traveler-focused networks allowed for the detection of a large outbreak of acute muscular sarcocystosis (AMS). Clinicians evaluating travelers returning ill from Malaysia with fever and myalgia noted the biphasic aspect of the disease, the later onset of elevated CPK and eosinophi...

  8. THE UNIVERSITY OF AKRON STUDY ON AIR POLLUTION AND HUMAN HEALTH EFFECTS II. EFFECTS ON ACUTE RESPIRATORY ILLNESS

    EPA Science Inventory

    The purpose of this study was to determine the effects of air pollution on acute respiratory illness (ARI). Levels of air pollutants were monitored on a daily 24-hour basis at two schools in Akron, Ohio. The children at each school completed daily diaries which served as a screen...

  9. Computerized general practice based networks yield comparable performance with sentinel data in monitoring epidemiological time-course of influenza-like illness and acute respiratory illness

    PubMed Central

    2010-01-01

    Background Computerized morbidity registration networks might serve as early warning systems in a time where natural epidemics such as the H1N1 flu can easily spread from one region to another. Methods In this contribution we examine whether general practice based broad-spectrum computerized morbidity registration networks have the potential to act as a valid surveillance instrument of frequently occurring diseases. We compare general practice based computerized data assessing the frequency of influenza-like illness (ILI) and acute respiratory infections (ARI) with data from a well established case-specific sentinel network, the European Influenza Surveillance Scheme (EISS). The overall frequency and trends of weekly ILI and ARI data are compared using both networks. Results Detection of influenza-like illness and acute respiratory illness occurs equally fast in EISS and the computerized network. The overall frequency data for ARI are the same for both networks, the overall trends are similar, but the increases and decreases in frequency do not occur in exactly the same weeks. For ILI, the overall rate was slightly higher for the computerized network population, especially before the increase of ILI, the overall trend was almost identical and the increases and decreases occur in the same weeks for both networks. Conclusions Computerized morbidity registration networks are a valid tool for monitoring frequent occurring respiratory diseases and the detection of sudden outbreaks. PMID:20307266

  10. Effect of Antiplatelet Therapy on Acute Respiratory Distress Syndrome and Mortality in Critically Ill Patients: A Meta-Analysis

    PubMed Central

    Wang, Lijun; Li, Heng; Gu, Xiaofei; Wang, Zhen; Liu, Su; Chen, Liyong

    2016-01-01

    Background Antiplatelet agents are commonly used for cardiovascular diseases, but their pleiotropic effects in critically ill patients are controversial. We therefore performed a meta-analysis of cohort studies to investigate the effect of antiplatelet therapy in the critically ill. Methods Nine cohort studies, retrieved from PubMed and Embase before November 2015, involving 14,612 critically ill patients and 4765 cases of antiplatelet users, were meta-analysed. The main outcome was hospital or 30-day mortality. Secondary outcome was acute respiratory distress syndrome (ARDS) or acute lung injury (ALI). Random- or fixed-effect models were taken for quantitative synthesis of the data. Results Antiplatelet therapy was associated with decreased mortality (odds ratio (OR) 0.61; 95% confidence interval (CI), 0.52–0.71; I2 = 0%; P <0. 001) and ARDS/ALI (OR 0.64; 95% CI, 0.50–0.82; I2 = 0%; P <0. 001). In every stratum of subgroups, similar findings on mortality reduction were consistently observed in critically ill patients. Conclusions Antiplatelet therapy is associated with reduced mortality and lower incidence of ARDS/ALI in critically ill patients, particularly those with predisposing conditions such as high-risk surgery, trauma, pneumonia, and sepsis. However, it remains unclear whether similar findings can be observed in the unselected and broad population with critical illness. PMID:27182704

  11. Acute coronary syndrome and decompression illness: a challenge for the diving physician.

    PubMed

    Brauzzi, Marco; Andreozzi, Fabio; De Fina, Laura; Tanasi, Paolo; Falini, Stefano

    2013-12-01

    Decompression illness (DCI) is a syndrome with diverse clinical manifestations but in which cardiac symptoms are rare. In the presence of cardiac symptoms, the necessity to rule out an acute coronary syndrome (ACS) which requires prompt treatment may result in delay to appropriate recompression treatment. We describe three cases with cardiologic symptoms referred to our centre by the Emergency Department (ED) of our facility. The first was a 48-year-old woman who lost consciousness during a dive and required cardiopulmonary resuscitation. The final diagnosis was acute myocardial infarction and the patient did not undergo recompression treatment. The second case was that of a 27-year-old man who complained of tachycardia, dyspnoea and vertigo soon after a dive. He was referred by helicopter ambulance and in the ED was diagnosed with new-onset atrial fibrillation. Recompression resulted in disappearance of his vertigo, and sinus rhythm was restored pharmacologically. The third case was a 43-year-old man, with a history of coronary artery disease, who had undergone coronary artery bypass grafting three years previously. After a repetitive dive without adequate decompression, he complained of crushing retrosternal pain and numbness in the upper left arm. All cardiovascular examinations were negative and the patient was recompressed, with resolution of his symptoms. Features to consider in arriving at the correct differential diagnosis in divers presenting with cardiac symptoms are discussed in the light of these three illustrative cases. PMID:24510330

  12. New trends of an old disease: the acute post infectious glomerulonephritis at the beginning of the new millenium.

    PubMed

    Stratta, Piero; Musetti, Claudio; Barreca, Antonella; Mazzucco, Gianna

    2014-06-01

    The association between acute renal disease and infection has been known since the mid '800s: acute post-infectious glomerulonephritis (PIGN) is a reactive immunological process against the kidney secondary to an infection, classically caused by a Streptococcus. The typical clinical presentation of PIGN is an acute nephritic syndrome with macro- or microscopic hematuria, proteinuria, hypertension, edema and renal function impairment of variable degree. The histology is characterized by an intracapillary glomerular proliferation, but may rarely be associated with an extracapillary proliferation. The classical childhood form is still present nowadays, even with severe cases, in developing countries, while in the last decades it almost disappeared in industrialized countries, where post-infectious GN are often found in elderly patients with multiple comorbidities. These clinical variants are usually related to other infective agents, like Staphylococcus aureus, both methicillin resistant (MRSA) and susceptible, and may be characterized by an IgA-dominant deposition. Kidney biopsy is rarely needed, especially in the child, while in the adult or old patient a biopsy is warranted if there is an atypical presentation or evolution, like rapidly progressive renal failure, absent or delayed function recovery, persisting low C3, nephrotic range proteinuria and persisting high proteinuria. Current therapy strategies rely on culture-guided systemic antibiotics, especially in the old patient, in which MRSA are relatively frequent, support therapy and only in very selected cases on steroids. These latter cases include the rare PIGN with crescents and those with a severe interstitial inflammation. PMID:24777751

  13. Advances in pediatrics in 2014: current practices and challenges in allergy, gastroenterology, infectious diseases, neonatology, nutrition, oncology and respiratory tract illnesses.

    PubMed

    Caffarelli, Carlo; Santamaria, Francesca; Cesari, Silvia; Sciorio, Elisa; Povesi-Dascola, Carlotta; Bernasconi, Sergio

    2015-01-01

    Major advances in the conduct of pediatric practice have been reported in the Italian Journal of Pediatrics in 2014. This review highlights developments in allergy, gastroenterology, infectious diseases, neonatology, nutrition, oncology and respiratory tract illnesses. Investigations endorse a need to better educate guardians and improve nutritional management in food allergy. Management of hyperbilirubinemia in neonates and of bronchiolitis have been improved by position statements of scientific societies. Novel treatments for infant colic and inflammatory bowel diseases have emerged. Studies suggest the diagnostic utility of ultrasonography in diagnosing community-acquired pneumonia. Progress in infectious diseases should include the universal varicella vaccination of children. Recommendations on asphyxia and respiratory distress syndrome have been highlighted in neonatology. Studies have evidenced that malnutrition remains a common underestimated problem in developing countries, while exposure to cancer risk factors in children is not negligible in Western countries. Advances in our understanding of less common diseases such as cystic fibrosis, plastic bronchitis, idiopathic pulmonary hemosiderosis facilitate diagnosis and management. Researches have led to new therapeutic approaches in patent ductus arteriosus and pediatric malignancies. PMID:26518317

  14. Focal mesangial-sclerosing glomerulonephritis and acute-spontaneous infectious canine hepatitis: structural, immunohistochemical and subcellular studies.

    PubMed

    Hervás, J; Gómez-Villamandos, J C; Pérez, J; Carrasco, L; Sierra, M A

    1997-06-01

    The glomerular alterations observed in a dog with acute spontaneous infectious canine hepatitis (ICH) are described. Histologic changes of the glomeruli were enlargement of the mesangium with presence of intranuclear inclusion bodies and without proliferation of mesangial cells. Electron microscopy revealed adenovirus replication sites in glomerular mesangial cells and in endothelial cells of glomerular capillaries, as well as a focal mesangial-sclerosing glomerulonephritis associated with electron dense deposits which were closely related with extracellular ICH viral particles and immunohistochemically reactive for immunoglobulin (Ig) G, IgA, IgM and C3c complement components. PMID:9239835

  15. Acute gastro-intestinal illness and its association with hydroclimatic factors in British Columbia, Canada: A time-series analysis

    NASA Astrophysics Data System (ADS)

    Galway, L. P.; Allen, D. M.

    2013-12-01

    Rising global temperatures and expected shifts in regional hydroclimatology in a changing climate are likely to influence the risk of infectious waterborne illness. This study examines the role of hydroclimatology as an underlying driver of the epidemiology of waterborne gastro-intestinal illness and contributes to our currently limited understanding of the possible ecosystem-mediated impacts of climate change on health. Using time-series regression analysis, we examine the associations between three hydroclimatic factors (monthly temperature, precipitation, and streamflow) and the monthly occurrence of AGI illness in two communities in the province of British Columbia, Canada. The two communities were selected as study sites to represent the dominant hydroclimatic regimes that characterize the province of BC: the rainfall-dominated hydroclimatic regime and snowmelt-dominated hydroclimatic regime Our results show that the number of monthly cases of AGI increased with increasing temperature, precipitation, and streamflow in the same month in the context of a rainfall-dominated regime and with increasing streamflow in the previous month in the context of a snowfall-dominated regime. These results suggest that hydroclimatic factors play a role in driving the occurrence and variability of AGI illness in this setting. Further, this study has highlighted that the nature and magnitude of the effects of hydroclimatic factors on waterborne illness vary across different hydroclimatic settings. We conclude that the watershed may be an appropriate context within which we can and should enhance our understanding of water-related climate change impacts on health. Examining the role of hydroclimatology as an underlying driver of the epidemiology of infectious disease is key to understanding of the possible ecosystem-mediated impacts of climate change on health and developing appropriate adaptation responses.

  16. Herbs and other dietary supplements: current regulations and recommendations for use to maintain health in the management of the common cold or other related infectious respiratory illnesses.

    PubMed

    Mathes, Angelo; Bellanger, Renee

    2010-04-01

    Herbal preparations are sold as dietary supplements in the United States and are subject to the rules and regulations of various health care and economic government agencies that monitor the sale of these products. One approach to assessing the usefulness of these substances is to focus on one particular disease state and then review both the primary literature and expert opinion. The common cold is an important illness due to its recurring nature, the number of people it afflicts, and its economic impact on patients. Dietary supplements have been shown to decrease the duration, the severity, and the frequency of symptoms of the common cold. The most commonly available supplements are zinc, ginseng, echinacea, and vitamin C. Data from expert opinion suggested that certain supplements are more beneficial than others to maintain one's health during episodes of the common cold. Expert opinion regarding the use of dietary supplements in other related infectious respiratory illnesses, such as the flu, when aggregated with expert opinion findings regarding the common cold were not contradictory. The primary literature provided insights into specific dosages and compounds that may be used in practice. PMID:21507804

  17. The Effects of Acute Blood Loss for Diagnostic Bloodwork and Fluid Replacement in Clinically Ill Mice

    PubMed Central

    Marx, James O; Jensen, JanLee A; Seelye, Stacie; Walton, Raquel M; Hankenson, F Claire

    2015-01-01

    Despite the great value of diagnostic bloodwork for identifying disease in animals, the volume of blood required for these analyses limits its use in laboratory mice, particularly when they are clinically ill. We sought to determine the effects of acute blood loss (ABL) following blood collection for diagnostic bloodwork in healthy mice compared with streptozotocin-induced diabetic and dextran sulfate sodium (DSS)-treated dehydrated mice. ABL caused several mild changes in the control mice, with significant decreases in body weight, temperature, and activity in both experimental groups; increased dehydration and azotemia in the DSS-treated mice; and a significant drop in the blood pressure of the diabetic mice. To determine whether these negative outcomes could be ameliorated, we treated mice with intraperitoneal lactated Ringers solution either immediately after or 30 min before ABL. Notably, preABL administration of fluids helped prevent the worsening of the dehydration and azotemia in the DSS-treated mice and the changes in blood pressure in the diabetic mice. However, fluid administration provided no benefit in control of blood pressure when administered after ABL in the diabetic mice. Furthermore, fluid therapy did not prevent ABL-induced drops in body weight and activity. Although one mouse not receiving fluid therapy became moribund at the 24-h time point, no animals died during the 24-h study. This investigation demonstrates that blood for diagnostic bloodwork can be collected safely from clinically ill mice and that preemptive fluid therapy mitigates some of the negative changes associated with this blood loss. PMID:26141445

  18. Association between Rainfall and Pediatric Emergency Department Visits for Acute Gastrointestinal Illness

    PubMed Central

    Drayna, Patrick; McLellan, Sandra L.; Simpson, Pippa; Li, Shun-Hwa; Gorelick, Marc H.

    2010-01-01

    Background Microbial water contamination after periods of heavy rainfall is well described, but its link to acute gastrointestinal illness (AGI) in children is not well known. Objectives We hypothesize an association between rainfall and pediatric emergency department (ED) visits for AGI that may represent an unrecognized, endemic burden of pediatric disease in a major U.S. metropolitan area served by municipal drinking water systems. Methods We conducted a retrospective time series analysis of visits to the Children’s Hospital of Wisconsin ED in Wauwatosa, Wisconsin. Daily visit totals of discharge International Classification of Diseases, 9th Revision codes of gastroenteritis or diarrhea were collected along with daily rainfall totals during the study period from 2002 to 2007. We used an autoregressive moving average model, adjusting for confounding variables such as sewage release events and season, to look for an association between daily visits and rainfall after a lag of 1–7 days. Results A total of 17,357 AGI visits were identified (mean daily total, 7.9; range, 0–56). Any rainfall 4 days prior was significantly associated with an 11% increase in AGI visits. Expected seasonal effects were also seen, with increased AGI visits in winter months. Conclusions We observed a significant association between rainfall and pediatric ED visits for AGI, suggesting a waterborne component of disease transmission in this population. The observed increase in ED visits for AGI occurred in the absence of any disease outbreaks reported to public health officials in our region, suggesting that rainfall-associated illness may be underestimated. Further study is warranted to better address this association. PMID:20515725

  19. Furosemide is associated with acute kidney injury in critically ill patients

    PubMed Central

    Levi, T.M.; Rocha, M.S.; Almeida, D.N.; Martins, R.T.C.; Silva, M.G.C.; Santana, N.C.P.; Sanjuan, I.T.; Cruz, C.M.S.

    2012-01-01

    Acute kidney injury (AKI) is common in critically ill patients. Diuretics are used without any evidence demonstrating a beneficial effect on renal function. The objective of the present study is to determine the incidence of AKI in an intensive care unit (ICU) and if there is an association between the use of furosemide and the development of AKI. The study involved a hospital cohort in which 344 patients were consecutively enrolled from January 2010 to January 2011. A total of 132 patients (75 females and 57 males, average age 64 years) remained for analysis. Most exclusions were related to ICU discharge in the first 24 h. Laboratory, sociodemographic and clinical data were collected until the development of AKI, medical discharge or patient death. The incidence of AKI was 55% (95%CI = 46-64). The predictors of AKI found by univariate analysis were septic shock: OR = 3.12, 95%CI = 1.36-7.14; use of furosemide: OR = 3.27, 95%CI = 1.57-6.80, and age: OR = 1.02, 95%CI = 1.00-1.04. Analysis of the subgroup of patients with septic shock showed that the odds ratio of furosemide was 5.5 (95%CI = 1.16-26.02) for development of AKI. Age, use of furosemide, and septic shock were predictors of AKI in critically ill patients. Use of furosemide in the subgroup of patients with sepsis/septic shock increased (68.4%) the chance of development of AKI when compared to the sample as a whole (43.9%) PMID:22641414

  20. Frequency of Epstein - Barr Virus in Patients Presenting with Acute Febrile Illness in Kenya

    PubMed Central

    Masakhwe, Clement; Ochanda, Horace; Nyakoe, Nancy; Ochiel, Daniel; Waitumbi, John

    2016-01-01

    Background Most acute febrile illnesses (AFI) are usually not associated with a specific diagnosis because of limitations of available diagnostics. This study reports on the frequency of EBV viremia and viral load in children and adults presenting with febrile illness in hospitals in Kenya. Methodology/Principal Findings A pathogen surveillance study was conducted on patients presenting with AFI (N = 796) at outpatient departments in 8 hospitals located in diverse regions of Kenya. Enrollment criterion to the study was fever without a readily diagnosable infection. All the patients had AFI not attributable to the common causes of fever in Kenyan hospitals, such as malaria or rickettsiae, leptospira, brucella and salmonella and they were hence categorized as having AFI of unknown etiology. EBV was detected in blood using quantitative TaqMan-based qPCR targeting a highly conserved BALF5 gene. The overall frequency of EBV viremia in this population was 29.2%, with significantly higher proportion in younger children of <5years (33.8%, p = 0.039) compared to patients aged ≥5 years (26.3% for 5–15 years or 18.8% for >15 years). With respect to geographical localities, the frequency of EBV viremia was higher in the Lake Victoria region (36.4%), compared to Kisii highland (24.6%), Coastal region (22.2%) and Semi-Arid region (25%). Furthermore, patients from the malaria endemic coastal region and the Lake Victoria region presented with significantly higher viremia than individuals from other regions of Kenya. Conclusions/Significance This study provides profiles of EBV in patients with AFI from diverse eco-regions of Kenya. Of significant interest is the high frequency of EBV viremia in younger children. The observed high frequencies of EBV viremia and elevated viral loads in residents of high malaria transmission areas are probably related to malaria induced immune activation and resultant expansion of EBV infected B-cells. PMID:27163791

  1. Safety of performing fiberoptic bronchoscopy in critically ill hypoxemic patients with acute respiratory failure

    PubMed Central

    Cracco, Christophe; Fartoukh, Muriel; Prodanovic, Hélène; Azoulay, Elie; Chenivesse, Cécile; Lorut, Christine; Beduneau, Gaëtan; Bui, Hoang Nam; Taille, Camille; Brochard, Laurent; Demoule, Alexandre; Maitre, Bernard

    2013-01-01

    Background Safety of fibreoptic bronchoscopy (FOB) in nonintubated critically ill patients with acute respiratory failure have not been extensively evaluated. We aimed to measure the incidence of intubation and need to increase ventilatory support following FOB and to identify predictive factors of this event. Methods A prospective multicenter observational study was carried out in 8 French adult intensive care units. 169 FOB performed in patients with a PaO2/FiO2 ratio equal or less than 300 were analyzed. Our main end point was intubation rate. The secondary end point was rate of increased ventilatory support defined as greater than a 50% increase in oxygen requirement, the need to start non invasive-positive pressure ventilation (NI-PPV) or increase NI-PPV support. Results Within 24 hours, an increase in ventilatory support was required following 59 (35%) bronchoscopies, of which 25 (15%) led to endotracheal intubation. The existence of chronic obstructive pulmonary disease (COPD) (OR:5.2 [1.6–17.8], p=0.007) or immunosuppression (OR : 5.4 [1.7–17.2], p=0.004) were significantly associated with the need for intubation in multivariable analysis. None of the baseline physiological parameters including the PaO2/FiO2 ratio was associated with intubation. Conclusion Bronchoscopy is often followed by an increase in ventilatory support in hypoxemic critically ill patients, but less frequently by the need for intubation. COPD, immunosuppression are associated with a need for invasive ventilation in the following 24 hours. PMID:23070123

  2. Urinary Biomarkers Indicative of Apoptosis and Acute Kidney Injury in the Critically Ill

    PubMed Central

    Vaara, Suvi T.; Lakkisto, Päivi; Immonen, Katariina; Tikkanen, Ilkka; Ala-Kokko, Tero; Pettilä, Ville

    2016-01-01

    Background Apoptosis is a key mechanism involved in ischemic acute kidney injury (AKI), but its role in septic AKI is controversial. Biomarkers indicative of apoptosis could potentially detect developing AKI prior to its clinical diagnosis. Methods As a part of the multicenter, observational FINNAKI study, we performed a pilot study among critically ill patients who developed AKI (n = 30) matched to critically ill patients without AKI (n = 30). We explored the urine and plasma levels of cytokeratin-18 neoepitope M30 (CK-18 M30), cell-free DNA, and heat shock protein 70 (HSP70) at intensive care unit (ICU) admission and 24h thereafter, before the clinical diagnosis of AKI defined by the Kidney Disease: Improving Global Outcomes -creatinine and urine output criteria. Furthermore, we performed a validation study in 197 consecutive patients in the FINNAKI cohort and analyzed the urine sample at ICU admission for CK-18 M30 levels. Results In the pilot study, the urine or plasma levels of measured biomarkers at ICU admission, at 24h, or their maximum value did not differ significantly between AKI and non-AKI patients. Among 20 AKI patients without severe sepsis, the urine CK-18 M30 levels were significantly higher at 24h (median 116.0, IQR [32.3–233.0] U/L) than among those 20 patients who did not develop AKI (46.0 [0.0–54.0] U/L), P = 0.020. Neither urine cell-free DNA nor HSP70 levels significantly differed between AKI and non-AKI patients regardless of the presence of severe sepsis. In the validation study, urine CK-18 M30 level at ICU admission was not significantly higher among patients developing AKI compared to non-AKI patients regardless of the presence of severe sepsis or CKD. Conclusions Our findings do not support that apoptosis detected with CK-18 M30 level would be useful in assessing the development of AKI in the critically ill. Urine HSP or cell-free DNA levels did not differ between AKI and non-AKI patients. PMID:26918334

  3. The influence of corticosteroids on sequential clinical and synovial fluid parameters in joints with acute infectious arthritis in the horse.

    PubMed

    Tulamo, R M; Bramlage, L R; Gabel, A A

    1989-09-01

    Infectious arthritis was induced experimentally in one tarsocrural joint of six horses by intra-articular injection of 1 ml Staphylococcus aureus-saline suspension with the addition of 200 mg methylprednisolone acetate. The corresponding contralateral joint was injected with 1 ml of saline with the addition of 200 mg methylprednisolone acetate, and served as a control. The purpose of the experiment was to examine the effect of corticosteroids on the acute clinical signs of infectious arthritis, and the associated changes in synovial fluid, to separate the effects of a steroid injection from those of infection alone. This should aid early diagnosis of infection. The progression of the infectious arthritis was assessed over nine days by clinical examination and sequential synovial fluid analysis. The corticosteroids masked the clinical signs in some horses for up to the third day although changes in the synovial fluid were present earlier. Cellular changes preceded biochemical changes initially. Leucocyte counts showed a significant increase in cell numbers after infection was established. Persistent neutrophilia, over 90 per cent, together with a pH under 6.9 were the most consistent findings in the infected synovia. Total protein values were lower in infected joints with, than those without, corticosteroids; although there was a progressive rise in total protein concentration throughout the experiment in both groups. Serum and synovial glucose difference and synovial lactate had very little diagnostic value because significant increases due to the corticosteroids were documented in the control joints. PMID:2776719

  4. Disparities between black and white patients in functional improvement after hospitalization for an acute illness.

    PubMed

    Sands, Laura P; Landefeld, C Seth; Ayers, Sandra Moody; Yaffe, Kristine; Palmer, Robert; Fortinsky, Richard; Counsell, Steven R; Covinsky, Kenneth E

    2005-10-01

    The aim of this study was to determine whether older black and white patients experience different rates of improvement in functioning after being acutely hospitalized. Of the 2,364 community-living patients in this prospective cohort study, 25% self-reported their race/ethnicity to be black. The outcomes were improvement in basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs) from admission to discharge and 90 days postdischarge. Multivariable models that included statistical adjustment for age, illness severity, in-hospital social service referral, dementia, admission level of functioning, and change in functioning from 2 weeks before admission were computed to determine whether black and white patients experienced significantly different rates of recovery at discharge and 90 days after discharge in ADL and IADL functioning. Black patients were as likely as white patients to improve in ADL functioning by discharge (odds ratio (OR)=0.97, 95% confidence interval (CI)=0.76-1.24) or by 90 days after discharge (OR=0.95, 95% CI=0.73-1.24) but significantly less likely to improve IADL functioning by discharge (OR=0.72, 95% CI=0.56-0.93) or by 90 days after discharge (OR=0.68, 95% CI=0.51-0.90). The findings suggest that differential rates of recovery in functioning after an acute hospitalization may contribute to racial/ethnic disparities in IADL functioning, which has implications for the setting of future interventions oriented toward reducing these disparities. PMID:16181184

  5. Prevalence and Correlation of Infectious Agents in Hospitalized Children with Acute Respiratory Tract Infections in Central China

    PubMed Central

    Li, Fu; Wen, Zhou; Liu, Weiyong; Li, Tongya; Qin, Kai; Wu, Jianguo; Liu, Yingle

    2015-01-01

    Acute respiratory tract infections (ARTIs) are associated with significant morbidity and mortality worldwide, especially in children under the age of 5 years. Almost 2 million children die from ARTIs each year, and most of them are from developing countries. The prevalence and correlation of pathogens in ARTIs are poorly understood, but are critical for improving case prevention, treatment, and management. In this study, we investigated the prevalence and correlation of infectious agents in children with ARTIs. A total of 39,756 children with one or more symptoms, including fever, cough, sore throat, tonsillitis, pharyngitis, herpangina, pneumonia, and bronchiolitis, were enrolled in the study. All patients were hospitalized in Wuhan Children’s Hospital between October 1, 2010 and September 30, 2012, and were evaluated for infectious agents. Pathogens, including Mycoplasma pneumoniae, influenza A virus, influenza B virus, adenoviruses, respiratory syncytial virus, parainfluenza virus, Legionella pneumophila, Chlamydophila pneumoniae, and Coxiella burnetii, were screened simultaneously in patient blood samples using anti-pathogen IgM tests. Regression analysis was used to reveal correlations among the pathogens. Our results showed that one or more pathogens were identified in 10,206 patients, and that Mycoplasma pneumoniae, adenoviruses, and influenza B virus were the leading infectious agents. Mixed-infections of pathogens were detected in 2,391 cases, with Mycoplasma pneumoniae as the most frequent pathogen. The most common agents in the co-infections were Mycoplasma pneumoniae and influenza B virus. Regression analysis revealed a linear correlation between the proportion of mixed infections and the incidence of multi-pathogen infections. The prevalence of infectious agents in children with ARTIs was determined. Equations were established to estimate multiple infections by single-pathogen detection. This revealed a linear correlation for pathogens in children

  6. Prevalence and correlation of infectious agents in hospitalized children with acute respiratory tract infections in Central China.

    PubMed

    Liu, Jia; Ai, Hongwu; Xiong, Ying; Li, Fu; Wen, Zhou; Liu, Weiyong; Li, Tongya; Qin, Kai; Wu, Jianguo; Liu, Yingle

    2015-01-01

    Acute respiratory tract infections (ARTIs) are associated with significant morbidity and mortality worldwide, especially in children under the age of 5 years. Almost 2 million children die from ARTIs each year, and most of them are from developing countries. The prevalence and correlation of pathogens in ARTIs are poorly understood, but are critical for improving case prevention, treatment, and management. In this study, we investigated the prevalence and correlation of infectious agents in children with ARTIs. A total of 39,756 children with one or more symptoms, including fever, cough, sore throat, tonsillitis, pharyngitis, herpangina, pneumonia, and bronchiolitis, were enrolled in the study. All patients were hospitalized in Wuhan Children's Hospital between October 1, 2010 and September 30, 2012, and were evaluated for infectious agents. Pathogens, including Mycoplasma pneumoniae, influenza A virus, influenza B virus, adenoviruses, respiratory syncytial virus, parainfluenza virus, Legionella pneumophila, Chlamydophila pneumoniae, and Coxiella burnetii, were screened simultaneously in patient blood samples using anti-pathogen IgM tests. Regression analysis was used to reveal correlations among the pathogens. Our results showed that one or more pathogens were identified in 10,206 patients, and that Mycoplasma pneumoniae, adenoviruses, and influenza B virus were the leading infectious agents. Mixed-infections of pathogens were detected in 2,391 cases, with Mycoplasma pneumoniae as the most frequent pathogen. The most common agents in the co-infections were Mycoplasma pneumoniae and influenza B virus. Regression analysis revealed a linear correlation between the proportion of mixed infections and the incidence of multi-pathogen infections. The prevalence of infectious agents in children with ARTIs was determined. Equations were established to estimate multiple infections by single-pathogen detection. This revealed a linear correlation for pathogens in children with

  7. A prospective study of rural drinking water quality and acute gastrointestinal illness

    PubMed Central

    Strauss, Barbara; King, Will; Ley, Arthur; Hoey, John R

    2001-01-01

    Background This study examined the relationship between the bacteriological contamination of drinking water from private wells and acute gastrointestinal illness (AGII), using current government standards for safe drinking water. Methods A prospective cohort study was conducted using 235 households (647 individuals) randomly selected from four rural hamlets. Data were collected by means of a self-administered questionnaire, a self-report diary of symptoms and two drinking water samples. Results Twenty percent of households sampled, had indicator bacteria (total coliform or Escherichia coli (E. coli)) above the current Canadian and United States standards for safe drinking water. No statistically significant associations between indicator bacteria and AGII were observed. The odds ratio (OR) for individuals exposed to E. coli above the current standards was 1.52 (95% confidence interval (CI), 0.33–6.92), compared to individuals with levels below current standards. The odds ratio estimate for individuals exposed to total coliforms above the current standards was 0.39 (95% CI, 0.10–1.50). Conclusions This study observed a high prevalence of bacteriological contamination of private wells in the rural hamlets studied. Individual exposure to contaminated water defined by current standards may be associated with an increased risk of AGII. PMID:11580869

  8. ALERT--a multiprofessional training course in the care of the acutely ill adult patient.

    PubMed

    Smith, Gary B; Osgood, Vicky M; Crane, Sue

    2002-03-01

    The Acute Life-threatening Events--Recognition and Treatment (ALERT) course is a one-day multidisciplinary course originally designed to give newly qualified doctors and nurses greater confidence and ability in the recognition and management of adult patients who have impending or established critical illness. It may also be suitable for many other groups of health service workers. ALERT was developed using principles common to many advanced life support courses and incorporates aspects of clinical governance, multidisciplinary education and interprofessional working. It incorporates pre-course reading, informal and interactive seminars, practical demonstrations and role-play during clinically based scenarios. A novel aspect of ALERT is that participants undertake role interchange during scenarios, thereby facilitating mutual understanding. At all times during the course, participants are encouraged to reflect on their actions and to pay particular attention to detail. The course focuses on those problems that lead ward nurses to call doctors for assistance, e.g. 'the blue patient', 'the hypotensive patient'. Communication skills are covered frequently in the course, during seminars and scenarios, but also as a specific session that covers three aspects--breaking bad news, writing patient notes and interpersonal/interprofessional communication. PMID:11886734

  9. Environment of care: vertical evacuation concerns for acutely ill patients and others with restricted mobility.

    PubMed

    Tzeng, Huey-Ming; Yin, Chang-Yi

    2014-01-01

    This perspective paper was intended to raise awareness and the urgency of needing additional evacuation-related, hospital building design policies. We addressed the challenges to maintain the integrity of exits and inadequate hospital design considerations for individuals with restricted mobility. Hospitals are occupied by people who may have restricted mobility and visitors who are likely unfamiliar with their surroundings. A hospital fire threatens all people in the building, but especially patients in the intensive care unit who are frail and have limited mobility. Evacuating immobile patients is complex, involving horizontal and vertical evacuation approaches. Hospital design must consider the needs of individuals with restricted mobility, who are the most vulnerable in case of a hospital fire. Consequently, we urge that acutely ill patients and others with restricted mobility should occupy units located on the ground floor or Level 2. In addition, when configuring the physical environment of hospitals, providing step-free ground floor access (indoor or outdoor ramps) and evacuation aids for vertical evacuation is crucial. Step-free ground floor access between Level 2 and the ground floor should be wide enough to allow transporting patients on their beds. A standard revision to include these recommendations is desperately needed. PMID:24404945

  10. When to start renal replacement therapy in critically ill patients with acute kidney injury: comment on AKIKI and ELAIN.

    PubMed

    Bagshaw, Sean M; Lamontagne, François; Joannidis, Michael; Wald, Ron

    2016-01-01

    The dilemma of whether and when to start renal replacement therapy among critically ill patients with acute kidney injury in the absence of conventional indications has long been a vexing challenge for clinicians. The lack of high-quality evidence has undoubtedly contributed decisional uncertainty and unnecessary practice variation. Recently, two randomized trials (ELAIN and AKIKI) reported specifically on the issue of the timing of initiation of renal replacement therapy in critically ill patients with acute kidney injury. In this commentary, their fundamental differences in trial design, sample size, and widely discrepant findings are considered in context. While both trials are important contributions towards informing practice on this issue, additional evidence from large multicenter randomized trials is needed. PMID:27495159

  11. Identifying critically ill patients with acute kidney injury for whom renal replacement therapy is inappropriate: an exercise in futility?

    PubMed Central

    Gabbay, Ezra; Meyer, Klemens B.

    2009-01-01

    Clinicians treating critically ill patients must consider the possibility that painful and expensive aggressive treatments might confer negligible benefit. Such treatments are often described as futile or inappropriate. We discuss the problem of deciding whether to initiate renal replacement therapy (RRT) for critically ill patients with acute kidney injury (AKI) in the context of the debate surrounding medical futility. The main problems in deciding when such treatment would be futile are that the concept itself is controversial and eludes quantitative definition, that available outcome data do not allow confident identification of patients who will not benefit from treatment and that the decision on RRT in a critically ill patient with AKI is qualitatively different from decisions on other modalities of intensive care and resuscitation, as well as from decisions on dialysis for chronic kidney disease. Despite these difficulties, nephrologists need to identify circumstances in which continued aggressive care would be futile before proceeding to initiate RRT. PMID:25949304

  12. Epidemiological and clinical features of dengue versus other acute febrile illnesses amongst patients seen at government polyclinics.

    PubMed

    Mustafa, B; Hani, A W Asmah; Chem, Y K; Mariam, M; Khairul, A H; Abdul Rasid, K; Chua, K B

    2010-12-01

    Classical dengue fever is characterized by the clinical features of fever, headache, severe myalgia and occasionally rash, which can also be caused by a number of other viral and bacterial infections. Five hundred and fifty eight patients who fulfilled the criteria of clinical diagnosis of acute dengue from 4 government outpatient polyclinics were recruited in this prospective field study. Of the 558 patients, 190 patients were categorized as acute dengue fever, 86 as recent dengue and 282 as non-dengue febrile illnesses based on the results of a number of laboratory tests. Epidemiological features of febrile patients showed that the mean age of patients in the dengue fever group was significantly younger in comparison with patients in the non-dengue group. There was no significant difference between the two groups with respect to gender but there was significant ethnic difference with foreign workers representing a higher proportion in the dengue fever group. Patients with acute dengue fever were more likely to have patient-reported rash and a history of dengue in family or neighbourhood but less likely to have respiratory symptoms, sore-throat and jaundice in comparison to patients with non-dengue febrile illnesses. As with patients with dengue fever, patients in the recent dengue group were more likely to have history of patient-reported rash and a history of dengue contact and less likely to have respiratory symptoms in comparison to patients with non-dengue febrile illnesses. In contrast to patients with dengue fever, patients in the recent dengue group were more likely to have abdominal pain and jaundice in comparison to non-dengue febrile patients. The finding strongly suggests that a proportion of patients in the recent dengue group may actually represent a subset of patients with acute dengue fever at the late stage of illness. PMID:21901948

  13. Short-term exposure to ambient particulate matter and emergency ambulance dispatch for acute illness in Japan.

    PubMed

    Tasmin, Saira; Ueda, Kayo; Stickley, Andrew; Yasumoto, Shinya; Phung, Vera Ling Hui; Oishi, Mizuki; Yasukouchi, Shusuke; Uehara, Yamato; Michikawa, Takehiro; Nitta, Hiroshi

    2016-10-01

    Short-term exposure to air pollution may be linked to negative health outcomes that require an emergency medical response. However, few studies have been undertaken on this phenomenon to date. The aim of this study therefore was to examine the association between short-term exposure to ambient suspended particulate matter (SPM) and emergency ambulance dispatches (EADs) for acute illness in Japan. Daily EAD data, daily mean SPM and meteorological data were obtained for four prefectures in the Kanto region of Japan for the period from 2007 to 2011. The area-specific association between daily EAD for acute illness and SPM was explored using generalized linear models while controlling for ambient temperature, relative humidity, seasonality, long-term trends, day of the week and public holidays. Stratified analyses were conducted to evaluate the modifying effects of age, sex and medical conditions. Area-specific estimates were combined using meta-analyses. For the total study period the mean level of SPM was 23.7μg/m(3). In general, higher SPM was associated with a significant increase in EAD for acute illness [estimated pooled relative risk (RR): 1.008, 95% CI: 1.007 to 1.010 per 10μg/m(3) increase in SPM at lag 0-1]. The effects of SPM on EAD for acute illness were significantly greater for moderate/mild medical conditions (e.g. cases that resulted in <3weeks hospitalization or no hospitalization) when compared to severe medical conditions (e.g. critical cases, and cases that led to >3weeks hospitalization or which resulted in death). Using EAD data, this study has shown the adverse health effects of ambient air pollution. This highlights the importance of reducing the level of air pollution in order to maintain population health and well-being. PMID:27235903

  14. Challenges and Rewards on the Road to Translational Systems Biology in Acute Illness: Four Case Reports from Interdisciplinary Teams

    PubMed Central

    An, Gary; Hunt, C. Anthony; Clermont, Gilles; Neugebauer, Edmund; Vodovotz, Yoram

    2007-01-01

    Introduction Translational systems biology approaches can be distinguished from mainstream systems biology in that their goal is to drive novel therapies and streamline clinical trials in critical illness. One systems biology approach, dynamic mathematical modeling (DMM), is increasingly used in dealing with the complexity of the inflammatory response and organ dysfunction. The use of DMM often requires a broadening of research methods and a multidisciplinary team approach that includes bioscientists, mathematicians, engineers, and computer scientists. However, the development of these groups must overcome domain-specific barriers to communication and understanding. Methods We present four case studies of successful translational, interdisciplinary systems biology efforts, which differ by organizational level from an individual to an entire research community. Results Case 1 is a single investigator involved in DMM of the acute inflammatory response at Cook County Hospital, in which extensive translational progress was made using agent-based models of inflammation and organ damage. Case 2 is a community-level effort from the University of Witten-Herdecke in Cologne, whose efforts have led to the formation of the Society for Complexity in Acute Illness. Case 3 is an institution-based group, the Biosystems Group at the University of California, San Francisco, whose work has included a focus on a common lexicon for DMM. Case 4 is an institution-based, trans-disciplinary research group (the Center for Inflammation and Regenerative Modeling at the University of Pittsburgh, whose modeling work has led to internal education efforts, grant support, and commercialization. Conclusion A transdisciplinary approach, which involves team interaction in an iterative fashion to address ambiguity and is supported by educational initiatives, is likely to be necessary for DMM in acute illness. Community-wide organizations such as the Society of Complexity in Acute Illness (SCAI) must

  15. Being in a process of transition to psychosis, as narrated by adults with psychotic illnesses acutely admitted to hospital

    PubMed Central

    Sebergsen, K; Norberg, A; Talseth, A-G

    2014-01-01

    Accessible summary Early intervention to prevent and reduce new episodes of psychosis involves patients, relatives and mental health personnel recognizing the early signs of psychosis. Twelve participants with psychotic illnesses narrated how they experienced becoming psychotic before they were admitted to acute psychiatric wards. The results of this study demonstrate that participants and their close others who sensed, understood and articulated experienced changes as signs of psychosis established a dialogue with mental health personnel and initiated treatment and care. Participants who did not perceive the experienced changes as signs of psychosis articulated the experienced changes as an awareness of a poor health condition and illness. These participants, who had no other people to advocate for them, appeared to experience poor communication and coercion during intervention. Abstract To assist in improving early interventions for psychosis, this study explored how adult people narrated their experience of becoming psychotic, and how contact with mental health personnel was established. Narrative interviews were conducted with 12 participants with psychotic illnesses recruited from acute psychiatric wards. The interviews were content analysed. Participants described being in a process of transition to psychosis as follows: experiencing changes as well-known signs of psychosis, experiencing sudden unexpected changes as signs of psychosis and experiencing unidentified changes as signs of illness. Our results show that participants and their close others who knew the signs of psychosis established a dialogue with mental health personnel and were better equipped to prevent and mitigate the psychosis. Our results demonstrate that participants who did not perceive the signs of psychosis and did not have other people to advocate for them were at risk for delayed treatment, poor communication and coercive interventions. Furthermore, participants who did not know the

  16. Healthcare-seeking behaviors for acute respiratory illness in two communities of Java, Indonesia: a cross-sectional survey.

    PubMed

    Praptiningsih, Catharina Y; Lafond, Kathryn E; Wahyuningrum, Yunita; Storms, Aaron D; Mangiri, Amalya; Iuliano, Angela D; Samaan, Gina; Titaley, Christiana R; Yelda, Fitra; Kreslake, Jennifer; Storey, Douglas; Uyeki, Timothy M

    2016-06-01

    Understanding healthcare-seeking patterns for respiratory illness can help improve estimations of disease burden and inform public health interventions to control acute respiratory disease in Indonesia. The objectives of this study were to describe healthcare-seeking behaviors for respiratory illnesses in one rural and one urban community in Western Java, and to explore the factors that affect care seeking. From February 8, 2012 to March 1, 2012, a survey was conducted in 2520 households in the East Jakarta and Bogor districts to identify reported recent respiratory illnesses, as well as all hospitalizations from the previous 12-month period. We found that 4% (10% of those less than 5years) of people had respiratory disease resulting in a visit to a healthcare provider in the past 2weeks; these episodes were most commonly treated at government (33%) or private (44%) clinics. Forty-five people (0.4% of those surveyed) had respiratory hospitalizations in the past year, and just over half of these (24/45, 53%) occurred at a public hospital. Public health programs targeting respiratory disease in this region should account for care at private hospitals and clinics, as well as illnesses that are treated at home, in order to capture the true burden of illness in these communities. PMID:26930154

  17. Acute Viral Respiratory Illnesses in Andean Children: a Household-Based Cohort Study

    PubMed Central

    Budge, Philip J.; Griffin, Marie R.; Edwards, Kathryn M.; Williams, John V.; Verastegui, Hector; Hartinger, Stella M.; Johnson, Monika; Klemenc, Jennifer M.; Zhu, Yuwei; Gil, Ana I.; Lanata, Claudio F.; Grijalva, Carlos G.

    2014-01-01

    Background Few community studies have measured the incidence, severity, and etiology of acute respiratory illness (ARI) among children living at high-altitude in remote rural settings. Methods We conducted active, household-based ARI surveillance among children aged <3 years in rural highland communities of San Marcos, Cajamarca, Peru from May 2009 through September 2011 (RESPIRA-PERU study). ARI (defined by fever or cough) were considered lower respiratory tract infections (LRTI) if tachypnea, wheezing, grunting, stridor, or retractions were present. Nasal swabs collected during ARI episodes were tested for respiratory viruses by real-time reverse-transcriptase polymerase chain reaction. ARI incidence was calculated using Poisson regression. Results During 755.1 child-years of observation among 892 children in 58 communities, 4,475 ARI were observed, yielding an adjusted incidence of 6.2 ARI/child-year (95% CI 5.9 – 6.5). Families sought medical care for 24% of ARI, 4% were classified as LRTI, and 1% led to hospitalization. Two of five deaths among cohort children were attributed to ARI. One or more respiratory virus was detected in 67% of 3957 samples collected. Virus-specific incidence rates per 100 child-years were: rhinovirus, 236; adenovirus, 73; parainfluenza virus, 46; influenza, 37; respiratory syncytial virus, 30; and human metapneumovirus, 17. Respiratory syncytial virus, metapneumovirus, and parainfluenza virus 1-3 comprised a disproportionate share of LRTI compared to other etiologies. Conclusions In this high-altitude rural setting with low population density, ARI in young children were common, frequently severe, and associated with a number of different respiratory viruses. Effective strategies for prevention and control of these infections are needed. PMID:24378948

  18. The Predictive Value of the NICE “Red Traffic Lights” in Acutely Ill Children

    PubMed Central

    Kerkhof, Evelien; Lakhanpaul, Monica; Ray, Samiran; Verbakel, Jan Y.; Van den Bruel, Ann; Thompson, Matthew; Berger, Marjolein Y.; Moll, Henriette A.; Oostenbrink, Rianne

    2014-01-01

    Objective Early recognition and treatment of febrile children with serious infections (SI) improves prognosis, however, early detection can be difficult. We aimed to validate the predictive rule-in value of the National Institute for Health and Clinical Excellence (NICE) most severe alarming signs or symptoms to identify SI in children. Design, Setting and Participants The 16 most severe (“red”) features of the NICE traffic light system were validated in seven different primary care and emergency department settings, including 6,260 children presenting with acute illness. Main Outcome Measures We focussed on the individual predictive value of single red features for SI and their combinations. Results were presented as positive likelihood ratios, sensitivities and specificities. We categorised “general” and “disease-specific” red features. Changes in pre-test probability versus post-test probability for SI were visualised in Fagan nomograms. Results Almost all red features had rule-in value for SI, but only four individual red features substantially raised the probability of SI in more than one dataset: “does not wake/stay awake”, “reduced skin turgor”, “non-blanching rash”, and “focal neurological signs”. The presence of ≥3 red features improved prediction of SI but still lacked strong rule-in value as likelihood ratios were below 5. Conclusions The rule-in value of the most severe alarming signs or symptoms of the NICE traffic light system for identifying children with SI was limited, even when multiple red features were present. Our study highlights the importance of assessing the predictive value of alarming signs in clinical guidelines prior to widespread implementation in routine practice. PMID:24633015

  19. Urinary L-FABP predicts poor outcomes in critically ill patients with early acute kidney injury.

    PubMed

    Parr, Sharidan K; Clark, Amanda J; Bian, Aihua; Shintani, Ayumi K; Wickersham, Nancy E; Ware, Lorraine B; Ikizler, T Alp; Siew, Edward D

    2015-03-01

    Biomarker studies for early detection of acute kidney injury (AKI) have been limited by nonselective testing and uncertainties in using small changes in serum creatinine as a reference standard. Here we examine the ability of urine L-type fatty acid-binding protein (L-FABP), neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), and kidney injury molecule-1 (KIM-1) to predict injury progression, dialysis, or death within 7 days in critically ill adults with early AKI. Of 152 patients with known baseline creatinine examined, 36 experienced the composite outcome. Urine L-FABP demonstrated an area under the receiver-operating characteristic curve (AUC-ROC) of 0.79 (95% confidence interval 0.70-0.86), which improved to 0.82 (95% confidence interval 0.75-0.90) when added to the clinical model (AUC-ROC of 0.74). Urine NGAL, IL-18, and KIM-1 had AUC-ROCs of 0.65, 0.64, and 0.62, respectively, but did not significantly improve discrimination of the clinical model. The category-free net reclassification index improved with urine L-FABP (total net reclassification index for nonevents 31.0%) and urine NGAL (total net reclassification index for events 33.3%). However, only urine L-FABP significantly improved the integrated discrimination index. Thus, modest early changes in serum creatinine can help target biomarker measurement for determining prognosis with urine L-FABP, providing independent and additive prognostic information when combined with clinical predictors. PMID:25229339

  20. Acute Undifferentiated Febrile Illness in Rural Cambodia: A 3-Year Prospective Observational Study

    PubMed Central

    Mueller, Tara C.; Siv, Sovannaroth; Khim, Nimol; Kim, Saorin; Fleischmann, Erna; Ariey, Frédéric; Buchy, Philippe; Guillard, Bertrand; González, Iveth J.; Christophel, Eva-Maria; Abdur, Rashid; von Sonnenburg, Frank; Bell, David; Menard, Didier

    2014-01-01

    In the past decade, malaria control has been successfully implemented in Cambodia, leading to a substantial decrease in reported cases. Wide-spread use of malaria rapid diagnostic tests (RDTs) has revealed a large burden of malaria-negative fever cases, for which no clinical management guidelines exist at peripheral level health facilities. As a first step towards developing such guidelines, a 3-year cross-sectional prospective observational study was designed to investigate the causes of acute malaria-negative febrile illness in Cambodia. From January 2008 to December 2010, 1193 febrile patients and 282 non-febrile individuals were recruited from three health centers in eastern and western Cambodia. Malaria RDTs and routine clinical examination were performed on site by health center staff. Venous samples and nasopharyngeal throat swabs were collected and analysed by molecular diagnostic tests. Blood cultures and blood smears were also taken from all febrile individuals. Molecular testing was applied for malaria parasites, Leptospira, Rickettsia, O. tsutsugamushi, Dengue- and Influenza virus. At least one pathogen was identified in 73.3% (874/1193) of febrile patient samples. Most frequent pathogens detected were P. vivax (33.4%), P. falciparum (26.5%), pathogenic Leptospira (9.4%), Influenza viruses (8.9%), Dengue viruses (6.3%), O. tsutsugamushi (3.9%), Rickettsia (0.2%), and P. knowlesi (0.1%). In the control group, a potential pathogen was identified in 40.4%, most commonly malaria parasites and Leptospira. Clinic-based diagnosis of malaria RDT-negative cases was poorly predictive for pathogen and appropriate treatment. Additional investigations are needed to understand their impact on clinical disease and epidemiology, and the possible role of therapies such as doxycycline, since many of these pathogens were seen in non-febrile subjects. PMID:24755844

  1. Disparities in smoking and acute respiratory illnesses among sexual minority young adults.

    PubMed

    Blosnich, John; Jarrett, Traci; Horn, Kimberly

    2010-10-01

    Morbidity and mortality from cigarette smoking remain major public health issues. Particularly, smoking has been associated with increased risk of acute respiratory illnesses (ARIs). Literature indicates that lesbian, gay, and bisexual (i.e., sexual minority) persons smoke more than the general population. Additionally, young adulthood is the second-most prevalent period of smoking uptake. Given this constellation of risk correlates, the authors examined whether sexual minority young adults experience increased odds of ARIs (i.e., strep throat, bronchitis, sinus infection, and asthma). Using cross-sectional data from the Spring 2006 National College Health Assessment, prevalence estimates of smoking were generated among young adult (age range, 18-24 years) lesbian/gay, bisexual, unsure, and heterosexual college students (n = 75,164). Nested logistic regression analyses were used to examine whether smoking status mediated the risk of ARIs among sexual orientation groups. Compared with heterosexual smokers, gay/lesbian smokers were more likely to have had strep throat, and bisexual smokers were more likely to have had sinus infection, asthma, and bronchitis. Whereas smoking mediated the risk of ARI, sexual minorities still showed higher odds of ARIs after adjustment for smoking. Sexual minority young adults may experience respiratory health disparities that may be linked to their higher smoking rates, and their higher rates of smoking lend urgency to the need for cessation interventions. Future studies are needed to explore whether chronic respiratory disease caused by smoking (i.e., lung cancer, COPD, emphysema) disproportionately affect sexual minority populations. PMID:20496074

  2. Healthcare use for acute gastrointestinal illness in two Inuit communities: Rigolet and Iqaluit, Canada†

    PubMed Central

    Harper, Sherilee L.; Edge, Victoria L.; Ford, James; Thomas, M. Kate; Pearl, David; Shirley, Jamal; McEwen, Scott A.

    2015-01-01

    Background The incidence of self-reported acute gastrointestinal illness (AGI) in Rigolet, Nunatsiavut, and Iqaluit, Nunavut, is higher than reported elsewhere in Canada; as such, understanding AGI-related healthcare use is important for healthcare provision, public health practice and surveillance of AGI. Objectives This study described symptoms, severity and duration of self-reported AGI in the general population and examined the incidence and factors associated with healthcare utilization for AGI in these 2 Inuit communities. Design Cross-sectional survey data were analysed using multivariable exact logistic regression to examine factors associated with individuals’ self-reported healthcare and over-the-counter (OTC) medication utilization related to AGI symptoms. Results In Rigolet, few AGI cases used healthcare services [4.8% (95% CI=1.5–14.4%)]; in Iqaluit, some cases used healthcare services [16.9% (95% CI=11.2–24.7%)]. Missing traditional activities due to AGI (OR=3.8; 95% CI=1.18–12.4) and taking OTC medication for AGI symptoms (OR=3.8; 95% CI=1.2–15.1) were associated with increased odds of using healthcare services in Iqaluit. In both communities, AGI severity and secondary symptoms (extreme tiredness, headache, muscle pains, chills) were significantly associated with increased odds of taking OTC medication. Conclusions While rates of self-reported AGI were higher in Inuit communities compared to non-Inuit communities in Canada, there were lower rates of AGI-related healthcare use in Inuit communities compared to other regions in Canada. As such, the rates of healthcare use for a given disease can differ between Inuit and non-Inuit communities, and caution should be exercised in making comparisons between Inuit and non-Inuit health outcomes based solely on clinic records and healthcare use. PMID:26001982

  3. Viruses in Nondisinfected Drinking Water from Municipal Wells and Community Incidence of Acute Gastrointestinal Illness

    PubMed Central

    Spencer, Susan K.; Kieke, Burney A.; Lambertini, Elisabetta; Loge, Frank J.

    2012-01-01

    Background: Groundwater supplies for drinking water are frequently contaminated with low levels of human enteric virus genomes, yet evidence for waterborne disease transmission is lacking. Objectives: We related quantitative polymerase chain reaction (qPCR)–measured enteric viruses in the tap water of 14 Wisconsin communities supplied by nondisinfected groundwater to acute gastrointestinal illness (AGI) incidence. Methods: AGI incidence was estimated from health diaries completed weekly by households within each study community during four 12-week periods. Water samples were collected monthly from five to eight households per community. Viruses were measured by qPCR, and infectivity assessed by cell culture. AGI incidence was related to virus measures using Poisson regression with random effects. Results: Communities and time periods with the highest virus measures had correspondingly high AGI incidence. This association was particularly strong for norovirus genogroup I (NoV-GI) and between adult AGI and enteroviruses when echovirus serotypes predominated. At mean concentrations of 1 and 0.8 genomic copies/L of NoV-GI and enteroviruses, respectively, the AGI incidence rate ratios (i.e., relative risk) increased by 30%. Adenoviruses were common, but tap-water concentrations were low and not positively associated with AGI. The estimated fraction of AGI attributable to tap-water–borne viruses was between 6% and 22%, depending on the virus exposure–AGI incidence model selected, and could have been as high as 63% among children < 5 years of age during the period when NoV-GI was abundant in drinking water. Conclusions: The majority of groundwater-source public water systems in the United States produce water without disinfection, and our findings suggest that populations served by such systems may be exposed to waterborne viruses and consequent health risks. PMID:22659405

  4. Chikungunya Fever Among Patients with Acute Febrile Illness Attending a Tertiary Care Hospital in Mumbai

    PubMed Central

    Galate, Lata Baswanna; Agrawal, Sachee R; Shastri, Jayanthi S; Londhey, Vikram

    2016-01-01

    Background: Chikungunya fever (CHIK) is an arboviral disease. Dengue fever (DENG) and CHIK are indistinguishable clinically and need to be differentiated by laboratory investigations. Purpose: This study aimed at estimating the seroprevalence of CHIK mono-infection and CHIK and DENG dual infection in suspected patients. We also analyzed the age, sex distribution, joint involvement, and relation of joint movement restriction with visual analog scale (VAS). Materials and Methods: Two hundred patients clinically suspected with DENG and CHIK were enrolled from a Tertiary Care Hospital in Mumbai from April 2012 to October 2013. The detailed history and examination findings were recorded. Serum samples were subjected to DENG and CHIK immunoglobulin G (IgM) enzyme-linked immunosorbent assay (ELISA). Results: The seroprevalence of CHIK was 12.5%. Mono-infection of CHIK was 3%, and CHIK and DENG dual infection was 9.5%. Most affected age group in CHIK cases was 46–60 years wherein female preponderance was seen. All 6 patients with CHIK mono-infection had fever and joint involvement; knee and elbow were the most commonly affected joints. All CHIK patients had VAS score of 6–10 with restricted joint movement. Of the patients with dual infection, the majorities were from 31 to 45 years with male preponderance; all had fever and joint pain mainly affecting knee and elbow. Of patients who had VAS score 6–10 in patients with dual infection, only 5.26% had restricted joint movement. Conclusion: IgM ELISA for Chikungunya infection should be included in the routine laboratory tests for acute febrile illness. PMID:27365916

  5. Evaluation of activity of hypothalamo-pituitary-gonadal axis in postmenopausal women suffering from severe acute illness

    PubMed Central

    Raj, M. Neelima; Suresh, V.; Mukka, Arun; Reddy, Amaresh; Sachan, Alok; Mohan, Alladi; Vengamma, B.; Rao, P.V.L.N. Srinivas

    2016-01-01

    Background & objectives: Postmenopausal women constitute an ideal model for studying the extent of hypothalamo-pituitary gonadal (HPG) axis suppression in critical illness as the gonadotropins are normally high and non-cyclical in them. The objective was to assess the impact of acute severe illness in postmenopausal women on the HPG axis and the activities of the hypothalamo-pituitary-adrenal (HPA), the hypothalamo- pituitary-thyroid (HPT) axes; and levels of serum prolactin, by comparison between critically ill postmenopausal women and otherwise healthy postmenopausal women. Methods: Thirty five consecutive postmenopausal women older than 60 yr admitted to medical intensive care with a Simplified Acute Physiology Score II (SAPS II) more than 30 were included. On day five of their in-hospital stay, blood samples were collected for oestradiol, luteinizing hormone (LH), follicle stimulating hormone (FSH), cortisol, androstenedione, prolactin and thyroid profile. Thirty five apparently healthy postmenopausal women were selected as controls. Results: Levels of LH, FSH, thyrotropin, free thyroxin (fT4) and free tri-iodothyronine (fT3) were lower while oestradiol, cortisol and dehydroepiandrosterone were higher among patients in comparison to healthy controls. Prolactin levels were similar in patients and controls. Among sick patients both FSH and fT4 showed a negative correlation (P<0.05) with the SAPS II score. Interpretation & conclusions: In critically ill postmenopausal women, paradoxically elevated oestrogen levels despite gonadotropin suppression suggests a non-ovarian origin. Prolactin remained unaltered in patients despite their illness, possibly reflecting atrophy of lactotrophs in menopause. PMID:26997016

  6. Community-acquired pneumonia and survival of critically ill acute exacerbation of COPD patients in respiratory intensive care units

    PubMed Central

    Lu, Zhiwei; Cheng, Yusheng; Tu, Xiongwen; Chen, Liang; Chen, Hu; Yang, Jian; Wang, Jinyan; Zhang, Liqin

    2016-01-01

    Purpose The aim of this study was to appraise the effect of community-acquired pneumonia (CAP) on inhospital mortality in critically ill acute exacerbation of COPD (AECOPD) patients admitted to a respiratory intensive care unit. Patients and methods A retrospective observational study was performed. Consecutive critically ill AECOPD patients receiving treatment in a respiratory intensive care unit were reviewed from September 1, 2012, to August 31, 2015. Categorical variables were analyzed using chi-square tests, and continuous variables were analyzed by Mann–Whitney U-test. Kaplan–Meier analysis was used to assess the association of CAP with survival of critically ill AECOPD patients for univariate analysis. Cox’s proportional hazards regression model was performed to identify risk factors for multivariate analysis. Results A total of 80 consecutive eligible individuals were reviewed. These included 38 patients with CAP and 42 patients without CAP. Patients with CAP had a higher inhospital rate of mortality than patients without CAP (42% vs 33.3%, P<0.05). Kaplan–Meier survival analysis showed that patients with CAP had a worse survival rate than patients without CAP (P<0.05). Clinical characteristics, including Acute Physiology and Chronic Health Evaluation II (APACHE II) score, C-reactive protein, and CAP, were found to be closely associated with survival of AECOPD individuals. Further multivariate Cox regression analysis confirmed that CAP and APACHE II were independent risk factors for inhospital mortality in critically ill AECOPD patients (CAP: hazard ratio, 5.29; 95% CI, 1.50–18.47, P<0.01 and APACHE II: hazard ratio, 1.20; 95% CI, 1.06–1.37, P<0.01). Conclusion CAP may be an independent risk factor for higher inhospital mortality in critically ill AECOPD patients. PMID:27563239

  7. The design and rationale for the Acute Medically Ill Venous Thromboembolism Prevention with Extended Duration Betrixaban (APEX) study.

    PubMed

    Cohen, Alexander T; Harrington, Robert; Goldhaber, Samuel Z; Hull, Russell; Gibson, C Michael; Hernandez, Adrian F; Kitt, Michael M; Lorenz, Todd J

    2014-03-01

    Randomized clinical trials have identified a population of acute medically ill patients who remain at risk for venous thromboembolism (VTE) beyond the standard duration of therapy and hospital discharge. The aim of the APEX study is to determine whether extended administration of oral betrixaban (35-42 days) is superior to a standard short course of prophylaxis with subcutaneous enoxaparin (10 ± 4 days followed by placebo) in patients with known risk factors for post-discharge VTE. Patients initially are randomized to receive either betrixaban or enoxaparin (and matching placebo) in a double dummy design. Following a standard duration period of enoxaparin treatment (with placebo tablets) or betrixaban (with placebo injections), patients receive only betrixaban (or alternative matching placebo). Patients are considered for enrollment if they are older than 40 years, have a specified medical illness, and restricted mobility. They must also meet the APEX criteria for increased VTE risk (aged ≥75 years, baseline D-Dimer ≥2× upper the limit of "normal", or 2 additional ancillary risk factors for VTE). The primary efficacy end point is the composite of asymptomatic proximal deep venous thrombosis, symptomatic deep venous thrombosis, non-fatal (pulmonary embolus) pulmonary embolism, or VTE-related death through day 35. The primary safety outcome is the occurrence of major bleeding. We hypothesize that extended duration betrixaban VTE prophylaxis will be safe and more effective than standard short duration enoxaparin in preventing VTE in acute medically ill patients with known risk factors for post hospital discharge VTE. PMID:24576517

  8. Hyperglycemia during induction therapy is associated with increased infectious complications in childhood acute lymphocytic leukemia

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Children with acute lymphocytic leukemia (ALL) are at high risk for developing hyperglycemia. Hyperglycemic adult ALL patients have shorter remissions, more infections, and increased mortality. No corresponding data are available in children. We hypothesized that children with ALL who become hypergl...

  9. A proposed emergency management program for acute care facilities in response to a highly virulent infectious disease.

    PubMed

    Petinaux, Bruno; Ferguson, Brandy; Walker, Milena; Lee, Yeo-Jin; Little, Gary; Parenti, David; Simon, Gary

    2016-01-01

    To address the organizational complexities associated with a highly virulent infectious disease (HVID) hazard, such as Ebola Virus Disease (EVD), an acute care facility should institute an emergency management program rooted in the fundamentals of mitigation, preparedness, response, and recovery. This program must address all known facets of the care of a patient with HVID, from unannounced arrival to discharge. The implementation of such a program not only serves to mitigate the risks from an unrecognized exposure but also serves to prepare the organization and its staff to provide for a safe response, and ensure a full recovery. Much of this program is based on education, training, and infection control measures along with resourcing for appropriate personal protective equipment which is instrumental in ensuring an organized and safe response of the acute care facility in the service to the community. This emergency management program approach can serve as a model in the care of not only current HVIDs such as EVD but also future presentations in our healthcare setting. PMID:26963227

  10. Risk Factors for Acute Kidney Injury in Older Adults With Critical Illness: A Retrospective Cohort Study

    PubMed Central

    Kane-Gill, Sandra L.; Sileanu, Florentina E.; Murugan, Raghavan; Trietley, Gregory S.; Handler, Steven M.; Kellum, John A.

    2014-01-01

    Background Risk for acute kidney injury (AKI) in older adults has not been systematically evaluated. We sought to delineate the determinants of risk for AKI in older compared to younger adults. Study Design Retrospective analysis of patients hospitalized in July 2000–September 2008. Setting & Participants We identified all adult patients admitted to an intensive care unit (ICU) (n=45,655) in a large tertiary care university hospital system. We excluded patients receiving dialysis or kidney transplant prior to hospital admission, and patients with baseline creatinine ≥ 4 mg/dl, liver transplantation, indeterminate AKI status, or unknown age, leaving 39,938 patients. Predictor We collected data on multiple susceptibilities and exposures including age, sex, race, body mass, comorbid conditions, severity of illness, baseline kidney function, sepsis, and shock. Outcomes We defined AKI according to KDIGO (Kidney Disease: Improving Global Outcomes) criteria. We examined susceptibilities and exposures across age strata for impact on development of AKI. Measurements We calculated area under the receiver operating characteristic curve (AUC) for prediction of AKI across age groups. Results 25,230 patients (63.2%) were aged 55 years or older. Overall 25,120 patients (62.9%) developed AKI (69.2% aged 55 years or older). Examples of risk factors for AKI in the oldest age category (75 years or older) were drugs (vancomycin, aminoglycosides, nonsteroidal anti-inflammatories), history of hypertension (OR, 1.13; 95% CI, 1.02–1.25) and sepsis (OR, 2.12; 95% CI, 1.68–2.67). Fewer variables remained predictive of AKI as age increased and the model for older patients was less predictive (p<0.001). For the age categories 18–54, 55–64, 65–74, and 75 years or older, the AUCs were 0.744 (95% CI, 0.735–0.752), 0.714 (95% CI, 0.702–0.726), 0.706 (95% CI, 0.693–0.718), and 0.673 (95% CI, 0.661–0.685), respectively. Limitations Analysis may not apply to non-ICU patients

  11. Physicians’ Decision Making Roles for an Acutely Unstable Critically and Terminally Ill Patient

    PubMed Central

    Uy, Jamie; White, Douglas B.; Mohan, Deepika; Arnold, Robert M.; Barnato, Amber E.

    2013-01-01

    Background There is substantial variation in use of life sustaining technologies in patients near the end of life but little is known about variation in physicians’ initial ICU admission and intubation decision making processes. Objective To describe variation in hospital-based physicians’ communication behaviors and decision making roles for ICU admission and intubation decisions for an acutely unstable critically and terminally ill patient. Methods We conducted a secondary analysis of transcribed simulation encounters from a multi-center observational study of physician decision making. The simulation depicted a 78 year-old man with metastatic gastric cancer and life threatening hypoxia. He has stable underlying preferences against ICU admission and intubation that he or his wife will report if asked. We coded encounters for communication behaviors (providing medical information, eliciting preferences/values, engaging the patient/surrogate in deliberation, and providing treatment recommendations) and used a previously-developed framework to classify subject physicians into four mutually-exclusive decision-making roles: informative (providing medical information only), facilitative (information + eliciting preferences/values + guiding surrogate to apply preferences/values), collaborative (information + eliciting + guiding + making a recommendation) and directive (making an independent treatment decision). Subjects 24 emergency physicians, 37 hospitalists, and 37 intensivists from 3 US academic medical centers. Results Subject physicians average 12.4 (SD 9.0) years since graduation from medical school. 38/98(39%) physicians sent the patient to the ICU, and 9/98(9%) ultimately decided to intubate. Most (93/98 (95%)) provided at least some medical information, but few explained the short-term prognosis with (26/98 (27%)) or without intubation (37/98 (38%)). Many (80/98 (82%)) elicited the patient's intubation preferences, but few (35/98 (36%)) explored the

  12. Mortality amongst Patients with Influenza-Associated Severe Acute Respiratory Illness, South Africa, 2009-2013

    PubMed Central

    Cohen, Cheryl; Moyes, Jocelyn; Tempia, Stefano; Groome, Michelle; Walaza, Sibongile; Pretorius, Marthi; Dawood, Halima; Chhagan, Meera; Haffejee, Summaya; Variava, Ebrahim; Kahn, Kathleen; von Gottberg, Anne; Wolter, Nicole; Cohen, Adam L.; Malope-Kgokong, Babatyi; Venter, Marietjie; Madhi, Shabir A.

    2015-01-01

    Introduction Data on the burden and risk groups for influenza-associated mortality from Africa are limited. We aimed to estimate the incidence and risk-factors for in-hospital influenza-associated severe acute respiratory illness (SARI) deaths. Methods Hospitalised patients with SARI were enrolled prospectively in four provinces of South Africa from 2009–2013. Using polymerase chain reaction, respiratory samples were tested for ten respiratory viruses and blood for pneumococcal DNA. The incidence of influenza-associated SARI deaths was estimated at one urban hospital with a defined catchment population. Results We enrolled 1376 patients with influenza-associated SARI and 3% (41 of 1358 with available outcome data) died. In patients with available HIV-status, the case-fatality proportion (CFP) was higher in HIV-infected (5%, 22/419) than HIV-uninfected individuals (2%, 13/620; p = 0.006). CFPs varied by age group, and generally increased with increasing age amongst individuals >5 years (p<0.001). On multivariable analysis, factors associated with death were age-group 45–64 years (odds ratio (OR) 4.0, 95% confidence interval (CI) 1.01–16.3) and ≥65 years (OR 6.5, 95%CI 1.2–34.3) compared to 1–4 year age-group who had the lowest CFP, HIV-infection (OR 2.9, 95%CI 1.1–7.8), underlying medical conditions other than HIV (OR 2.9, 95%CI 1.2–7.3) and pneumococcal co-infection (OR 4.1, 95%CI 1.5–11.2). The estimated incidence of influenza-associated SARI deaths per 100,000 population was highest in children <1 year (20.1, 95%CI 12.1–31.3) and adults aged 45–64 years (10.4, 95%CI 8.4–12.9). Adjusting for age, the rate of death was 20-fold (95%CI 15.0–27.8) higher in HIV-infected individuals than HIV-uninfected individuals. Conclusion Influenza causes substantial mortality in urban South Africa, particularly in infants aged <1 year and HIV-infected individuals. More widespread access to antiretroviral treatment and influenza vaccination may reduce this

  13. Economics of dialysis dependence following renal replacement therapy for critically ill acute kidney injury patients

    PubMed Central

    Ethgen, Olivier; Schneider, Antoine G.; Bagshaw, Sean M.; Bellomo, Rinaldo; Kellum, John A.

    2015-01-01

    Background The obective of this study was to perform a cost-effectiveness analysis comparing intermittent with continuous renal replacement therapy (IRRT versus CRRT) as initial therapy for acute kidney injury (AKI) in the intensive care unit (ICU). Methods Assuming some patients would potentially be eligible for either modality, we modeled life year gained, the quality-adjusted life years (QALYs) and healthcare costs for a cohort of 1000 IRRT patients and a cohort of 1000 CRRT patients. We used a 1-year, 5-year and a lifetime horizon. A Markov model with two health states for AKI survivors was designed: dialysis dependence and dialysis independence. We applied Weibull regression from published estimates to fit survival curves for CRRT and IRRT patients and to fit the proportion of dialysis dependence among CRRT and IRRT survivors. We then applied a risk ratio reported in a large retrospective cohort study to the fitted CRRT estimates in order to determine the proportion of dialysis dependence for IRRT survivors. We conducted sensitivity analyses based on a range of differences for daily implementation cost between CRRT and IRRT (base case: CRRT day $632 more expensive than IRRT day; range from $200 to $1000) and a range of risk ratios for dialysis dependence for CRRT as compared with IRRT (from 0.65 to 0.95; base case: 0.80). Results Continuous renal replacement therapy was associated with a marginally greater gain in QALY as compared with IRRT (1.093 versus 1.078). Despite higher upfront costs for CRRT in the ICU ($4046 for CRRT versus $1423 for IRRT in average), the 5-year total cost including the cost of dialysis dependence was lower for CRRT ($37 780 for CRRT versus $39 448 for IRRT on average). The base case incremental cost-effectiveness analysis showed that CRRT dominated IRRT. This dominance was confirmed by extensive sensitivity analysis. Conclusions Initial CRRT is cost-effective compared with initial IRRT by reducing the rate of long-term dialysis

  14. The epidemiology and prognostic factors of mortality in critically ill children with acute kidney injury in Taiwan.

    PubMed

    Chang, Jei-Wen; Jeng, Mei-Jy; Yang, Ling-Yu; Chen, Tzeng-Ji; Chiang, Shu-Chiung; Soong, Wen-Jue; Wu, Keh-Gong; Lee, Yu-Sheng; Wang, Hsin-Hui; Yang, Chia-Feng; Tsai, Hsin-Lin

    2015-03-01

    The incidence of acute kidney injury (AKI) in critically ill children varies among countries. Here we used claims data from the Taiwanese National Health Insurance program from 2006 to 2010 to investigate the epidemiological features and identify factors that predispose individuals to developing AKI and mortality in critically ill children with AKI. Of 60,338 children in this nationwide cohort, AKI was identified in 850, yielding an average incidence rate of 1.4%. Significant independent risk factors for AKI were the use of extracorporeal membrane oxygenation, mechanical ventilation or vasopressors, intrinsic renal diseases, sepsis, and age more than 1 year. Overall, of the AKI cases, 46.5% were due to sepsis, 36.1% underwent renal replacement therapy, and the mortality rate was 44.2%. Multivariate analysis showed that the use of vasopressors, mechanical ventilation, and hemato-oncological disorders were independent predictors of mortality in AKI patients. Thirty-two of the 474 patients who survived had progression to chronic kidney disease or end-stage renal disease. Thus, although not common, AKI in critically ill children still has a high mortality rate associated with a variety of factors. Long-term close follow-up to prevent progressive chronic kidney disease in survivors of critical illnesses with AKI is mandatory. PMID:25252027

  15. Acute Pesticide Illnesses Associated with Off-Target Pesticide Drift from Agricultural Applications: 11 States, 1998–2006

    PubMed Central

    Lee, Soo-Jeong; Mehler, Louise; Beckman, John; Diebolt-Brown, Brienne; Prado, Joanne; Lackovic, Michelle; Waltz, Justin; Mulay, Prakash; Schwartz, Abby; Mitchell, Yvette; Moraga-McHaley, Stephanie; Gergely, Rita

    2011-01-01

    Background: Pesticides are widely used in agriculture, and off-target pesticide drift exposes workers and the public to harmful chemicals. Objective: We estimated the incidence of acute illnesses from pesticide drift from outdoor agricultural applications and characterized drift exposure and illnesses. Methods: Data were obtained from the National Institute for Occupational Safety and Health’s Sentinel Event Notification System for Occupational Risks–Pesticides program and the California Department of Pesticide Regulation. Drift included off-target movement of pesticide spray, volatiles, and contaminated dust. Acute illness cases were characterized by demographics, pesticide and application variables, health effects, and contributing factors. Results: From 1998 through 2006, we identified 2,945 cases associated with agricultural pesticide drift from 11 states. Our findings indicate that 47% were exposed at work, 92% experienced low-severity illness, and 14% were children (< 15 years). The annual incidence ranged from 1.39 to 5.32 per million persons over the 9-year period. The overall incidence (in million person-years) was 114.3 for agricultural workers, 0.79 for other workers, 1.56 for nonoccupational cases, and 42.2 for residents in five agriculture-intensive counties in California. Soil applications with fumigants were responsible for the largest percentage (45%) of cases. Aerial applications accounted for 24% of cases. Common factors contributing to drift cases included weather conditions, improper seal of the fumigation site, and applicator carelessness near nontarget areas. Conclusions: Agricultural workers and residents in agricultural regions had the highest rate of pesticide poisoning from drift exposure, and soil fumigations were a major hazard, causing large drift incidents. Our findings highlight areas where interventions to reduce off-target drift could be focused. PMID:21642048

  16. [Acute rheumatic fever and infectious-inflammatory diseases of the pharynx: the relationship, treatment, and prophylaxis].

    PubMed

    Belov, B S

    2015-01-01

    The relationship between pharyngeal infections, such as tonsillitis and pharyngitis, caused by group A beta-hemolytic streptococci (BHSA) and acute rheumatic fever (ARF) is a well-established fact confirmed by numerous studies carried out along the following lines: epidemiological, immunological, therapeutic, and prophylactic. The currently available data provide an opportunity to discuss the existence of «rheumatogenic» BHSA strains exhibiting a number of characteristic clinical and morphological properties. According to the current recommendations penicillins remain the means of first-line therapy for the treatment of acute forms of BHSA-induced tonsillitis and pharyngitis, whereas the macrolides should be applied only as the alternative medications in the patients with intolerance to beta-lactam antibiotics. This article contains characteristics of BHSA-carrier state and the principal indications for the prescription of antibiotics to the patients with these conditions. The key principle of secondary medicamental prophylaxis of acute respiratory infections are expounded along with the main fines of future research on the problems associated with BHSA-induced pharyngeal infections. PMID:26870861

  17. An Analysis of Hematological Parameters as a Diagnostic test for Malaria in Patients with Acute Febrile Illness: An Institutional Experience

    PubMed Central

    Jairajpuri, Zeeba Shamim; Rana, Safia; Hassan, Mohd Jaseem; Nabi, Farhat; Jetley, Sujata

    2014-01-01

    Objectives Hematological changes are among the most common complications encountered in malaria. This study analyzes and statistically evaluates the hematological changes as a diagnostic test for malaria in patients with acute febrile illness and whether these could guide the physician to institute specific antimalarial treatment. Methods The present study was an observational study, conducted from January to December 2012. A total of 723 patients presenting with acute febrile illness at our hospital were evaluated. A complete blood count and malarial parasite microscopy were performed for each patient. Results The findings showed that 172 out of 723 patients (24%) were diagnosed to have malaria by positive smear report. There were 121 males and 51 females with a male to female ratio of 2.3:1. Maximum number of cases were seen in the 20-30 years age group. There was a statistically significant reduction in hemoglobin (p<0.005), platelet count (p<0.001) and total leukocyte count (p<0.001) levels in patients with malaria compared to those without the disease. Likelihood ratios for a positive result of platelets (6.2) and total leukocyte count (3.4) was relevant as compared to hemoglobin (1.61) and Red cell distribution width (1.79). The negative predictive values for hemoglobin (79%), total leukocyte count (86%), platelets (94%) and Red cell distribution width (93%) were significant. Red cell distribution width values were found to be higher in patients with malaria than in patients without malaria (p<0.001). Conclusion This study revealed that routinely used laboratory findings such as hemoglobin, leukocytes, platelet counts and even red cell distribution width values can provide a diagnostic clue in a patient with acute febrile illness in endemic areas, thus increasing the probability of malaria and enhancing prompt initiation of treatment. PMID:24498476

  18. Comparing the validity of different measures of illness severity: a hospital-level analysis for acute myocardial infarction.

    PubMed

    Gandjour, Afschin; Ku-Goto, Meei-Hsiang; Ho, Vivian

    2012-08-01

    The aim of the study is to assess the validity of three measures of illness severity (prior year's hospital expenditures, Charlson and Elixhauser indices), by analysing the effect of introducing report cards on hospitals treating patients with acute myocardial infarction (AMI). Medicare claims data were obtained for 1992-1997 for AMI patients aged 65+. We used differences-in-differences regression analysis to assess the impact of report cards introduced in New Jersey and Pennsylvania on the illness severity of AMI patients with and without coronary artery bypass graft (CABG) surgery (relative to states without report cards). The analysis was conducted at the hospital level. For validation we used raw mortality and re-admission trends for AMI patients. While prior hospital expenditures suggest a considerable change in the illness severity of AMI patients in Pennsylvania relative to other states, raw mortality and re-admission trends in Pennsylvania are relatively consistent with the trend in the rest of the USA. In line with raw mortality and re-admission data, the Charlson and Elixhauser indices do not imply a considerable change in the severity of AMI patients in Pennsylvania. For CABG patients, illness severity - as measured by all three severity measurement methods - decreased after introduction of report cards, particularly in Pennsylvania. In conclusion, for AMI patients the Charlson and Elixhauser indices are a more valid measure of illness severity than prior year's hospital expenditures. After report cards were introduced, healthier AMI patients were more likely to receive CABG surgery, while sicker patients were avoided. PMID:23135888

  19. [Relationship between child day-care attendance and acute infectious disease. A systematic review].

    PubMed

    Ochoa Sangrador, Carlos; Barajas Sánchez, M Verisima; Muñoz Martín, Beatriz

    2007-01-01

    Child day-care attendance is considered to be an acute early childhood disease risk factor, the studies available however not affording the possibility of fully quantifying this risk. A systematic review of clinical trials and cohort studies was conducted, in which the effects child day-care attendance had on the health of young children based on the Cochrane Collaboration, PubMed and Spanish Medical Index databases, without any time or language-related limits, were analyzed and rounded out with analyses of referenced works and an additional EMBASE search. The methodological quality was evaluated by means of personalized criteria. Pooling measures (relative risks, incidence density ratios and weighted mean differences) were calculated with their confidence intervals, assuming random effects models. A significant increase was found to exist of a risk consistent over time and among different social and geographical environments. Considering the most methodologically-stringent studies with adjusted effect estimates, child day-care attendance was related to an increased risk of upper respiratory tract infection (RR=1,88), acute otitis media (RR=1,58), otitis media with fluid draining (RR=2,43), lower respiratory tract infections (overall RR=210; acute pneumonia RR=1.70; broncholitis RR=1,80; bronchitis RR=2,10) and gastroenteritis (RR=1,40). Child day-care attendance could be responsible for 33%-50% of the episodes of respiratory infection and gastroenteritis among the exposed population. In conclusion, it can be said that the risk for childhood health attributable to the child day-care attendance is discreet but of high-impact. This information has some major implications for research, clinical practice, healthcare authorities and society as a whole. PMID:17639680

  20. Experience with a Simplified Computer Based Intensive Care Monitoring System in the Management of Acutely Ill Surgical Patients

    PubMed Central

    Hadley, H. Roger; Rutherford, Harold G.; Smith, Louis L.; Briggs, Burton A.; Neilsen, Ivan R.; Rau, Richard

    1979-01-01

    The need exists for a simplified and ecomonical computer based monitoring system for critically ill surgical patients. Such a system would enjoy widespread use in surgical intensive care units in regional, as well as larger community hospitals. We have assembled such a system which provides digital readout of the usual physiologic parameters, and also provide computer storage of accumulated data for review and evaluation of patient care. The computer provides graphic and digital display and digital printout for subsequent inclusion in the patient records. Most frequent indications for this system include the development of acute respiratory insufficiency or acute circulatory failure due to invasive sepsis and/or severe arteriosclerotic cardiovascular disease. Information most beneficial in patient care included measurement of cardiac output;alveolar arterial oxygen gradient. ImagesFigure 1Figure 5Figure 9Figure 11

  1. Acute Neurological Illness in a Kidney Transplant Recipient Following Infection With Enterovirus-D68: An Emerging Infection?

    PubMed

    Wali, R K; Lee, A H; Kam, J C; Jonsson, J; Thatcher, A; Poretz, D; Ambardar, S; Piper, J; Lynch, C; Kulkarni, S; Cochran, J; Djurkovic, S

    2015-12-01

    We report the first case of enterovirus-D68 infection in an adult living-donor kidney transplant recipient who developed rapidly progressive bulbar weakness and acute flaccid limb paralysis following an upper respiratory infection. We present a 45-year-old gentleman who underwent pre-emptive living-donor kidney transplantation for IgA nephropathy. Eight weeks following transplantation, he developed an acute respiratory illness from enterovirus/rhinovirus that was detectable in nasopharyngeal (NP) swabs. Within 24 h of onset of respiratory symptoms, the patient developed binocular diplopia which rapidly progressed to multiple cranial nerve dysfunctions (acute bulbar syndrome) over the next 24 h. Within the next 48 h, asymmetric flaccid paralysis of the left arm and urinary retention developed. While his neurological symptoms were evolving, the Centers for Disease Control reported that the enterovirus strain from the NP swabs was, in fact, Enterovirus-D68 (EV-D68). Magnetic resonance imaging of the brain demonstrated unique gray matter and anterior horn cell changes in the midbrain and spinal cord, respectively. Constellation of these neurological symptoms and signs was suggestive for postinfectious encephalomyelitis (acute disseminated encephalomyelitis [ADEM]) from EV-D68. Treatment based on the principles of ADEM included intensive physical therapy and other supportive measures, which resulted in a steady albeit slow improvement in his left arm and bulbar weakness, while maintaining stable allograft function. PMID:26228743

  2. Acute Kidney Injury Classification for Critically Ill Cirrhotic Patients: A Comparison of the KDIGO, AKIN, and RIFLE Classifications

    PubMed Central

    Pan, Heng-Chih; Chien, Yu-Shan; Jenq, Chang-Chyi; Tsai, Ming-Hung; Fan, Pei-Chun; Chang, Chih-Hsiang; Chang, Ming-Yang; Tian, Ya-Chung; Fang, Ji-Tseng; Yang, Chih-Wei; Chen, Yung-Chang

    2016-01-01

    Critically ill cirrhotic patients have high mortality rates, particularly when they present with acute kidney injury (AKI) on admission. The Kidney Disease: Improving Global Outcomes (KDIGO) group aimed to standardize the definition of AKI and recently published a new AKI classification. However, the efficacy of the KDIGO classification for predicting outcomes of critically ill cirrhotic patients is unclear. We prospectively enrolled 242 cirrhotic patients from a 10-bed specialized hepatogastroenterology intensive care unit (ICU) in a 2000-bed tertiary-care referral hospital. Demographic parameters and clinical variables on day 1 of admission were prospectively recorded. The overall in-hospital mortality rate was 62.8%. Liver diseases were usually attributed to hepatitis B viral infection (26.9%). The major cause of ICU admission was upper gastrointestinal bleeding (38.0%). Our result showed that the KDIGO classification had better discriminatory power than RIFLE and AKIN criteria in predicting in-hospital mortality. Cumulative survival rates at the 6-month after hospital discharge differed significantly between patients with and without AKI on ICU admission day. In summary, we identified that the outcome prediction performance of KDIGO classification is superior to that of AKIN or RIFLE classification in critically ill cirrhotic patients. PMID:26983372

  3. Leptospirosis as Frequent Cause of Acute Febrile Illness in Southern Sri Lanka

    PubMed Central

    Bodinayake, Champika; Nagahawatte, Ajith; Devasiri, Vasantha; Kodikara-Arachichi, Wasantha; Strouse, John J.; Flom, Judith E.; Dumler, J. Stephen; Woods, Christopher W.

    2011-01-01

    To determine the proportion of fevers caused by leptospirosis, we obtained serum specimens and epidemiologic and clinical data from patients in Galle, Sri Lanka, March–October 2007. Immunoglobulin M ELISA was performed on paired serum specimens to diagnose acute (seroconversion or 4-fold titer rise) or past (titer without rise) leptospirosis and seroprevalence (acute). We compared (individually) the diagnostic yield of acute-phase specimens and clinical impression with paired specimens for acute leptospirosis. Of 889 patients with paired specimens, 120 had acute leptosoirosis and 241 had past leptospirosis. The sensitivity and specificity of acute-phase serum specimens were 17.5% (95% confidence interval [CI] 11.2%–25.5%) and 69.2% (95% CI 65.5%–72.7%), respectively, and of clinical impression 22.9% (95% CI 15.4%–32.0%) and 91.7% (95% CI 89.2%–93.8%), respectively. For identifying acute leptospirosis, clinical impression is insensitive, and immunoglobulin M results are more insensitive and costly. Rapid, pathogen-based tests for early diagnosis are needed. PMID:21888794

  4. Antibiotic use and clinical outcomes in the acute setting under management by an infectious diseases acute physician versus other clinical teams: a cohort study

    PubMed Central

    Jones, Nicola; Mistry, Vikash; Crook, Derrick; Peto, Tim; Walker, A Sarah

    2016-01-01

    Objectives To assess the magnitude of difference in antibiotic use between clinical teams in the acute setting and assess evidence for any adverse consequences to patient safety or healthcare delivery. Design Prospective cohort study (1 week) and analysis of linked electronic health records (3 years). Setting UK tertiary care centre. Participants All patients admitted sequentially to the acute medical service under an infectious diseases acute physician (IDP) and other medical teams during 1 week in 2013 (n=297), and 3 years 2012–2014 (n=47 585). Primary outcome measure Antibiotic use in days of therapy (DOT): raw group metrics and regression analysis adjusted for case mix. Secondary outcome measures 30-day all-cause mortality, treatment failure and length of stay. Results Antibiotic use was 173 vs 282 DOT/100 admissions in the IDP versus non-IDP group. Using case mix-adjusted zero-inflated Poisson regression, IDP patients were significantly less likely to receive an antibiotic (adjusted OR=0.25 (95% CI 0.07 to 0.84), p=0.03) and received shorter courses (adjusted rate ratio (RR)=0.71 (95% CI 0.54 to 0.93), p=0.01). Clinically stable IDP patients of uncertain diagnosis were more likely to have antibiotics held (87% vs 55%; p=0.02). There was no significant difference in treatment failure or mortality (adjusted p>0.5; also in the 3-year data set), but IDP patients were more likely to be admitted overnight (adjusted OR=3.53 (95% CI 1.24 to 10.03), p=0.03) and have longer length of stay (adjusted RR=1.19 (95% CI 1.05 to 1.36), p=0.007). Conclusions The IDP-led group used 30% less antibiotic therapy with no adverse clinical outcome, suggesting antibiotic use can be reduced safely in the acute setting. This may be achieved in part by holding antibiotics and admitting the patient for observation rather than prescribing, which has implications for costs and hospital occupancy. More information is needed to indicate whether any such longer admission will

  5. Infectious complications in children with acute myeloid leukemia: decreased mortality in multicenter trial AML-BFM 2004

    PubMed Central

    Bochennek, K; Hassler, A; Perner, C; Gilfert, J; Schöning, S; Klingebiel, T; Reinhardt, D; Creutzig, U; Lehrnbecher, T

    2016-01-01

    Infections are an important cause for morbidity and mortality in pediatric acute myeloid leukemia (AML). We therefore characterized infectious complications in children treated according to the trial AML-BFM 2004. Patients with Down syndrome were excluded from the analysis. Data were gathered from the medical records in the hospital where the patients were treated. A total of 405 patients (203 girls; median age 8.4 years) experienced 1326 infections. Fever without identifiable source occurred in 56.1% of the patients and clinically and microbiologically documented infections in 17.5% and 32.4% of the patients, respectively. In all, 240 Gram-positive (112 viridans group streptococci) and 90 Gram-negative isolates were recovered from the bloodstream. Invasive fungal infection was diagnosed in 3% of the patients. Three children each died of Gram-negative bacteremia and invasive aspergillosis, respectively. As compared with the results of AML-BFM 93 with lower dose intensity, infection-related morbidity was slightly higher in AML-BFM 2004 (3.3. versus 2.8 infections per patient), whereas infection-related mortality significantly decreased (1.5% versus 5.4% P=0.003). Specific anti-infective recommendations included in the treatment protocol, regular training courses for pediatric hematologists and increasing experience may be the reason for reduced infection-related mortality in children with AML. Further studies are needed to decrease infection-related morbidity. PMID:26771808

  6. Estimating the Burden of Acute Gastrointestinal Illness: A Pilot Study of the Prevalence and Underreporting in Saint Lucia, Eastern Caribbean

    PubMed Central

    Jaime, Alina; Mckensie, Martin; Auguste, Ava; Pérez, Enrique; Indar, Lisa

    2013-01-01

    Saint Lucia was the first country to conduct a burden of illness study in the Caribbean to determine the community prevalence and underreporting of acute gastroenteritis (AGE). A retrospective cross-sectional population survey on AGE-related illness was administered to a random sample of residents of Saint Lucia in 20 April–16 May 2008 and 6-13 December 2009 to capture the high- and low-AGE season respectively. Of the selected 1,150 individuals, 1,006 were administered the survey through face-to-face interviews (response rate 87.4%). The overall monthly prevalence of AGE was 3.9%. The yearly incidence rate was 0.52 episodes/person-year. The age-adjusted monthly prevalence was 4.6%. The highest monthly prevalence of AGE was among children aged <5 years (7.5%) and the lowest in persons aged 45-64 years (2.6%). The average number of days an individual suffered from diarrhoea was 3.8 days [range 1-21 day(s)]. Of the reported AGE cases, only seven (18%) sought medical care; however, 83% stayed at home due to the illness [(range 1-16 day(s), mean 2.5]; and 26% required other individuals to take care of them. The estimated underreporting of syndromic AGE and laboratory-confirmed foodborne disease pathogens was 81% and 99% respectively during the study period. The economic cost for treating syndromic AGE was estimated at US$ 3,892.837 per annum. This was a pilot study on the burden of illness (BOI) in the Caribbean. The results of the study should be interpreted within the limitations and challenges of this study. Lessons learnt were used for improving the implementation procedures of other BOI studies in the Caribbean.

  7. Comparison of severe acute respiratory illness (sari) and clinical pneumonia case definitions for the detection of influenza virus infections among hospitalized patients, western Kenya, 2009-2013.

    PubMed

    Makokha, Caroline; Mott, Joshua; Njuguna, Henry N; Khagayi, Sammy; Verani, Jennifer R; Nyawanda, Bryan; Otieno, Nancy; Katz, Mark A

    2016-07-01

    Although the severe acute respiratory illness (SARI) case definition is increasingly used for inpatient influenza surveillance, pneumonia is a more familiar term to clinicians and policymakers. We evaluated WHO case definitions for severe acute respiratory illness (SARI) and pneumonia (Integrated Management of Childhood Illnesses (IMCI) for children aged <5 years and Integrated Management of Adolescent and Adult Illnesses (IMAI) for patients aged ≥13 years) for detecting laboratory-confirmed influenza among hospitalized ARI patients. Sensitivities were 84% for SARI and 69% for IMCI pneumonia in children aged <5 years and 60% for SARI and 57% for IMAI pneumonia in patients aged ≥13 years. Clinical pneumonia case definitions may be a useful complement to SARI for inpatient influenza surveillance. PMID:27219455

  8. Active Hemovigilance Significantly Improves Reporting of Acute Non-infectious Adverse Reactions to Blood Transfusion.

    PubMed

    Agnihotri, Naveen; Agnihotri, Ajju

    2016-09-01

    One of the key purposes of a hemovigilance program is to improve reporting of transfusion related adverse events and subsequent data-driven improvement in blood transfusion (BT) practices. We conducted a study over 3 years to assess the impact of healthcare worker training and an active feedback programme on reporting of adverse reactions to BTs. All hospitalized patients who required a BT were included in the study. Healthcare workers involved in BT to patients were sensitized and trained in adverse reaction reporting by conducting training sessions and meetings. All the transfused patients were 'actively' monitored for any acute adverse reaction by using a uniquely coded blood issue form. A total of 18,914 blood components transfused to 5785 different patients resulted in 61 adverse reaction episodes. This incidence of 0.32 % in our study was found to be significantly higher (p < 0.005) than that reported from the same region in the past. Red blood cell units were the most frequently transfused component and thus most commonly involved in an adverse reaction (42.6 %), however apheresis platelets had the highest chance of reaction per unit transfused (0.66 %). There was no mortality associated with the BT during the study period. An active surveillance program significantly improves reporting and management of adverse reactions to BTs. PMID:27429527

  9. Continuous Venovenous Hemofiltration (CVVH) Versus Conventional Treatment for Acute Severe Hypernatremia in Critically Ill Patients: A Retrospective Study.

    PubMed

    Ma, Feng; Bai, Ming; Li, Yangping; Yu, Yan; Liu, Yirong; Zhou, Meilan; Li, Li; Jing, Rui; Zhao, Lijuan; He, Lijie; Li, Rong; Huang, Chen; Wang, Hanmin; Sun, Shiren

    2015-11-01

    Patients with severe hypernatremia who receive conventional treatment are often undertreated. Data on the management of acute hypernatremia using continuous venovenous hemofiltration (CVVH) are limited to anecdotes. This study aimed to evaluate the efficacy and safety of CVVH treatment for acute severe hypernatremia in critically ill patients in a retrospective cohort. A total of 95 patients who were admitted to our ICU between January 2009 and January 2014 were analyzed as the original cohort. These patients were divided into CVVH and conventional treatment groups. The patients in the conventional and CVVH groups were then matched by age, reason for ICU admission, vasopressor dependency, basic serum sodium concentration, and Glasgow scores. A Cox regression model was used to adjust the confounding variables. In the original cohort, the 28-day survival rates were 41.9% and 25.0% for the CVVH and conventional treatment groups, respectively. Conventional treatment (HR = 2.1, 95% CI 1.1-3.8, P = 0.019) was an independent predictor of patient mortality in the multivariate Cox regression model. In the matched cohort, the two groups were not significantly different in baseline characteristics. The CVVH group had a significantly greater reduction in the serum sodium concentration (0.78 [0.63-1.0] mmol/L/h versus 0.13 [0.009-0.33] mmol/L/h), P < 0.001) and an improved 28-day survival rate (34.8% vs. 8.7%, P = 0.002) compared with the conventional treatment group. The two groups did not differ significantly in treatment-related complications. CVVH treatment is possibly more effective than conventional treatment for the management of acute severe hypernatremia in critically ill patients. PMID:26473438

  10. Infectious Uveitis

    PubMed Central

    2015-01-01

    Infectious uveitis is one of the most common and visually devastating causes of uveitis in the US and worldwide. This review provides a summary of the identification, treatment, and complications associated with certain forms of viral, bacterial, fungal, helminthic, and parasitic uveitis. In particular, this article reviews the literature on identification and treatment of acute retinal necrosis due to herpes simplex virus, varicella virus, and cytomegalovirus. While no agreed-upon treatment has been identified, the characteristics of Ebola virus panuveitis is also reviewed. In addition, forms of parasitic infection such as Toxoplasmosis and Toxocariasis are summarized, as well as spirochetal uveitis. Syphilitic retinitis is reviewed given its increase in prevalence over the last decade. The importance of early identification and treatment of infectious uveitis is emphasized. Early identification can be achieved with a combination of maintaining a high suspicion, recognizing certain clinical features, utilizing multi-modal imaging, and obtaining specimens for molecular diagnostic testing. PMID:26618074

  11. Albumin administration in the acutely ill: what is new and where next?

    PubMed Central

    2014-01-01

    Albumin solutions have been used worldwide for the treatment of critically ill patients since they became commercially available in the 1940s. However, their use has become the subject of criticism and debate in more recent years. Importantly, all fluid solutions have potential benefits and drawbacks. Large multicenter randomized studies have provided valuable data regarding the safety of albumin solutions, and have begun to clarify which groups of patients are most likely to benefit from their use. However, many questions remain related to where exactly albumin fits within our fluid choices. Here, we briefly summarize some of the physiology and history of albumin use in intensive care before offering some evidence-based guidance for albumin use in critically ill patients. PMID:25042164

  12. How communication affects prescription decisions in consultations for acute illness in children: a systematic review and meta-ethnography

    PubMed Central

    2014-01-01

    Background Communication within primary care consultations for children with acute illness can be problematic for parents and clinicians, with potential misunderstandings contributing to over–prescription of antibiotics. This review aimed to synthesise the evidence in relation to communication and decision making in consultations for children with common acute illness. Methods A systematic search of MEDLINE, EMBASE, CINAHL, PsycINFO, SSCI, SIGLE, Dissertation Express and NHS economic evaluation databases was conducted. Studies of primary care settings in high income countries which made direct observations of consultations and reported qualitative data were included. Included studies were appraised using the process recommended by the Cochrane Qualitative Methods Group. Credibility was assessed as high for most studies but transferability was usually assessed low or unclear. Data were synthesised using a meta–ethnographic approach. Results Thirty–five papers and 2 theses reporting on 13 studies were included, 7 of these focussed on children with respiratory tract infections (RTI) and the remaining 6 included children with any presenting illness. Parent communication focussed on their concerns and information needs, whereas clinician communication focussed on diagnosis and treatment decisions. During information exchanges, parents often sought to justify the need for the consultation, while clinicians frequently used problem minimising language, resulting in parents and clinicians sometimes talking at cross–purposes. In the context of RTIs, a range of parent communication behaviours were interpreted by clinicians as indicating an expectation for antibiotics; however, most were ambiguous and could also be interpreted as raising concerns or requests for further information. The perceived expectation for antibiotics often changed clinician decision making into clinician–parent negotiation. Conclusions Misunderstandings occurred due to parents and clinicians

  13. The Relationship between Poverty and Healthcare Seeking among Patients Hospitalized with Acute Febrile Illnesses in Chittagong, Bangladesh.

    PubMed

    Herdman, M Trent; Maude, Richard James; Chowdhury, Md Safiqul; Kingston, Hugh W F; Jeeyapant, Atthanee; Samad, Rasheda; Karim, Rezaul; Dondorp, Arjen M; Hossain, Md Amir

    2016-01-01

    Delays in seeking appropriate healthcare can increase the case fatality of acute febrile illnesses, and circuitous routes of care-seeking can have a catastrophic financial impact upon patients in low-income settings. To investigate the relationship between poverty and pre-hospital delays for patients with acute febrile illnesses, we recruited a cross-sectional, convenience sample of 527 acutely ill adults and children aged over 6 months, with a documented fever ≥38.0°C and symptoms of up to 14 days' duration, presenting to a tertiary referral hospital in Chittagong, Bangladesh, over the course of one year from September 2011 to September 2012. Participants were classified according to the socioeconomic status of their households, defined by the Oxford Poverty and Human Development Initiative's multidimensional poverty index (MPI). 51% of participants were classified as multidimensionally poor (MPI>0.33). Median time from onset of any symptoms to arrival at hospital was 22 hours longer for MPI poor adults compared to non-poor adults (123 vs. 101 hours) rising to a difference of 26 hours with adjustment in a multivariate regression model (95% confidence interval 7 to 46 hours; P = 0.009). There was no difference in delays for children from poor and non-poor households (97 vs. 119 hours; P = 0.394). Case fatality was 5.9% vs. 0.8% in poor and non-poor individuals respectively (P = 0.001)-5.1% vs. 0.0% for poor and non-poor adults (P = 0.010) and 6.4% vs. 1.8% for poor and non-poor children (P = 0.083). Deaths were attributed to central nervous system infection (11), malaria (3), urinary tract infection (2), gastrointestinal infection (1) and undifferentiated sepsis (1). Both poor and non-poor households relied predominantly upon the (often informal) private sector for medical advice before reaching the referral hospital, but MPI poor participants were less likely to have consulted a qualified doctor. Poor participants were more likely to attribute delays in

  14. The Relationship between Poverty and Healthcare Seeking among Patients Hospitalized with Acute Febrile Illnesses in Chittagong, Bangladesh

    PubMed Central

    Herdman, M. Trent; Maude, Richard James; Chowdhury, Md. Safiqul; Kingston, Hugh W. F.; Jeeyapant, Atthanee; Samad, Rasheda; Karim, Rezaul; Dondorp, Arjen M.; Hossain, Md. Amir

    2016-01-01

    Delays in seeking appropriate healthcare can increase the case fatality of acute febrile illnesses, and circuitous routes of care-seeking can have a catastrophic financial impact upon patients in low-income settings. To investigate the relationship between poverty and pre-hospital delays for patients with acute febrile illnesses, we recruited a cross-sectional, convenience sample of 527 acutely ill adults and children aged over 6 months, with a documented fever ≥38.0°C and symptoms of up to 14 days’ duration, presenting to a tertiary referral hospital in Chittagong, Bangladesh, over the course of one year from September 2011 to September 2012. Participants were classified according to the socioeconomic status of their households, defined by the Oxford Poverty and Human Development Initiative’s multidimensional poverty index (MPI). 51% of participants were classified as multidimensionally poor (MPI>0.33). Median time from onset of any symptoms to arrival at hospital was 22 hours longer for MPI poor adults compared to non-poor adults (123 vs. 101 hours) rising to a difference of 26 hours with adjustment in a multivariate regression model (95% confidence interval 7 to 46 hours; P = 0.009). There was no difference in delays for children from poor and non-poor households (97 vs. 119 hours; P = 0.394). Case fatality was 5.9% vs. 0.8% in poor and non-poor individuals respectively (P = 0.001)—5.1% vs. 0.0% for poor and non-poor adults (P = 0.010) and 6.4% vs. 1.8% for poor and non-poor children (P = 0.083). Deaths were attributed to central nervous system infection (11), malaria (3), urinary tract infection (2), gastrointestinal infection (1) and undifferentiated sepsis (1). Both poor and non-poor households relied predominantly upon the (often informal) private sector for medical advice before reaching the referral hospital, but MPI poor participants were less likely to have consulted a qualified doctor. Poor participants were more likely to attribute delays in

  15. Mapping chronic illness in the age of globalization: reclaiming the good for the chronically ill.

    PubMed

    del Pilar Camargo Plazas, Maria

    2009-01-01

    Until recently, infectious diseases were the main cause of death worldwide. New medical discoveries and the evolution of public health improved life expectancy and the ability to survive acute threats, thus changing the course of diseases from acute to chronic. Today, chronic illness is the most important health concern worldwide. Chronic illness increases existing poverty and pushes other people into it. As nurses, members of the healthcare system and members of this world, we cannot forget that our response toward globalization and chronic disease has to be centered in leadership through reorienting local and national healthcare systems. All actions must be grounded in the ethical treatment of the ill; we cannot close our eyes in hospitals or communities to what is happening now worldwide because our responsibility is to promote health, prevent disease, and care for human beings. PMID:19461220

  16. Noninvasive positive pressure ventilation as treatment for acute respiratory failure in critically ill patients

    PubMed Central

    Antonelli, Massimo; Conti, Giorgio

    2000-01-01

    Our current state of knowledge on noninvasive positive pressure ventilation (NPPV) and technical aspects are discussed in the present review. In patients with chronic obstructive pulmonary disease, NPPV can be considered a valid therapeutic option to prevent endotracheal intubation. Evidence suggests that, before eventual endotracheal intubation, NPPV should be considered as first-line intervention in the early phases of acute exacerbation of chronic obstructive pulmonary disease. Small randomized and non-randomized studies on the application of NPPV in patients with acute hypoxaemic respiratory failure showed promising results, with reduction in complications such as sinusitis and ventilator-associated pneumonia, and in the duration of intensive care unit stay. The conventional use of NPPV in hypoxaemic acute respiratory failure still remains controversial, however. Large randomized studies are still needed before extensive clinical application in this condition. PMID:11094492

  17. Acute kidney injury in critically ill patients with lung disease: kidney-lung crosstalk

    PubMed Central

    de Abreu, Krasnalhia Lívia Soares; da Silva Junior, Geraldo Bezerra; Muniz, Thalita Diógenes; Barreto, Adller Gonçalves Costa; Lima, Rafael Siqueira Athayde; Holanda, Marcelo Alcântara; Pereira, Eanes Delgado Barros; Libório, Alexandre Braga; Daher, Elizabeth de Francesco

    2013-01-01

    Objective To examine the factors associated with acute kidney injury and outcome in patients with lung disease. Methods A prospective study was conducted with 100 consecutive patients admitted to a respiratory intensive care unit in Fortaleza (CE), Brazil. The risk factors for acute kidney injury and mortality were investigated in a group of patients with lung diseases. Results The mean age of the study population was 57 years, and 50% were male. The incidence of acute kidney injury was higher in patients with PaO2/FiO2<200 mmHg (54% versus 23.7%; p=0.02). Death was observed in 40 cases and the rate of mortality of the acute kidney injury group was higher (62.8% versus 27.6%; p=0.01). The independent factor that was found to be associated with acute kidney injury was PaO2/FiO2<200 mmHg (p=0.01), and the independent risk factors for death were PEEP at admission (OR: 3.6; 95%CI: 1.3-9.6; p=0.009) and need for hemodialysis (OR: 7.9; 95%CI: 2.2-28.3; p=0.001). Conclusion There was a higher mortality rate in the acute kidney injury group. Increased mortality was associated with mechanical ventilation, high PEEP, urea and need for dialysis. Further studies must be performed to better establish the relationship between kidney and lung injury and its impact on patient outcome. PMID:23917978

  18. Prognostics factors for mortality and renal recovery in critically ill patients with acute kidney injury and renal replacement therapy

    PubMed Central

    Gaião, Sérgio Mina; Gomes, André Amaral; Paiva, José Artur Osório de Carvalho

    2016-01-01

    Objective Identify prognostic factors related to mortality and non-recovery of renal function. Methods A prospective single-center study was conducted at the intensive care medicine department of a university hospital between 2012 and 2015. Patients with acute kidney injury receiving continuous renal replacement therapy were included in the study. Clinical and analytical parameters were collected, and the reasons for initiation and discontinuation of renal replacement therapy were examined. Results A total of 41 patients were included in the study, of whom 43.9% had sepsis. The median Simplified Acute Physiology Score II (SAPSII) was 56 and the mortality was 53.7%, with a predicted mortality of 59.8%. The etiology of acute kidney injury was often multifactorial (56.1%). Survivors had lower cumulative fluid balance (median = 3,600mL, interquartile range [IQR] = 1,175 - 8,025) than non-survivors (median = 12,000mL, IQR = 6,625 - 17,875; p = 0.004). Patients who recovered renal function (median = 51.0, IQR = 45.8 - 56.2) had lower SAPS II than those who do not recover renal function (median = 73, IQR = 54 - 85; p = 0.005) as well as lower fluid balance (median = 3,850, IQR = 1,425 - 8,025 versus median = 11,500, IQR = 6,625 - 16,275; p = 0.004). Conclusions SAPS II at admission and cumulative fluid balance during renal support therapy were risk factors for mortality and non-recovery of renal function among critically ill patients with acute kidney injury needing renal replacement therapy. PMID:27096679

  19. Effectiveness of early discharge planning in acutely ill or injured hospitalized older adults: a systematic review and meta-analysis

    PubMed Central

    2013-01-01

    Background Older age and higher acuity are associated with prolonged hospital stays and hospital readmissions. Early discharge planning may reduce lengths of hospital stay and hospital readmissions; however, its effectiveness with acutely admitted older adults is unclear. Methods In this systematic review, we compared the effectiveness of early discharge planning to usual care in reducing index length of hospital stay, hospital readmissions, readmission length of hospital stay, and mortality; and increasing satisfaction with discharge planning and quality of life for older adults admitted to hospital with an acute illness or injury. We searched the Cochrane Library, DARE, HTA, NHSEED, ACP, MEDLINE, EMBASE, CINAHL, Proquest Dissertations and Theses, PubMed, Web of Science, SciSearch, PEDro, Sigma Theta Tau International’s registry of nursing research, Joanna Briggs Institute, CRISP, OT Seeker, and several internet search engines. Hand-searching was conducted in four gerontological journals and references of all included studies and previous systematic reviews. Two reviewers independently extracted data and assessed risk of bias. Data were pooled using a random-effects meta-analysis. Where meta-analysis was not possible, narrative analysis was performed. Results Nine trials with a total of 1736 participants were included. Compared to usual care, early discharge planning was associated with fewer hospital readmissions within one to twelve months of index hospital discharge [risk ratio (RR) = 0.78, 95% CI = 0.69 − 0.90]; and lower readmission lengths of hospital stay within three to twelve months of index hospital discharge [weighted mean difference (WMD) = −2.47, 95% confidence intervals (CI) = −4.13 − −0.81)]. No differences were found in index length of hospital stay, mortality or satisfaction with discharge planning. Narrative analysis of four studies indicated that early discharge planning was associated with greater overall quality of life and the

  20. West Nile Virus Documented in Indonesia from Acute Febrile Illness Specimens

    PubMed Central

    Myint, Khin Saw Aye; Kosasih, Herman; Artika, I. Made; Perkasa, Aditya; Puspita, Mita; Ma'roef, Chairin Nisa; Antonjaya, Ungke; Ledermann, Jeremy P.; Powers, Ann M.; Alisjahbana, Bachti

    2014-01-01

    We report the presence of West Nile virus in a cryopreserved, dengue-negative serum specimen collected from an acute fever case on Java in 2004–2005. The strain belongs to genotype lineage 2, which has recently been implicated in human outbreaks in Europe. PMID:24420775

  1. Serum visfatin concentration in acutely ill and weight-recovered patients with anorexia nervosa.

    PubMed

    Seidel, Maria; King, Joseph A; Ritschel, Franziska; Döpmann, Johanna; Bühren, Katharina; Seitz, Jochen; Roessner, Veit; Westphal, Sabine; Egberts, Karin; Burghardt, Roland; Wewetzer, Christoph; Fleischhaker, Christian; Hebebrand, Johannes; Herpertz-Dahlmann, Beate; Ehrlich, Stefan

    2015-03-01

    Visfatin is a recently described protein that is thought to regulate the process of adipocyte differentiation. Findings suggest that visfatin may be actively involved in the control of weight regulatory networks. However, to what extent and which role it plays in eating disorders is still poorly understood, as mixed results have been reported. The aim of the current study was to investigate serum visfatin concentrations on a cross sectional sample between acute anorexia nervosa patients (n=44), weight recovered patients (n=13) and healthy controls (n=46) and a longitudinal sample of acute patients (n=57) during weight recovery at three different time-points. Results did not show significant differences in visfatin between the three groups; however, acute patients showed a higher visfatin/BMI-SDS ratio than controls and recovered patients. Longitudinal results revealed an increase of visfatin levels during therapy. Our results suggest that high ratios of visfatin/BMI-SDS could be a state marker in acute anorexia nervosa, displaying a compensatory mechanism of the individual to maintain normal visfatin levels under malnourished conditions. PMID:25617618

  2. Acute respiratory illness: popular health culture and mother's knowledge in the Philippines.

    PubMed

    Nichter, M; Nichter, M

    1994-05-01

    Acute respiratory infection (ARI) is one of the chief causes of morbidity and mortality in the third world. This ethnographic study of ARI in the Philippines draws attention to local knowledge, sign recognition, perceptions of severity, and cultural factors influencing health care seeking. The mix of research methods used to generate data on these issues is discussed. PMID:8041235

  3. Acute Febrile Illness Surveillance in a Tertiary Hospital Emergency Department: Comparison of Influenza and Dengue Virus Infections

    PubMed Central

    Lorenzi, Olga D.; Gregory, Christopher J.; Santiago, Luis Manuel; Acosta, Héctor; Galarza, Ivonne E.; Hunsperger, Elizabeth; Muñoz, Jorge; Bui, Duy M.; Oberste, M. Steven; Peñaranda, Silvia; García-Gubern, Carlos; Tomashek, Kay M.

    2013-01-01

    In 2009, an increased proportion of suspected dengue cases reported to the surveillance system in Puerto Rico were laboratory negative. As a result, enhanced acute febrile illness (AFI) surveillance was initiated in a tertiary care hospital. Patients with fever of unknown origin for 2–7 days duration were tested for Leptospira, enteroviruses, influenza, and dengue virus. Among the 284 enrolled patients, 31 dengue, 136 influenza, and 3 enterovirus cases were confirmed. Nearly half (48%) of the confirmed dengue cases met clinical criteria for influenza. Dengue patients were more likely than influenza patients to have hemorrhage (81% versus 26%), rash (39% versus 9%), and a positive tourniquet test (52% versus 18%). Mean platelet and white blood cell count were lower among dengue patients. Clinical diagnosis can be particularly difficult when outbreaks of other AFI occur during dengue season. A complete blood count and tourniquet test may be useful to differentiate dengue from other AFIs. PMID:23382160

  4. The influence of acute kidney injury on antimicrobial dosing in critically ill patients: are dose reductions always necessary?

    PubMed

    Blot, Stijn; Lipman, Jeffrey; Roberts, Darren M; Roberts, Jason A

    2014-05-01

    Optimal dosing of antimicrobial therapy is pivotal to increase the likelihood of survival in critically ill patients with sepsis. Drug exposure that maximizes bacterial killing, minimizes the development of antimicrobial resistance, and avoids concentration-related toxicities should be considered the target of therapy. However, antimicrobial dosing is problematic as pathophysiological factors inherent to sepsis that alter may result in reduced concentrations. Alternatively, sepsis may evolve to multiple-organ dysfunction including acute kidney injury (AKI). In this case, decreased clearance of renally cleared drugs is possible, which may lead to increased concentrations that may cause drug toxicities. Consequently, when dosing antibiotics in septic patients with AKI, one should consider factors that may lead to underdosing and overdosing. Drug-specific pharmacokinetic and pharmacodynamic data may be helpful to guide dosing in these circumstances. Yet, because of the high interpatient variability in pharmacokinetics of antibiotics during sepsis, this issue remains a significant challenge. PMID:24602849

  5. Acute febrile illness surveillance in a tertiary hospital emergency department: comparison of influenza and dengue virus infections.

    PubMed

    Lorenzi, Olga D; Gregory, Christopher J; Santiago, Luis Manuel; Acosta, Héctor; Galarza, Ivonne E; Hunsperger, Elizabeth; Muñoz, Jorge; Bui, Duy M; Oberste, M Steven; Peñaranda, Silvia; García-Gubern, Carlos; Tomashek, Kay M

    2013-03-01

    In 2009, an increased proportion of suspected dengue cases reported to the surveillance system in Puerto Rico were laboratory negative. As a result, enhanced acute febrile illness (AFI) surveillance was initiated in a tertiary care hospital. Patients with fever of unknown origin for 2-7 days duration were tested for Leptospira, enteroviruses, influenza, and dengue virus. Among the 284 enrolled patients, 31 dengue, 136 influenza, and 3 enterovirus cases were confirmed. Nearly half (48%) of the confirmed dengue cases met clinical criteria for influenza. Dengue patients were more likely than influenza patients to have hemorrhage (81% versus 26%), rash (39% versus 9%), and a positive tourniquet test (52% versus 18%). Mean platelet and white blood cell count were lower among dengue patients. Clinical diagnosis can be particularly difficult when outbreaks of other AFI occur during dengue season. A complete blood count and tourniquet test may be useful to differentiate dengue from other AFIs. PMID:23382160

  6. Sick building syndrome: Acute illness among office workers--the role of building ventilation, airborne contaminants and work stress

    SciTech Connect

    Letz, G.A. )

    1990-05-01

    Outbreaks of acute illness among office workers have been reported with increasing frequency during the past 10-15 years. In the majority of cases, hazardous levels of airborne contaminants have not been found. Generally, health complaints have involved mucous membrane and respiratory tract irritation and nonspecific symptoms such as headache and fatigue. Except for rare examples of hypersensitivity pneumonitis related to microbiologic antigens, there have been no reports of serious morbidity or permanent sequelae. However, the anxiety, lost work time, decreased productivity and resources spent in investigating complaints has been substantial. NIOSH has reported on 446 Health Hazards Evaluations that were done in response to indoor air complaints. This data base is the source of most of the published accounts of building-related illness. Their results are summarized here with a discussion of common pollutants (tobacco smoke, formaldehyde, other organic volatiles), and the limitations of the available industrial hygiene and epidemiologic data. There has been one large scale epidemiologic survey of symptoms among office workers. The results associate risk of symptoms to building design and characteristics of the heating/air-conditioning systems, consistent with the NIOSH experience. Building construction since the 1970s has utilized energy conservation measures such as improved insulation, reduced air exchange, and construction without opening windows. These buildings are considered airtight and are commonly involved in episodes of building-associated illness in which no specific etiologic agent can be identified. After increasing the percentage of air exchange or correcting specific deficiencies found in the heating/air-conditioning systems, the health complaints often resolve, hence, the term tight building syndrome or sick building syndrome.

  7. Estimating the number of cases of acute gastrointestinal illness (AGI) associated with Canadian municipal drinking water systems.

    PubMed

    Murphy, H M; Thomas, M K; Medeiros, D T; McFADYEN, S; Pintar, K D M

    2016-05-01

    The estimated burden of endemic acute gastrointestinal illness (AGI) annually in Canada is 20·5 million cases. Approximately 4 million of these cases are domestically acquired and foodborne, yet the proportion of waterborne cases is unknown. A number of randomized controlled trials have been completed to estimate the influence of tap water from municipal drinking water plants on the burden of AGI. In Canada, 83% of the population (28 521 761 people) consumes tap water from municipal drinking water plants serving >1000 people. The drinking water-related AGI burden associated with the consumption of water from these systems in Canada is unknown. The objective of this research was to estimate the number of AGI cases attributable to consumption of drinking water from large municipal water supplies in Canada, using data from four household drinking water intervention trials. Canadian municipal water treatment systems were ranked into four categories based on source water type and quality, population size served, and treatment capability and barriers. The water treatment plants studied in the four household drinking water intervention trials were also ranked according to the aforementioned criteria, and the Canadian treatment plants were then scored against these criteria to develop four AGI risk groups. The proportion of illnesses attributed to distribution system events vs. source water quality/treatment failures was also estimated, to inform the focus of future intervention efforts. It is estimated that 334 966 cases (90% probability interval 183 006-501 026) of AGI per year are associated with the consumption of tap water from municipal systems that serve >1000 people in Canada. This study provides a framework for estimating the burden of waterborne illness at a national level and identifying existing knowledge gaps for future research and surveillance efforts, in Canada and abroad. PMID:26564554

  8. Incidence and viral aetiologies of acute respiratory illnesses (ARIs) in the United States: a population-based study.

    PubMed

    Szilagyi, P G; Blumkin, A; Treanor, J J; Gallivan, S; Albertin, C; Lofthus, G K; Schnabel, K C; Donahue, J G; Thompson, M G; Shay, D K

    2016-07-01

    We conducted prospective, community-wide surveillance for acute respiratory illnesses (ARIs) in Rochester, NY and Marshfield, WI during a 3-month period in winter 2011. We estimated the incidence of ARIs in each community, tested for viruses, and determined the proportion of ARIs associated with healthcare visits. We used a rolling cross-sectional design to sample participants, conducted telephone interviews to assess ARI symptoms (defined as a current illness with feverishness or cough within the past 7 days), collected nasal/throat swabs to identify viruses, and extracted healthcare utilization from outpatient/inpatient records. Of 6492 individuals, 321 reported an ARI within 7 days (4·9% total, 5·7% in Rochester, 4·4% in Marshfield); swabs were collected from 208 subjects. The cumulative ARI incidence for the entire 3-month period was 52% in Rochester [95% confidence interval (CI) 42-63] and 35% in Marshfield (95% CI 28-42). A specific virus was identified in 39% of specimens: human coronavirus (13% of samples), rhinovirus (12%), RSV (7%), influenza virus (4%), human metapneumovirus (4%), and adenovirus (1%). Only 39/200 (20%) had a healthcare visit (2/9 individuals with influenza). ARI incidence was ~5% per week during winter. PMID:26931351

  9. Aetiologies of Acute Undifferentiated Febrile illness in Adult Patients – an Experience from a Tertiary Care Hospital in Northern India

    PubMed Central

    Ahmad, Sohaib; Agarwal, R K; Dhar, Minakshi; Mittal, Manish; Sharma, Shiwani

    2015-01-01

    Introduction Acute undifferentiated febrile illness (AUFI) is a common clinical entity in most of the hospitals. The fever can be potentially fatal if the aetiology is not recognized and appropriately treated early. Aim To describe the aetiology of fever among patients in a tertiary care hospital in Northern India. Materials and Methods A one-year retro-prospective, observational study was conducted in adults (age>18years) presenting with undifferentiated febrile illness (of duration 5-14 days). Diagnosis was confirmed by suitable laboratory tests after exhaustive clinical examination. Results A total of 2547 patients with AUFI were evaluated. Of these, 1663 (65.3%) were males and 884 (34.7%) were females. Dengue (37.54%); enteric fever (16.5%); scrub typhus (14.42%); bacterial sepsis (10.3%); malaria (6.8%); hepatitis A (1.9%); hepatitis E (1.4%); leptospirosis (0.14%); were the main infections while no specific diagnosis could be delineated in 11%. Mixed infections were noted in 48 (1.9%) patients. Conclusion A good clinical acumen supported by the basic investigations can help diagnose the cause of fever with reasonable certainty. PMID:26816892

  10. Quinine allergy causing acute severe systemic illness: report of 4 patients manifesting multiple hematologic, renal, and hepatic abnormalities

    PubMed Central

    2003-01-01

    Quinine is widely used for the common symptom of leg cramps. Quinine tablets require a prescription, but quinine and the product from which it is derived, cinchona, are also available without prescription. They are components of over-the-counter remedies for many common symptoms, of nutrition products, and of beverages such as tonic water and bitter lemon. Although quinine has been used for centuries, initially as an extract from the bark of the cinchona tree, allergic reactions to quinine can be severe and can affect multiple organs. These allergic reactions can cause thrombocytopenia, neutropenia, anemia, disseminated intravascular coagulation, acute renal failure, liver toxicity, and neurological abnormalities. Because quinine use is often intermittent, defining quinine as a cause of an acute disorder may be difficult. Moreover, since quinine use is often self-regulated, patients may not mention it in response to direct questions about medication use, adding to diagnostic difficulty. The diversity and severity of quinine-associated disorders and the difficulties of diagnosis are illustrated by the presentation of 4 case histories. Awareness of the variety of potential quinine-associated reactions is important for accurate diagnosis and critical for prevention of recurrent illness. PMID:16278718

  11. The University of Akron study on air pollution and human health effects II. Effects on acute respiratory illness.

    PubMed

    Mostardi, R A; Woebkenberg, N R; Ely, D L; Conlon, M; Atwood, G

    1981-01-01

    The purpose of this study was to determine the effects of air pollution on acute respiratory illness (ARI). Levels of air pollutants were monitored on a daily 24-hour basis at two schools in Akron, Ohio. The children at each school completed daily diaries which served as a screening mechanism for detecting ARI. Once an ARI was isolated, pulmonary function tests (PFT) were run during the symptomatic phase; once the child became asymptomatic, tests were continued for 2 wk. The results of this study indicate that SO2 and NO2 levels are higher at the school that borders industry. Results of daily diaries indicate a higher incidence of symptoms-especially cough, runny nose, and sore throat-in the polluted area. Pulmonary function tests indicate that respiratory airways are being compromised to a much greater extent at the polluted school, as indicated by significantly reduced levels of forced expiratory volume and maximal midexpiratory flow as compared to baseline. Recent evidence suggests that frequency and severity of ARI in childhood are related to chronic obstructive lung disease as adults. In lieu of these findings, it is suggested that the levels of SO2 and NO2 in urban areas be carefully considered, as they relate to acute subclinical syndromes and chronic clinical respiratory disease. PMID:7294889

  12. [Hepatotoxicity in the critically ill patient. The liver under an acute severe insult].

    PubMed

    García de Lorenzo y Mateos, A; Rodríguez Montes, J A

    2008-05-01

    The liver plays an essential role in the metabolism of most of the nutrients since it is a mainly metabolic organ carrying out a series of physiological and metabolic processes related with protein and energy metabolism. The intestinal tract is considered a key element in the development of Multiorgan Dysfunction (MOD) or failure by loosing its barrier function (impaired permeability) against toxins, bio-products and occasionally intraluminal bacteria secondary to hypoxia, one of the main pathophysiogenic mechanisms being the insufficient blood flow to splacnic organs. Liver dysfunction and/or impairment of liver function test are a common event in critically ill patients. They may be due to previous liver cirrhosis or to more immediate causes of liver failure such as sepsis, drugs, liver transplant or any of the multiple etiologies for hepatitis. PMID:18714407

  13. Long-Term Outcome of Critically Ill Adult Patients with Acute Epiglottitis

    PubMed Central

    Hernu, Romain; Baudry, Thomas; Bohé, Julien; Piriou, Vincent; Allaouchiche, Bernard; Disant, François; Argaud, Laurent

    2015-01-01

    Background Acute epiglottitis is a potentially life threatening disease, with a growing incidence in the adult population. Its long-term outcome after Intensive Care Unit (ICU) hospitalization has rarely been studied. Methodology and Principal Findings Thirty-four adult patients admitted for acute epiglottitis were included in this retrospective multicentric study. The mean age was 44±12 years (sex ratio: 5.8). Sixteen patients (47%) had a history of smoking while 8 (24%) had no previous medical history. The average time of disease progression before ICU was 2.6±3.6 days. The main reasons for hospitalization were continuous monitoring (17 cases, 50%) and acute respiratory distress (10 cases, 29%). Microbiological documentation could be made in 9 cases (26%), with Streptococcus spp. present in 7 cases (21%). Organ failure at ICU admission occurred in 8 cases (24%). Thirteen patients (38%) required respiratory assistance during ICU stay; 9 (26%) required surgery. Two patients (6%) died following hypoxemic cardiac arrest. Five patients (15%) had sequelae at 1 year. Patients requiring respiratory assistance had a longer duration of symptoms and more frequent anti inflammatory use before ICU admission and sequelae at 1 year (p<0.05 versus non-ventilated patients). After logistic regression analysis, only exposure to anti-inflammatory drugs before admission was independently associated with airway intervention (OR, 4.96; 95% CI, 1.06-23.16). Conclusions and Significance The profile of the cases consisted of young smoking men with little comorbidity. Streptococcus spp. infection represented the main etiology. Outcome was favorable if early respiratory tract protection could be performed in good conditions. Morbidity and sequelae were greater in patients requiring airway intervention. PMID:25945804

  14. Long-Term Survival in Older Critically Ill Patients with Acute Ischemic Stroke

    PubMed Central

    Liou, Jinn-Ing; Smith, Maureen A.

    2009-01-01

    Objective To compare survival in older patients with acute ischemic stroke admitted to intensive care units (ICU) with those not requiring ICU care and to assess the impact of mechanical ventilation (MV) and percutaneous gastrostomy tubes (PEG) on long-term mortality. Design Multi-center retrospective cohort study. Setting Administrative data from the Centers for Medicare and Medicaid Services covering 93 metropolitan counties primarily in the Eastern half of the United States. Patients 31,301 patients discharged with acute ischemic stroke in 2000. Interventions None Measurements Mortality from the time of index hospitalization up to the end of the follow-up period of 12 months. Information was also gathered on use of mechanical ventilation, percutaneous gastrostomy, sociodemographic variables and a host of comorbid conditions. Main Results 26% of all patients with acute ischemic stroke required ICU admission. The crude death rate for ICU stroke patients was 21% at 30 days and 40% at 1-year follow-up. At 30 days, after adjustment of sociodemographic variables and comorbidities, ICU patients had a 29% higher mortality hazard compared to non-ICU patients. Mechanical ventilation was associated with a five-fold higher mortality hazard (hazard ratio 5.59, confidence interval 4.93–6.34). The use of PEG was not associated with mortality at 30 days. By contrast, at 1-year follow up in 30-day survivors, ICU admission was not associated with mortality hazard (hazard ratio 1.01; 95% confidence interval 0.93–1.09). Mechanical ventilation still had a higher risk of death (hazard ratio 1.88, 95% confidence interval 1.57–2.25), and PEG patients had a 2.59 fold greater mortality hazard (95% confidence interval 2.38–2.82). Conclusions Both short-term and long-term mortality in older patients with acute ischemic stroke admitted to ICUs is lower than previously reported. The need for MV and PEG are markers for poor long-term outcome. Future research should focus on the

  15. Acute Respiratory Failure in Critically Ill Patients with Interstitial Lung Disease

    PubMed Central

    Zafrani, Lara; Lemiale, Virginie; Lapidus, Nathanael; Lorillon, Gwenael; Schlemmer, Benoît; Azoulay, Elie

    2014-01-01

    Background Patients with chronic known or unknown interstitial lung disease (ILD) may present with severe respiratory flares that require intensive management. Outcome data in these patients are scarce. Patients and Methods Clinical and radiological features were collected in 83 patients with ILD-associated acute respiratory failure (ARF). Determinants of hospital mortality and response to corticosteroid therapy were identified by logistic regression. Results Hospital and 1-year mortality rates were 41% and 54% respectively. Pulmonary hypertension, computed tomography (CT) fibrosis and acute kidney injury were independently associated with mortality (odds ratio (OR) 4.55; 95% confidence interval (95%CI) (1.20–17.33); OR, 7.68; (1.78–33.22) and OR 10.60; (2.25–49.97) respectively). Response to steroids was higher in patients with shorter time from hospital admission to corticosteroid therapy. Patients with fibrosis on CT had lower response to steroids (OR, 0.03; (0.005–0.21)). In mechanically ventilated patients, overdistension induced by high PEEP settings was associated with CT fibrosis and hospital mortality. Conclusion Mortality is high in ILD-associated ARF. CT and echocardiography are valuable prognostic tools. Prompt corticosteroid therapy may improve survival. PMID:25115557

  16. [Social capital, poverty and self-perception of family support in cases of acute respiratory illness].

    PubMed

    Hamui-Sutton, Alicia; Ponce-Rosas R, E Raúl; Irigoyen-Coria, Arnulfo; Halabe-Cherem, José

    2009-01-01

    The aim of this study was to correlate the socio structural variables of the Simplified Index of Family Poverty with the self-perception of resources that conform social capital among patients with acute respiratory disease (ARD). We used a qualitative and quantitative methodology. The sample included 848 cases distributed in seven Rural Medicine Units of Mexico. We considered three pathways described by Kawachi where social capital might have an impact on individual health. The bivariate correlation and discriminant analysis showed that when there is evidence of poverty in the family, the statistically significant differences are mainly observed in self-perception. Moral support of sons and daughters is thereby increased when there is an ARD. We concluded that when there is a higher index of family poverty there is a decreased access to social resources when a family member is diagnosed with an ARD. PMID:20077867

  17. The non-thyroidal illness syndrome in acute coronary syndrome is associated with increased cardiac morbidity and mortality

    PubMed Central

    Adawiyah, J; Norasyikin, A W; Mat, N H; Shamsul, A S; Azmi, K Nor

    2010-01-01

    Introduction The non-thyroidal illness syndrome (NTIS) or the sick euthyroid syndrome refers to abnormal changes in circulating thyroid hormones due to systemic illnesses. Thyroid hormones are pivotal in the regulation of normal cardiac functions. However, the effects of the NTIS on the heart in acute coronary syndrome (ACS) are still unclear. Methods A 6-month prospective cohort study involving 85 patients admitted with ACS was carried out. TSH, FT4 and FT3 were assessed on days 1, 5 and 42. Antithyroid peroxidase antibodies, antithyroglobulin antibodies, fasting blood sugar, HbA1c and fasting serum lipid were obtained on admission. Mortality, functional status (Killip and New York Heart Association Classifications), arrhythmias and readmission rate were recorded. Results The prevalence of NTIS was 53%. It was seen in 48% of unstable angina (UA), 54% of non-ST elevation myocardial infarction (NSTEMI) and 56% of ST elevation myocardial infarction (STEMI) patients. NTIS is associated with cardiovascular mortality, all-cause mortality, severe heart failure and a higher readmission rate. The levels of FT3 correlate with severity of myocardial damage as measured by CK and Troponin T. Lower TSH was seen in the non-survivors and in those with ventricular arrhythmias. The most common presentation of NTIS was low FT3 (43.5%), followed by low TSH (12.9%) and FT4 (4.7%). None of the predisposing factors analysed were associated with the development of NTIS. Conclusions NTIS in patients with ACS is associated with increased cardiovascular mortality and morbidity, and affects UA, NSTEMI and STEMI equally. PMID:27325934

  18. Acute Muscular Sarcocystosis: An International Investigation Among Ill Travelers Returning From Tioman Island, Malaysia, 2011–2012

    PubMed Central

    Esposito, Douglas H.; Stich, August; Epelboin, Loïc; Malvy, Denis; Han, Pauline V.; Bottieau, Emmanuel; da Silva, Alexandre; Zanger, Philipp; Slesak, Günther; van Genderen, Perry J. J.; Rosenthal, Benjamin M.; Cramer, Jakob P.; Visser, Leo G.; Muñoz, José; Drew, Clifton P.; Goldsmith, Cynthia S.; Steiner, Florian; Wagner, Noémie; Grobusch, Martin P.; Plier, D. Adam; Tappe, Dennis; Sotir, Mark J.; Brown, Clive; Brunette, Gary W.; Fayer, Ronald; von Sonnenburg, Frank; Neumayr, Andreas; Kozarsky, Phyllis E.

    2015-01-01

    Background Through 2 international traveler-focused surveillance networks (GeoSentinel and TropNet), we identified and investigated a large outbreak of acute muscular sarcocystosis (AMS), a rarely reported zoonosis caused by a protozoan parasite of the genus Sarcocystis, associated with travel to Tioman Island, Malaysia, during 2011–2012. Methods Clinicians reporting patients with suspected AMS to GeoSentinel submitted demographic, clinical, itinerary, and exposure data. We defined a probable case as travel to Tioman Island after 1 March 2011, eosinophilia (>5%), clinical or laboratory-supported myositis, and negative trichinellosis serology. Case confirmation required histologic observation of sarcocysts or isolation of Sarcocystis species DNA from muscle biopsy. Results Sixty-eight patients met the case definition (62 probable and 6 confirmed). All but 2 resided in Europe; all were tourists and traveled mostly during the summer months. The most frequent symptoms reported were myalgia (100%), fatigue (91%), fever (82%), headache (59%), and arthralgia (29%); onset clustered during 2 distinct periods: “early” during the second and “late” during the sixth week after departure from the island. Blood eosinophilia and elevated serum creatinine phosphokinase (CPK) levels were observed beginning during the fifth week after departure. Sarcocystis nesbitti DNA was recovered from 1 muscle biopsy. Conclusions Clinicians evaluating travelers returning ill from Malaysia with myalgia, with or without fever, should consider AMS, noting the apparent biphasic aspect of the disease, the later onset of elevated CPK and eosinophilia, and the possibility for relapses. The exact source of infection among travelers to Tioman Island remains unclear but needs to be determined to prevent future illnesses. PMID:25091309

  19. Host Biomarkers for Distinguishing Bacterial from Non-Bacterial Causes of Acute Febrile Illness: A Comprehensive Review

    PubMed Central

    Kapasi, Anokhi J.; Dittrich, Sabine; González, Iveth J.; Rodwell, Timothy C.

    2016-01-01

    Background In resource limited settings acute febrile illnesses are often treated empirically due to a lack of reliable, rapid point-of-care diagnostics. This contributes to the indiscriminate use of antimicrobial drugs and poor treatment outcomes. The aim of this comprehensive review was to summarize the diagnostic performance of host biomarkers capable of differentiating bacterial from non-bacterial infections to guide the use of antibiotics. Methods Online databases of published literature were searched from January 2010 through April 2015. English language studies that evaluated the performance of one or more host biomarker in differentiating bacterial from non-bacterial infection in patients were included. Key information extracted included author information, study methods, population, pathogens, clinical information, and biomarker performance data. Study quality was assessed using a combination of validated criteria from the QUADAS and Lijmer checklists. Biomarkers were categorized as hematologic factors, inflammatory molecules, cytokines, cell surface or metabolic markers, other host biomarkers, host transcripts, clinical biometrics, and combinations of markers. Findings Of the 193 citations identified, 59 studies that evaluated over 112 host biomarkers were selected. Most studies involved patient populations from high-income countries, while 19% involved populations from low- and middle-income countries. The most frequently evaluated host biomarkers were C-reactive protein (61%), white blood cell count (44%) and procalcitonin (34%). Study quality scores ranged from 23.1% to 92.3%. There were 9 high performance host biomarkers or combinations, with sensitivity and specificity of ≥85% or either sensitivity or specificity was reported to be 100%. Five host biomarkers were considered weak markers as they lacked statistically significant performance in discriminating between bacterial and non-bacterial infections. Discussion This manuscript provides a summary

  20. Higher serum chloride concentrations are associated with acute kidney injury in unselected critically ill patients

    PubMed Central

    2013-01-01

    Background Chloride administration has been found to be harmful to the kidney in critically ill patients. However the association between plasma chloride concentration and renal function has never been investigated. Methods This was a retrospective study conducted in a tertiary 24-bed intensive care unit from September 2010 to November 2012. Data on serum chloride for each patient during their ICU stay were abstracted from electronic database. Cl0 referred to the initial chloride on ICU entry, Clmax, Clmin and Clmean referred to the maximum, minimum and mean chloride values before the onset of AKI, respectively. AKI was defined according to the conventional AKIN criteria. Univariate and multivariable analysis were performed to examine the association of chloride and AKI development. Results A total of 1221 patients were included into analysis during study period. Three hundred and fifty-seven patients (29.2%) developed AKI. Clmax was significantly higher in AKI than in non-AKI group (111.8 ± 8.1 vs 107.9 ±5.4 mmol/l; p < 0.001); Cl0 was not significantly different between AKI and non-AKI patients; Clmean was significantly higher in AKI than non-AKI (104.3 ±5.8 vs 103.4 ± 4.5; p = 0.0047) patients. Clmax remained to be associated with AKI in multivariable analysis (OR: 1.10, 95% CI: 1.08-1.13). Conclusion Chloride overload as represented by Clmean and Clmax is significantly associated with the development of AKI. PMID:24164963

  1. Basal and inducible levels of Hsp70 in patients with acute heat illness induced during training

    PubMed Central

    Xiao, Chengfeng; Wu, Tangchun; Ren, Aiming; Pan, Qin; Chen, Sheng; Wu, Fen; Li, Xiaoying; Wang, Ruibo; Hightower, Lawrence E.; Tanguay, Robert M.

    2003-01-01

    Heat shock proteins (Hsps) or stress proteins, and, in particular, the inducible, cytosolic Hsp70, represent a highly conserved response to heat exposure and to a variety of noxious stimuli. Many investigations have shown correlations between the aberrant expression of Hsps and disease states. Whether the basal and inducible levels of Hsp70 are of any biological significance in patients with heat-induced diseases remains unknown. In the present study, we compared the basal and inducible levels of Hsp70 by flow cytometry in lymphocytes of patients with heat-induced diseases and after recovery from this disease, and in matched controls. Both groups comprised individuals who exercised by running in the same hot environment. The level of inducible Hsp70 was also measured after a heat treatment of lymphocytes in vitro. The results show that there is variation of basal and inducible Hsp70 levels among individuals. However, the group of patients suffering from heat-induced illnesses in May shows a significantly higher basal (P = 0.02) level of Hsp70 than does the control group. Individuals who have an increased level of Hsp70 may be more sensitive to heat or may respond differently. The level of Hsp70 may represent a biomarker to evaluate whether they are more susceptible to stresses than other individuals. Interestingly, the basal level of Hsp70 is higher in both the patient group and the control group in November than in May. In fact, the basal levels of Hsp70 in the patient and control groups are essentially the same in November, perhaps reflecting the successful stress conditioning of both groups. PMID:12820658

  2. Keynote Presentation at the Eight International Congress of Behavioral Medicine: the Pittsburgh common cold studies: psychosocial predictors of susceptibility to respiratory infectious illness.

    PubMed

    Cohen, Sheldon

    2005-01-01

    This article provides a selected overview of 20 years of research on the role of psychosocial factors in susceptibility to upper respiratory infections. We present evidence from our laboratory that psychological stress is associated with increased risk for developing respiratory illness for persons intentionally exposed to a common cold virus, that the longer the duration of the stressor the greater the risk, and that stress association with susceptibility may be mediated by stress-induced disruption of the regulation of proinflammatory cytokines. We further provide evidence that social relationships (social integration and social support) are also associated with risk for respiratory illness: Social integration is associated with reduced risk irrespective of stress level and social support protects persons from the pathogenic influences of stress. Finally, we report recent evidence that lower levels of early childhood socioeconomic status (SES) are associated with greater risk of viral-induced illness during adulthood, independent of adult SES. PMID:16083315

  3. Clinical impact of potentially inappropriate medications during hospitalization of acutely ill older patients with multimorbidity

    PubMed Central

    Kersten, Hege; Hvidsten, Lara T; Gløersen, Gløer; Wyller, Torgeir Bruun; Wang-Hansen, Marte Sofie

    2015-01-01

    Objective: To identify potentially inappropriate medications (PIMs), to compare drug changes between geriatric and other medical wards, and to investigate the clinical impact of PIMs in acutely hospitalized older adults. Setting and subjects: Retrospective study of 232 home-dwelling, multimorbid older adults (aged ≥75 years) acutely admitted to Vestfold Hospital Trust, Norway. Main outcome measures. PIMs were identified by Norwegian general practice (NORGEP) criteria and Beers’ 2012 criteria. Clinical correlates were laboratory measures, functional and mental status, physical frailty, and length of stay. Results: Mean (SD) age was 86 (5.7) years, and length of stay was 6.5 (4.8) days. During the stay, the mean number of drugs used regularly changed from 7.8 (3.6) to 7.9 (3.6) (p = 0.22), and drugs used pro re nata (prn) changed from 1.4 (1.6) to 2.0 (1.7) (p < 0.001). The prevalence of any PIM changed from 39.2% to 37.9% (p = 0.076), while anticholinergics and benzodiazepines were reduced significantly (p ≤ 0.02). The geriatric ward reduced drug dosages (p < 0.001) and discontinued PIMs (p < 0.001) significantly more often than other medical wards. No relations between number of PIMS and clinical outcomes were identified, but the concomitant use of ≥3 psychotropic/opioid drugs was associated with reduced hand-grip strength (p ≤ 0.012). Conclusion: Hospitalization did not change polypharmacy or PIMs. Drug treatment was more appropriate on the geriatric than other medical wards. No clinical impact of PIMs was observed, but prescribers should be vigilant about concomitant prescription of ≥3 psychotropics/opioids.KEY POINTSAcute hospitalization of older patients with multimorbidity did not increase polypharmacy or potentially inappropriate medications.Prescription of anticholinergics and benzodiazepines was significantly reduced.The geriatric ward reduced drug dosages and discontinued potentially inappropriate medications more

  4. Infectious Diseases

    MedlinePlus

    Infectious diseases kill more people worldwide than any other single cause. Infectious diseases are caused by germs. Germs are tiny living ... to live NIH: National Institute of Allergy and Infectious Diseases

  5. Infectious Diseases

    MedlinePlus

    Infectious diseases kill more people worldwide than any other single cause. Infectious diseases are caused by germs. Germs are tiny living ... live NIH: National Institute of Allergy and Infectious Diseases

  6. Acute lower respiratory illness in under-five children in Rio Grande, Rio Grande do Sul State, Brazil: prevalence and risk factors.

    PubMed

    Prietsch, Silvio O M; Fischer, Gilberto B; César, Juraci A; Lempek, Berenice S; Barbosa, Luciano V; Zogbi, Luciano; Cardoso, Olga C; Santos, Adriana M

    2008-06-01

    This study aimed to determine the prevalence of acute lower respiratory illness and to identify associated factors among children less than five years of age in the city of Rio Grande, southern Brazil. Using a cross-sectional survey, a standardized household questionnaire was applied to mothers or guardians. Information was collected on household conditions, socioeconomic status, and parental smoking. Prenatal care attendance, nutritional status, breastfeeding pattern, and use of health services for the children were also investigated. Data analysis was based on prevalence ratios and logistic regression, using a conceptual framework. Among 771 children studied, 23.9% presented acute lower respiratory illness. The main risk factors were previous episodes of acute lower respiratory infection or wheezing, crowding, maternal schooling less than five years, monthly family income less than US$ 200, four or more people per room, asthma in family members, and maternal smoking. Mothers 30 years or older were identified as a protective factor. These results can help define specific measures to reduce morbidity and mortality due to acute lower respiratory illness in this setting. PMID:18545768

  7. Sleep after critical illness: Study of survivors of acute respiratory distress syndrome and systematic review of literature

    PubMed Central

    Dhooria, Sahajal; Sehgal, Inderpaul Singh; Agrawal, Anshu Kumar; Agarwal, Ritesh; Aggarwal, Ashutosh Nath; Behera, Digambar

    2016-01-01

    Background and Aims: This study aims to evaluate the sleep quality, architecture, sleep-related quality of life, and sleep-disordered breathing (SDB) in acute respiratory distress syndrome (ARDS) survivors early after discharge. Materials and Methods: In this prospective, observational study, consecutive patients with ARDS discharged from the Intensive Care Unit (ICU) underwent evaluation with Epworth sleepiness scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Functional Outcomes of Sleep Questionnaire (FOSQ), and overnight polysomnography. Patients having one or more of the following characteristics were classified as having abnormal sleep: ESS>10, PSQI>5, FOSQ <17.9, apnea–hypopnea index (AHI) ≥5, or AHI during rapid eye movement (REM) sleep ≥5. Results: Twenty patients (median interquartile range [IQR] age of 24 [22–28] years, 11 [55%] females) were included in the study. Acute febrile illness of unknown etiology with multi-organ dysfunction syndrome was the most common underlying etiology for ARDS. The median (IQR) PaO2/FiO2 ratio and APACHE II scores on admission were 176 (151–191.5) and 14 (14–16), respectively. The median (IQR) duration of stay in the ICU was 10 days (7.3–19.5). The overall sleep efficiency (median [IQR], 54% [32.3–65.4%]) was poor. None of the patients had ESS>10, seven (35%) had global PSQI>5 and one had FOSQ <17.9. Ten (50%) patients had at least one characteristic that suggested abnormal sleep (4 insomnia, 2 central sleep apnea, 1 obstructive sleep apnea, 1 REM-SDB, and 2 with a high PSQI, but no specific sleep abnormality). Conclusions: Sleep disturbances are common in ARDS survivors early after discharge from the ICU. PMID:27390455

  8. Association of oliguria with the development of acute kidney injury in the critically ill.

    PubMed

    Vaara, Suvi T; Parviainen, Ilkka; Pettilä, Ville; Nisula, Sara; Inkinen, Outi; Uusaro, Ari

    2016-01-01

    Urine output (UO) criterion may increase the sensitivity of the definition of acute kidney injury (AKI). We determined whether the empirically derived definition for oliguria(<0.5 ml/kg/h) is independently associated with adverse outcome. Data analysis included hourly recorded UO from the prospective, multicenter FINNAKI study conducted in 16 Finnish intensive care units. Confounder-adjusted association of oliguria of different severity and duration primarily with the development of AKI defined by creatinine criterion (Cr-AKI) or renal replacement therapy(RRT) was assessed. Secondarily, we determined the association of oliguria with 90-day mortality. Of the 1966 patients analyzed for the development of AKI, 454 (23.1%) reached this endpoint. Within this AKI cohort, 312 (68.7%)developed Cr-AKI, 21 (4.6%) commenced RRT without Cr-AKI, and 121 (26.7%) commenced RRT with Cr-AKI. Episodes of severe oliguria (<0.1 ml/kg/h) for more than 3 h were independently associated with the development of Cr-AKI or RRT. The shortest periods of consecutive oliguria independently associated with an increased risk for 90-day mortality were 6–12 h of oliguria from 0.3 to <0.5 ml/kg/h, over 6 h of oliguria from 0.1 to <0.3 ml/kg/h, and severe oliguria lasting over 3 h.Thus, our findings underlie the importance of hourly UO measurements. PMID:27169784

  9. Infectious Diseases in Day Care.

    ERIC Educational Resources Information Center

    Sleator, Esther K.

    Discussed in this publication are infectious illnesses for which children attending day care appear to be at special risk. Also covered are the common cold, some infectious disease problems receiving media attention, and some other annoying but not serious diseases, such as head lice, pinworms, and contagious skin conditions. Causes,…

  10. Defining urine output criterion for acute kidney injury in critically ill patients

    PubMed Central

    Macedo, Etienne; Malhotra, Rakesh; Claure-Del Granado, Rolando; Fedullo, Peter; Mehta, Ravindra L.

    2011-01-01

    Background. The widespread use of RIFLE and AKIN classification systems for acute kidney injury (AKI) diagnosis and staging has established the association between AKI severity and adverse outcomes. However, as a result of the difficulties in measuring and recording the urine output every hour, a few prospective studies have validated the urine output criterion as stated in these classification systems. We assessed hourly urine output in ICU patients using an automated and accurate device to determine if changes in urine flow and volume could be a sensitive marker of AKI. Additionally, we assessed various definitions of oliguria to determine whether measurement of urine output using a fixed 6-h interval that matches nurses’ shifts would be equivalent to the current standard for AKI diagnosis and staging. Methods. Hourly urine output was recorded continuously using a digital monitor in a medical ICU. Serum creatinine measurements were done at least once per 24 h. We assessed changes in urine output by four different definitions of oliguria. Patients with no AKI by either criterion were compared with patients diagnosed exclusively by the urine output criterion, exclusively by serum creatinine criterion and by both criteria. Results. Fifty-five percent of patients had an episode of oliguria during the ICU stay. There was no significant difference assessing urine output every hour or the total urine volume in a 6-h period for the detection of episodes of oliguria. Twenty-one patients (28%) were diagnosed as AKI using the serum creatinine criterion, whereas additional 24 (32%) were identified by the urine output criterion. Conclusions. Episodes of oliguria occur frequently in ICU patients and identify a higher percentage of AKI patients compared to serum creatinine criterion. Alterations in urine flow may be a sensitive marker of renal dysfunction and need to be validated in larger cohorts. PMID:20562094

  11. Burden and viral aetiology of influenza-like illness and acute respiratory infection in intensive care units.

    PubMed

    Tramuto, Fabio; Maida, Carmelo Massimo; Napoli, Giuseppe; Mammina, Caterina; Casuccio, Alessandra; Cala', Cinzia; Amodio, Emanuele; Vitale, Francesco

    2016-04-01

    The purpose of this investigation was to study the viral aetiology of influenza-like illness (ILI) and acute respiratory tract infection (ARTI) among patients requiring intensive care unit admission. A cross-sectional retrospective study was carried out in Sicily over a 4-year period. A total of 233 respiratory samples of patients with ILI/ARTI admitted to intensive care units were molecularly analyzed for the detection of a comprehensive panel of aetiologic agents of viral respiratory infections. About 45% of patients was positive for at least one pathogen. Single aetiology occurred in 75.2% of infected patients, while polymicrobial infection was found in 24.8% of positive subjects. Influenza was the most common aetiologic agent (55.7%), especially among adults. Most of patients with multiple aetiology (76.9%) were adults and elderly. Mortality rates among patients with negative or positive aetiology did not significantly differ (52.4% and 47.6%, respectively). Highly transmissible respiratory pathogens are frequently detected among patients with ILI/ARTI admitted in intensive care units, showing the occurrence of concurrent infections by different viruses. The knowledge of the circulation of several types of microorganisms is of crucial importance in terms of appropriateness of therapies, but also for the implication in prevention strategies and hospital epidemiology. PMID:26706819

  12. An Outbreak of Acute Febrile Illness Caused by Sandfly Fever Sicilian Virus in the Afar Region of Ethiopia, 2011

    PubMed Central

    Woyessa, Abyot Bekele; Omballa, Victor; Wang, David; Lambert, Amy; Waiboci, Lilian; Ayele, Workenesh; Ahmed, Abdi; Abera, Negga Asamene; Cao, Song; Ochieng, Melvin; Montgomery, Joel M.; Jima, Daddi; Fields, Barry

    2014-01-01

    In malaria-endemic regions, many medical facilities have limited capacity to diagnose non-malarial etiologies of acute febrile illness (AFI). As a result, the etiology of AFI is seldom determined, although AFI remains a major cause of morbidity in developing countries. An outbreak of AFI was reported in the Afar region of Ethiopia in August of 2011. Retrospectively, 12,816 suspected AFI cases were identified by review of medical records. Symptoms were mild and self-limiting within 3 days after the date of onset; no fatalities were identified. All initial test results of AFI patient specimens were negative for selected pathogens using standard microbiological and molecular techniques. High-throughput sequencing of nucleic acid extracts of serum specimens from 29 AFI cases identified 17 (59%) of 29 samples as positive for Sandfly Fever Sicilian Virus (SFSV). These results were further confirmed by specific reverse transcription polymerase chain reaction. This is the first study implicating SFSV as an etiological agent for AFI in Ethiopia. PMID:25266349

  13. Chronic pain associated with the Chikungunya Fever: long lasting burden of an acute illness

    PubMed Central

    2010-01-01

    Background Chikungunya virus (CHIKV) is responsible for major epidemics worldwide. Autochthonous cases were recently reported in several European countries. Acute infection is thought to be monophasic. However reports on chronic pain related to CHIKV infection have been made. In particular, the fact that many of these patients do not respond well to usual analgesics suggests that the nature of chronic pain may be not only nociceptive but also neuropathic. Neuropathic pain syndromes require specific treatment and the identification of neuropathic characteristics (NC) in a pain syndrome is a major step towards pain control. Methods We carried out a cross-sectional study at the end of the major two-wave outbreak lasting 17 months in Réunion Island. We assessed pain in 106 patients seeking general practitioners with confirmed infection with the CHIK virus, and evaluated its impact on quality of life (QoL). Results The mean intensity of pain on the visual-analogical scale (VAS) was 5.8 ± 2.1, and its mean duration was 89 ± 2 days. Fifty-six patients fulfilled the definition of chronic pain. Pain had NC in 18.9% according to the DN4 questionnaire. Conversely, about two thirds (65%) of patients with NC had chronic pain. The average pain intensity was similar between patients with or without NC (6.0 ± 1.7 vs 6.1 ± 2.0). However, the total score of the Short Form-McGill Pain Questionnaire (SF-MPQ)(15.5 ± 5.2 vs 11.6 ± 5.2; p < 0.01) and both the affective (18.8 ± 6.2 vs 13.4 ± 6.7; p < 0.01) and sensory subscores (34.3 ± 10.7 vs 25.0 ± 9.9; p < 0.01) were significantly higher in patients with NC. The mean pain interference in life activities calculated from the Brief Pain Inventory (BPI) was significantly higher in patients with chronic pain than in patients without it (6.8 ± 1.9 vs 5.9 ± 1.9, p < 0.05). This score was also significantly higher in patients with NC than in those without such a feature (7.2 ± 1.5 vs 6.1 ± 1.9, p < 0.05). Conclusions There

  14. Acute Uncomplicated Febrile Illness in Children Aged 2-59 months in Zanzibar – Aetiologies, Antibiotic Treatment and Outcome

    PubMed Central

    Elfving, Kristina; Shakely, Deler; Andersson, Maria; Baltzell, Kimberly; Ali, Abdullah S.; Bachelard, Marc; Falk, Kerstin I.; Ljung, Annika; Msellem, Mwinyi I.; Omar, Rahila S.; Parola, Philippe; Xu, Weiping; Petzold, Max; Trollfors, Birger; Björkman, Anders; Lindh, Magnus; Mårtensson, Andreas

    2016-01-01

    Background Despite the fact that a large proportion of children with fever in Africa present at primary health care facilities, few studies have been designed to specifically study the causes of uncomplicated childhood febrile illness at this level of care, especially in areas like Zanzibar that has recently undergone a dramatic change from high to low malaria transmission. Methods We prospectively studied the aetiology of febrile illness in 677 children aged 2–59 months with acute uncomplicated fever managed by IMCI (Integrated Management of Childhood Illness) guidelines in Zanzibar, using point-of-care tests, urine culture, blood-PCR, chest X-ray (CXR) of IMCI-pneumonia classified patients, and multiple quantitative (q)PCR investigations of nasopharyngeal (NPH) (all patients) and rectal (GE) swabs (diarrhoea patients). For comparison, we also performed NPH and GE qPCR analyses in 167 healthy community controls. Final fever diagnoses were retrospectively established based on all clinical and laboratory data. Clinical outcome was assessed during a 14-day follow-up. The utility of IMCI for identifying infections presumed to require antibiotics was evaluated. Findings NPH-qPCR and GE-qPCR detected ≥1 pathogen in 657/672 (98%) and 153/164 (93%) of patients and 158/166 (95%) and 144/165 (87%) of controls, respectively. Overall, 57% (387/677) had IMCI-pneumonia, but only 12% (42/342) had CXR-confirmed pneumonia. Two patients were positive for Plasmodium falciparum. Respiratory syncytial virus (24.5%), influenza A/B (22.3%), rhinovirus (10.5%) and group-A streptococci (6.4%), CXR-confirmed pneumonia (6.2%), Shigella (4.3%) were the most common viral and bacterial fever diagnoses, respectively. Blood-PCR conducted in a sub-group of patients (n = 83) without defined fever diagnosis was negative for rickettsiae, chikungunya, dengue, Rift Valley fever and West Nile viruses. Antibiotics were prescribed to 500 (74%) patients, but only 152 (22%) had an infection

  15. CLINICAL CHARACTERISTICS, OUTCOMES AND RISK FACTORS FOR DEATH AMONG CRITICALLY ILL PATIENTS WITH HIV-RELATED ACUTE KIDNEY INJURY

    PubMed Central

    LUNA, Leonardo Duarte Sobreira; SOARES, Douglas de Sousa; JUNIOR, Geraldo Bezerra da SILVA; CAVALCANTE, Malena Gadelha; MALVEIRA, Lara Raissa Cavalcante; MENESES, Gdayllon Cavalcante; PEREIRA, Eanes Delgado Barros; DAHER, Elizabeth De Francesco

    2016-01-01

    SUMMARY Background: The aim of this study is to describe clinical characteristics, outcomes and risk factors for death among patients with HIV-related acute kidney injury (AKI) admitted to an intensive care unit (ICU). Methods: A retrospective study was conducted with HIV-infected AKI patients admitted to the ICU of an infectious diseases hospital in Fortaleza, Brazil. All the patients with confirmed diagnosis of HIV and AKI admitted from January 2004 to December 2011 were included. A comparison between survivors and non-survivors was performed. Risk factors for death were investigated. Results: Among 256 AKI patients admitted to the ICU in the study period, 73 were identified as HIV-infected, with a predominance of male patients (83.6%), and the mean age was 41.2 ± 10.4 years. Non-survivor patients presented higher APACHE II scores (61.4 ± 19 vs. 38.6 ± 18, p = 0.004), used more vasoconstrictors (70.9 vs. 37.5%, p = 0.02) and needed more mechanical ventilation - MV (81.1 vs. 35.3%, p = 0.001). There were 55 deaths (75.3%), most of them (53.4%) due to septic shock. Independent risk factors for mortality were septic shock (OR = 14.2, 95% CI = 2.0-96.9, p = 0.007) and respiratory insufficiency with need of MV (OR = 27.6, 95% CI = 5.0-153.0, p < 0.001). Conclusion: Non-survivor HIV-infected patients with AKI admitted to the ICU presented higher severity APACHE II scores, more respiratory damage and hemodynamic impairment than survivors. Septic shock and respiratory insufficiency were independently associated to death. PMID:27410912

  16. [A Case of Acute Acalculous Cholecystitis During Infectious Mononucleosis Caused by the Epstein-Barr Virus in a Young Woman].

    PubMed

    Ono, Shiro; Kobayashi, Tadanao; Nishio, Kenji

    2016-05-01

    Infection with the Epstein-Barr virus (EBV) is a common disease and is mainly asymptomatic during childhood, whereas infectious mononucleosis with clinical signs such as fever, pharyngitis, lymphadenopathy and hepatosplenomegaly often occurs in adolescents and adults with primary infection. Acalculous cholecystitis has been reported as a rare complication. We report herein a case of acalculous cholecystitis accompanied by infectious mononucleosis by EBV, which was treated successfully by medical treatment. A 33-year-old woman who had been admitted by fever, pharyngitis and lymphadenopathy developed a right upper quadrant pain, that was diagnosed as acalculous cholecystitis based on an imaging study. Antibiotic treatment did not resolve the symptoms, and surgical intervention was considered. We diagnosed her as having infectious mononucleosis based on a typical physical presentation and seropositivity for the EBV viral capsid antigen, suggesting that the acalculous cholecystatis might have been a complication of the EBV infection. After the administration of glucocorticoid and acyclovir, the patient became afebrile and the abdominal pain disappeared. Though acalculous cholecystitis rarely accompanies infectious mononucleosis caused by EBV, clinicians should be aware of this complication to avoid unnecessary cholecystectomy. PMID:27529970

  17. Fight against infectious diseases.

    PubMed

    Soda, K; Kamakura, M; Kitamura, K

    1996-08-01

    During early Meiji era in Japan, there were frequent epidemics of fatal acute communicable diseases such as cholera, dysentery and smallpox, and preventive measures and preparations for acute infectious diseases were urgently needed. Together with improvement of scientific preparations, the Communicable Disease Prevention Law was promulgated in 1897. Then gradually until 1940's, the focus of preventive measures have been shifted from acute infectious diseases to chronic ones, particularly tuberculosis. After the World War II, except the short period of social confusion, major legally-defined communicable diseases had been decreasing rapidly mainly due to the use of antibiotics and improvement of environmental sanitation. At the same time, the introduction of preventive vaccination marked a new era for the prevention of infectious diseases and was largely responsible for the remarkable decrease of infant mortality in Japan. Recently the concept of defense by vaccination against infectious diseases has evolved from group-oriented to individual-oriented, so that the Preventive Vaccination Law was drastically revised in 1994. Currently, effective counter-measures against newly emerged infectious diseases, as viral hepatitis, institution-acquired infection, viral hemorrhagic fever etc., have been implemented. For the future, improvement of infections disease surveillance, vaccine development and expansion of vaccination coverage along with monitoring side-effects, preventive health education on AIDS/STDs, addressing the special needs of foreigners living in Japan and international collaboration for disease control abroad are all vital to the success of protection of the public's health from infectious diseases in Japan. PMID:8800275

  18. Evaluation of Intermittent Hemodialysis in Critically Ill Cancer Patients with Acute Kidney Injury Using Single-Pass Batch Equipment

    PubMed Central

    Torres da Costa e Silva, Verônica; Costalonga, Elerson C.; Oliveira, Ana Paula Leandro; Hung, James; Caires, Renato Antunes; Hajjar, Ludhmila Abrahão; Fukushima, Julia T.; Soares, Cilene Muniz; Bezerra, Juliana Silva; Oikawa, Luciane; Yu, Luis; Burdmann, Emmanuel A.

    2016-01-01

    Background Data on renal replacement therapy (RRT) in cancer patients with acute kidney injury (AKI) in the intensive care unit (ICU) is scarce. The aim of this study was to assess the safety and the adequacy of intermittent hemodialysis (IHD) in critically ill cancer patients with AKI. Methods and Findings In this observational prospective cohort study, 149 ICU cancer patients with AKI were treated with 448 single-pass batch IHD procedures and evaluated from June 2010 to June 2012. Primary outcomes were IHD complications (hypotension and clotting) and adequacy. A multiple logistic regression was performed in order to identify factors associated with IHD complications (hypotension and clotting). Patients were 62.2 ± 14.3 years old, 86.6% had a solid cancer, sepsis was the main AKI cause (51%) and in-hospital mortality was 59.7%. RRT session time was 240 (180–300) min, blood/dialysate flow was 250 (200–300) mL/min and UF was 1000 (0–2000) ml. Hypotension occurred in 25% of the sessions. Independent risk factors (RF) for hypotension were dialysate conductivity (each ms/cm, OR 0.81, CI 0.69–0.95), initial mean arterial pressure (each 10 mmHg, OR 0.49, CI 0.40–0.61) and SOFA score (OR 1.16, CI 1.03–1.30). Clotting and malfunctioning catheters (MC) occurred in 23.8% and 29.2% of the procedures, respectively. Independent RF for clotting were heparin use (OR 0.57, CI 0.33–0.99), MC (OR 3.59, CI 2.24–5.77) and RRT system pressure increase over 25% (OR 2.15, CI 1.61–4.17). Post RRT blood tests were urea 71 (49–104) mg/dL, creatinine 2.71 (2.10–3.8) mg/dL, bicarbonate 24.1 (22.5–25.5) mEq/L and K 3.8 (3.5–4.1) mEq/L. Conclusion IHD for critically ill patients with cancer and AKI offered acceptable hemodynamic stability and provided adequate metabolic control. PMID:26938932

  19. Clinical, Paraclinical, and Antimicrobial Resistance Features of Community-Acquired Acute Bacterial Meningitis at a Large Infectious Diseases Ward in Tehran, Iran.

    PubMed

    Heydari, Behrooz; Khalili, Hossein; Karimzadeh, Iman; Emadi-Kochak, Hamid

    2016-01-01

    In this study demographic, clinical, paraclinical, microbiological, and therapeutic features of patients with community-acquired acute bacterial meningitis admitted to a referral center for infectious diseases in Iran, have been evaluated. Medical records of adult (> 18 years) individuals with confirmed diagnosis of community-acquired bacterial meningitis during a 4-year period were retrospectively reviewed. All required data were obtained from patients' medical charts. Available findings about antimicrobial susceptibility of isolated bacteria from CSF and/or blood were also collected. Kirby-Bauer disc diffusion method was used to determine their antimicrobial susceptibility profile. Details of medical management including antibiotic regimen, duration, patients' outcome, and possible sequelae of meningitis were recorded. The most commonly isolated microorganism from CSF or blood of patients was Streptococcus pneumonia (33.33%) followed by Neisseria meningitidis (27.78%) and Haemophilus influenza (16.67%). The most common antimicrobial regimen was ceftriaxone plus vancomycin (69.44%) followed by ceftriaxone plus vancomycin plus ampicillin (11.11%). Neurological sequelae of meningitis including cranial nerve palsy, deafness, and hemiparesis were identified in 4 (11.11%), 2 (5.56%), and 1 (2.78%) subjects, respectively. Regarding mortality, only 3 (8.33%) patients died from bacterial meningitis and the remaining 33 individuals discharged from the hospital. In conclusion, findings of the current study demonstrated that the mean incidence of acute bacterial meningitis in a referral infectious diseases ward in Iran was 9 episodes per year. The majority cases of community-acquired acute bacterial meningitis admitted to our center had negative CSF culture and classic triad of meningitis was absent in them. PMID:27610176

  20. Clinical, Paraclinical, and Antimicrobial Resistance Features of Community-Acquired Acute Bacterial Meningitis at a Large Infectious Diseases Ward in Tehran, Iran

    PubMed Central

    Heydari, Behrooz; Khalili, Hossein; Karimzadeh, Iman; Emadi-Kochak, Hamid

    2016-01-01

    In this study demographic, clinical, paraclinical, microbiological, and therapeutic features of patients with community-acquired acute bacterial meningitis admitted to a referral center for infectious diseases in Iran, have been evaluated. Medical records of adult (> 18 years) individuals with confirmed diagnosis of community-acquired bacterial meningitis during a 4-year period were retrospectively reviewed. All required data were obtained from patients’ medical charts. Available findings about antimicrobial susceptibility of isolated bacteria from CSF and/or blood were also collected. Kirby-Bauer disc diffusion method was used to determine their antimicrobial susceptibility profile. Details of medical management including antibiotic regimen, duration, patients’ outcome, and possible sequelae of meningitis were recorded. The most commonly isolated microorganism from CSF or blood of patients was Streptococcus pneumonia (33.33%) followed by Neisseria meningitidis (27.78%) and Haemophilus influenza (16.67%). The most common antimicrobial regimen was ceftriaxone plus vancomycin (69.44%) followed by ceftriaxone plus vancomycin plus ampicillin (11.11%). Neurological sequelae of meningitis including cranial nerve palsy, deafness, and hemiparesis were identified in 4 (11.11%), 2 (5.56%), and 1 (2.78%) subjects, respectively. Regarding mortality, only 3 (8.33%) patients died from bacterial meningitis and the remaining 33 individuals discharged from the hospital. In conclusion, findings of the current study demonstrated that the mean incidence of acute bacterial meningitis in a referral infectious diseases ward in Iran was 9 episodes per year. The majority cases of community-acquired acute bacterial meningitis admitted to our center had negative CSF culture and classic triad of meningitis was absent in them. PMID:27610176

  1. Computed tomography-defined abdominal adiposity is associated with acute kidney injury in critically ill trauma patients

    PubMed Central

    Shashaty, Michael G. S.; Kalkan, Esra; Bellamy, Scarlett L.; Reilly, John P.; Holena, Daniel N.; Cummins, Kathleen; Lanken, Paul N.; Feldman, Harold I.; Reilly, Muredach P.; Udupa, Jayaram K.; Christie, Jason D.

    2014-01-01

    Objective Higher body mass index (BMI) is associated with increased risk of acute kidney injury (AKI) after major trauma. Since BMI is non-specific, reflecting lean, fluid, and adipose mass, we evaluated the use of computed tomography (CT) to determine if abdominal adiposity underlies the BMI-AKI association. Design Prospective cohort study. Setting Level I Trauma Center of a university hospital. Patients Patients older than 13 years with an Injury Severity Score ≥16 admitted to the trauma intensive care unit were followed for development of AKI over five days. Those with isolated severe head injury or on chronic dialysis were excluded. Interventions None Measurements and Main Results Clinical, anthropometric, and demographic variables were collected prospectively. CT images at the level of the L4-5 intervertebral disc space were extracted from the medical record and used by two operators to quantitate visceral and subcutaneous adipose tissue (VAT and SAT, respectively) areas. AKI was defined by Acute Kidney Injury Network (AKIN) creatinine and dialysis criteria. Of 400 subjects, 327 (81.8%) had CT scans suitable for analysis: 264/285 (92.6%) blunt trauma subjects, 63/115 (54.8%) penetrating trauma subjects. VAT and SAT areas were highly correlated between operators (ICC>0.999, p<0.001 for each) and within operator (ICC>0.999, p<0.001 for each). In multivariable analysis, the standardized risk of AKI was 15.1% (95% CI 10.6%,19.6%), 18.1% (14%,22.2%), and 23.1% (18.3%,27.9%) at the 25th, 50th, and 75th percentiles of VAT area, respectively (p=0.001), with similar findings when using SAT area as the adiposity measure. Conclusions Quantitation of abdominal adiposity using CT scans obtained for clinical reasons is feasible and highly reliable in critically ill trauma patients. Abdominal adiposity is independently associated with AKI in this population, confirming that excess adipose tissue contributes to the BMI-AKI association. Further studies of the potential

  2. The Ukrainian version of the pediatric Canadian acute respiratory illness and flu scale: a linguistic validation study

    PubMed Central

    Gerasimov, Sergei V; Belova, Halyna A; Pavuk, Halyna L; Seniuk, Ihor M; Strekalina, Yulia I

    2014-01-01

    Background There is no internationally recognized outcome measure for the assessment of acute respiratory tract infections (ARTIs) in children. The only identifiable scale initially developed for pediatric application has been the Canadian acute respiratory illness and flu scale (CARIFS). The aim of our trial was to adapt the English version of the CARIFS to the Ukrainian language. Materials and methods We performed forward and backward translation of the original version of the CARIFS according to the recommended standard. Then, the final CARIFS-based Ukrainian questionnaires were given to 149 caregivers whose 3–12 years old children suffered from ARTI. The questionnaires were completed twice by a caregiver 3–6 hours apart and once by a physician just after the second completion by a caregiver. The database was analyzed to assess the consistency (the Cronbach’s α coefficient), sensitivity (the standardized response mean; the effect size), reliability (test–retest analysis), and validity (Pearson’s correlation) of the CARIFS in the Ukrainian language. Results The backward translation of the Ukrainian version of the CARIFS demonstrated its good correspondence to the English version. The Cronbach’s α coefficient was 0.805, and item to total correlation coefficients varied from 0.185 to 0.665. The standardized response mean was 1.73, and the effect size was 2.50 suggesting good sensitivity of the scale. In the test–retest reliability analysis of 99 questionnaires, the median CARIFS score for the first and the second measurement was 19.0 (interquartile range [IQR]: 14.5–25.0) and 19.0 (IQR: 15.0–25.0), respectively, with a median change of 0.0 (IQR: −1.0 to 0.0, P=0.996). The Pearson’s correlation coefficient between the CARIFS score completed by a responder and a physician was 0.832 (P=0.004). Conclusion The Ukrainian version of the CARIFS-based English questionnaire proved to be a consistent, sensitive, reliable, and valid instrument in the

  3. Illness cognition as a predictor of exercise habits and participation in cardiac prevention and rehabilitation programs after acute coronary syndrome

    PubMed Central

    2013-01-01

    Background Despite well-established medical recommendations, many cardiac patients do not exercise regularly either independently or through formal cardiac prevention and rehabilitation programs (CPRP). This non-adherence is even more pronounced among minority ethnic groups. Illness cognition (IC), i.e. the way people perceive the situation they encounter, has been recognized as a crucial determinant of health-promoting behavior. Few studies have applied a cognitive perspective to explain the disparity in exercising and CPRP attendance between cardiac patients from different ethnic backgrounds. Based on the Health Belief Model (HBM) and the Common Sense Model (CSM), the objective was to assess the association of IC with exercising and with participation in CPRP among Jewish/majority and Arab/minority patients hospitalized with acute coronary syndrome. Methods Patients (N = 420) were interviewed during hospitalization (January-2009 until August- 2010) about IC, with 6-month follow-up interviews about exercise habits and participation in CPRP. Determinants that predict active lifestyle and participation in CPRP were assessed using backward stepwise logistic regression. Results Perceived susceptibility to heart disease and sense and personal control were independently associated with exercising 6 months after the acute event (OR = 0.58, 95% CI: 0.42-0.80 and OR = 1.09, 95% CI: 1.02-1.17, per unit on a 5-point scale). Perceived benefits of regular exercise and a sense of personal control were independently associated with participation in CPRP (OR = 1.56, 95% CI: 1.12-2.16 and OR = 1.08, 95% CI: 1.01-1.15, per unit on a 5-point scale). None of the IC variables assessed could explain the large differences in health promoting behaviors between the majority and minority ethnic groups. Conclusions IC should be taken into account in future interventions to promote physical activity and participation in CPRP for both ethnic groups. Yet, because IC failed

  4. The burden and determinants of self-reported acute gastrointestinal illness in an Indigenous Batwa Pygmy population in southwestern Uganda.

    PubMed

    Clark, S; Berrang-Ford, L; Lwasa, S; Namanya, D B; Edge, V L; Harper, S

    2015-08-01

    Acute gastrointestinal illness (AGI) is an important public health priority worldwide. Few studies have captured the burden of AGI in developing countries, and even fewer have focused on Indigenous populations. This study aimed to estimate the incidence and determinants of AGI within a Batwa Pygmy Indigenous population in southwestern Uganda. A retrospective cross-sectional survey was conducted in January 2013 via a census of 10 Batwa communities (n = 583 participants). The AGI case definition included any self-reported symptoms of diarrhoea or vomiting in the past 2 weeks. The 14-day prevalence of AGI was 6·17% [95% confidence interval (CI) 4·2-8·1], corresponding to an annual incidence rate of 1·66 (95% CI 1·1-2·2) episodes of AGI per person-year. AGI prevalence was greatest in children aged <3 years (11·3%). A multivariable mixed-effects logistic regression model controlling for clustering at the community level indicated that exposure to goats [odds ratio (OR) 2·6, 95% CI 1·0-6·8], being a child aged <3 years (OR 4·8, 95% CI 1·2-18·9), and being a child, adolescent or senior Batwa in the higher median of wealth (OR 7·0, 95% CI 3·9-9·2) were significantly associated with having AGI. This research represents the first Indigenous community-census level study of AGI in Uganda, and highlights the substantial burden of AGI within this population. PMID:25500189

  5. Population Pharmacokinetics of Colistin Methanesulfonate and Colistin in Critically Ill Patients with Acute Renal Failure Requiring Intermittent Hemodialysis.

    PubMed

    Jacobs, M; Grégoire, N; Mégarbane, B; Gobin, P; Balayn, D; Marchand, S; Mimoz, O; Couet, W

    2016-03-01

    Colistin is increasingly used as a last option for the treatment of severe infections due to Gram-negative bacteria in critically ill patients requiring intermittent hemodialysis (HD) for acute renal failure. Our objective was to characterize the pharmacokinetics (PK) of colistin and its prodrug colistin methanesulfonate (CMS) in this population and to suggest dosing regimen recommendations. Eight intensive care unit (ICU) patients who were under intermittent HD and who were treated by CMS (Colimycine) were included. Blood samples were collected between two consecutive HD sessions. CMS and colistin concentrations were measured by a specific chromatographic assay and were analyzed using a PK population approach (Monolix software). Monte Carlo simulations were conducted to predict the probability of target attainment (PTA). CMS nonrenal clearance was increased in ICU-HD patients. Compared with that of ICU patients included in the same clinical trial but with preserved renal function, colistin exposure was increased by 3-fold in ICU-HD patients. This is probably because a greater fraction of the CMS converted into colistin. To maintain colistin plasma concentrations high enough (>3 mg/liter) for high PTA values (area under the concentration-time curve for the free, unbound fraction of a drug [fAUC]/MIC of >10 and fAUC/MIC of >50 for systemic and lung infections, respectively), at least for MICs lower than 1.5 mg/liter (nonpulmonary infection) or 0.5 mg/liter (pulmonary infection), the dosing regimen of CMS should be 1.5 million international units (MIU) twice daily on non-HD days. HD should be conducted at the end of a dosing interval, and a supplemental dose of 1.5 MIU should be administered after the HD session (i.e., total of 4.5 MIU for HD days). This study has confirmed and complemented previously published data and suggests an a priori clear and easy to follow dosing strategy for CMS in ICU-HD patients. PMID:26729492

  6. Measurement of acute nonspecific low back pain perception in primary care physical therapy: reliability and validity of the brief illness perception questionnaire

    PubMed Central

    2013-01-01

    Background The eight-item Brief Illness Perception Questionnaire is used as a screening instrument in physical therapy to assess mental defeat in patients with acute low back pain, besides patient perception might determine the course and risk for chronic low back pain. However, the psychometric properties of the Brief Illness Perception Questionnaire in common musculoskeletal disorders like acute low back pain have not been adequately studied. Patients’ perceptions vary across different populations and affect coping styles. Thus, our aim was to determine the internal consistency, test-retest reliability and validity of the Dutch language version of the Brief Illness Perception Questionnaire in acute non-specific low back pain patients in primary care physical therapy. Methods A non-experimental cross-sectional study with two measurements was performed. Eighty-four acute low back pain patients, in multidisciplinary health care center in Dutch primary care with a sample mean (SD) age of 42 (12) years, participated in the study. Internal consistency (Cronbach’s α) and test-retest procedures (Intraclass Correlation Coefficients and limits of agreement) were evaluated at a one-week interval. The concurrent validity of the Brief Illness Perception Questionnaire was examined by using the Mental Health Component of the Short Form 36 Health Survey. Results The Cronbach’s α for internal consistency was 0.73 (95% CI, 0.67 – 0.83); and the Intraclass Correlation Coefficient test-retest reliability was acceptable: 0.72 (95% CI, 0.53 – 0.82), however, the limits of agreement were large. The Intraclass Correlation Coefficient measuring concurrent validity 0.65 (95% CI, 0.46 – 0.80). Conclusion The Dutch version of the Brief Illness Perception Questionnaire is an appropriate instrument for measuring patients’ perceptions in acute low back pain patients, showing acceptable internal consistency and reliability. Concurrent validity is adequate, however, the

  7. Acute encephalitis as initial presentation of primary HIV infection.

    PubMed

    Nzwalo, Hipólito; Añón, Rosário Pazos; Àguas, Maria João

    2012-01-01

    Acute encephalitis is a life-threatening condition. A wide variety of infectious agents are implicated and in many patients no cause is found. HIV acute seroconversion illness can rarely present as acute encephalitis. Although most experts agree in starting antiretroviral treatment in severe acute HIV infection, the evidence of the benefits are still lacking. The authors report a case of severe acute encephalitis as a primary presentation of HIV infection in which introduction of highly active antiretroviral treatment resulted in clinical recovery. This case highlights the need to consider HIV infection in the differential diagnosis of treatable viral encephalitis. PMID:22761210

  8. Therapeutic effect of Chinese patent medicine "Wuhuanghu" on porcine infectious pleuropneumonia and its acute and subchronic toxicity as well as evaluation of safety pharmacology.

    PubMed

    Wang, Guangxi; Kang, Shuai; Yin, Zhongqiong; Jia, Ren-Yong; Lai, Xin; Zhou, Xun; Liang, Xiao-Xia; Li, Li-Xia; Zou, Yuan-Feng; Lv, Cheng; He, Chang-Liang; Ye, Gang; Yin, Li-Zi; Jing, Bo

    2015-09-01

    Chinese patent medicines play an important role in veterinary clinical use. The aim of this study is to research the anti-infection effect of Chinese patent medicine "Wuhuanghu" for the treatment of porcine infectious pleuropneumonia and to evaluate the safety of "Wuhuanghu" in order to provide a comprehensive understanding of its toxicity. The anti-infection results showed that the treatment with "Wuhuanghu" could significantly inhibit pneumonia and decrement of the pneumonia in high, medium and low doses of "Wuhuanghu" groups were 70.97%, 61.29% and 58.06% respectively. The acute toxicity test showed that rats in the highest group (5000mg/kg) had no death and no abnormal response, suggesting the LD50 of "Wuhuanghu" was more than 5000mg/kg. The subchronic toxicity study showed that hematology indexes in all groups had no obvious differences; blood biochemical index, only albumin and total cholesterol in middle and low doses of "Wuhuanghu" groups were significantly decreased when compared with control group. The clinical pathology showed that the target organ of "Wuhuanghu" was liver. The safety pharmacology study indicated that "Wuhuanghu" had no side effects on rats. In conclusion, "Wuhuanghu" has therapeutic and protective effects to porcine infectious pleuropneumonia in a dose-dependent manner and "Wuhuanghu" is a safe veterinary medicine. PMID:26245812

  9. Effect of sedation on short-term and long-term outcomes of critically ill patients with acute respiratory insufficiency

    PubMed Central

    Xing, Xue-zhong; Gao, Yong; Wang, Hai-jun; Qu, Shi-ning; Huang, Chu-lin; Zhang, Hao; Wang, Hao; Xiao, Qing-ling; Sun, Ke-lin

    2015-01-01

    BACKGROUND: The present study aimed to determine the short-term and long-term outcomes of critically ill patients with acute respiratory insufficiency who had received sedation or no sedation. METHODS: The data of 91 patients who had received mechanical ventilation in the first 24 hours between November 2008 and October 2009 were retrospectively analyzed. These patients were divided into two groups: a sedation group (n=28) and a non-sedation group (n=63). The patients were also grouped in two groups: deep sedation group and daily interruption and /or light sedation group. RESULTS: Overall, the 91 patients who had received ventilation ≥48 hours were analyzed. Multivariate analysis demonstrated two independent risk factors for in-hospital death: sequential organ failure assessment score (P=0.019, RR 1.355, 95%CI 1.051–1.747, B=0.304, SE=0.130, Wald=50483) and sedation (P=0.041, RR 5.015, 95%CI 1.072–23.459, B=1.612, SE=0.787, Wald=4.195). Compared with the patients who had received no sedation, those who had received sedation had a longer duration of ventilation, a longer stay in intensive care unit and hospital, and an increased in-hospital mortality rate. The Kaplan-Meier method showed that patients who had received sedation had a lower 60-month survival rate than those who had received no sedation (76.7% vs. 88.9%, Log-rank test=3.630, P=0.057). Compared with the patients who had received deep sedation, those who had received daily interruption or light sedation showed a decreased in-hospital mortality rate (57.1% vs. 9.5%, P=0.008). The 60-month survival of the patients who had received deep sedation was significantly lower than that of those who had daily interruption or light sedation (38.1% vs. 90.5%, Log-rank test=6.783, P=0.009). CONCLUSIONS: Sedation was associated with in-hospital death. The patients who had received sedation had a longer duration of ventilation, a longer stay in intensive care unit and in hospital, and an increased in

  10. Sleep Patterns Are Associated with Common Illness in Adolescents

    PubMed Central

    Orzech, Kathryn M.; Acebo, Christine; Seifer, Ronald; Barker, David; Carskadon, Mary A.

    2014-01-01

    Summary This prospective, field-based study examined the association between actigraphically-measured total sleep time and incident illness including cold, flu, gastroenteritis, and other common infectious diseases (e.g., strep throat) in adolescents over the course of a school semester. Participants were 56 adolescents ages 14–19 years (mean = 16.6 (standard deviation = 1.2), 39% male) from 5 high schools in Rhode Island. Beginning in late January, adolescents wore actigraphs (mean 91 (19) days, range 16 – 112 days) and were assigned post-hoc to Longer or Shorter sleep groups based on median splits. Adolescents were interviewed weekly across as many as 16 weeks (modal number of interviews = 13) using a structured protocol that included 14 health event questions. Illness events and illness-related school absences were coded for 710 completed interviews, with 681 illness events and 90 school absences reported. Outcomes (illness bouts, illness duration, and absences) were compared among sex, sleep, and academic year groups using non-parametric regression. In a subset of 18 subjects, mean actigraphically estimated total sleep time 6 nights before matched illness/wellness events was compared using MANOVA. Longer sleepers and males reported fewer illness bouts; total sleep time effects were more apparent in males than females. A trend was found for shorter total sleep time before ill events. The present findings in this small naturalistic sample indicate that acute illnesses were more frequent in otherwise healthy adolescents with shorter sleep, and illness events were associated with less sleep during the prior week than comparable matched periods without illness. PMID:24134661

  11. Acute Ataxia in Childhood: 11-Year Experience at a Major Pediatric Neurology Referral Center.

    PubMed

    Thakkar, Kavita; Maricich, Stephen M; Alper, Gulay

    2016-08-01

    We categorized the causes of acute ataxia in the pediatric population-referred to the Division of Neurology-at a large, urban pediatric medical center. Of the 120 cases identified over the past 11 years, post-infectious cerebellar ataxia was the most commonly diagnosed (59%), followed by drug intoxication, opsoclonus-myoclonus ataxia syndrome, episodic ataxia, acute cerebellitis, cerebellar stroke, ADEM, meningitis, cerebral vein thrombosis, Leigh's disease, Miller-Fisher syndrome, and concussion. Among the patients with post-infectious cerebellar ataxia, 85% were 1-6 years old and all had a history of antecedent viral illness. CSF pleocytosis was present in 40% of patients; all had normal brain MRIs. The majority (91%) recovered within 30 days. We conclude that post-infectious cerebellar ataxia remains the most common cause of acute ataxia in childhood and that it carries a good prognosis. We also differentiate acute post-infectious cerebellar ataxia from other causes with similar presentations. PMID:27071467

  12. Study Design of the Microcirculatory Shock Occurrence in Acutely Ill Patients (microSOAP): an International Multicenter Observational Study of Sublingual Microcirculatory Alterations in Intensive Care Patients

    PubMed Central

    Vellinga, Namkje A. R.; Boerma, E. Christiaan; Koopmans, Matty; Donati, Abele; Dubin, Arnaldo; Shapiro, Nathan I.; Pearse, Rupert M.; Bakker, Jan; Ince, Can

    2012-01-01

    Objective. Sublingual microcirculatory alterations are associated with an adverse prognosis in several critical illness subgroups. Up to now, single-center studies have reported on sublingual microcirculatory alterations in ICU patient subgroups, but an extensive evaluation of the prevalence of these alterations is lacking. We present the study design of an international multicenter observational study to investigate the prevalence of microcirculatory alterations in critically ill: the Microcirculatory Shock Occurrence in Acutely ill Patients (microSOAP). Methods. 36 ICU's worldwide have participated in this study aiming for inclusion of over 500 evaluable patients. To enable communication and data collection, a website, an Open Clinica 3.0 database, and image uploading software have been designed. A one-session assessment of the sublingual microcirculation using Sidestream Dark Field imaging and data collection on patient characteristics has been performed in every ICU patient >18 years, regardless of underlying disease. Statistical analysis will provide insight in the prevalence and severity of sublingual alterations, its relation to systemic hemodynamic variables, disease, therapy, and outcome. Conclusion. This study will be the largest microcirculation study ever performed. It is expected that this study will also establish a basis for future studies related to the microcirculation in critically ill. PMID:22666566

  13. Acute Illness Associated with Exposure to a New Soil Fumigant Containing Dimethyl Disulfide-Hillsborough County, Florida, 2014.

    PubMed

    Mulay, Prakash R; Cavicchia, Philip; Watkins, Sharon M; Tovar-Aguilar, Antonio; Wiese, Michael; Calvert, Geoffrey M

    2016-01-01

    Dimethyl disulfide (DMDS) is a new soil fumigant that is considered a replacement for methyl bromide. In 2014, the Florida Department of Health (FDOH) received several complaints of illness following a strong DMDS odor in Hillsborough County. Public health investigation of DMDS-related illness was conducted to assess illness and identify areas to target for prevention activities. This investigation included surveillance, interviews, review of medical records, review of supporting documentation, and determination of pesticide-related illness and injury case status. FDOH interviewed 66 people complaining of illness related to DMDS. Thirty-two were classified as possible and 11 as suspicious cases of DMDS-related illness. Among cases, the mean age was 48 years (range: 3-71 years). The majority were non-Hispanic (n = 43, 100%), white (n = 40, 93%), and female (n = 23, 53.5%). The most common signs and symptoms reported by exposed people included eye pain, throat irritation, nausea, dizziness, headache, and fatigue. There were 88% of cases classified as having low severity of illness and 12% classified as having moderate severity. The average distance from an application site among individuals who reported being exposed at or near their home was 0.74 miles for those classified as cases (n = 36) and 2.84 miles for those not classified as cases (n = 21, P < .05). This is the first known comprehensive report of DMDS-related illness in humans. Even though illnesses associated with DMDS in this investigation were generally of low severity, it is important to identify better ways to prevent off-target movement of DMDS and to improve notification to communities when nearby DMDS applications are planned. PMID:27409156

  14. High-Altitude Illness

    MedlinePlus

    ... altitude illness: Acute mountain sickness High-altitude pulmonary edema (also called HAPE), which affects the lungs High-altitude cerebral edema (also called HACE), which affects the brain These ...

  15. Burden of substance use disorders, mental illness, and correlates of infectious diseases among soon-to-be released prisoners in Azerbaijan

    PubMed Central

    Azbel, Lyuba; Wickersham, Jeffrey A.; Wegman, Martin P.; Polonsky, Maxim; Suleymanov, Murad; Ismayilov, Rafik; Dvoryak, Sergey; Rotberga, Signe; Altice, Frederick L.

    2015-01-01

    Background Despite low HIV prevalence in the South Caucasus region, transmission is volatile. Little data are available from this region about addiction and infectious diseases among prisoners who transition back to communities. Methods A nation-wide randomly sampled biobehavioral health survey was conducted in 13 non-specialty Azerbaijani prisons among soon-to-be-released prisoners. After informed consent, participants underwent standardized health assessment surveys and testing for HIV, hepatitis B and C, and syphilis. Results Of the 510 participants (mean age = 38.2 years), 11.4% were female, and 31.9% reported pre-incarceration drug injection, primarily of heroin. Prevalence of HCV (38.2%), HIV (3.7%), syphilis (3.7%), and HBV (2.7%) was high. Among the 19 HIV-infected inmates, 14 (73.7%) were aware of their HIV status, 12 (63.2%) were receiving antiretroviral therapy (ART), and 5 (26.3%) had CD4 < 350 cells/mL (4 of these were on ART). While drug injection was the most significant independent correlate of HCV (AOR = 12.9; p = 0.001) and a significant correlate of HIV (AOR = 8.2; p = 0.001), both unprotected sex (AOR = 3.31; p = 0.049) and working in Russia/Ukraine (AOR = 4.58; p = 0.008) were also correlated with HIV. Conclusion HIV and HCV epidemics are concentrated among people who inject drugs (PWIDs) in Azerbaijan, and magnified among prisoners. A transitioning HIV epidemic is emerging from migration from high endemic countries and heterosexual risk. The high diagnostic rate and ART coverage among Azerbaijani prisoners provides new evidence that HIV treatment as prevention in former Soviet Union (FSU) countries is attainable, and provides new insights for HCV diagnosis and treatment as new medications become available. Within prison evidence-based addiction treatments with linkage to community care are urgently needed. PMID:25861943

  16. A feasible strategy for preventing blood clots in critically ill patients with acute kidney injury (FBI): study protocol for a randomized controlled trial

    PubMed Central

    2014-01-01

    Background Previous pharmacokinetic trials suggested that 40 mg subcutaneous enoxaparin once daily provided inadequate thromboprophylaxis for intensive care unit patients. Critically ill patients with acute kidney injury are at increased risk of venous thromboembolism and yet are often excluded from these trials. We hypothesized that for critically ill patients with acute kidney injury receiving continuous renal replacement therapy, a dose of 1 mg/kg enoxaparin subcutaneously once daily would improve thromboprophylaxis without increasing the risk of bleeding. In addition, we seek to utilize urine output prior to discontinuing dialysis, and low neutrophil gelatinase-associated lipocalin in dialysis-free intervals, as markers of renal recovery. Methods/Design In a multicenter, double-blind randomized controlled trial in progress at three intensive care units across Denmark, we randomly assign eligible critically ill adults with acute kidney injury into a treatment (1 mg/kg enoxaparin subcutaneously once daily) or control arm (40 mg enoxaparin subcutaneously once daily) upon commencement of continuous renal replacement therapy. We calculated that with 133 patients in each group, the study would have 80% power to show a 40% reduction in the relative risk of venous thromboembolism with 1 mg/kg enoxaparin, at a two-sided alpha level of 0.05. An interim analysis will be conducted after the first 67 patients have been included in each group. Enrolment began in March 2013, and will continue for two years. The primary outcome is the occurrence of venous thromboembolism. Secondary outcomes include anti-factor Xa activity, bleeding, heparin-induced thrombocytopenia, filter lifespan, length of stay, ventilator free days, and mortality. We will also monitor neutrophil gelatinase-associated lipocalin and urine volume to determine whether they can be used as prognostic factors for renal recovery. Discussion Critically ill unit patients with acute kidney injury present a

  17. Infectious diseases in air travellers arriving in the UK.

    PubMed

    Gerard, E

    2002-06-01

    The ease of access to air travel and its increased popularity over the last 30 years have led to a significant incidence of imported infectious diseases and potential infectious hazards. The commonest type of illness found is acute gastroenteritis. Tuberculosis and malaria are not currently common conditions encountered in the UK, but medical vigilance is increasingly necessary as a result of these and other infectious diseases being carried by arriving air travellers. Risks of transmission to other passengers have been considered, and tuberculosis has been shown to have relatively low infectivity on commercial flights. Incidence of serious communicable disease occurring in arriving passengers is low, and should be referred to communicable disease specialists for advice on management. High standards of precautionary hygiene measures are mandatory to commercial aircraft to prevent spread of infectious agents. Disease vectors and products of animal origin pose additional potential threats to public health. Vigilance by environmental health specialists helps maintain national defences against this group of threats. Alertness to recent travel history and awareness of international public health concerns is essential for clinicians likely to encounter sick members of the travelling public. The largest commercial airports have health surveillance units, tasked with acting as a first line of defence against infectious disease. The majority of cases do not present in flight or at the airport, so they can present to any primary care clinician or emergency department. An integrated strategy for health protection will be developed in the UK with the setting up of a Health Protection Agency. PMID:12134773

  18. Acute Pancreatitis in a Patient with Complicated Falciparum Malaria

    PubMed Central

    Bhattacharya, Prasanta Kumar; Lynrah, Kryshan G; Ete, Tony; Issar, Neel Kanth

    2016-01-01

    Malaria is one of the most common protozoan diseases, especially in tropical countries. The clinical manifestation of malaria, especially falciparum malaria varies from mild acute febrile illness to life threatening severe systemic complications involving one or more organ systems. We would like to report a case of complicated falciparum malaria involving cerebral, renal, hepatic system along with acute pancreatitis. The patient was successfully treated with anti malarial and other supportive treatment. To the best of our knowledge there are very few reports of acute pancreatitis due to malaria. Falciparum malaria therefore should be added to the list of infectious agents causing acute pancreatitis especially in areas where malaria is endemic. PMID:26894117

  19. Acute BVDV-2 infection in beef calves delays humoral responses to a non-infectious antigen challenge

    PubMed Central

    McCorkell, Robert; Horsman, Shawn R.; Wynne-Edwards, Katherine; Muench, Greg; van Drunen Littel-van den Hurk, Sylvia; Waeckerlin, Regula; Eschbaumer, Michael; Dardari, Rkia; Chaiyakul, Mark; Gajda, Pawel; Czub, Markus; van der Meer, Frank

    2015-01-01

    Immunosuppressive effects of an intranasal challenge with non-cytopathic bovine viral diarrhea virus (BVDV) 2a (strain 1373) were assessed through acquired and innate immune system responses to ovalbumin (OVA). Concurrent BVDV infection was hypothesized to delay and reduce the humoral response to ovalbumin (administered on days 3 and 15 post-inoculation). Infected animals followed the expected clinical course. BVDV titers, and anti-BVDV antibodies confirmed the course of infection and were not affected by the administration of OVA. Both the T-helper (CD4+) and B-cell (CD20+) compartments were significantly (P < 0.05) reduced in infected animals, while the gamma-delta T-cell population (Workshop cluster 1+, WC1+) decreased slightly in numbers. Infection with BVDV delayed the increase in OVA IgG by approximately 3 d from day 12 through day 21 post-inoculation. Between days 25 and 37 post-inoculation following BVDV infection the IgM concentration in the BVDV− group decreased while the OVA IgM titer still was rising in the BVDV+ animals. Thus, active BVDV infection delays IgM and IgG responses to a novel, non-infectious antigen. PMID:26483584

  20. [Interest of ambulatory simplified acute physiology score (ASAPS) applied to patients admitted in an intensive care unit of an infectious diseases unit in Dakar].

    PubMed

    Dia, N M; Diallo, I; Manga, N M; Diop, S A; Fortes-Deguenonvo, L; Lakhe, N A; Ka, D; Seydi, M; Diop, B M; Sow, P S

    2015-08-01

    The evaluation of patients by a scale of gravity allows a better categorization of patients admitted in intensive care unit (ICU). Our study had for objective to estimate interest of Ambulatory Simplified Acute Physiologic Score (ASAPS) applied to patients admitted in ICU of infectious diseases department of FANN hospital. It was about a descriptive and analytical retrospective study, made from the data found in patients' files admitted into the USI infectious diseases department of FANN hospital in Dakar, from January 1(st), 2009 till December 31st, 2009.The data of 354 patients' files were analyzed. The sex-ratio was 1.77 with an average age of 37.6 years ± 19.4 years old [5-94 years]. The majority of the patients were unemployed paid (39.6%). The most frequent failures were the following ones: neurological (80.5%), cardio-respiratory (16.7%). The average duration of stay was 6.2 days ± 8.2 days going of less than 24 hours to more than 10 weeks. The deaths arose much more at night (53.1%) than in the daytime (46.9%) and the strongest rate of death was recorded in January (61.5%), most low in October (26.7%). The global mortality was 48.3%. The rate of lethality according to the highest main diagnosis was allocated to the AIDS (80.5%). The average ambulatory simplified acute physiology score was 5.3 ± 3.6 with extremes of 0 and 18. The deaths in our series increased with this index (p = 0.000005). The female patients had a rate of lethality higher than that of the men people, 55.5% against 44.2% (p = 0.03). In spite of a predictive score of a high survival (ASAPS < 8), certain number of patients died (n = 105) that is 61.4% of the deaths. The metabolic disturbances, hyperleukocytosis or leukopenia when realised, the presence of a chronic disease, seemed also to influence this lethality. ASAPS only, although interesting, would not good estimate the gravity of patients, where from the necessity thus of a minimum biological balance sheet. It seems better adapted

  1. Emergent Infectious Uveitis

    PubMed Central

    Khairallah, Moncef; Jelliti, Bechir; Jenzeri, Salah

    2009-01-01

    Infectious causes should always be considered in all patients with uveitis and it should be ruled out first. The differential diagnosis includes multiple well-known diseases including herpes, syphilis, toxoplasmosis, tuberculosis, bartonellosis, Lyme disease, and others. However, clinicians should be aware of emerging infectious agents as potential causes of systemic illness and also intraocular inflammation. Air travel, immigration, and globalization of business have overturned traditional pattern of geographic distribution of infectious diseases, and therefore one should work locally but think globally, though it is not possible always. This review recapitulates the systemic and ocular mainfestations of several emergent infectious diseases relevant to the ophthalmologist including Rickettsioses, West Nile virus infection, Rift valley fever, dengue fever, and chikungunya. Retinitis, chorioretinitis, retinal vasculitis, and optic nerve involvement have been associated with these emergent infectious diseases. The diagnosis of any of these infections is usually based on pattern of uveitis, systemic symptoms and signs, and specific epidemiological data and confirmed by detection of specific antibody in serum. A systematic ocular examination, showing fairly typical fundus findings, may help in establishing an early clinical diagnosis, which allows prompt, appropriate management. PMID:20404989

  2. Outbreak of acute febrile respiratory illness caused by human adenovirus B P14H11F14 in a military training camp in Shandong China.

    PubMed

    Dongliu, Yuan; Guoliang, Yang; Haocheng, Xu; Shuaijia, Qing; Li, Bing; Yanglei, Jia

    2016-09-01

    This study reports an outbreak of acute febrile respiratory illness caused by human adenovirus B [P14H11F14] in a military training center in China between May and June 2014. In total, 164 military personnel were affected, and two patients were admitted into the intensive care unit of the military regional central hospital. A HAdV-B [P14H11F14] virus was confirmed as the etiological pathogen of this acute outbreak of febrile respiratory illness based on clinical manifestations, epidemiological characteristics, specific molecular detection results, phylogenetic analysis, and serological assays. The virus was isolated by the rhabdomyosarcoma cell culture method, and the complete sequences of the E1A, penton base, hexon, and fiber genes were determined and deposited in the GenBank database. Phylogenetic and sequence homology analyses indicated that the isolated strain is most closely related to some HAdV-55 strains from mainland China. However, this strain appeared to be less virulent than former HAdV-55 strains. According to the chest X-ray results of 31 affected patients, there was no radiological evidence of pneumonia. The most frequent symptoms in these patients were sore throat (95.12 %, 156/164) and tonsillitis (93.29 %, 153/164). During the course of the outbreak, incorrect response measures and some potential risk factors, such as fire training and marching training, may have exacerbated the spread of the infection. This outbreak illustrates the urgent need to improve the epidemiological and etiological surveillance of HAdV infections and to improve the ability of doctors and health officials in basic units of the Chinese army to respond effectively to febrile respiratory illness. PMID:27352268

  3. Infection-related mortality in children with acute lymphoblastic leukemia: an analysis of infectious deaths on UKALL2003.

    PubMed

    O'Connor, David; Bate, Jessica; Wade, Rachel; Clack, Rachel; Dhir, Sunita; Hough, Rachael; Vora, Ajay; Goulden, Nick; Samarasinghe, Sujith

    2014-08-14

    Although infection is the major cause of treatment-related mortality (TRM) in childhood acute lymphoblastic leukemia, factors associated with infection-related mortality (IRM) are poorly understood. To address this, we report an analysis of all 75 cases of IRM in the United Kingdom Childhood Acute Lymphoblastic Leukaemia Randomised Trial 2003 (UKALL 2003). The 5-year cumulative incidence of IRM was 2.4% (95% confidence interval [CI], 1.9%-3.0%), accounting for 75 (30%) of 249 trial deaths and 75 (64%) of 117 TRM deaths. Risk for IRM as a proportion of TRM was greater in induction than other phases (77% vs 56%; P = .02). Sixty-eight percent of cases were associated with bacterial infection (64% Gram-negative) and 20% with fungal infection. Down syndrome was the most significant risk factor for IRM (odds ratio [OR], 12.08; 95% CI, 6.54-22.32; P < .0001). In addition, there was a trend toward increased IRM in girls (OR, 1.63; 95% CI, 1.02-2.61; P = .04), as well as increasing treatment intensity (regimen B vs A: OR, 2.11 [95% CI, 1.24-3.60]; regimen C vs A: OR, 1.41 [95% CI, 0.76-2.62]; P = .02). Importantly, patients with Down syndrome were at significantly higher risk for IRM during maintenance (P = .048). Our results confirm Down syndrome as a major risk factor for IRM. Enhanced supportive care and prophylactic antibiotics should be considered in high-risk patient groups and during periods of increased risk. This study was registered at http://www.controlled-trials.com/ as #ISRCTN07355119. PMID:24904116

  4. Inherent illnesses and attacks: an ethnographic study of interpretations of childhood Acute Respiratory Infections (ARIs) in Manhiça, southern Mozambique

    PubMed Central

    2011-01-01

    Background Pneumonia is a leading cause of childhood hospitalisation and child mortality in Africa. This study explores local interpretations of Acute Respiratory Infections (ARIs), focusing on caretakers of children under five in the context of hospital care seeking. Methods The study took place in Manhiça, southern Mozambique and used Focused Ethnographic Study tools (FES) including field exercises and interviews. Results Understandings of terms used to describe ARIs differed between caretakers and hospital staff. Children's sicknesses that hospital staff diagnosed as ARIs were interpreted by caretakers as intermittent "attacks" of xifuva, a permanent, inherent and incurable chest illness. Caretakers thought that it was possible to manage and treat the attacks, which were caused by immediate natural factors such as food or the weather, but not the underlying illness, which was seen as having more indirect and social causes. Explanations of illness could not be neatly separated into pluralistic categories, but were characterised by syncretism, with "lay" and "biomedical" terms and concepts intermingling in practical care-seeking interactions between caretakers and health staff. Conclusions Health promotion should take into account the syncretism involved in explanations of ARIs in the context of practical care seeking for children. In doing so, it should draw upon lay interpretations and terminologies in order to stress the importance of seeking hospital care for all xifuva-type illnesses as well as seeking care for any subsequent attacks of an already diagnosed xifuva. However, this should be undertaken with awareness that the meanings of the terms used in practical care-seeking interactions may change over time. Health communication about ARIs should therefore be ongoing and evidence-based, even if ARIs appear to be well understood. PMID:21752260

  5. Daily variability of rainfall and emergency department visits of acute gastrointestinal illness in North Carolina, 2006-2008

    EPA Science Inventory

    Background & Aims: Projections based on climate models suggest that the frequency of extreme rainfall events will continue to rise over the next several decades. We aim to investigate the temporal relationship between daily variability of rainfall and acute gastrointestinal illne...

  6. Acute undifferentiated febrile illness in adult hospitalized patients: the disease spectrum and diagnostic predictors - an experience from a tertiary care hospital in South India.

    PubMed

    Chrispal, Anugrah; Boorugu, Harikishan; Gopinath, Kango Gopal; Chandy, Sara; Prakash, John Antony Jude; Thomas, Elsa Mary; Abraham, Asha Mary; Abraham, O C; Thomas, Kurien

    2010-10-01

    Local prevalences of individual diseases influence the prioritization of the differential diagnoses of a clinical syndrome of acute undifferentiated febrile illness (AFI). This study was conducted in order to delineate the aetiology of AFI that present to a tertiary hospital in southern India and to describe disease-specific clinical profiles. An 1-year prospective, observational study was conducted in adults (age >16 years) who presented with an undifferentiated febrile illness of duration 5-21 days, requiring hospitalization. Blood cultures, malarial parasites and febrile serology (acute and convalescent), in addition to clinical evaluations and basic investigations were performed. Comparisons were made between each disease and the other AFIs. A total of 398 AFI patients were diagnosed with: scrub typhus (47.5%); malaria (17.1%); enteric fever (8.0%); dengue (7.0%); leptospirosis (3.0%); spotted fever rickettsiosis (1.8%); Hantavirus (0.3%); alternate diagnosis (7.3%); and unclear diagnoses (8.0%). Leucocytosis, acute respiratory distress syndrome, aseptic meningitis, mild serum transaminase elevation and hypoalbuminaemia were independently associated with scrub typhus. Normal leukocyte counts, moderate to severe thrombocytopenia, renal failure, splenomegaly and hyperbilirubinaemia with mildly elevated serum transaminases were associated with malaria. Rash, overt bleeding manifestations, normal to low leukocyte counts, moderate to severe thrombocytopenia and significantly elevated hepatic transaminases were associated with dengue. Enteric fever was associated with loose stools, normal to low leukocyte counts and normal platelet counts. It is imperative to maintain a sound epidemiological database of AFIs so that evidence-based diagnostic criteria and treatment guidelines can be developed. PMID:20870680

  7. A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis

    PubMed Central

    2011-01-01

    Introduction Our aim was to investigate the impact of early versus late initiation of renal replacement therapy (RRT) on clinical outcomes in critically ill patients with acute kidney injury (AKI). Methods Systematic review and meta-analysis were used in this study. PUBMED, EMBASE, SCOPUS, Web of Science and Cochrane Central Registry of Controlled Clinical Trials, and other sources were searched in July 2010. Eligible studies selected were cohort and randomised trials that assessed timing of initiation of RRT in critically ill adults with AKI. Results We identified 15 unique studies (2 randomised, 4 prospective cohort, 9 retrospective cohort) out of 1,494 citations. The overall methodological quality was low. Early, compared with late therapy, was associated with a significant improvement in 28-day mortality (odds ratio (OR) 0.45; 95% confidence interval (CI), 0.28 to 0.72). There was significant heterogeneity among the 15 pooled studies (I2 = 78%). In subgroup analyses, stratifying by patient population (surgical, n = 8 vs. mixed, n = 7) or study design (prospective, n = 10 vs. retrospective, n = 5), there was no impact on the overall summary estimate for mortality. Meta-regression controlling for illness severity (Acute Physiology And Chronic Health Evaluation II (APACHE II)), baseline creatinine and urea did not impact the overall summary estimate for mortality. Of studies reporting secondary outcomes, five studies (out of seven) reported greater renal recovery, seven (out of eight) studies showed decreased duration of RRT and five (out of six) studies showed decreased ICU length of stay in the early, compared with late, RRT group. Early RRT did not; however, significantly affect the odds of dialysis dependence beyond hospitalization (OR 0.62 0.34 to 1.13, I2 = 69.6%). Conclusions Earlier institution of RRT in critically ill patients with AKI may have a beneficial impact on survival. However, this conclusion is based on heterogeneous studies of variable quality

  8. Acute effects of air pollution on influenza-like illness in Nanjing, China: A population-based study.

    PubMed

    Huang, Lei; Zhou, Lian; Chen, Jin; Chen, Kai; Liu, Yang; Chen, Xiaodong; Tang, Fenyang

    2016-03-01

    Influenza-like illness causes substantial morbidity and mortality. Air pollution has already been linked to many health issues, and increasing evidence in recent years supports an association between air pollution and respiratory infections. It is a pioneer study in China to quantify the effects of air pollution on influenza-like illness. This study used wavelet coherence analysis and generalized additive models to explore the potential association between air pollution (including particulate matter with aerodynamic diameter ≦2.5 μm (PM2.5), particulate matter with aerodynamic diameter ≦10 μm (PM10) and nitrogen dioxide (NO2)) and influenza-like illness (a total of 59860 cases) in Nanjing, China from January 1, 2013 to December 31, 2013. The average concentrations of PM2.5, PM10 and NO2 were 77.37 μg/m(3), 135.20 μg/m(3) and 55.80 μg/m(3). An interquartile range increase in PM2.5 concentration was associated with a 2.99% (95% confidence interval (CI): 1.64%, 4.36%) increase in daily influenza-like cases on the same day, while the corresponding increase in NO2 was associated with a 3.77% (95% CI: 2.01%, 5.56%) increase in daily cases. People aged 0-4 were proved to be significantly susceptible to PM10 and NO2; 5-14 ages were significantly susceptible to PM2.5 and PM10; and 15-24 ages were significantly susceptible to all the analyzed air pollutants. Air pollution effects tended to be null or negative for patients aged over 25, which might be due to the small number of influenza-like cases in this age group. This study can be useful for understanding the adverse health effects of air pollution and the cause of influenza-like illness. PMID:26766354

  9. Early lactate clearance for predicting active bleeding in critically ill patients with acute upper gastrointestinal bleeding: a retrospective study.

    PubMed

    Wada, Tomoki; Hagiwara, Akiyoshi; Uemura, Tatsuki; Yahagi, Naoki; Kimura, Akio

    2016-08-01

    Not all patients with upper gastrointestinal bleeding (UGIB) require emergency endoscopy. Lactate clearance has been suggested as a parameter for predicting patient outcomes in various critical care settings. This study investigates whether lactate clearance can predict active bleeding in critically ill patients with UGIB. This single-center, retrospective, observational study included critically ill patients with UGIB who met all of the following criteria: admission to the emergency department (ED) from April 2011 to August 2014; had blood samples for lactate evaluation at least twice during the ED stay; and had emergency endoscopy within 6 h of ED presentation. The main outcome was active bleeding detected with emergency endoscopy. Classification and regression tree (CART) analyses were performed using variables associated with active bleeding to derive a prediction rule for active bleeding in critically ill UGIB patients. A total of 154 patients with UGIB were analyzed, and 31.2 % (48/154) had active bleeding. In the univariate analysis, lactate clearance was significantly lower in patients with active bleeding than in those without active bleeding (13 vs. 29 %, P < 0.001). Using the CART analysis, a prediction rule for active bleeding is derived, and includes three variables: lactate clearance; platelet count; and systolic blood pressure at ED presentation. The rule has 97.9 % (95 % CI 90.2-99.6 %) sensitivity with 32.1 % (28.6-32.9 %) specificity. Lactate clearance may be associated with active bleeding in critically ill patients with UGIB, and may be clinically useful as a component of a prediction rule for active bleeding. PMID:26837207

  10. A UK general practice population cohort study investigating the association between lipid lowering drugs and 30-day mortality following medically attended acute respiratory illness

    PubMed Central

    Joshi, Roshni; Myles, Puja R.

    2016-01-01

    Background. Cholesterol lowering drugs HMG-CoA reductase inhibitors (statins) and PPARα activators (fibrates) have been shown to reduce host inflammation via non-disease specific immunomodulatory mechanisms. Recent studies suggest that commonly prescribed drugs in general practice, statins and fibrates, may be beneficial in influenza-like illness related mortality. This retrospective cohort study examines the association between two lipid lowering drugs, statins and fibrates, and all-cause 30-day mortality following a medically attended acute respiratory illness (MAARI). Methods. Primary care patient data were retrospectively extracted from the UK Clinical Practice Research Datalink (CPRD) database. The sample comprised 201,179 adults aged 30 years or older experiencing a MAARI episode. Patient exposure to statins or fibrates was coded as separate dichotomous variables and deemed current if the most recent GP prescription was issued in the 30 days prior to MAARI diagnosis. Multivariable logistic regression and Cox regression were used for analyses. Adjustment was carried out for chronic lung disease, heart failure, metformin and glitazones, comorbidity burden, socio-demographic and lifestyle variables such as smoking status and body mass index (BMI). Statistical interaction tests were carried out to check for effect modification by gender, body mass index, smoking status and comorbidity. Results. A total of 1,096 (5%) patients died within the 30-day follow up period. Of this group, 213 (19.4%) were statin users and 4 (0.4%) were fibrate users. After adjustment, a significant 35% reduction in odds [adj OR; 0.65 (95% CI [0.52–0.80])] and a 33% reduction in the hazard [adj HR: 0.67 (95% CI [0.55–0.83])] of all-cause 30-day mortality following MAARI was observed in statin users. A significant effect modification by comorbidity burden was observed for the association between statin use and MAARI-related mortality. Fibrate use was associated with a non

  11. A UK general practice population cohort study investigating the association between lipid lowering drugs and 30-day mortality following medically attended acute respiratory illness.

    PubMed

    Joshi, Roshni; Venkatesan, Sudhir; Myles, Puja R

    2016-01-01

    Background. Cholesterol lowering drugs HMG-CoA reductase inhibitors (statins) and PPARα activators (fibrates) have been shown to reduce host inflammation via non-disease specific immunomodulatory mechanisms. Recent studies suggest that commonly prescribed drugs in general practice, statins and fibrates, may be beneficial in influenza-like illness related mortality. This retrospective cohort study examines the association between two lipid lowering drugs, statins and fibrates, and all-cause 30-day mortality following a medically attended acute respiratory illness (MAARI). Methods. Primary care patient data were retrospectively extracted from the UK Clinical Practice Research Datalink (CPRD) database. The sample comprised 201,179 adults aged 30 years or older experiencing a MAARI episode. Patient exposure to statins or fibrates was coded as separate dichotomous variables and deemed current if the most recent GP prescription was issued in the 30 days prior to MAARI diagnosis. Multivariable logistic regression and Cox regression were used for analyses. Adjustment was carried out for chronic lung disease, heart failure, metformin and glitazones, comorbidity burden, socio-demographic and lifestyle variables such as smoking status and body mass index (BMI). Statistical interaction tests were carried out to check for effect modification by gender, body mass index, smoking status and comorbidity. Results. A total of 1,096 (5%) patients died within the 30-day follow up period. Of this group, 213 (19.4%) were statin users and 4 (0.4%) were fibrate users. After adjustment, a significant 35% reduction in odds [adj OR; 0.65 (95% CI [0.52-0.80])] and a 33% reduction in the hazard [adj HR: 0.67 (95% CI [0.55-0.83])] of all-cause 30-day mortality following MAARI was observed in statin users. A significant effect modification by comorbidity burden was observed for the association between statin use and MAARI-related mortality. Fibrate use was associated with a non

  12. Fate of Central Venous Catheters Used for Acute Extracorporeal Treatment in Critically Ill Pediatric Patients: A Single Center Experience.

    PubMed

    Rus, Rina R; Premru, Vladimir; Novljan, Gregor; Grošelj-Grenc, Mojca; Ponikvar, Rafael

    2016-06-01

    Renal replacement treatment (RRT) is required in severe acute kidney injury, and a functioning central venous catheter (CVC) is crucial. Twenty-eight children younger than 16 years have been treated at the University Medical Centre Ljubljana between 2003 and 2012 with either acute hemodialysis (HD) and/or plasma exchange (PE), and were included in our study. The age of the patients ranged from 2 days to 14.1 years. Sixty-six CVCs were inserted (52% de novo, 48% guide wire). The sites of insertion were the jugular vein in 20% and the femoral vein in 80%. Catheters were in function from 1 day to 27 days. The most common cause for CVC removal or exchange was catheter dysfunction (50%). CVCs were mostly inserted in the femoral vein, which is the preferred site of insertion in acute HD/PE because of the smaller number of complications. PMID:27312920

  13. Preventing Infectious Disease in Sports.

    ERIC Educational Resources Information Center

    Howe, Warren B.

    2003-01-01

    Preventing infectious disease in sports is fundamental to maintaining team effectiveness and helping athletes avoid the adverse effects of illness. Good hygiene, immunization, minimal exposure to specific diseases, and certain prophylactic measures are essential. Teammates, coaches, trainers, officials, healthcare providers, and community public…

  14. Symptom control in end-of-life care: pain, eating, acute illnesses, panic attacks, and aggressive care.

    PubMed

    Lamers, William M

    2005-01-01

    This feature is based on actual questions and answers adapted from a service provided by the Hospice Foundation of America. Queries addressing the propriety of managing acute medical conditions in patients enrolled in a terminal care program and the mistaken belief that death from cancer is always painful are provided. Questions included in this set address management of acute medical conditions during end-of-life care, the lack of inevitability of pain with cancer, nutrition in advanced disease, managing panic attacks, and appropriate care for a dying 90 year old gentleman. PMID:16431836

  15. Estimating the burden of acute gastrointestinal illness due to Giardia, Cryptosporidium, Campylobacter, E. coli O157 and norovirus associated with private wells and small water systems in Canada.

    PubMed

    Murphy, H M; Thomas, M K; Schmidt, P J; Medeiros, D T; McFADYEN, S; Pintar, K D M

    2016-05-01

    Waterborne illness related to the consumption of contaminated or inadequately treated water is a global public health concern. Although the magnitude of drinking water-related illnesses in developed countries is lower than that observed in developing regions of the world, drinking water is still responsible for a proportion of all cases of acute gastrointestinal illness (AGI) in Canada. The estimated burden of endemic AGI in Canada is 20·5 million cases annually - this estimate accounts for under-reporting and under-diagnosis. About 4 million of these cases are domestically acquired and foodborne, yet the proportion of waterborne cases is unknown. There is evidence that individuals served by private systems and small community systems may be more at risk of waterborne illness than those served by municipal drinking water systems in Canada. However, little is known regarding the contribution of these systems to the overall drinking water-related AGI burden in Canada. Private water supplies serve an estimated 12% of the Canadian population, or ~4·1 million people. An estimated 1·4 million (4·1%) people in Canada are served by small groundwater (2·6%) and surface water (1·5%) supplies. The objective of this research is to estimate the number of AGI cases attributable to water consumption from these supplies in Canada using a quantitative microbial risk assessment (QMRA) approach. This provides a framework for others to develop burden of waterborne illness estimates for small water supplies. A multi-pathogen QMRA of Giardia, Cryptosporidium, Campylobacter, E. coli O157 and norovirus, chosen as index waterborne pathogens, for various source water and treatment combinations was performed. It is estimated that 103 230 AGI cases per year are due to the presence of these five pathogens in drinking water from private and small community water systems in Canada. In addition to providing a mechanism to assess the potential burden of AGI attributed to small systems and

  16. Infectious Arthritis

    MedlinePlus

    Most kinds of arthritis cause pain and swelling in your joints. Joints are places where two bones meet, such as your elbow or knee. Infectious arthritis is an infection in the joint. The infection ...

  17. The effect of continuous versus intermittent renal replacement therapy on the outcome of critically ill patients with acute renal failure (CONVINT): a prospective randomized controlled trial

    PubMed Central

    2014-01-01

    Introduction Acute renal failure (ARF) requiring renal replacement therapy (RRT) occurs frequently in ICU patients and significantly affects mortality rates. Previously, few large clinical trials investigated the impact of RRT modalities on patient outcomes. Here we investigated the effect of two major RRT strategies (intermittent hemodialysis (IHD) and continuous veno-venous hemofiltration (CVVH)) on mortality and renal-related outcome measures. Methods This single-center prospective randomized controlled trial (“CONVINT”) included 252 critically ill patients (159 male; mean age, 61.5 ± 13.9 years; Acute Physiology and Chronic Health Evaluation (APACHE) II score, 28.6 ± 8.8) with dialysis-dependent ARF treated in the ICUs of a tertiary care academic center. Patients were randomized to receive either daily IHD or CVVH. The primary outcome measure was survival at 14 days after the end of RRT. Secondary outcome measures included 30-day-, intensive care unit-, and intrahospital mortality, as well as course of disease severity/biomarkers and need for organ-support therapy. Results At baseline, no differences in disease severity, distributions of age and gender, or suspected reasons for acute renal failure were observed. Survival rates at 14 days after RRT were 39.5% (IHD) versus 43.9% (CVVH) (odds ratio (OR), 0.84; 95% confidence interval (CI), 0.49 to 1.41; P = 0.50). 14-day-, 30-day, and all-cause intrahospital mortality rates were not different between the two groups (all P > 0.5). No differences were observed in days on RRT, vasopressor days, days on ventilator, or ICU-/intrahospital length of stay. Conclusions In a monocentric RCT, we observed no statistically significant differences between the investigated treatment modalities regarding mortality, renal-related outcome measures, or survival at 14 days after RRT. Our findings add to mounting data demonstrating that intermittent and continuous RRTs may be considered equivalent approaches

  18. Viruses in non-disinfected drinking water from municipal wells are related to community rates of acute gastrointestinal illness

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Groundwater supplies for drinking water are frequently contaminated with low-levels of human enteric virus genomes, yet evidence for waterborne disease transmission is lacking. We related qPCR-measured enteric viruses in the tap water of 14 non-chlorinating communities in the U.S. to acute gastroint...

  19. Prevalence of patients with acute febrile illnesses and positive dengue NS1 tests in a tertiary hospital in Papua New Guinea.

    PubMed

    Asigau, Viola; Lavu, Evelyn K; McBride, William J H; Biloh, Eric; Naroi, Francis; Koana, Egi; Ferguson, John K; Laman, Moses

    2015-01-01

    Because the prevalence of dengue fever in urban settings in Papua New Guinea is unknown, we investigated the presence of dengue using the NS1 antigen test in an outpatient-based prospective observational study at Port Moresby General Hospital. Of 140 patients with acute febrile illnesses, dengue fever was diagnosed in 14.9% (20 of 134; 95% confidence interval [95% CI] = 9.6-22.4). Malaria (2 of 137; 1.5%; 95% CI = 0.3-5.7), chikungunya (3 of 140; 2.1%; 95% CI = 0.6-6.6), and bacterial bloodstream infections (0 of 80; 0%; 95% CI = 0-5.7) were uncommon. Dengue fever should no longer be considered rare in Papua New Guinea. PMID:25331803

  20. Changes in Clinical Presentation and Epidemiology of Respiratory Pathogens Associated With Acute Respiratory Illness in Military Trainees After Reintroduction of Adenovirus Vaccine

    PubMed Central

    Yun, Heather C.; Young, Adam N.; Caballero, Manuel Y.; Lott, Lisa; Cropper, Thomas L.; Murray, Clinton K.

    2015-01-01

    Background. Adenovirus (Ad) has long been the predominant cause of acute respiratory illness (ARI) in military trainees. In 2011, live oral Ad vaccines for serotypes 4 and 7 were reintroduced into US basic military training populations. This study evaluated the impact on clinical presentations and other respiratory pathogens. Methods. The Center for Advanced Molecular Detection at Joint Base San Antonio-Lackland prospectively collects demographic, clinical, and polymerase chain reaction data from respiratory specimens (throat swab and nasal wash) among Air Force trainees presenting for care of ARI. Results. From June 2008 to August 2013, 2660 trainees enrolled and were tested for selected respiratory pathogens. Post-vaccine introduction (VI), reported systemic symptoms were less frequent, including fever (38% vs 94%) and myalgia (37% vs 67%; P < .01). Median temperature and heart rate decreased (98.4 vs 101.3°F, 81 vs 96 beats per minute; P < .01). Ad detection decreased for all Ad (3% vs 68%), Ad4 (1% vs 70%), 7 (0% vs 8%), 14 (0% vs 5%), and 3 (0.1% vs 2%); P < .01). Rhinovirus and cases with no pathogen identified increased in frequency (35% vs 18%, 51% vs 14%; P < .01). Conclusions. Acute respiratory illness in military trainees post-VI is associated with decreased severity of systemic symptoms and reduced fever and heart rate. Marked reductions in frequency of Ad serotypes are seen, including those in the vaccine, with no serotype shift. However, detection of several other respiratory pathogens, most notably rhinovirus, is observed in increasing proportions, and a majority are now undiagnosed clinical syndromes. PMID:26380351

  1. Canadian Cardiovascular Society Consensus Conference recommendations on heart failure update 2007: Prevention, management during intercurrent illness or acute decompensation, and use of biomarkers

    PubMed Central

    Arnold, J Malcolm O; Howlett, Jonathan G; Dorian, Paul; Ducharme, Anique; Giannetti, Nadia; Haddad, Haissam; Heckman, George A; Ignaszewski, Andrew; Isaac, Debra; Jong, Philip; Liu, Peter; Mann, Elizabeth; McKelvie, Robert S; Moe, Gordon W; Parker, John D; Svendsen, Anna M; Tsuyuki, Ross T; O’Halloran, Kelly; Ross, Heather J; Rao, Vivek; Sequeira, Errol J; White, Michel

    2007-01-01

    Heart failure is common, yet it is difficult to treat. It presents in many different guises and circumstances in which therapy needs to be individualized. The Canadian Cardiovascular Society published a comprehensive set of recommendations in January 2006 on the diagnosis and management of heart failure, and the present update builds on those core recommendations. Based on feedback obtained through a national program of heart failure workshops during 2006, several topics were identified as priorities because of the challenges they pose to health care professionals. New evidence-based recommendations were developed using the structured approach for the review and assessment of evidence adopted and previously described by the Society. Specific recommendations and practical tips were written for the prevention of heart failure, the management of heart failure during intercurrent illness, the treatment of acute heart failure, and the current and future roles of biomarkers in heart failure care. Specific clinical questions that are addressed include: which patients should be identified as being at high risk of developing heart failure and which interventions should be used? What complications can occur in heart failure patients during an intercurrent illness, how should these patients be monitored and which medications may require a dose adjustment or discontinuation? What are the best therapeutic, both drug and nondrug, strategies for patients with acute heart failure? How can new biomarkers help in the treatment of heart failure, and when and how should BNP be measured in heart failure patients? The goals of the present update are to translate best evidence into practice, to apply clinical wisdom where evidence for specific strategies is weaker, and to aid physicians and other health care providers to optimally treat heart failure patients to result in a measurable impact on patient health and clinical outcomes in Canada. PMID:17245481

  2. Information needs of parents for acute childhood illness: determining ‘what, how, where and when’ of safety netting using a qualitative exploration with parents and clinicians

    PubMed Central

    Jones, Caroline H D; Neill, Sarah; Lakhanpaul, Monica; Roland, Damian; Singlehurst-Mooney, Hayley; Thompson, Matthew

    2014-01-01

    Objective To explore the views of parents and clinicians regarding the optimal content, format and delivery of safety netting information for acute childhood illness. Design Qualitative study including semistructured focus groups and interviews. Setting First contact care settings, community centres, children's centres and nurseries in the Midlands, UK. Participants 27 parents from a travelling community, Asian British community and white British community. Sixteen clinicians including 10 doctors and 6 nurses from a general practice surgery, an out-of-hours service and two emergency departments (paediatric and combined adult and paediatric). Results Participants described a need for safety netting to contain information on signs and symptoms of serious and common illnesses, illness management and where and when to seek help. Resources should be basic, simple to use and contain simple symbols. A key criterion was professional endorsement of resources. Internet-based information was desired which is reliable, consistent and up-to-date. Participants described a need for different types of information: that which could be delivered during consultations, as well as more general information for parents to access before consulting a healthcare professional. Face-to-face education, written materials and digital media were suggested delivery mechanisms. Audiovisual material was preferred by families with low literacy. Participants commonly suggested internet-based and phone-based resources, but the travelling community was less comfortable with these approaches. Conclusions A multifaceted and tailored approach to safety netting is needed so that effective resources are available for parents with varying information needs, literacy levels and ability to use information technology. We have identified key aspects of content, quality criteria, format and delivery mechanisms for safety netting information from the perspectives of clinicians and parents. Resources should be

  3. Intermittent high-volume predilution on-line haemofiltration versus standard intermittent haemodialysis in critically ill patients with acute kidney injury: a prospective randomized study

    PubMed Central

    Škofic, Nataša; Arnol, Miha; Buturović-Ponikvar, Jadranka; Ponikvar, Rafael

    2012-01-01

    Background The optimal modality of dialysis treatment in critically ill patients with acute kidney injury (AKI) remains unclear. Intermittent high-volume predilution on-line haemofiltration (HF) is not a well-established dialysis modality. The purpose of the study was to compare clinical outcomes between HF and standard intermittent haemodialysis (HD) in this specific population. Methods In this prospective, randomized, controlled single-centre clinical study, we compared mortality and recovery of kidney function between HF and HD in critically ill adult patients with AKI. The primary study outcome was 60-day all-cause mortality. Secondary study outcomes included 30-day and in-hospital all-cause mortality along with recovery of kidney function. Time to kidney function recovery and the number of required dialysis procedures were analyzed in the subgroup of patients with in-hospital recovery of kidney function. Results Baseline characteristics of the 273 patients in the two study groups were similar. All-cause mortality by Day 60 was 65.0% in the HF group and 65.5% in the HD group (hazard ratio, 0.98; 95% confidence interval, 0.71–1.33; P = 0.87). There were also no significant differences between the two groups in 30-day and in-hospital all-cause mortality or recovery of kidney function. Time to kidney function recovery and the number of required dialysis procedures were similar between the HF and the HD subgroup of patients with in-hospital recovery of kidney function. Conclusions Dialysis treatment with intermittent high-volume predilution on-line HF in critically ill patients with AKI did not decrease mortality, improve recovery of kidney function or reduce the need for dialysis support compared to standard intermittent HD. PMID:22513706

  4. The use of vital signs as predictors for serious bacterial infections in children with acute febrile illness in a pediatric emergency setting in Sudan

    PubMed Central

    Salah, Elmuntasir Taha; Ahmed, Emad; Elhussien, Manal; Salah, Tarig

    2014-01-01

    Distinguishing children with serious infections from those with milder, self-limiting febrile illnesses remains a daily challenge in primary care and hospital emergency department. Measurement of vital signs is recommended as part of this assessment. To determine whether vital signs can predict children with serious bacterial infections, we studied the data of children aged 1 month to < 16 years presented who with acute febrile illness to a Pediatric emergency department in Sudan. Sample size was 150 patients. The severity of infection was classified as serious or not serious bacterial infection. Vital signs and oxygen saturation were recorded and compared to the final outcome of these children. Data analyzed bivariably and multivariably using regression analysis. Ten percent of patients were classified as having serious bacterial infection. Tachycardia and tachypnea were the most sensitive and specific in predicting serious bacterial infections with (80%, 86.6 % sensitivity) and (97.4%, 83.7% specificity), respectively. High temperature, severe hypoxemia and hypotension were the least sensitive but highly specific signs of serious bacterial infections. As a conclusion, vital signs can be used to differentiate children with serious bacterial infections from those with non-serious bacterial infections in pediatric emergency departments and has comparable sensitivity to more complicated triage systems.

  5. Data on respiratory variables in critically ill patients with acute respiratory failure placed on proportional assist ventilation with load adjustable gain factors (PAV+).

    PubMed

    Georgopoulos, Dimitris; Xirouchaki, Nectaria; Tzanakis, Nikolaos; Younes, Magdy

    2016-09-01

    The data show respiratory variables in 108 critically ill patients with acute respiratory failure placed on proportional assist ventilation with load adjustable gain factors (PAV+) after at least 36 h on passive mechanical ventilation. PAV+ was continued for 48 h until the patients met pre-defined criteria either for switching to controlled modes or for breathing without ventilator assistance. Data during passive mechanical ventilation and during PAV+ are reported. Data are acquired from the whole population, as well as from patients with and without acute respiratory distress syndrome. The reported variables are tidal volume, driving pressure (ΔP, the difference between static end-inspiratory plateau pressure and positive end-expiratory airway pressure), respiratory system compliance and resistance, and arterial blood gasses. The data are supplemental to our original research article, which described individual ΔP in these patients and examined how it related to ΔP when the same patients were ventilated with passive mechanical ventilation using the currently accepted lung-protective strategy "Driving pressure during assisted mechanical ventilation. Is it controlled by patient brain?" [1]. PMID:27358909

  6. Noninvasive and invasive positive pressure ventilation for acute respiratory failure in critically ill patients: a comparative cohort study

    PubMed Central

    Meeder, Annelijn M.; Tjan, Dave H. T.

    2016-01-01

    Background Noninvasive positive pressure ventilation (NPPV) for acute respiratory failure in the intensive care unit (ICU) is associated with a marked reduction in intubation rate, complications, hospital length of stay and mortality. Multiple studies have indicated that patients failing NPPV have worse outcomes compared with patients with successful NPPV treatment; however limited data is available on risks associated with NPPV failure resulting in (delayed) intubation and outcomes compared with initial intubation. The purpose of this study is to assess rates and predictors of NPPV failure and to compare hospital outcomes of patients with NPPV failure with those patients primarily intubated without a prior NPPV trial. Methods A retrospective observational study using data from patients with acute respiratory failure admitted to the ICU in the period 2013–2014. All patients treated with NPPV were evaluated. A sample of patients who were primarily intubated was randomly selected to serve as controls for the group of patients who failed NPPV. Results NPPV failure was recorded in 30.8% of noninvasively ventilated patients and was associated with longer ICU stay [OR, 1.16, 95% confidence interval (95% CI): 1.04–1.30] and lower survival rates (OR, 0.10, 95% CI: 0.02–0.59) compared with NPPV success. Multivariate analysis showed presence of severe sepsis at study entry, higher Simplified Acute Physiology II Score (SAPS-II) score, lower ratio of arterial oxygen tension to fraction of inspired oxygen (PF-ratio) and lower plasma glucose were predictors for NPPV failure. After controlling for potential confounders, patients with NPPV failure did not show any difference in hospital outcomes compared with patients who were primarily intubated. Conclusions Patients with acute respiratory failure and NPPV failure have worse outcomes compared with NPPV success patients, however not worse than initially intubated patients. An initial trial of NPPV therefore may be suitable

  7. Health care utilization for acute illnesses in an urban setting with a refugee population in Nairobi, Kenya: a cross-sectional survey

    PubMed Central

    2014-01-01

    Background Estimates place the number of refugees in Nairobi over 100,000. The constant movement of refugees between countries of origin, refugee camps, and Nairobi poses risk of introduction and transmission of communicable diseases into Kenya. We assessed the care-seeking behavior of residents of Eastleigh, a neighborhood in Nairobi with urban refugees. Methods During July and August 2010, we conducted a Health Utilization Survey in Section II of Eastleigh. We used a multistage random cluster sampling design to identify households for interview. A standard questionnaire on the household demographics, water and sanitation was administered to household caretakers. Separate questionnaires were administered to household members who had one or more of the illnesses of interest. Results Of 785 households targeted for interview, data were obtained from 673 (85.7%) households with 3,005 residents. Of the surveyed respondents, 290 (9.7%) individuals reported acute respiratory illness (ARI) in the previous 12 months, 222 (7.4%) reported fever in the preceding 2 weeks, and 54 (1.8%) reported having diarrhea in the 30 days prior to the survey. Children <5 years old had the highest frequency of all the illnesses surveyed: 17.1% (95% CI 12.2-21.9) reported ARI, 10.0% (95% CI 6.2-13.8) reported fever, and 6.9% (3.8-10.0) reported diarrhea during the time periods specified for each syndrome. Twenty-nine [7.5% (95% CI 4.3-10.7)] hospitalizations were reported among all age groups of those who sought care. Among participants who reported ≥1 illness, 330 (77.0%) sought some form of health care; most (174 [59.8%]) sought health care services from private health care providers. Fifty-five (18.9%) participants seeking healthcare services visited a pharmacy. Few residents of Eastleigh (38 [13.1%]) sought care at government-run facilities, and 24 (8.2%) sought care from a relative, a religious leader, or a health volunteer. Of those who did not seek any health care services (99 [23

  8. Preliminary Data: An Adapted Hospital Elder Life Program to Prevent Delirium and Reduce Complications of Acute Illness in Long-Term Care Delivered by Certified Nursing Assistants.

    PubMed

    Boockvar, Kenneth S; Teresi, Jeanne A; Inouye, Sharon K

    2016-05-01

    Nursing home (NH) residents have a high prevalence of delirium risk factors, experience two to four acute medical conditions (e.g., infections) each year, and have an incidence of delirium during these conditions similar to that of hospitalized older adults. Many NH residents with delirium do not return to their prior level of cognitive function. They are more likely to die, be hospitalized, and less likely to be discharged home than those without delirium. Research on the prevention or treatment of delirium in NHs is limited. This article describes the development and pilot testing of a multicomponent delirium prevention intervention in the NH setting adapted from the Hospital Elder Life Program (HELP-LTC). Activities to reduce the risk of delirium that were appropriate for functionally impaired NH residents were developed and delivered during treatment for and recovery from acute illness, a novel resident-targeting approach. Expertly trained certified nursing assistants (CNAs - a total of 1.4 full-time equivalent (FTE) positions-) visited residents throughout the facility and delivered the activities. The current study reports on incident delirium, delirium remission, cognitive and physical function change, hospitalization, and death associated with acute medical conditions as ascertained by a program coordinator. The integration and acceptance of the CNAs' activities by residents and staff are also reported on. Hospitalization and death were ascertained in a nonintervention comparison group. Findings support a test of the intervention in a controlled trial. The potential effect is great; there are approximately 1.4 million NH residents in the United States and an estimated 1 million with dementia or cognitive impairment, an important delirium risk factor. An intervention would be broadly adoptable if a reduction in healthcare costs through prevention of hospitalization offset the cost of the program's CNAs. PMID:27160212

  9. Challenges of Establishing the Correct Diagnosis of Outbreaks of Acute Febrile Illnesses in Africa: The Case of a Likely Brucella Outbreak among Nomadic Pastoralists, Northeast Kenya, March–July 2005

    PubMed Central

    Ari, Mary D.; Guracha, Argata; Fadeel, Moustafa Abdel; Njuguna, Charles; Njenga, M. Kariuki; Kalani, Rosalia; Abdi, Hassan; Warfu, Osman; Omballa, Victor; Tetteh, Christopher; Breiman, Robert F.; Pimentel, Guillermo; Feikin, Daniel R.

    2011-01-01

    An outbreak of acute febrile illness was reported among Somali pastoralists in remote, arid Northeast Kenya, where drinking raw milk is common. Blood specimens from 12 patients, collected mostly in the late convalescent phase, were tested for viral, bacterial, and parasitic pathogens. All were negative for viral and typhoid serology. Nine patients had Brucella antibodies present by at least one of the tests, four of whom had evidence suggestive of acute infection by the reference serologic microscopic agglutination test. Three patients were positive for leptospiral antibody by immunoglobulin M enzyme-linked immunosorbent assay, and two were positive for malaria. Although sensitive and specific point-of-care testing methods will improve diagnosis of acute febrile illness in developing countries, challenges of interpretation still remain when the outbreaks are remote, specimens collected too late, and positive results for multiple diseases are obtained. Better diagnostics and tools that can decipher overlapping signs and symptoms in such settings are needed. PMID:22049048

  10. Mitigating Infectious Disease Outbreaks

    NASA Astrophysics Data System (ADS)

    Davey, Victoria

    The emergence of new, transmissible infections poses a significant threat to human populations. As the 2009 novel influenza A/H1N1 pandemic and the 2014-2015 Ebola epidemic demonstrate, we have observed the effects of rapid spread of illness in non-immune populations and experienced disturbing uncertainty about future potential for human suffering and societal disruption. Clinical and epidemiologic characteristics of a newly emerged infectious organism are usually gathered in retrospect as the outbreak evolves and affects populations. Knowledge of potential effects of outbreaks and epidemics and most importantly, mitigation at community, regional, national and global levels is needed to inform policy that will prepare and protect people. Study of possible outcomes of evolving epidemics and application of mitigation strategies is not possible in observational or experimental research designs, but computational modeling allows conduct of `virtual' experiments. Results of well-designed computer simulations can aid in the selection and implementation of strategies that limit illness and death, and maintain systems of healthcare and other critical resources that are vital to public protection. Mitigating Infectious Disease Outbreaks.

  11. Infectious Arthritis

    MedlinePlus

    ... Another form of reactive arthritis starts with eating food or handling something that has bacteria on it. To diagnose infectious arthritis, your health care provider may do tests of your blood, urine, and joint fluid. Treatment includes medicines and sometimes surgery.

  12. [Investigation of an outbreak of acute respiratory illness due to exposure to chlorine gas in a public swimming pool].

    PubMed

    Almagro Nievas, Diego; Acuña Castillo, Rafael; Hernández Jerez, Antonio; Robles Montes, Alberto

    2008-01-01

    A case-control study was designed to investigate a chemical accident that occurred in a swimming-pool in the summer of 2005. The aim was to describe the environmental factors involved in the accident, to assess the effect of chlorine gas on the respiratory system, and to perform a clinical and spirometric follow-up. The following interventions were carried out: environmental inspection, epidemiologic survey (including sociodemographic variables), location at the time of the accident, perception of an abnormal smell, and clinical and spirometric outcomes to assess respiratory function. Sixty-five cases and 48 controls were identified and interviewed. The accident was produced by accidental admixture of hydrochloric acid with sodium hypochlorite resulting in chlorine gas release. The main clinical symptoms were dyspnea and cough. The risk of becoming ill was 10-fold higher in children with a previous lung disease and was 4-fold higher when the distance from the chlorine source was less than 40 m. All cases recovered completely, except one who had a history of asthma. PMID:18579056

  13. Mycoplasma pneumoniae preceding Lemierre's syndrome due to Fusobacterium nucleatum complicated by acute Epstein-Barr virus (EBV) infectious mononucleosis in an immunocompetent host.

    PubMed

    Klein, Natalie C; Petelin, Andrew; Cunha, Burke A

    2013-01-01

    We report an unusual case of Lemierre's syndrome due to a rare species of Fusobacterium, that is, Fusobacterium nucleatum preceded by Mycoplasma pneumoniae pharyngitis and followed later by Epstein-Barr virus infectious mononucleosis. PMID:22464641

  14. Assessment of Worldwide Acute Kidney Injury, Renal Angina and Epidemiology in Critically Ill Children (AWARE): A Prospective Study to Improve Diagnostic Precision

    PubMed Central

    Basu, Rajit K; Kaddourah, Ahmad; Terrell, Tara; Mottes, Theresa; Arnold, Patricia; Jacobs, Judd; Andringa, Jennifer; Armor, Melissa; Hayden, Lauren; Goldstein, Stuart L

    2015-01-01

    Background Acute kidney injury (AKI) is associated with poor outcomes in critically ill children. Recent international consensus panels recommend standardized classification systems to improve the precision of AKI diagnosis, but there is a paucity of data to enable this refinement, particularly in pediatric critical care. Methods/Design This is a prospective observational study. We anticipate collecting data from more than 5500 critically ill children admitted to 32 pediatric intensive care units (PICUs) across the world, during the calendar year of 2014. Data will be collected continuously for three months at each center on all children older than 90 days and younger than 25 years admitted to the ICU. Demographic, resuscitative, and daily physiological and lab data will be captured at individual centers using MediData Rave™, a commercial system designed to manage and report clinical research data. Kidney specific measured variables include changes in serum creatinine and urine output, cumulative fluid overload (%), serum creatinine corrected for fluid balance, and KDIGO AKI stage. Urinary AKI biomarkers to be measured include: urinary neutrophil gelatinase lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver-type fatty acid binding protein (l-FABP), and interleukin-18 (IL-18). Biomarker combinations will be created from different pairs and triplets of urinary biomarkers. The primary analysis will compare the discrimination of these panels versus changes in creatinine for prediction of severe AKI by Day 7 of ICU admission. Secondary analysis will investigate the prediction of biomarkers for injury ‘time based phenotypes’: duration (>2 days), severity (KDIGO stage, use of renal replacement therapy), reversibility (time to return of serum creatinine to baseline), association with fluid overload > 10%, and disease association (sepsis, hypovolemia, hypoxemia, or nephrotoxic). Discussion The Assessment of Worldwide Acute Kidney Injury, Renal Angina and

  15. Detection of viral and bacterial pathogens in hospitalized children with acute respiratory illnesses, Chongqing, 2009-2013.

    PubMed

    Wei, Lan; Liu, Wei; Zhang, Xiao-Ai; Liu, En-Mei; Wo, Yin; Cowling, Benjamin J; Cao, Wu-Chun

    2015-04-01

    Acute respiratory infections (ARIs) cause large disease burden each year. The codetection of viral and bacterial pathogens is quite common; however, the significance for clinical severity remains controversial. We aimed to identify viruses and bacteria in hospitalized children with ARI and the impact of mixed detections.Hospitalized children with ARI aged ≤16 were recruited from 2009 to 2013 at the Children's Hospital of Chongqing Medical University, Chongqing, China. Nasopharyngeal aspirates (NPAs) were collected for detection of common respiratory viruses by reverse transcription polymerase chain reaction (RT-PCR) or PCR. Bacteria were isolated from NPAs by routine culture methods. Detection and codetection frequencies and clinical features and severity were compared.Of the 3181 hospitalized children, 2375 (74.7%) were detected with ≥1 virus and 707 (22.2%) with ≥1 bacteria, 901 (28.3%) with ≥2 viruses, 57 (1.8%) with ≥2 bacteria, and 542 (17.0%) with both virus and bacteria. The most frequently detected were Streptococcus pneumoniae, respiratory syncytial virus, parainfluenza virus, and influenza virus. Clinical characteristics were similar among different pathogen infections for older group (≥6 years old), with some significant difference for the younger. Cases with any codetection were more likely to present with fever; those with ≥2 virus detections had higher prevalence of cough; cases with virus and bacteria codetection were more likely to have cough and sputum. No significant difference in the risk of pneumonia, severe pneumonia, and intensive care unit admission were found for any codetection than monodetection.There was a high codetection rate of common respiratory pathogens among hospitalized pediatric ARI cases, with fever as a significant predictor. Cases with codetection showed no significant difference in severity than those with single pathogens. PMID:25906103

  16. Acute cerebellar ataxia

    MedlinePlus

    Cerebellar ataxia; Ataxia - acute cerebellar; Cerebellitis; Post-varicella acute cerebellar ataxia; PVACA ... Acute cerebellar ataxia in children, especially younger than age 3, may occur several weeks after an illness caused by a virus. ...

  17. Burden, seasonal pattern and symptomatology of acute respiratory illnesses with different viral aetiologies in children presenting at outpatient clinics in Hong Kong.

    PubMed

    Wei, L; Chan, K-H; Ip, D K M; Fang, V J; Fung, R O P; Leung, G M; Peiris, M J S; Cowling, B J

    2015-09-01

    Respiratory viruses cause acute respiratory diseases with a broad and overlapping spectrum of symptoms. We examined the clinical symptoms and explored the patterns of various respiratory viral infections in children in Hong Kong. Among 2090 specimens collected from outpatient care (2007-2010), 1343 (64.3%) were positive for any virus by the xTAG assay, and 81 (3.9%) were positive for co-infection. The most frequently detected viruses among children aged 6-15 years were enterovirus/rhinovirus and influenza virus A, whereas most non-influenza viruses were more frequently detected in younger children. Higher body temperature was more common for illnesses associated with influenza viruses than for those associated with non-influenza viruses, but other symptoms were largely similar across all infections. The seasonality pattern varied among different viruses, with influenza virus A being the predominant virus detected in winter, and enterovirus/rhinovirus being more commonly detected than influenza virus A in the other three seasons, except for 2009. PMID:26033670

  18. Post-infectious disease syndrome.

    PubMed Central

    Bannister, B. A.

    1988-01-01

    Many post-infectious syndromes have been recognized in the last 50 years, some following viral infections and others closely related to bacterial disease. The occurrence of prolonged fatigue following an apparent viral illness of varying severity is also well documented. The lack of a recognizable precipitating cause and the tendency for epidemic fatigue to occur among hospital staff led many to believe that the illness may be psychogenic in origin. However, there is serological evidence that some cases may follow enterovirus infections or occasionally delayed convalescence from infectious mononucleosis. Much interesting work is currently in progress relating fatigue to persisting immunological abnormalities, and the development of molecular immunology makes this a most exciting field of research. This paper reviews the evidence for and against a definitive post-viral fatigue syndrome and examines the results of research carried out in the last 50 years. PMID:3074289

  19. Towards the Burden of Human Leptospirosis: Duration of Acute Illness and Occurrence of Post-Leptospirosis Symptoms of Patients in The Netherlands

    PubMed Central

    Straetemans, Masja; Alba, Sandra; Goeijenbier, Marco; van Gorp, Eric C. M.; Boer, Kimberly R.; Wagenaar, Jiri F. P.; Hartskeerl, Rudy A.

    2013-01-01

    Background Leptospirosis is a global zoonotic disease. Although important for the assessment of the burden of leptospirosis, data on the duration of the illness and the occurrence of post-leptospirosis complaints are not well documented. Hence the main objective of this study was to estimate the occurrence of persistent complaints and duration of hospital stay in laboratory confirmed leptospirosis patients in the Netherlands during 1985 to 2010. Additionally, several risk factors potentially impacting on the occurrence of post-leptospirosis complaints were investigated. Methods/Principal Findings The duration of the acute phase of leptospirosis was 16 days (IQR 12–23); 10 days (IQR 7–16) were spent hospitalized. Eighteen fatal cases were excluded from this analysis. Complaints of leptospirosis patients by passive case investigations (CPC) derived from files on ambulant consultations occurring one month after hospital discharge, revealed persistent complaints in 108 of 236 (45.8%) laboratory confirmed cases. Data on persistent complaints after acute leptospirosis (PCAC), assessed in 225 laboratory confirmed leptospirosis cases collected through questionnaires during 1985-1993, indicated 68 (30.2%) PCAC cases. Frequently reported complaints included (extreme) fatigue, myalgia, malaise, headache, and a weak physical condition. These complaints prolonged in 21.1% of the cases beyond 24 months after onset of disease. There was no association between post-leptospirosis complaints and hospitalization. However, individuals admitted at the intensive care unit (ICU) were twice as likely to have continuing complaints after discharge adjusting for age and dialysis (OR 2.0 95% CI 0.8-4.8). No significant association could be found between prolongation of complaints and infecting serogroup, although subgroup analysis suggest that infection with serogroups Sejroe (OR 4.8, 95%CI 0.9-27.0) and icterohaemorrhagiae (OR 2.0, 95%CI 0.9-4.3 CI) are more likely to result in CPC than

  20. After 2015: infectious diseases in a new era of health and development

    PubMed Central

    Dye, Christopher

    2014-01-01

    Running over timescales that span decades or centuries, the epidemiological transition provides the central narrative of global health. In this transition, a reduction in mortality is followed by a reduction in fertility, creating larger, older populations in which the main causes of illness and death are no longer acute infections of children but chronic diseases of adults. Since the year 2000, the Millennium Development Goals (MDGs) have provided a framework for accelerating the decline of infectious diseases, backed by a massive injection of foreign investment to low-income countries. Despite the successes of the MDGs era, the inhabitants of low-income countries still suffer an enormous burden of disease owing to diarrhoea, pneumonia, HIV/AIDS, tuberculosis, malaria and other pathogens. Adding to the predictable burden of endemic disease, the threat of pandemics is ever-present and global. With a view to the future, this review spotlights five aspects of the fight against infection beyond 2015, when the MDGs will be replaced by a new set of goals for poverty reduction and sustainable development. These aspects are: exploiting the biological links between infectious and non-infectious diseases; controlling infections among the new urban majority; enhancing the response to international health threats; expanding childhood immunization programmes to prevent acute and chronic diseases in adults; and working towards universal health coverage. By scanning the wider horizon now, infectious disease specialists have the chance to shape the post-2015 era of health and development. PMID:24821913

  1. Avian infectious laryngotracheitis.

    PubMed

    Bagust, T J; Jones, R C; Guy, J S

    2000-08-01

    Avian infectious laryngotracheitis (ILT) herpesvirus continues to cause sporadic cases of respiratory disease in chickens world-wide. Sources of transmission of ILT infection are three-fold, namely: chickens with acute upper respiratory tract disease, latently infected 'carrier' fowls which excrete infectious laryngotracheitis virus (ILTV) when stressed, and all fomites (inanimate articles as well as the personnel in contact with infected chickens). Infectious laryngotracheitis virus infectivity can persist for weeks to months in tracheal mucus or carcasses. Rigorous site biosecurity is therefore critical in ILT disease control. Furthermore, while current (modified live) ILT vaccines can offer good protection, the strains of ILTV used in vaccines can also produce latent infections, as well as ILT disease following bird-to-bird spread. The regional nature of reservoirs of ILTV-infected flocks will tend to interact unfavourably with widely varying ILT control practices in the poultry industry, so as to periodically result in sporadic and unexpected outbreaks of ILT in intensive poultry industry populations. Precautions for trade-related movements of chickens of all ages must therefore include an accurate knowledge of the ILT infection status, both of the donor and recipient flocks. PMID:10935275

  2. Prospective surveillance study of acute respiratory infections, influenza-like illness and seasonal influenza vaccine in a cohort of juvenile idiopathic arthritis patients

    PubMed Central

    2013-01-01

    Background Acute respiratory infections (ARI) are frequent in children and complications can occur in patients with chronic diseases. We evaluated the frequency and impact of ARI and influenza-like illness (ILI) episodes on disease activity, and the immunogenicity and safety of influenza vaccine in a cohort of juvenile idiopathic arthritis (JIA) patients. Methods Surveillance of respiratory viruses was conducted in JIA patients during ARI season (March to August) in two consecutive years: 2007 (61 patients) and 2008 (63 patients). Patients with ARI or ILI had respiratory samples collected for virus detection by real time PCR. In 2008, 44 patients were immunized with influenza vaccine. JIA activity index (ACRPed30) was assessed during both surveillance periods. Influenza hemagglutination inhibition antibody titers were measured before and 30-40 days after vaccination. Results During the study period 105 ARI episodes were reported and 26.6% of them were ILI. Of 33 samples collected, 60% were positive for at least one virus. Influenza and rhinovirus were the most frequently detected, in 30% of the samples. Of the 50 JIA flares observed, 20% were temporally associated to ARI. Influenza seroprotection rates were higher than 70% (91-100%) for all strains, and seroconversion rates exceeded 40% (74-93%). In general, response to influenza vaccine was not influenced by therapy or disease activity, but patients using anti-TNF alpha drugs presented lower seroconversion to H1N1 strain. No significant differences were found in ACRPed30 after vaccination and no patient reported ILI for 6 months after vaccination. Conclusion ARI episodes are relatively frequent in JIA patients and may have a role triggering JIA flares. Trivalent split influenza vaccine seems to be immunogenic and safe in JIA patients. PMID:23510667

  3. Pilot Study of the Pharmacokinetics of Cefotaxime in Critically Ill Patients with Acute Kidney Injury Treated with Continuous Renal Replacement Therapy.

    PubMed

    Koedijk, Joost B; Valk-Swinkels, Corinne G H; Rijpstra, Tom A; Touw, Daan J; Mulder, Paul G H; van der Voort, Peter H J; van 't Veer, Nils E; van der Meer, Nardo J M

    2016-06-01

    The objective of this study was to describe the pharmacokinetics of cefotaxime (CTX) in critically ill patients with acute kidney injury (AKI) when treated with continuous renal replacement therapy (CRRT) in the intensive care unit (ICU). This single-center prospective observational pilot study was performed among ICU-patients with AKI receiving ≥48 h concomitant CRRT and CTX. CTX was administered intravenously 1,000 mg (bolus) every 6 h for 4 days. CRRT was performed as continuous venovenous hemofiltration (CVVH). Plasma concentrations of CTX and its active metabolite desacetylcefotaxime (DAC) were measured during CVVH treatment. CTX plasma levels and patient data were used to construct concentration-time curves. By using this data, the duration of plasma levels above 4 mg/liter (four times the MIC) was calculated and analyzed. Twenty-seven patients were included. The median CTX peak level was 55 mg/liter (range, 19 to 98 mg/liter), the median CTX trough level was 12 mg/liter (range, 0.8 to 37 mg/liter), and the median DAC plasma level was 15 mg/liter (range, 1.5 to 48 mg/liter). Five patients (19%) had CTX plasma levels below 4 mg/liter at certain time points during treatment. In at least 83% of the time any patient was treated with CTX, the CTX plasma level stayed above 4 mg/liter. A dosing regimen of 1,000 mg of CTX given four times daily is likely to achieve adequate plasma levels in patients with AKI treated with CVVH. Dose reduction might be a risk for suboptimal treatment. PMID:27021325

  4. Development of a TaqMan Array Card for Acute-Febrile-Illness Outbreak Investigation and Surveillance of Emerging Pathogens, Including Ebola Virus.

    PubMed

    Liu, Jie; Ochieng, Caroline; Wiersma, Steve; Ströher, Ute; Towner, Jonathan S; Whitmer, Shannon; Nichol, Stuart T; Moore, Christopher C; Kersh, Gilbert J; Kato, Cecilia; Sexton, Christopher; Petersen, Jeannine; Massung, Robert; Hercik, Christine; Crump, John A; Kibiki, Gibson; Maro, Athanasia; Mujaga, Buliga; Gratz, Jean; Jacob, Shevin T; Banura, Patrick; Scheld, W Michael; Juma, Bonventure; Onyango, Clayton O; Montgomery, Joel M; Houpt, Eric; Fields, Barry

    2016-01-01

    Acute febrile illness (AFI) is associated with substantial morbidity and mortality worldwide, yet an etiologic agent is often not identified. Convalescent-phase serology is impractical, blood culture is slow, and many pathogens are fastidious or impossible to cultivate. We developed a real-time PCR-based TaqMan array card (TAC) that can test six to eight samples within 2.5 h from sample to results and can simultaneously detect 26 AFI-associated organisms, including 15 viruses (chikungunya, Crimean-Congo hemorrhagic fever [CCHF] virus, dengue, Ebola virus, Bundibugyo virus, Sudan virus, hantaviruses [Hantaan and Seoul], hepatitis E, Marburg, Nipah virus, o'nyong-nyong virus, Rift Valley fever virus, West Nile virus, and yellow fever virus), 8 bacteria (Bartonella spp., Brucella spp., Coxiella burnetii, Leptospira spp., Rickettsia spp., Salmonella enterica and Salmonella enterica serovar Typhi, and Yersinia pestis), and 3 protozoa (Leishmania spp., Plasmodium spp., and Trypanosoma brucei). Two extrinsic controls (phocine herpesvirus 1 and bacteriophage MS2) were included to ensure extraction and amplification efficiency. Analytical validation was performed on spiked specimens for linearity, intra-assay precision, interassay precision, limit of detection, and specificity. The performance of the card on clinical specimens was evaluated with 1,050 blood samples by comparison to the individual real-time PCR assays, and the TAC exhibited an overall 88% (278/315; 95% confidence interval [CI], 84% to 92%) sensitivity and a 99% (5,261/5,326, 98% to 99%) specificity. This TaqMan array card can be used in field settings as a rapid screen for outbreak investigation or for the surveillance of pathogens, including Ebola virus. PMID:26491176

  5. Development of a TaqMan Array Card for Acute-Febrile-Illness Outbreak Investigation and Surveillance of Emerging Pathogens, Including Ebola Virus

    PubMed Central

    Liu, Jie; Ochieng, Caroline; Wiersma, Steve; Ströher, Ute; Towner, Jonathan S.; Whitmer, Shannon; Nichol, Stuart T.; Moore, Christopher C.; Kersh, Gilbert J.; Kato, Cecilia; Sexton, Christopher; Petersen, Jeannine; Massung, Robert; Hercik, Christine; Crump, John A.; Kibiki, Gibson; Maro, Athanasia; Mujaga, Buliga; Gratz, Jean; Jacob, Shevin T.; Banura, Patrick; Scheld, W. Michael; Juma, Bonventure; Onyango, Clayton O.; Montgomery, Joel M.

    2015-01-01

    Acute febrile illness (AFI) is associated with substantial morbidity and mortality worldwide, yet an etiologic agent is often not identified. Convalescent-phase serology is impractical, blood culture is slow, and many pathogens are fastidious or impossible to cultivate. We developed a real-time PCR-based TaqMan array card (TAC) that can test six to eight samples within 2.5 h from sample to results and can simultaneously detect 26 AFI-associated organisms, including 15 viruses (chikungunya, Crimean-Congo hemorrhagic fever [CCHF] virus, dengue, Ebola virus, Bundibugyo virus, Sudan virus, hantaviruses [Hantaan and Seoul], hepatitis E, Marburg, Nipah virus, o'nyong-nyong virus, Rift Valley fever virus, West Nile virus, and yellow fever virus), 8 bacteria (Bartonella spp., Brucella spp., Coxiella burnetii, Leptospira spp., Rickettsia spp., Salmonella enterica and Salmonella enterica serovar Typhi, and Yersinia pestis), and 3 protozoa (Leishmania spp., Plasmodium spp., and Trypanosoma brucei). Two extrinsic controls (phocine herpesvirus 1 and bacteriophage MS2) were included to ensure extraction and amplification efficiency. Analytical validation was performed on spiked specimens for linearity, intra-assay precision, interassay precision, limit of detection, and specificity. The performance of the card on clinical specimens was evaluated with 1,050 blood samples by comparison to the individual real-time PCR assays, and the TAC exhibited an overall 88% (278/315; 95% confidence interval [CI], 84% to 92%) sensitivity and a 99% (5,261/5,326, 98% to 99%) specificity. This TaqMan array card can be used in field settings as a rapid screen for outbreak investigation or for the surveillance of pathogens, including Ebola virus. PMID:26491176

  6. Hemodynamic variables and progression of acute kidney injury in critically ill patients with severe sepsis: data from the prospective observational FINNAKI study

    PubMed Central

    2013-01-01

    Introduction Knowledge of the association of hemodynamics with progression of septic acute kidney injury (AKI) is limited. However, some recent data suggest that mean arterial pressure (MAP) exceeding current guidelines (60–65 mmHg) may be needed to prevent AKI. We hypothesized that higher MAP during the first 24 hours in the intensive care unit (ICU), would be associated with a lower risk of progression of AKI in patients with severe sepsis. Methods We identified 423 patients with severe sepsis and electronically recorded continuous hemodynamic data in the prospective observational FINNAKI study. The primary endpoint was progression of AKI within the first 5 days of ICU admission defined as new onset or worsening of AKI by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. We evaluated the association of hemodynamic variables with this endpoint. We included 53724 10-minute medians of MAP in the analysis. We analysed the ability of time-adjusted MAP to predict progression of AKI by receiver operating characteristic (ROC) analysis. Results Of 423 patients, 153 (36.2%) had progression of AKI. Patients with progression of AKI had significantly lower time-adjusted MAP, 74.4 mmHg [68.3-80.8], than those without progression, 78.6 mmHg [72.9-85.4], P < 0.001. A cut-off value of 73 mmHg for time-adjusted MAP best predicted the progression of AKI. Chronic kidney disease, higher lactate, higher dose of furosemide, use of dobutamine and time-adjusted MAP below 73 mmHg were independent predictors of progression of AKI. Conclusions The findings of this large prospective multicenter observational study suggest that hypotensive episodes (MAP under 73 mmHg) are associated with progression of AKI in critically ill patients with severe sepsis. PMID:24330815

  7. Enhanced risk of illness during the 1918 influenza pandemic after previous influenza-like illnesses in three military populations.

    PubMed

    Shanks, G D; Burroughs, S A; Sohn, J D; Waters, N C; Smith, V F; Waller, M; Brundage, J F

    2016-07-01

    The reasons for the unprecedented mortality during the 1918 influenza pandemic remain poorly understood. We examined morbidity records from three military cohorts from years prior to and during the 1918 pandemic period to assess the effects of previous respiratory illnesses on experiences during the pandemic. Clinical registers and morbidity lists were examined to identify all medical encounters for acute respiratory illnesses in students at two U.S. military officer training academies and Australian soldiers deployed in Europe. Influenza-like illness prior to the major pandemic wave of 1918 predisposed Australian soldiers [relative risk (RR) 1·37, 95% confidence interval (CI) 1·18-1·60, P < 0·0001] and US officer trainees at West Point (RR 3·10, 95% CI 2·13-4·52, P < 0·0001) and Annapolis (RR 2·03, 95% CI 1·65-2·50, P < 0·0001) to increased risks of medically treated illnesses in late 1918. The findings suggest that susceptibility to and/or clinical expressions of the 1918 pandemic influenza virus depended on previous experiences with respiratory infectious agents. The findings are consistent with observations during the 2009 pandemic in Canada and may reflect antibody-dependent enhancement of influenza infection. PMID:26957052

  8. The microbiome and critical illness.

    PubMed

    Dickson, Robert P

    2016-01-01

    The central role of the microbiome in critical illness is supported by a half century of experimental and clinical study. The physiological effects of critical illness and the clinical interventions of intensive care substantially alter the microbiome. In turn, the microbiome predicts patients' susceptibility to disease, and manipulation of the microbiome has prevented or modulated critical illness in animal models and clinical trials. This Review surveys the microbial ecology of critically ill patients, presents the facts and unanswered questions surrounding gut-derived sepsis, and explores the radically altered ecosystem of the injured alveolus. The revolution in culture-independent microbiology has provided the tools needed to target the microbiome rationally for the prevention and treatment of critical illness, holding great promise to improve the acute and chronic outcomes of the critically ill. PMID:26700442

  9. Acute and persistent diarrhea.

    PubMed

    Grimwood, Keith; Forbes, David A

    2009-12-01

    Socially disadvantaged Indigenous infants and children living in western industrialized countries experience high rates of infectious diarrhea, no more so than Aboriginal children from remote and rural regions of Northern Australia. Diarrheal disease, poor nutrition, and intestinal enteropathy reflect household crowding, inadequate water and poor sanitation and hygiene. Acute episodes of watery diarrhea are often best managed by oral glucose-electrolyte solutions with continuation of breastfeeding and early reintroduction of feeding. Selective use of lactose-free milk formula, short-term zinc supplementation and antibiotics may be necessary for ill children with poor nutrition, persistent symptoms, or dysentery. Education, high standards of environmental hygiene, breastfeeding, and immunization with newly licensed rotavirus vaccines are all needed to reduce the unacceptably high burden of diarrheal disease encountered in young children from Indigenous communities. PMID:19962025

  10. Travel and migration associated infectious diseases morbidity in Europe, 2008

    PubMed Central

    2010-01-01

    Background Europeans represent the majority of international travellers and clinicians encountering returned patients have an essential role in recognizing, and communicating travel-associated public health risks. Methods To investigate the morbidity of travel associated infectious diseases in European travellers, we analysed diagnoses with demographic, clinical and travel-related predictors of disease, in 6957 ill returned travellers who presented in 2008 to EuroTravNet centres with a presumed travel associated condition. Results Gastro-intestinal (GI) diseases accounted for 33% of illnesses, followed by febrile systemic illnesses (20%), dermatological conditions (12%) and respiratory illnesses (8%). There were 3 deaths recorded; a sepsis caused by Escherichia coli pyelonephritis, a dengue shock syndrome and a Plasmodium falciparum malaria. GI conditions included bacterial acute diarrhea (6.9%), as well as giardiasis and amebasis (2.3%). Among febrile systemic illnesses with identified pathogens, malaria (5.4%) accounted for most cases followed by dengue (1.9%) and others including chikungunya, rickettsial diseases, leptospirosis, brucellosis, Epstein Barr virus infections, tick-borne encephalitis (TBE) and viral hepatitis. Dermatological conditions were dominated by bacterial infections, arthropod bites, cutaneous larva migrans and animal bites requiring rabies post-exposure prophylaxis and also leishmaniasis, myasis, tungiasis and one case of leprosy. Respiratory illness included 112 cases of tuberculosis including cases of multi-drug resistant or extensively drug resistant tuberculosis, 104 cases of influenza like illness, and 5 cases of Legionnaires disease. Sexually transmitted infections (STI) accounted for 0.6% of total diagnoses and included HIV infection and syphilis. A total of 165 cases of potentially vaccine preventable diseases were reported. Purpose of travel and destination specific risk factors was identified for several diagnoses such as Chagas

  11. Development and validation of the Thai version of the 4 ‘A’s Test for delirium screening in hospitalized elderly patients with acute medical illnesses

    PubMed Central

    Kuladee, Sanchai; Prachason, Thanavadee

    2016-01-01

    Background The English version of the 4 ‘A’s Test (4AT) is a rapid screening tool for delirium with a high sensitivity and specificity among hospitalized elderly patients. Objective To develop the Thai version of the 4AT (4AT-T) and assess its validity. Subjects and setting A total of 97 elderly patients aged 60 years or above who were admitted to the general medical wards were included. Methods Both authors independently translated the English version of the 4AT into Thai and thereafter developed a single reconciled forward translation by consensus. Back translation was performed by a bilingual native English speaker and it was then reviewed to ensure its agreement with the original one. After 24 hours of admission, subjects were enrolled and clinical data collected. Definite diagnosis of delirium was made by a psychiatrist using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text-Revision criteria and the 6-item Thai Delirium Rating Scale; the 4AT was then administered to participants by nurses within 30 minutes. A 4AT score ≥4 was considered positive for delirium screening. The optimal cut-off point of the 4AT-T was identified by Youden’s index. Results In all, 24 out of 97 participants met the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text-Revision criteria for delirium. At a cut-off score of 4 or greater, the 4AT-T exhibited satisfactory diagnostic performance with a sensitivity of 83.3% (95% confidence interval (CI): 62.6%–95.3%) and specificity of 86.3% (95% CI: 76.3%–93.2%). The area under the receiver operating characteristic curve was 0.92. The specified score provided maximal Youden’s index, suggesting an optimal criterion value for delirium screening. Conclusion The 4AT-T is a valid delirium-screening instrument for hospitalized elderly patients with acute medical illnesses. PMID:26966365

  12. Determinants of Calcium Infusion Rate During Continuous Veno-venous Hemofiltration with Regional Citrate Anticoagulation in Critically Ill Patients with Acute Kidney Injury

    PubMed Central

    Liu, De-Lin; Huang, Li-Feng; Ma, Wen-Liang; Ding, Qi; Han, Yue; Zheng, Yue; Li, Wen-Xiong

    2016-01-01

    Background: It is unclear that how to decide the calcium infusion rate during continuous veno-venous hemofiltration (CVVH) with regional citrate anticoagulation (RCA). This study aimed to assess the determinants of calcium infusion rate during CVVH with RCA in critically ill patients with acute kidney injury (AKI). Methods: A total of 18 patients with AKI requiring CVVH were prospectively analyzed. Postdilution CVVH was performed with a fixed blood flow rate of 150 ml/min and a replacement fluid flow rate of 2000 ml/h for each new circuit. The infusion of 4% trisodium citrate was started at a rate of 29.9 mmol/h prefilter and adjusted according to postfilter ionized calcium. The infusion of 10% calcium gluconate was initiated at a rate of 5.5 mmol/h and adjusted according to systemic ionized calcium. The infusion rate of trisodium citrate and calcium gluconate as well as ultrafiltrate flow rate were recorded at 1, 2, 4, 6, 12, and 24 h after starting CVVH, respectively. The calcium loss rate by CVVH was also calculated. Results: Fifty-seven sessions of CVVH were performed in 18 AKI patients. The citrate infusion rate, calcium loss rate by CVVH, and calcium infusion rate were 31.30 (interquartile range: 2.70), 4.60 ± 0.48, and 5.50 ± 0.35 mmol/h, respectively. The calcium infusion rate was significantly higher than that of calcium loss rate by CVVH (P < 0.01). The correlation coefficient between the calcium and citrate infusion rates, and calcium infusion and calcium loss rates by CVVH was −0.031 (P > 0.05) and 0.932 (P < 0.01), respectively. In addition, calcium infusion rate (mmol/h) = 1.77 + 0.8 × (calcium loss rate by CVVH, mmol/h). Conclusions: The calcium infusion rate correlates significantly with the calcium loss rate by CVVH but not with the citrate infusion rate in a fixed blood flow rate during CVVH with RCA. PMID:27411455

  13. Epidemiology of Severe Acute Respiratory Illness (SARI) among Adults and Children Aged ≥5 Years in a High HIV-Prevalence Setting, 2009–2012

    PubMed Central

    Cohen, Cheryl; Walaza, Sibongile; Moyes, Jocelyn; Groome, Michelle; Tempia, Stefano; Pretorius, Marthi; Hellferscee, Orienka; Dawood, Halima; Haffejee, Summaya; Variava, Ebrahim; Kahn, Kathleen; Tshangela, Akhona; von Gottberg, Anne; Wolter, Nicole; Cohen, Adam L.; Kgokong, Babatyi; Venter, Marietjie; Madhi, Shabir A.

    2015-01-01

    Objective There are few published studies describing severe acute respiratory illness (SARI) epidemiology amongst older children and adults from high HIV-prevalence settings. We aimed to describe SARI epidemiology amongst individuals aged ≥5 years in South Africa. Methods We conducted prospective surveillance for individuals with SARI from 2009–2012. Using polymerase chain reaction, respiratory samples were tested for ten viruses, and blood for pneumococcal DNA. Cumulative annual SARI incidence was estimated at one site with population denominators. Findings We enrolled 7193 individuals, 9% (621/7067) tested positive for influenza and 9% (600/6519) for pneumococcus. HIV-prevalence was 74% (4663/6334). Among HIV-infected individuals with available data, 41% of 2629 were receiving antiretroviral therapy (ART). The annual SARI hospitalisation incidence ranged from 325-617/100,000 population. HIV-infected individuals experienced a 13–19 times greater SARI incidence than HIV-uninfected individuals (p<0.001). On multivariable analysis, compared to HIV-uninfected individuals, HIV-infected individuals were more likely to be receiving tuberculosis treatment (odds ratio (OR):1.7; 95%CI:1.1–2.7), have pneumococcal infection (OR 2.4; 95%CI:1.7–3.3) be hospitalised for >7 days rather than <2 days (OR1.7; 95%CI:1.2–2.2) and had a higher case-fatality ratio (8% vs 5%;OR1.7; 95%CI:1.2–2.3), but were less likely to be infected with influenza (OR 0.6; 95%CI:0.5–0.8). On multivariable analysis, independent risk indicators associated with death included HIV infection (OR 1.8;95%CI:1.3–2.4), increasing age-group, receiving mechanical ventilation (OR 6.5; 95%CI:1.3–32.0) and supplemental-oxygen therapy (OR 2.6; 95%CI:2.1–3.2). Conclusion The burden of hospitalized SARI amongst individuals aged ≥5 years is high in South Africa. HIV-infected individuals are the most important risk group for SARI hospitalization and mortality in this setting. PMID:25706880

  14. The association between farming activities, precipitation, and the risk of acute gastrointestinal illness in rural municipalities of Quebec, Canada: a cross-sectional study

    PubMed Central

    2010-01-01

    Background Increasing livestock density and animal manure spreading, along with climate factors such as heavy rainfall, may increase the risk of acute gastrointestinal illness (AGI). In this study we evaluated the association between farming activities, precipitation and AGI. Methods A cross-sectional telephone survey of randomly selected residents (n = 7006) of 54 rural municipalities in Quebec, Canada, was conducted between April 2007 and April 2008. AGI symptoms and several risk factors were investigated using a phone questionnaire. We calculated the monthly prevalence of AGI, and used multivariate logistic regression, adjusting for several demographic and risk factors, to evaluate the associations between AGI and both intensive farming activities and cumulative weekly precipitation. Cumulative precipitation over each week, from the first to sixth week prior to the onset of AGI, was analyzed to account for both the delayed effect of precipitation on AGI, and the incubation period of causal pathogens. Cumulative precipitation was treated as a four-category variable: high (≥90th percentile), moderate (50th to <90th percentile), low (10th to <50th percentile), and very low (<10th percentile) precipitation. Results The overall monthly prevalence of AGI was 5.6% (95% CI 5.0%-6.1%), peaking in winter and spring, and in children 0-4 years old. Living in a territory with intensive farming was negatively associated with AGI: adjusted odds ratio (OR) = 0.70 (95% CI 0.51-0.96). Compared to low precipitation periods, high precipitation periods in the fall (September, October, November) increased the risk of AGI three weeks later (OR = 2.20; 95% CI 1.09-4.44) while very low precipitation periods in the summer (June, July, August) increased the risk of AGI four weeks later (OR = 2.19; 95% CI 1.02-4.71). Further analysis supports the role of water source on the risk of AGI. Conclusions AGI poses a significant burden in Quebec rural municipalities with a peak in winter

  15. Foodborne Illness

    MedlinePlus

    ... people in the U.S. get sick from contaminated food. Common culprits include bacteria, parasites and viruses. Symptoms ... are the most common cause of foodborne illness. Foods may have some bacteria on them when you ...

  16. Heat Illness

    MedlinePlus

    ... high humidity, sweating just isn't enough. Your body temperature can rise to dangerous levels and you can ... include Heatstroke - a life-threatening illness in which body temperature may rise above 106° F in minutes; symptoms ...

  17. Foodborne Illnesses

    MedlinePlus

    ... Some parasites and chemicals also cause foodborne illnesses. Bacteria Bacteria are tiny organisms that can cause infections of the GI tract. Not all bacteria are harmful to humans. Some harmful bacteria may ...

  18. Heat Illness

    MedlinePlus

    ... humidity, sweating just isn't enough. Your body temperature can rise to dangerous levels and you can ... Heatstroke - a life-threatening illness in which body temperature may rise above 106° F in minutes; symptoms ...

  19. The Liver in Critical Illness.

    PubMed

    Damm, Tessa W; Kramer, David J

    2016-07-01

    Caring for critically ill patients with acute and/or chronic liver dysfunction poses a unique challenge. Proper resuscitation and early consideration for transfer to liver transplant centers have resulted in improved outcomes. Liver support devices and cellular models have not yet shown mortality benefit, but they hold promise in the critical care of patients with liver disease. This article reviews pertinent anatomic and physiologic considerations of the liver in critical illness, followed by a selective review of associated organ dysfunction. PMID:27339681

  20. Network Television Evening News Coverage of Infectious Disease Events.

    ERIC Educational Resources Information Center

    Greenberg, Michael; Wartenberg, Daniel

    1990-01-01

    Examines coverage of several infectious diseases and teenage suicide to see whether television news favors covering illness where it clusters or when it occurs near major news centers where it is easier to cover. Finds that television news did go to where the illness broke out but tended to favor reporting urban over rural suicides. (RS)

  1. Febrile Illness with Skin Rashes

    PubMed Central

    2015-01-01

    Skin rashes that appear during febrile illnesses are in fact caused by various infectious diseases. Since infectious exanthematous diseases range from mild infections that disappear naturally to severe infectious diseases, focus on and basic knowledge of these diseases is very important. But, these include non-infectious diseases, so that comprehensive knowledge of these other diseases is required. Usually, early diagnostic testing for a febrile illness with a rash is inefficient. For clinical diagnosis of diseases accompanied by skin rash and fever, a complete history must be taken, including recent travel, contact with animals, medications, and exposure to forests and other natural environments. In addition, time of onset of symptoms and the characteristics of the rash itself (morphology, location, distribution) could be helpful in the clinical diagnosis. It is also critical to understand the patient's history of specific underlying diseases. However, diagnostic basic tests could be helpful in diagnosis if they are repeated and the clinical course is monitored. Generally, skin rashes are nonspecific and self-limited. Therefore, it could be clinically meaningful as a characteristic diagnostic finding in a very small subset of specific diseases. PMID:26483989

  2. A possible association between acute infectious diarrhoea in pregnant women and congenital abnormalities in their offspring--a population-based case-control study.

    PubMed

    Acs, Nándor; Bánhidy, Ferenc; Puhó, Erzsébet H; Czeizel, Andrew E

    2010-05-01

    The possible association between Salmonella gastroenteritis (SGE) and infectious diarrhoea in pregnancy (IDP) and structural birth defects, i.e. congenital abnormalities (CA) in the offspring, has not been studied. The dataset of the Hungarian Case-Control Surveillance of Congenital Abnormalities, 1980-1996 was evaluated. There were 15 (0.07%) and 82 (0.36%) out of 22,843 cases and 23 (0.06%) and 70 (0.18%) out of 38,151 (0.34%) controls with mothers who had medically recorded SGE and IDP, respectively. There was no association of SGE and a higher risk of CA. However, a higher risk of cleft lip +/- palate, congenital limb deficiencies, multiple CAs and cardiovascular CAs was found in the offspring of mothers with IDP. A possible explanation for the association of IDP with higher risk for some specific CAs may be the high fever in IDP. PMID:20100117

  3. Meningoencephalitis-like onset of post-infectious AQP4-IgG-positive optic neuritis complicated by GM1-IgG-positive acute polyneuropathy.

    PubMed

    Benedetti, Luana; Franciotta, Diego; Beronio, Alessandro; Delucchi, Stefano; Capellini, Cesare; Del Sette, Massimo

    2015-02-01

    Fifteen days after a respiratory infection, a 45-year-old woman presented with paresthesias in the hands and feet, bilateral loss of vision, fever, headache, and impairment of consciousness. Magnetic resonance imaging (MRI) showed predominant lesions in the optic tracts, optic chiasm, and hypothalamus. Cerebrospinal fluid analysis revealed elevated protein level, and lymphocytic pleocytosis. Neurophysiological studies disclosed a demyelinating sensorimotor polyneuropathy. Serum anti-Mycoplasma pneumoniae immunoglobulin (Ig)M, anti-GM1 IgG, and anti-AQP4 IgG were positive. This case, which is remarkable for post-infectious meningoencephalitis-like onset, MRI picture, and dysimmunity to central and peripheral nervous system autoantigens, underpins the pivotal diagnostic role of anti-AQP4-IgG, and expands the list of clinico-pathological findings that can associate with neuromyelitis optica spectrum disorders. PMID:24557856

  4. A Study on the Epidemiology and Aetiology of Acute Gastroenteritis in Adult Patients Presenting at the Infectious Diseases Hospital in Tirana, Albania

    PubMed Central

    Stroni, Gentian P.; Dhimolea, Majlinda M.; Pipero, Pëllumb S.; Kraja, Dhimiter V.; Sallavaci, Suela Y.; Bino, Silva F.

    2014-01-01

    Background: Acute gastroenteritis remains a common cause of hospital emergency room visits in Albania. However, the aetiology of severe gastroenteritis leading to hospitalization in adults frequently remains unclear. Aims: Our objective was to study the epidemiology and causes of community-acquired, acute gastroenteritis in adult patients presenting to hospital. Study Design: Cross sectional study. Methods: A prospective study was conducted from January 2010 to January 2012, among patients ≥15 years old with community-acquired gastroenteritis presenting to the emergency room of the University Hospital “Mother Theresa” in Tirana, Albania. Stool samples and rectal swabs were collected from the patients for microbiological testing. Results: The median age of the study patients was 33 (15–88) years and 577 (58%) were females. The median age of males was 35 (15–87) years. The vast majority of cases occurred in urban area (849, 85%), p<0.01. Patients were admitted throughout the year with peak admissions for patients infected by bacterial pathogens in summer and those affected by viral pathogens in autumn. A total of 917 (91.7%) patients underwent a laboratory examination. The overall isolation rate was 51%. Bacterial pathogens were found in 29%, viral pathogens in 19% and protozoal pathogens in 2.5% of patients. No aetiological agent or other cause of acute diarrhoea was found in 449 (49%) patients. Twenty-nine (3.2%) patients were hospitalized. Conclusion: Despite extensive laboratory investigations, enteropathogens were detected in only 51% of adult patients who presented to the hospital ER with acute gastroenteritis. Viral infections ranked as the second most common cause of gastroenteritis in adults. PMID:25625016

  5. Infectious Risks of Air Travel.

    PubMed

    Mangili, Alexandra; Vindenes, Tine; Gendreau, Mark

    2015-10-01

    Infectious diseases are still among the leading causes of death worldwide due to their persistence, emergence, and reemergence. As the recent Ebola virus disease and MERS-CoV outbreaks demonstrate, the modern epidemics and large-scale infectious outbreaks emerge and spread quickly. Air transportation is a major vehicle for the rapid spread and dissemination of communicable diseases, and there have been a number of reported outbreaks of serious airborne diseases aboard commercial flights including tuberculosis, severe acute respiratory syndrome, influenza, smallpox, and measles, to name a few. In 2014 alone, over 3.3 billion passengers (a number equivalent to 42% of the world population) and 50 million metric tons of cargo traveled by air from 41,000 airports and 50,000 routes worldwide, and significant growth is anticipated, with passenger numbers expected to reach 5.9 billion by 2030. Given the increasing numbers of travelers, the risk of infectious disease transmission during air travel is a significant concern, and this chapter focuses on the current knowledge about transmission of infectious diseases in the context of both transmissions within the aircraft passenger cabin and commercial aircraft serving as vehicles of worldwide infection spread. PMID:26542037

  6. Infant Feeding and Illness on an Indian Reservation

    PubMed Central

    Macaulay, Ann C.

    1981-01-01

    In 1978, the prevalence of breast-feeding in Caughnawaga was 45%. This study examined some of the differences between mothers who breast-fed and those who bottle-fed, and documented infectious illnesses in the first year of life. Bottle-fed babies had five times more episodes of infectious illnesses in their first year of life than those babies exclusively breast-fed for three months. PMID:21289747

  7. Teacher led school-based surveillance can allow accurate tracking of emerging infectious diseases - evidence from serial cross-sectional surveys of febrile respiratory illness during the H1N1 2009 influenza pandemic in Singapore

    PubMed Central

    2012-01-01

    Background Schools are important foci of influenza transmission and potential targets for surveillance and interventions. We compared several school-based influenza monitoring systems with clinic-based influenza-like illness (ILI) surveillance, and assessed the variation in illness rates between and within schools. Methods During the initial wave of pandemic H1N1 (pdmH1N1) infections from June to Sept 2009 in Singapore, we collected data on nation-wide laboratory confirmed cases (Sch-LCC) and daily temperature monitoring (Sch-DTM), and teacher-led febrile respiratory illness reporting in 6 sentinel schools (Sch-FRI). Comparisons were made against age-stratified clinic-based influenza-like illness (ILI) data from 23 primary care clinics (GP-ILI) and proportions of ILI testing positive for pdmH1N1 (Lab-ILI) by computing the fraction of cumulative incidence occurring by epidemiological week 30 (when GP-ILI incidence peaked); and cumulative incidence rates between school-based indicators and sero-epidemiological pdmH1N1 incidence (estimated from changes in prevalence of A/California/7/2009 H1N1 hemagglutination inhibition titers ≥ 40 between pre-epidemic and post-epidemic sera). Variation in Sch-FRI rates in the 6 schools was also investigated through a Bayesian hierarchical model. Results By week 30, for primary and secondary school children respectively, 63% and 79% of incidence for Sch-LCC had occurred, compared with 50% and 52% for GP-ILI data, and 48% and 53% for Sch-FRI. There were 1,187 notified cases and 7,588 episodes in the Sch-LCC and Sch-DTM systems; given school enrollment of 485,723 children, this represented 0.24 cases and 1.6 episodes per 100 children respectively. Mean Sch-FRI rate was 28.8 per 100 children (95% CI: 27.7 to 29.9) in the 6 schools. We estimate from serology that 41.8% (95% CI: 30.2% to 55.9%) of primary and 43.2% (95% CI: 28.2% to 60.8%) of secondary school-aged children were infected. Sch-FRI rates were similar across the 6 schools

  8. Influence of pre-existing invasive aspergillosis on allo-HSCT outcome: a retrospective EBMT analysis by the Infectious Diseases and Acute Leukemia Working Parties.

    PubMed

    Penack, O; Tridello, G; Hoek, J; Socié, G; Blaise, D; Passweg, J; Chevallier, P; Craddock, C; Milpied, N; Veelken, H; Maertens, J; Ljungman, P; Cornelissen, J; Thiebaut-Bertrand, A; Lioure, B; Michallet, M; Iacobelli, S; Nagler, A; Mohty, M; Cesaro, S

    2016-03-01

    Historically, invasive aspergillosis (IA) has been a major barrier for allogeneic hematopoietic stem cell transplantation (allo-HSCT). The influence of invasive IA on long-term survival and on transplant-related complications has not been investigated in a larger patient cohort under current conditions. Our aim was to analyze the long-term outcome of patients undergoing allo-HSCT with a history of prior IA. We used European Society for Blood and Marrow Transplantation database data of first allo-HSCTs performed between 2005 and 2010 in patients with acute leukemia. One thousand one hundred and fifty patients with data on IA before allo-HSCT were included in the analysis. The median follow-up time was 52.1 months. We found no significant impact of IA on major transplant outcome variables such as overall survival, relapse-free survival, non-relapse mortality, cumulative incidence of acute GvHD grade II-IV, chronic GvHD, pulmonary complications and leukemia relapse. However, we found a trend toward lower overall survival (P=0.078, hazard ratio (HR) (95% confidence interval (CI)): 1.16 (0.98, 1.36)) and higher non-relapse mortality (P=0.150, HR (95% CI): 1.19 (0.94, 1.50)) in allo-HSCT recipients with pre-existing IA. Our data suggest that a history of IA should not generally be a contraindication when considering the performance of allo-HSCT in patients with acute leukemia. PMID:26501769

  9. Infectious Risks of Traveling Abroad.

    PubMed

    Chen, Lin H; Blair, Barbra M

    2015-08-01

    A popular leisure activity, international travel can be associated with some infections. The most common travel-related illnesses appear to be gastrointestinal, dermatologic, respiratory, and systemic febrile syndromes. The pretravel medical consultation includes immunizations, malaria chemoprophylaxis, self-treatment for traveler's diarrhea, and advice on the prevention of a myriad of other infectious causes including dengue, chikungunya, rickettsiosis, leptospirosis, schistosomiasis, and strongyloidiasis. Travel to locations experiencing outbreaks such as Ebola virus disease, Middle East respiratory syndrome, avian influenza, and chikungunya call for specific alerts on preventive strategies. After travel, evaluation of an ill traveler must explore details of exposure, including destinations visited; activities; ingestion of contaminated food or drinks; contact with vectors, animals, fresh water, or blood and body fluids; and other potential exposures. Knowledge of the geographic distribution of infectious diseases is important in generating the differential diagnoses and testing accordingly. Empiric treatment is sometimes necessary when suspicion of a certain diagnosis is strong and confirmatory tests are delayed or lacking, particularly for infections that are rapidly progressive (for example, malaria) or for which timing of testing is prolonged (such as leptospirosis). PMID:26350325

  10. Observational Research in Childhood Infectious Diseases (ORChID): a dynamic birth cohort study

    PubMed Central

    Lambert, Stephen Bernard; Ware, Robert S; Cook, Anne L; Maguire, Frances A; Whiley, David M; Bialasiewicz, Seweryn; Mackay, Ian M; Wang, David; Sloots, Theo P; Nissen, Michael D; Grimwood, Keith

    2012-01-01

    Introduction Even in developed economies infectious diseases remain the most common cause of illness in early childhood. Our current understanding of the epidemiology of these infections is limited by reliance on data from decades ago performed using low-sensitivity laboratory methods, and recent studies reporting severe, hospital-managed disease. Methods and analysis The Observational Research in Childhood Infectious Diseases (ORChID) study is an ongoing study enrolling a dynamic birth cohort to document the community-based epidemiology of viral respiratory and gastrointestinal infections in early childhood. Women are recruited antenatally, and their healthy newborn is followed for the first 2 years of life. Parents keep a daily symptom diary for the study child, collect a weekly anterior nose swab and dirty nappy swab and complete a burden diary when a child meets pre-defined illness criteria. Specimens will be tested for a wide range of viruses by real-time PCR assays. Primary analyses involves calculating incidence rates for acute respiratory illness (ARI) and acute gastroenteritis (AGE) for the cohort by age and seasonality. Control material from children when they are without symptoms will allow us to determine what proportion of ARIs and AGE can be attributed to specific pathogens. Secondary analyses will assess the incidence and shedding duration of specific respiratory and gastrointestinal pathogens. Ethics and dissemination This study is approved by The Human Research Ethics Committees of the Children's Health Queensland Hospital and Health Service, the Royal Brisbane and Women's Hospital and The University of Queensland. Trial registration clinicaltrials.gov NCT01304914. PMID:23117571

  11. [Comparative study of two antitussive drugs in the treatment of acute dry cough of infectious origin (prospective, randomized, single blind study)].

    PubMed

    Pujet, J C; Keddad, K; Sévenier, F; Jolivet-Landreau, I

    2002-01-01

    The objective was to compare, during a 5-day therapy, the efficacy and tolerability of an antihistaminic antitussive syrup, oxomemazine, combining a small quantity of guaifenesine (T), with a centrally acting antitussive, clobutinol (S), in adult patients aged from 18 to 70 years and presenting with a dry cough of infectious origin. This study was performed by 22 general practitioners and 130 ambulatory patients were enrolled. The primary criterion of this multicenter, randomized, single blind study was to compare the evolution of cough intensity using a Visual Analog Squale (VAS) graduated from 0 to 10 cm. Nine secondary criteria including tolerability were also assessed. With regard to cough intensity, the treatments were not equivalent. A greater reduction was observed with T (-5.2 +/- 2.3 versus -4.3 +/- 2.3). This result was confirmed by a further reduction in cough intensity at days: 2 (p = 0.04), 4 (p = 0.05), and 5 (p = 0.02). The frequency of cough disappearance before the end of the study was significantly greater for T than for S: 46% versus 29% (p = 0.05). The time before disappearance of the cough was 4.0 + 1.1 days for both medicines. Induction of sleep and the frequency of nocturnal wakening were significantly better for T from day 4 (p = 0.02). The drowsiness induced by T meant that diurnal quality of life was better with S on days 1 (p = 0.002) and 2 (p = 0.01). Tolerability was similar for both medicines. In conclusion, as a symptomatic treatment of dry cough, T is efficient and well tolerated. Moreover, we have observed a tendency towards superior efficacy of T than S. T is therefore a useful alternative in the therapeutic armamentarium available to the general practitioner. PMID:12611200

  12. Recombinant bivalent vaccines against infectious laryngotracheitis and Newcastle disease

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Infectious laryngotracheitis (ILT) is a highly contagious acute respiratory disease of chickens caused by infection of infectious laryngotracheitis virus (ILTV). The current commercial ILT vaccines are either not safe or less effective. Therefore, there is a pressing need to develop safer and more...

  13. Febrile Illness in the Athlete

    PubMed Central

    Dick, Natalie A.; Diehl, Jason J.

    2014-01-01

    Context: Acute febrile illnesses are common in athletes over the course of training and competition seasons. Complete recovery and rapid yet safe return to participation are critical for competitive athletes. Alterations in thermoregulation, metabolism, fluid homeostasis, muscle strength, and endurance, as well as potential complications for the athlete and others, must be considered. Evidence Acquisition: The PubMed database was searched (1970-2013) for all English-language articles related to febrile illness in sport, using the keywords fever, febrile, body temperature, thermoregulation, infection, illness, disease, exercise, athlete, sport, performance, return to play, metabolism, hydration, and dehydration. Study Design: Clinical review. Level of Evidence: Level 4. Results: Limited data confirm that febrile illness is correlated with alterations in the body’s thermoregulatory system, with increases in metabolic rate, and with effects in fluid homeostasis. Human and animal studies demonstrate a decrease in muscle strength and endurance secondary to muscle catabolism in febrile illness. However, indirect evidence suggests that regular exercise enhances the immune response. No strong clinical research has been published on return to play during or following acute febrile illness, excluding mononucleosis and myocarditis. Conclusion: Fever is correlated with an increase in insensible fluid losses, dehydration, metabolic demands, and dysregulation of body temperature. Fever can have detrimental effects on the musculoskeletal system, including decreasing strength and endurance, generalized muscle catabolism, and increase in perceived fatigue. Participating in strenuous exercise during febrile illness can worsen the illness and has demonstrated increased lethality in animal models. No consensus recommendations support return to activity before resolution of fever, and training should be resumed gradually once fever and dehydration have resolved. PMID:24790692

  14. Perceived Stress in Chronic Illness: A Comparative Analysis of Four Diseases.

    ERIC Educational Resources Information Center

    Revenson, Tracey A.; Felton, Barbara J.

    Most studies of stress and coping processes among patients with serious illnesses have focused on acute illness states. Far less research has involved systematic examination of the types and frequency of illness-related stresses experienced by individuals living with chronic illness. To compare the nature and degree of illness-related stress posed…

  15. Randomised, double blind, placebo controlled comparison of ginkgo biloba and acetazolamide for prevention of acute mountain sickness among Himalayan trekkers: the prevention of high altitude illness trial (PHAIT)

    PubMed Central

    Gertsch, Jeffrey H; Basnyat, Buddha; Johnson, E William; Onopa, Janet; Holck, Peter S

    2004-01-01

    Objective To evaluate the efficacy of ginkgo biloba, acetazolamide, and their combination as prophylaxis against acute mountain sickness. Design Prospective, double blind, randomised, placebo controlled trial. Setting Approach to Mount Everest base camp in the Nepal Himalayas at 4280 m or 4358 m and study end point at 4928 m during October and November 2002. Participants 614 healthy western trekkers (487 completed the trial) assigned to receive ginkgo, acetazolamide, combined acetazolamide and ginkgo, or placebo, initially taking at least three or four doses before continued ascent. Main outcome measures Incidence measured by Lake Louise acute mountain sickness score ≥ 3 with headache and one other symptom. Secondary outcome measures included blood oxygen content, severity of syndrome (Lake Louise scores ≥ 5), incidence of headache, and severity of headache. Results Ginkgo was not significantly different from placebo for any outcome; however participants in the acetazolamide group showed significant levels of protection. The incidence of acute mountain sickness was 34% for placebo, 12% for acetazolamide (odds ratio 3.76, 95% confidence interval 1.91 to 7.39, number needed to treat 4), 35% for ginkgo (0.95, 0.56 to 1.62), and 14% for combined ginkgo and acetazolamide (3.04, 1.62 to 5.69). The proportion of patients with increased severity of acute mountain sickness was 18% for placebo, 3% for acetazoalmide (6.46, 2.15 to 19.40, number needed to treat 7), 18% for ginkgo (1, 0.52 to 1.90), and 7% for combined ginkgo and acetazolamide (2.95, 1.30 to 6.70). Conclusions When compared with placebo, ginkgo is not effective at preventing acute mountain sickness. Acetazolamide 250 mg twice daily afforded robust protection against symptoms of acute mountain sickness. PMID:15070635

  16. Transmission Dynamics and Control of Severe Acute Respiratory Syndrome

    NASA Astrophysics Data System (ADS)

    Lipsitch, Marc; Cohen, Ted; Cooper, Ben; Robins, James M.; Ma, Stefan; James, Lyn; Gopalakrishna, Gowri; Chew, Suok Kai; Tan, Chorh Chuan; Samore, Matthew H.; Fisman, David; Murray, Megan

    2003-06-01

    Severe acute respiratory syndrome (SARS) is a recently described illness of humans that has spread widely over the past 6 months. With the use of detailed epidemiologic data from Singapore and epidemic curves from other settings, we estimated the reproductive number for SARS in the absence of interventions and in the presence of control efforts. We estimate that a single infectious case of SARS will infect about three secondary cases in a population that has not yet instituted control measures. Public-health efforts to reduce transmission are expected to have a substantial impact on reducing the size of the epidemic.

  17. Parainfluenza Virus Infection Among Human Immunodeficiency Virus (HIV)-Infected and HIV-Uninfected Children and Adults Hospitalized for Severe Acute Respiratory Illness in South Africa, 2009–2014

    PubMed Central

    Cohen, Adam L.; Sahr, Philip K.; Treurnicht, Florette; Walaza, Sibongile; Groome, Michelle J.; Kahn, Kathleen; Dawood, Halima; Variava, Ebrahim; Tempia, Stefano; Pretorius, Marthi; Moyes, Jocelyn; Olorunju, Steven A. S.; Malope-Kgokong, Babatyi; Kuonza, Lazarus; Wolter, Nicole; von Gottberg, Anne; Madhi, Shabir A.; Venter, Marietjie; Cohen, Cheryl

    2015-01-01

    Background. Parainfluenza virus (PIV) is a common cause of acute respiratory tract infections, but little is known about PIV infection in children and adults in Africa, especially in settings where human immunodeficiency virus (HIV) prevalence is high. Methods. We conducted active, prospective sentinel surveillance for children and adults hospitalized with severe acute respiratory illness (SARI) from 2009 to 2014 in South Africa. We enrolled controls (outpatients without febrile or respiratory illness) to calculate the attributable fraction for PIV infection. Respiratory specimens were tested by multiplex real-time reverse-transcription polymerase chain reaction assay for parainfluenza types 1, 2, and 3. Results. Of 18 282 SARI cases enrolled, 1188 (6.5%) tested positive for any PIV type: 230 (19.4%) were type 1; 168 (14.1%) were type 2; 762 (64.1%) were type 3; and 28 (2.4%) had coinfection with 2 PIV types. After adjusting for age, HIV serostatus, and respiratory viral coinfection, the attributable fraction for PIV was 65.6% (95% CI [confidence interval], 47.1–77.7); PIV contributed to SARI among HIV-infected and -uninfected children <5 years of age and among individuals infected with PIV types 1 and 3. The observed overall incidence of PIV-associated SARI was 38 (95% CI, 36–39) cases per 100 000 population and was highest in children <1 year of age (925 [95% CI, 864–989] cases per 100 000 population). Compared with persons without HIV, persons with HIV had an increased relative risk of PIV hospitalization (9.4; 95% CI, 8.5–10.3). Conclusions. Parainfluenza virus causes substantial severe respiratory disease in South Africa among children <5 years of age, especially those that are infected with HIV. PMID:26566534

  18. Decompression illness.

    PubMed

    Vann, Richard D; Butler, Frank K; Mitchell, Simon J; Moon, Richard E

    2011-01-01

    Decompression illness is caused by intravascular or extravascular bubbles that are formed as a result of reduction in environmental pressure (decompression). The term covers both arterial gas embolism, in which alveolar gas or venous gas emboli (via cardiac shunts or via pulmonary vessels) are introduced into the arterial circulation, and decompression sickness, which is caused by in-situ bubble formation from dissolved inert gas. Both syndromes can occur in divers, compressed air workers, aviators, and astronauts, but arterial gas embolism also arises from iatrogenic causes unrelated to decompression. Risk of decompression illness is affected by immersion, exercise, and heat or cold. Manifestations range from itching and minor pain to neurological symptoms, cardiac collapse, and death. First-aid treatment is 100% oxygen and definitive treatment is recompression to increased pressure, breathing 100% oxygen. Adjunctive treatment, including fluid administration and prophylaxis against venous thromboembolism in paralysed patients, is also recommended. Treatment is, in most cases, effective although residual deficits can remain in serious cases, even after several recompressions. PMID:21215883

  19. Infectious ileocecitis--appendicitis mimicking syndrome.

    PubMed

    Zganjer, M; Roic, G; Cizmic, A; Pajic, A

    2005-01-01

    The purpose of our study is to emphasize the central role of ultrasound (US) in finding the cause of abdominal pain in children. Ultrasound of the lower abdomen quadrant should be considered in all cases in which the clinical signs and symptoms are not diagnostic of appendicitis. There is a wide range of clinical syndromes and diseases which can easily be diagnosed using a high resolution ultrasound with adjunct of color and power Doppler. The spectrum of abnormalities includes appendicitis, mesenteric lymphadenitis, infectious ileocecitis, Crohn's disease, intussusception, ovarian cysts, and encysted cerebrospinal fluid. One of the most common causes of acute abdominal pain in children is acute terminal ileitis (infectious ileocecitis) with mesenteric lymphadenitis. Ultrasound is the best tool to rapidly differentiate this disease from acute appendicitis, and prevent unnecessary laparotomy (Ref. 12). PMID:16201735

  20. Contagious rhythm: infectious diseases of 20th century musicians.

    PubMed

    Sartin, Jeffrey S

    2010-07-01

    Infectious diseases have led to illness and death for many famous musicians, from the classical period to the rock 'n' roll era. By the 20th century, as public health improved and orchestral composers began living more settled lives, infections among American and European musicians became less prominent. By mid-century, however, seminal jazz musicians famously pursued lifestyles characterized by drug and alcohol abuse. Among the consequences of this risky lifestyle were tuberculosis, syphilis, and chronic viral hepatitis. More contemporary rock musicians have experienced an epidemic of hepatitis C infection and HIV/AIDS related to intravenous drug use and promiscuity. Musical innovation is thus often accompanied by diseases of neglect and overindulgence, particularly infectious illnesses, although risky behavior and associated infectious illnesses tend to decrease as the style matures. PMID:20660936

  1. Contagious Rhythm: Infectious Diseases of 20th Century Musicians

    PubMed Central

    Sartin, Jeffrey S.

    2010-01-01

    Infectious diseases have led to illness and death for many famous musicians, from the classical period to the rock ’n’ roll era. By the 20th century, as public health improved and orchestral composers began living more settled lives, infections among American and European musicians became less prominent. By mid-century, however, seminal jazz musicians famously pursued lifestyles characterized by drug and alcohol abuse. Among the consequences of this risky lifestyle were tuberculosis, syphilis, and chronic viral hepatitis. More contemporary rock musicians have experienced an epidemic of hepatitis C infection and HIV/AIDS related to intravenous drug use and promiscuity. Musical innovation is thus often accompanied by diseases of neglect and overindulgence, particularly infectious illnesses, although risky behavior and associated infectious illnesses tend to decrease as the style matures. PMID:20660936

  2. Gallbladder wall thickening in infectious mononucleosis: an ominous sign.

    PubMed Central

    O'Donovan, N.; Fitzgerald, E.

    1996-01-01

    Gallbladder wall thickening (3 mm or greater) is a nonspecific finding with many causes. We describe two cases caused by infectious mononucleosis. Other causes of gallbladder wall thickening are described and the literature is reviewed. We suggest that the finding of gallbladder wall thickening in a patient with infectious mononucleosis implies that the patient is very ill, and its observation should lead to close patient monitoring. Images Figure PMID:8761505

  3. The devil is in the detail: Acute Guillain-Barré syndrome camouflaged as neurosarcoidosis in a critically ill patient admitted to an Intensive Care Unit.

    PubMed

    Sarada, Pooja Prathapan; Sundararajan, Krishnaswamy

    2016-04-01

    Guillain-Barré syndrome (GBS) is an acute demyelinating polyneuropathy, usually evoked by antecedent infection. Sarcoidosis is a multisystem chronic granulomatous disorder with neurological involvement occurring in a minority. We present a case of a 43-year-old Caucasian man who presented with acute ascending polyradiculoneuropathy with a recent diagnosis of pulmonary sarcoidosis. The absence of acute flaccid paralysis excluded a clinical diagnosis of GBS in the first instance. Subsequently, a rapid onset of proximal weakness with multi-organ failure led to the diagnosis of GBS, which necessitated intravenous immunoglobulin and plasmapheresis to which the patient responded adequately, and he was subsequently discharged home. Neurosarcoidosis often masquerades as other disorders, leading to a diagnostic dilemma; also, the occurrence of a GBS-like clinical phenotype secondary to neurosarcoidosis may make diagnosing coexisting GBS a therapeutic challenge. This article not only serves to exemplify the rare association of neurosarcoidosis with GBS but also highlights the need for a high index of clinical suspicion for GBS and accurate history taking in any patient who may present with rapidly progressing weakness to an Intensive Care Unit. PMID:27303139

  4. The devil is in the detail: Acute Guillain–Barré syndrome camouflaged as neurosarcoidosis in a critically ill patient admitted to an Intensive Care Unit

    PubMed Central

    Sarada, Pooja Prathapan; Sundararajan, Krishnaswamy

    2016-01-01

    Guillain–Barré syndrome (GBS) is an acute demyelinating polyneuropathy, usually evoked by antecedent infection. Sarcoidosis is a multisystem chronic granulomatous disorder with neurological involvement occurring in a minority. We present a case of a 43-year-old Caucasian man who presented with acute ascending polyradiculoneuropathy with a recent diagnosis of pulmonary sarcoidosis. The absence of acute flaccid paralysis excluded a clinical diagnosis of GBS in the first instance. Subsequently, a rapid onset of proximal weakness with multi-organ failure led to the diagnosis of GBS, which necessitated intravenous immunoglobulin and plasmapheresis to which the patient responded adequately, and he was subsequently discharged home. Neurosarcoidosis often masquerades as other disorders, leading to a diagnostic dilemma; also, the occurrence of a GBS-like clinical phenotype secondary to neurosarcoidosis may make diagnosing coexisting GBS a therapeutic challenge. This article not only serves to exemplify the rare association of neurosarcoidosis with GBS but also highlights the need for a high index of clinical suspicion for GBS and accurate history taking in any patient who may present with rapidly progressing weakness to an Intensive Care Unit. PMID:27303139

  5. Hypoglycemia Revisited in the Acute Care Setting

    PubMed Central

    Tsai, Shih-Hung; Lin, Yen-Yue; Hsu, Chin-Wang; Cheng, Chien-Sheng

    2011-01-01

    Hypoglycemia is a common finding in both daily clinical practice and acute care settings. The causes of severe hypoglycemia (SH) are multi-factorial and the major etiologies are iatrogenic, infectious diseases with sepsis and tumor or autoimmune diseases. With the advent of aggressive lowering of HbA1c values to achieve optimal glycemic control, patients are at increased risk of hypoglycemic episodes. Iatrogenic hypoglycemia can cause recurrent morbidity, sometime irreversible neurologic complications and even death, and further preclude maintenance of euglycemia over a lifetime of diabetes. Recent studies have shown that hypoglycemia is associated with adverse outcomes in many acute illnesses. In addition, hypoglycemia is associated with increased mortality among elderly and non-diabetic hospitalized patients. Clinicians should have high clinical suspicion of subtle symptoms of hypoglycemia and provide prompt treatment. Clinicians should know that hypoglycemia is associated with considerable adverse outcomes in many acute critical illnesses. In order to reduce hypoglycemia-associated morbidity and mortality, timely health education programs and close monitoring should be applied to those diabetic patients presenting to the Emergency Department with SH. ED disposition strategies should be further validated and justified to achieve balance between the benefits of euglycemia and the risks of SH. We discuss relevant issues regarding hypoglycemia in emergency and critical care settings. PMID:22028152

  6. International Adaptation: Psychosocial and parenting experiences of caregivers who travel to the United States to obtain acute medical care for their seriously ill child

    PubMed Central

    Margolis, Rachel; Ludi, Erica; Pao, Maryland; Wiener, Lori

    2013-01-01

    Despite the increasing trend of travel for medical purposes, little is known about the experience of parents and other caregivers who come to the United States specifically to obtain medical treatment for their seriously ill child. In this exploratory, descriptive qualitative study, we used a semi-structured narrative guide to conduct in-depth interviews with 22 Spanish or English-speaking caregivers about the challenges encountered and adaptation required when entering a new medical and cultural environment. Caregivers identified the language barrier and transnational parenting as challenges while reporting hospital staff and their own families as major sources of support. Using the results of the study as a guide, clinical and program implications are provided and recommendations for social work practice discussed. PMID:23947542

  7. Optimization of psychopharmacotherapy for schizophrenia in a male, locked, non-acute unit serving for persistently ill patients over one year.

    PubMed

    Suzuki, Takefumi; Uchida, Hiroyuki; Takeuchi, Hiroyoshi; Tsunoda, Kenichi; Ishizuki, Tomomi; Mimura, Masaru

    2015-07-30

    We describe real-world psychopharmacological treatment in a Japanese, male, closed psychiatric unit where clozapie was still unavailable. Fifty-five persistently-ill patients with schizophrenia (ICD-10), mean ± S.D. age: 57.5 ± 13.0 y.o., duration of illness and admissions: 30.9 ± 15.2 years and 20.7 ± 14.5 years, respectively) treated longitudinally were evaluated. The rule was to treat with a simplest possible psychotropic regimen without polypharmacy. Compared to the baseline, the number and dose of antipsychotics were reduced from 1.9 to 1.1 and 1012 mg/day to 607 mg/day, respectively. The number of total psychotropics was minimized from 4.7 to 2.1, with a simplified once or twice daily dosing. Overall, the CGI-Severity and FACT-Sz (global functioning) improved slightly from 5.8 to 5.5 and 28.7 to 32.6, respectively. Of note, no patients got worse in comparison with the baseline clinical presentation. Forty-four patients were successfully treated with a single antipsychotic; only seven needed two antipsychotics simultaneously while 36 had been treated with antipsychotic polypharmacy at baseline. Benzodiazepines (mostly lorazepam) and antiparkinsonian drugs were prescribed in 28 and only two, respectively. Nineteen needed adjunctive valproate (average blood levels: 99.3 ± 21.8 μg/mL) and nine used lithium (0.61 ± 0.26 mEq/L). Optimization of psychopharmacotherapy is still possible for difficult-to-treat patients and, while augmentation of an antipsychotic with mood stabilizers is frequently needed, antipsychotic polypharmacy should be exceptional. PMID:25935376

  8. Psychiatric disorders impacting critical illness.

    PubMed

    Struble, Laura M; Sullivan, Barbara J; Hartman, Laurie S

    2014-03-01

    An astounding 30% to 50% of older patients who are hospitalized for a medical condition also have a psychiatric disorder. The intent of this article is to prepare acute care nurses to meet the mental health needs of older adults with a critical illness and prevent untoward sequelae of medical events. The authors discuss the importance of baseline assessment data, issues related to informed consent, manifestations of common psychiatric disorders that may be seen in older adults in the acute care setting, as well as strategies to improve patient outcomes. PMID:24484928

  9. Incidence and severity of acute respiratory illness in families exposed to different levels of air pollution, New York metropolitan area, 1971-1972

    SciTech Connect

    Love, G.J.; Lan, S.P.; Shy, C.M.; Struba, R.J.

    1981-03-01

    The incidence and severity of acute respiratory disease was studied in families in three New York communities with different ambient levels of SO/sub 2/ and particulate air pollution. Upper, lower, and total respiratory disease rates in fathers, mothers, and school children tended to be higher in the communities with higher pollution levels. Similar higher rates, however, were not observed among preschool children. Regression analyses were used to adjust rates for socioeconomic status, parental smoking, chronic bronchitis in parents, and possible indoor pollution resulting from the use of a gas stove for cooking. After these adjustments the community differences were still significant (P < .01), for school children. The indoor pollution related to gas stoves was a significant covariate among children. The effects of smoking were inconsistent. It was not possible to attribute the higher rates observed to any specific pollutant, since both SO/sub 2/ and particulate matter levels were higher in the high pollution communities, nor was it possible to attribute the excesses to current levels of exposure or to a residual effect of previous higher exposure concentrations. The fact that young children did not follow the patern suggests the latter. It was concluded, however, that current or previous exposures to the complexity of air pollutants in New York City was at least partially responsible for increased incidences of acute respiratory disease.

  10. The incidence and severity of acute respiratory illness in families exposed to different levels of air pollution, New York metropolitan area, 1971-1972.

    PubMed

    Love, G J; Lan, S p; Shy, C M; Struba, R J

    1981-01-01

    The incidence and severity of acute respiratory disease was studied in families in three New York communities with different ambient levels of SO2 and particulate air pollution. Upper, lower, and total respiratory disease rates in fathers, mothers, and school children tended to be higher in the communities with higher pollution levels. Similar higher rates, however, were not observed among preschool children. Regression analyses were used to adjust rates for socioeconomic status, parental smoking, chronic bronchitis in parents, and possible indoor pollution resulting from the use of a gas stove for cooking. After these adjustments the community differences were still significant (P less than .01), for schoolchildren. The indoor pollution related to gas stoves was a significant covariate among children. The effects of smoking were inconsistent. It was not possible to attribute the higher rates observed to any specific pollutant, since both SO2 and particulate matter levels were higher in the high pollution communities, nor was it possible to attribute the excesses to current levels of exposure or to a residual effect of previous higher exposure concentrations. The fact that young children did not follow the pattern suggests the latter. It was concluded, however, that current or previous exposures to the complexity of air pollutants in New York City was at least partially responsible for increased incidences of acute respiratory disease. PMID:7212778

  11. Detection and characterization of respiratory viruses causing acute respiratory illness and asthma exacerbation in children during three different seasons (2011–2014) in Mexico City

    PubMed Central

    Moreno-Valencia, Yazmin; Hernandez-Hernandez, Victor A; Romero-Espinoza, Jose A I; Coronel-Tellez, Rodrigo H; Castillejos-Lopez, Manuel; Hernandez, Andres; Perez-Padilla, Rogelio; Alejandre-Garcia, Alejandro; de la Rosa-Zamboni, Daniela; Ormsby, Christopher E; Vazquez-Perez, Joel A

    2015-01-01

    Background Viral infections play a significant role in causing acute respiratory infections (ARIs) and exacerbations of chronic diseases. Acute respiratory infections are now the leading cause of mortality in children worldwide, especially in developing countries. Recently, human rhinovirus (HRV) infection has been emerged as an important cause of pneumonia and asthma exacerbation. Objectives To determine the role of several viral agents principally, respiratory syncytial virus, and HRV in children with ARIs and their relationship with asthma exacerbation and pneumonia. Methods Between October 2011 and March 2014, 432 nasopharyngeal samples of children <15 years of age with ARI hospitalized at a referral hospital for respiratory diseases were tested for the presence of respiratory viruses using a multiplex RT-qPCR. Clinical, epidemiological, and demographic data were collected and associated with symptomatology and viral infections. Results Viral infections were detected in at least 59·7% of the enrolled patients, with HRV (26·6%) being the most frequently detected. HRV infections were associated with clinical features of asthma and difficulty in breathing such as wheezing (P = 0·0003), supraesternal (P = 0·046), and xiphoid retraction (P = 0·030). HRV subtype C (HRV-C) infections were associated with asthma (P = 0·02). Conclusions Human rhinovirus was the virus most commonly detected in pediatric patients with ARI. There is also an association of HRV-C infection with asthma exacerbation, emphasizing the relevance of this virus in severe pediatric respiratory disease. PMID:26289993

  12. Overview of Infectious Diseases

    MedlinePlus

    ... Español Text Size Email Print Share Overview of Infectious Diseases Page Content Article Body I nfectious diseases are ... worms Last Updated 11/21/2015 Source Immunizations & Infectious Diseases: An Informed Parent's Guide (Copyright © 2006 American Academy ...

  13. [Infectious diseases research].

    PubMed

    Carratalà, Jordi; Alcamí, José; Cordero, Elisa; Miró, José M; Ramos, José Manuel

    2008-12-01

    There has been a significant increase in research activity into infectious diseases in Spain in the last few years. The Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) currently has ten study groups, with the cooperation of infectious diseases specialists and microbiologists from different centres, with significant research activity. The program of Redes Temáticas de Investigación Cooperativa en Salud (Special Topics Cooperative Health Research Networks) is an appropriate framework for the strategic coordination of research groups from the Spanish autonomous communities. The Spanish Network for Research in Infectious Diseases (REIPI) and the Network for Research in AIDS (RIS) integrate investigators in Infectious Diseases from multiple groups, which continuously perform important research projects. Research using different experimental models in infectious diseases, in numerous institutions, is an important activity in our country. The analysis of the recent scientific production in Infectious Diseases shows that Spain has a good position in the context of the European Union. The research activity in Infectious Diseases carried out in our country is a great opportunity for the training of specialists in this area of knowledge. PMID:19195467

  14. An outbreak of acute fever among steam turbine condenser cleaners.

    PubMed

    Lauderdale, J F; Johnson, C C

    1983-03-01

    Ten of twelve men who participated in the cleaning of an electric power steam turbine condenser clogged with freshwater sponge experienced an acute febrile illness. Two similar outbreaks have been previously described, one of which has been attributed to the Legionnaires' Disease bacterium. Epidemiologic studies of this case showed a syndrome very similar to the two previously reported episodes. However, the exact etiology for this outbreak has not been identified. Environmental sampling was not initiated until after the cleaning was completed. Subsequent testing did not reveal any likely cause for the outbreak. The delayed onset of symptoms and the nature of the illness pointed to an infectious agent. In the absence of any suitable criteria for employee exposure evaluation, it is suggested that crews cleaning condensers under unusually dirty conditions, especially if eye or respiratory symptoms are reported, should be provided with respiratory protection. PMID:6846141

  15. FastStats: Infectious Disease

    MedlinePlus

    ... this? Submit What's this? Submit Button NCHS Home Infectious Disease Recommend on Facebook Tweet Share Compartir Data are ... Health, United States trend tables with data on infectious disease Seroprevalence of six infectious diseases among adults in ...

  16. The diagnosis of urinary tract infections in young children (DUTY): protocol for a diagnostic and prospective observational study to derive and validate a clinical algorithm for the diagnosis of UTI in children presenting to primary care with an acute illness

    PubMed Central

    2012-01-01

    Background Urinary tract infection (UTI) is common in children, and may cause serious illness and recurrent symptoms. However, obtaining a urine sample from young children in primary care is challenging and not feasible for large numbers. Evidence regarding the predictive value of symptoms, signs and urinalysis for UTI in young children is urgently needed to help primary care clinicians better identify children who should be investigated for UTI. This paper describes the protocol for the Diagnosis of Urinary Tract infection in Young children (DUTY) study. The overall study aim is to derive and validate a cost-effective clinical algorithm for the diagnosis of UTI in children presenting to primary care acutely unwell. Methods/design DUTY is a multicentre, diagnostic and prospective observational study aiming to recruit at least 7,000 children aged before their fifth birthday, being assessed in primary care for any acute, non-traumatic, illness of ≤ 28 days duration. Urine samples will be obtained from eligible consented children, and data collected on medical history and presenting symptoms and signs. Urine samples will be dipstick tested in general practice and sent for microbiological analysis. All children with culture positive urines and a random sample of children with urine culture results in other, non-positive categories will be followed up to record symptom duration and healthcare resource use. A diagnostic algorithm will be constructed and validated and an economic evaluation conducted. The primary outcome will be a validated diagnostic algorithm using a reference standard of a pure/predominant growth of at least >103, but usually >105 CFU/mL of one, but no more than two uropathogens. We will use logistic regression to identify the clinical predictors (i.e. demographic, medical history, presenting signs and symptoms and urine dipstick analysis results) most strongly associated with a positive urine culture result. We will then use economic evaluation

  17. Prevalence, codetection and seasonal distribution of upper airway viruses and bacteria in children with acute respiratory illnesses with cough as a symptom.

    PubMed

    O'Grady, K F; Grimwood, K; Sloots, T P; Whiley, D M; Acworth, J P; Phillips, N; Goyal, V; Chang, A B

    2016-06-01

    Most studies exploring the role of upper airway viruses and bacteria in paediatric acute respiratory infections (ARI) focus on specific clinical diagnoses and/or do not account for virus-bacteria interactions. We aimed to describe the frequency and predictors of virus and bacteria codetection in children with ARI and cough, irrespective of clinical diagnosis. Bilateral nasal swabs, demographic, clinical and risk factor data were collected at enrollment in children aged <15 years presenting to an emergency department with an ARI and where cough was a symptom. Swabs were tested by polymerase chain reaction for 17 respiratory viruses and seven respiratory bacteria. Logistic regression was used to investigate associations between child characteristics and codetection of the organisms of interest. Between December 2011 and August 2014, swabs were collected from 817 (93.3%) of 876 enrolled children, median age 27.7 months (interquartile range 13.9-60.3 months). Overall, 740 (90.6%) of 817 specimens were positive for any organism. Both viruses and bacteria were detected in 423 specimens (51.8%). Factors associated with codetection were age (adjusted odds ratio (aOR) for age <12 months = 4.9, 95% confidence interval (CI) 3.0, 7.9; age 12 to <24 months = 6.0, 95% CI 3.7, 9.8; age 24 to <60 months = 2.4, 95% CI 1.5, 3.9), male gender (aOR 1.46; 95% CI 1.1, 2.0), child care attendance (aOR 2.0; 95% CI 1.4, 2.8) and winter enrollment (aOR 2.0; 95% CI 1.3, 3.0). Haemophilus influenzae dominated the virus-bacteria pairs. Virus-H. influenzae interactions in ARI should be investigated further, especially as the contribution of nontypeable H. influenzae to acute and chronic respiratory diseases is being increasingly recognized. PMID:26916343

  18. Non-Infectious Meningitis

    MedlinePlus

    ... Resources for Healthcare Professionals Related Links Vaccine Schedules Preteen & Teen Vaccines Meningococcal Disease Sepsis Non-Infectious Meningitis ... confusion) Top of Page Related Links Vaccine Schedules Preteen & Teen Vaccines Meningococcal Disease Sepsis File Formats Help: ...

  19. Modeling Infectious Diseases

    MedlinePlus

    ... MIDAS models require a breadth of knowledge, the network draws together an interdisciplinary team of researchers with expertise in epidemiology, infectious diseases, computational biology, statistics, social sciences, physics, computer sciences and informatics. In 2006, MIDAS modelers simulated ...

  20. Middle East respiratory syndrome coronavirus not detected in children hospitalized with acute respiratory illness in Amman, Jordan, March 2010 to September 2012

    PubMed Central

    Khuri-Bulos, N.; Payne, D. C.; Lu, X.; Erdman, D.; Wang, L.; Faouri, S.; Shehabi, A.; Johnson, M.; Becker, M. M.; Denison, M. R.; Williams, J. V.; Halasa, N. B.

    2015-01-01

    Hospitalized children < 2 years of age in Amman, Jordan, admitted for fever and/or respiratory symptoms, were tested for Middle East respiratory syndrome coronavirus (MERS-CoV): MERS-CoV by real-time RT-PCR (rRT-PCR). This was a prospective year-round viral surveillance study in children <2 years of age admitted with acute respiratory symptoms and/or fever from March 2010 to September 2012 and enrolled from a government-run hospital, Al-Bashir in Amman, Jordan. Clinical and demographic data, including antibiotic use, were collected. Combined nasal/throat swabs were collected, aliquoted, and frozen at −80°C. Specimen aliquots were shipped to Vanderbilt University and the Centers for Disease Control and Prevention (CDC), and tested by rRT-PCR for MERS-CoV. Of the 2433 subjects enrolled from 16 March 2010 to 10 September 2012, 2427 subjects had viral testing and clinical data. Of 1898 specimens prospectively tested for other viruses between 16 March 2010 and 18 March 2012, 474 samples did not have other common respiratory viruses detected. These samples were tested at CDC for MERS-CoV and all were negative by rRT-PCR for MERS-CoV. Of the remaining 531 samples, collected from 19 March 2012 to 10 September 2012 and tested at Vanderbilt, none were positive for MERS-CoV. Our negative findings from a large sample of young Jordanian children hospitalized with fever and/or respiratory symptoms suggest that MERS-CoV was not widely circulating in Amman, Jordan, during the 30-month period of prospective, active surveillance occurring before and after the first documented MERS-CoV outbreak in the Middle East region. PMID:24313317

  1. Middle East respiratory syndrome coronavirus not detected in children hospitalized with acute respiratory illness in Amman, Jordan, March 2010 to September 2012.

    PubMed

    Khuri-Bulos, N; Payne, D C; Lu, X; Erdman, D; Wang, L; Faouri, S; Shehabi, A; Johnson, M; Becker, M M; Denison, M R; Williams, J V; Halasa, N B

    2014-07-01

    Hospitalized children < 2 years of age in Amman, Jordan, admitted for fever and/or respiratory symptoms, were tested for Middle East respiratory syndrome coronavirus (MERS-CoV): MERS-CoV by real-time RT-PCR (rRT-PCR). This was a prospective year-round viral surveillance study in children <2 years of age admitted with acute respiratory symptoms and/or fever from March 2010 to September 2012 and enrolled from a government-run hospital, Al-Bashir in Amman, Jordan. Clinical and demographic data, including antibiotic use, were collected. Combined nasal/throat swabs were collected, aliquoted, and frozen at -80°C. Specimen aliquots were shipped to Vanderbilt University and the Centers for Disease Control and Prevention (CDC), and tested by rRT-PCR for MERS-CoV. Of the 2433 subjects enrolled from 16 March 2010 to 10 September 2012, 2427 subjects had viral testing and clinical data. Of 1898 specimens prospectively tested for other viruses between 16 March 2010 and 18 March 2012, 474 samples did not have other common respiratory viruses detected. These samples were tested at CDC for MERS-CoV and all were negative by rRT-PCR for MERS-CoV. Of the remaining 531 samples, collected from 19 March 2012 to 10 September 2012 and tested at Vanderbilt, none were positive for MERS-CoV. Our negative findings from a large sample of young Jordanian children hospitalized with fever and/or respiratory symptoms suggest that MERS-CoV was not widely circulating in Amman, Jordan, during the 30-month period of prospective, active surveillance occurring before and after the first documented MERS-CoV outbreak in the Middle East region. PMID:24313317

  2. Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study

    PubMed Central

    Bagshaw, Sean M; Laupland, Kevin B; Doig, Christopher J; Mortis, Garth; Fick, Gordon H; Mucenski, Melissa; Godinez-Luna, Tomas; Svenson, Lawrence W; Rosenal, Tom

    2005-01-01

    Introduction Severe acute renal failure (sARF) is associated with considerable morbidity, mortality and use of healthcare resources; however, its precise epidemiology and long-term outcomes have not been well described in a non-specified population. Methods Population-based surveillance was conducted among all adult residents of the Calgary Health Region (population 1 million) admitted to multidisciplinary and cardiovascular surgical intensive care units between May 1 1999 and April 30 2002. Clinical records were reviewed and outcome at 1 year was assessed. Results sARF occurred in 240 patients (11.0 per 100,000 population/year). Rates were highest in males and older patients (≥65 years of age). Risk factors for development of sARF included previous heart disease, stroke, pulmonary disease, diabetes mellitus, cancer, connective tissue disease, chronic renal dysfunction, and alcoholism. The annual mortality rate was 7.3 per 100,000 population with rates highest in males and those ≥65 years. The 28-day, 90-day, and 1-year case-fatality rates were 51%, 60%, and 64%, respectively. Increased Charlson co-morbidity index, presence of liver disease, higher APACHE II score, septic shock, and need for continuous renal replacement therapy were independently associated with death at 1 year. Renal recovery occurred in 78% (68/87) of survivors at 1 year. Conclusion sARF is common and males, older patients, and those with underlying medical conditions are at greatest risk. Although the majority of patients with sARF will die, most survivors will become independent from renal replacement therapy within a year. PMID:16280066

  3. Infectious optic neuropathy.

    PubMed

    Golnik, Karl C

    2002-03-01

    A wide variety of infectious agents are known to cause optic neuropathy. This article will consider the bacteria, spirochetes, fungi, and viruses that most commonly affect the optic nerve. Clinical presentation is variable, but some pathogens often produce a characteristic funduscopic pattern. Diagnosis is usually made on the basis of clinical suspicion and serologic testing. Polymerase chain reaction is also increasingly utilized. Most infectious agents can be effectively treated but visual recovery is highly variable. PMID:15513450

  4. Ethics and infectious disease.

    PubMed

    Selgelid, Michael J

    2005-06-01

    Bioethics apparently suffers from a misdistribution of research resources analogous to the '10/90' divide in medical research. Though infectious disease should be recognized as a topic of primary importance for bioethics, the general topic of infectious disease has received relatively little attention from the discipline of bioethics in comparison with things like abortion, euthanasia, genetics, cloning, stem cell research, and so on. The fact that the historical and potential future consequences of infectious diseases are almost unrivalled is one reason that the topic of infectious disease warrants more attention from bioethicists. The 'Black Death' eliminated one third of the European population during the 14th Century; the 1989 flu killed between 20 and 100 million people; and, in the 20th Century smallpox killed perhaps three times more people than all the wars of that period. In the contemporary world, epidemics (AIDS, multi-drug resistant turberculosis, and newly emerging infectious diseases such as SARS) continue to have dramatic consequences. A second reason why the topic of infectious disease deserves further attention is that it raises difficult ethical questions of its own. While infected individuals can threaten the health of other individuals and society as a whole, for example, public health care measures such as surveillance, isolation, and quarantine can require the infringement of widely accepted basic human rights and liberties. An important and difficult ethical question asks how to strike a balance between the utilitarian aim of promoting public health, on the one hand, and libertarian aims of protecting privacy and freedom of movement, on the other, in contexts involving diseases that are--to varying degrees--contagious, deadly, or otherwise dangerous. Third, since their burden is most heavily shouldered by the poor (in developing countries), infectious diseases involve issues of justice--which should be a central concern of ethics. I conclude

  5. Feigning Acute Intermittent Porphyria

    PubMed Central

    Elkhatib, Rania; Idowu, Modupe; Brown, Gregory S.; Jaber, Yasmeen M.; Reid, Matthew B.; Person, Cheryl

    2014-01-01

    Acute intermittent porphyria (AIP) is an autosomal dominant genetic defect in heme synthesis. Patients with this illness can have episodic life-threatening attacks characterized by abdominal pain, neurological deficits, and psychiatric symptoms. Feigning this illness has not been reported in the English language literature to date. Here, we report on a patient who presented to the hospital with an acute attack of porphyria requesting opiates. Diligent assessment of extensive prior treatment records revealed thirteen negative tests for AIP. PMID:25525547

  6. [Preoperative evaluation and perioperative prevention of infectious diseases].

    PubMed

    Moriyama, Kiyoshi

    2010-09-01

    Preoperative evaluation of infectious diseases in patients for elective and non-elective surgery is important for the anesthesiologists not only to rule out the patient's state of illness, but also to prevent transmission of infectious diseases in healthcare settings. To prevent transmission of infectious diseases in healthcare settings, Center for Disease Control published guidelines that consist of standard precaution and transmission-based precautions. In the face of exposure to known infectious diseases, certain post exposure prophylaxis has been established, especially against exposure to human immunodeficiency virus and hepatitis B virus. There are also growing interests in perioperative prevention of surgical site infection, since World Health Organization has published surgical safety checklist with the slogan "Safe surgery saves life". Anesthesiologists need to have knowledge on the prevention of surgical site infection especially on antibiotic prophylaxis, because it starts in the operating room. PMID:20857671

  7. A mouse model for infectious mononucleosis.

    PubMed

    Flaño, Emilio; Woodland, David L; Blackman, Marcia A

    2002-01-01

    Epstein-Barr virus (EBV) is a ubiquitous human gamma-herpesvirus that establishes life-long latency and is associated with lymphoproliferative disorders and the development of several malignancies. EBV infection is frequently, but not always, associated with the development of a syndrome termed infectious mononucleosis. The recent isolation and characterization of a murine gamma-herpesvirus, MHV-68 (gammaHV-68) has provided the first small animal model for studying immunity and pathogenesis of a gamma-herpesvirus in its natural host. MHV-68 has important biological and genetic similarities with the human gamma-herpesviruses. Following intranasal infection of mice with MHV-68, an acute respiratory infection in the lung develops and is cleared, followed by the establishment of latency. Similar to EBV, MHV-68 latency is largely established in B cells, although other cell types can be latently infected. The establishment of latency correlates with a prominent splenomegaly, polyclonal B cell activation with associated autoantibody production, and CD8+ T cell-dominated peripheral blood lymphocytosis, in many aspects mirroring EBV-induced infectious mononucleosis. There are key differences in the MHV-68- and EBV-induced CD8+ T cell responses however. Whereas the expanded CD8+ T cells associated with EBV-induced mononucleosis are largely the outgrowth of T cells responding to lytic viral epitopes elicited during the acute phase of the response, the CD8+ T cell lymphocytosis associated with MHV-68-induced infectious mononucleosis is dominated by an oligoclonal population of T cells expressing Vbeta4+ T cell receptors that are not reactive to acute viral epitopes. The focus of this article will be to highlight the similarities and differences in the infectious mononucleosis syndrome associated with human and murine gamma-herpesviruses. PMID:12018460

  8. The impact of home-based HIV counseling and testing on care-seeking and incidence of common infectious disease syndromes in rural western Kenya

    PubMed Central

    2014-01-01

    Background In much of Africa, most individuals living with HIV do not know their status. Home-based counseling and testing (HBCT) leads to more HIV-infected people learning their HIV status. However, there is little data on whether knowing one’s HIV-positive status necessarily leads to uptake of HIV care, which could in turn, lead to a reduction in the prevalence of common infectious disease syndromes. Methods In 2008, Kenya Medical Research Institute (KEMRI) in collaboration with the Centers for Disease Control and Prevention (CDC) offered HBCT to individuals (aged ≥13 years) under active surveillance for infectious disease syndromes in Lwak in rural western Kenya. HIV test results were linked to morbidity and healthcare-seeking data collected by field workers through bi-weekly home visits. We analyzed changes in healthcare seeking behaviors using proportions, and incidence (expressed as episodes per person-year) of acute respiratory illness (ARI), severe acute respiratory illness (SARI), acute febrile illness (AFI) and diarrhea among first-time HIV testers in the year before and after HBCT, stratified by their test result and if HIV-positive, whether they sought care at HIV Patient Support Centers (PSCs). Results Of 9,613 individuals offered HBCT, 6,366 (66%) were first-time testers, 698 (11%) of whom were HIV-infected. One year after HBCT, 50% of HIV-infected persons had enrolled at PSCs – 92% of whom had started cotrimoxazole and 37% of those eligible for antiretroviral treatment had initiated therapy. Among HIV-infected persons enrolled in PSCs, AFI and diarrhea incidence decreased in the year after HBCT (rate ratio [RR] 0.84; 95% confidence interval [CI] 0.77 – 0.91 and RR 0.84, 95% CI 0.73 – 0.98, respectively). Among HIV-infected persons not attending PSCs and among HIV-uninfected persons, decreases in incidence were significantly lower. While decreases also occurred in rates of respiratory illnesses among HIV-positive persons in care, there were

  9. Antimicrobial therapy of acute diarrhoea: a clinical review.

    PubMed

    Lübbert, Christoph

    2016-01-01

    Diarrhoea is one of the most commonly occurring diseases. This article presents a review of the current state of the treatment of acute infectious diarrhoea, as well as of the most important pathogens. The general principles of the therapy of diarrhoea are exemplified, followed by a description of the targeted antimicrobial therapy of the most important bacterial gastrointestinal infections, including salmonellosis, shigellosis and Campylobacter infections, as well as infections with pathogenic Escherichia coli strains, yersiniosis and cholera. Diarrhoea caused by toxigenic Clostridium difficile strains has increased in incidence and in severity. These infections will therefore be described in detail, including important new aspects of treatment. Symptomatic therapy is still the most important component of the treatment of infectious diarrhoea. However, empirical antibiotic therapy should be considered for severely ill patients with a high frequency of stools, fever, bloody diarrhoea, underlying immune deficiency, advanced age or significant comorbidities. Increasing resistance, in particular against fluoroquinolones, must be taken into consideration. Therapy with motility inhibitors is not recommended for Shiga toxin-producing Escherichia coli (STEC) infections, Clostridium difficile infections (CDI), and severe colitis. The macrocyclic antibiotic fidaxomicin can reduce the rate of recurrent disease in CDI. Furthermore, evidence for the benefits of faecal microbiota transplantation as a treatment option for multiple recurrences of CDI is increasing. In conclusion, the treatment of acute diarrhoea is still primarily supportive. General empirical antibiotic therapy for acute diarrhoea is not evidence-based. PMID:26641310

  10. Illness beliefs in schizophrenia.

    PubMed

    Kinderman, Peter; Setzu, Erika; Lobban, Fiona; Salmon, Peter

    2006-10-01

    Beliefs about health and illness shape emotional responses to illness, health-related behaviour and relationships with health-care providers in physical illness. Researchers are beginning to study the illness beliefs of people with psychosis, primarily using models developed in relation to physical illness. It is likely that modifications to these models will be necessary if they are to apply to mental disorders, and it is probable that some of the assumptions underlying the models will be inappropriate. In particular, different dimensions of understanding may be present in mental illness in comparison to those identified in physical illness. The present study examines the beliefs of 20 patients in the UK diagnosed with schizophrenia, including 10 currently psychotic inpatients and 10 outpatients in remission, about their experiences, using qualitative interviews and thematic analysis. Patients currently experiencing psychosis did not identify their experiences as separable 'illnesses' and did not have 'illness beliefs'. Patients currently in a period of remission appraised their experiences as distinct from their own normal behaviour, but used conceptual frameworks of understanding that deviated significantly from conventional 'health belief' models. Patients' ways of understanding mental illness did not parallel those described in physical illnesses. Methods for assessing beliefs about mental illness should therefore not be transferred directly from studies of beliefs about physical illness, but should be tailored to the nature of patients' beliefs about mental illness. PMID:16777306

  11. Comorbid medical illness in bipolar disorder

    PubMed Central

    Forty, Liz; Ulanova, Anna; Jones, Lisa; Jones, Ian; Gordon-Smith, Katherine; Fraser, Christine; Farmer, Anne; McGuffin, Peter; Lewis, Cathryn M.; Hosang, Georgina M.; Rivera, Margarita; Craddock, Nick

    2014-01-01

    Background Individuals with a mental health disorder appear to be at increased risk of medical illness. Aims To examine rates of medical illnesses in patients with bipolar disorder (n = 1720) and to examine the clinical course of the bipolar illness according to lifetime medical illness burden. Method Participants recruited within the UK were asked about the lifetime occurrence of 20 medical illnesses, interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and diagnosed according to DSM-IV criteria. Results We found significantly increased rates of several medical illnesses in our bipolar sample. A high medical illness burden was associated with a history of anxiety disorder, rapid cycling mood episodes, suicide attempts and mood episodes with a typically acute onset. Conclusions Bipolar disorder is associated with high rates of medical illness. This comorbidity needs to be taken into account by services in order to improve outcomes for patients with bipolar disorder and also in research investigating the aetiology of affective disorder where shared biological pathways may play a role. PMID:25359927

  12. Forecasting Infectious Disease Outbreaks

    NASA Astrophysics Data System (ADS)

    Shaman, J. L.

    2015-12-01

    Dynamic models of infectious disease systems abound and are used to study the epidemiological characteristics of disease outbreaks, the ecological mechanisms affecting transmission, and the suitability of various control and intervention strategies. The dynamics of disease transmission are non-linear and consequently difficult to forecast. Here, we describe combined model-inference frameworks developed for the prediction of infectious diseases. We show that accurate and reliable predictions of seasonal influenza outbreaks can be made using a mathematical model representing population-level influenza transmission dynamics that has been recursively optimized using ensemble data assimilation techniques and real-time estimates of influenza incidence. Operational real-time forecasts of influenza and other infectious diseases have been and are currently being generated.

  13. Infectious Chronic Rhinosinusitis.

    PubMed

    Bose, Sumit; Grammer, Leslie C; Peters, Anju T

    2016-01-01

    Chronic rhinosinusitis (CRS) is a persistent inflammatory disease that affects a multitude of people worldwide. The pathogenesis of CRS involves many factors including genetics, status of the sinonasal microbiome, infections, and environmental influences. Comorbidities associated with CRS include asthma, allergic rhinitis, bronchiectasis, and certain kinds of immunodeficiency. CRS can be divided into different subtypes based on endotypes and phenotypes. Infectious CRS is one such category. The etiology of infectious CRS is usually secondary to chronic bacterial infection that commonly begins with a viral upper respiratory tract infection. Humoral antibody deficiencies can underlie difficult-to-treat or recurrent CRS. Infectious CRS can be treated with antimicrobials, topical or oral corticosteroids, and nasal saline irrigations. Patients with CRS and humoral immunodeficiency may require an aggressive treatment approach including immunoglobulin replacement therapy. Despite advancements in the field of CRS, targeted therapies and reliable biomarkers are still lacking. PMID:27393772

  14. Acute diarrhea.

    PubMed

    Barr, Wendy; Smith, Andrew

    2014-02-01

    Acute diarrhea in adults is a common problem encountered by family physicians. The most common etiology is viral gastroenteritis, a self-limited disease. Increases in travel, comorbidities, and foodborne illness lead to more bacteria-related cases of acute diarrhea. A history and physical examination evaluating for risk factors and signs of inflammatory diarrhea and/or severe dehydration can direct any needed testing and treatment. Most patients do not require laboratory workup, and routine stool cultures are not recommended. Treatment focuses on preventing and treating dehydration. Diagnostic investigation should be reserved for patients with severe dehydration or illness, persistent fever, bloody stool, or immunosuppression, and for cases of suspected nosocomial infection or outbreak. Oral rehydration therapy with early refeeding is the preferred treatment for dehydration. Antimotility agents should be avoided in patients with bloody diarrhea, but loperamide/simethicone may improve symptoms in patients with watery diarrhea. Probiotic use may shorten the duration of illness. When used appropriately, antibiotics are effective in the treatment of shigellosis, campylobacteriosis, Clostridium difficile, traveler's diarrhea, and protozoal infections. Prevention of acute diarrhea is promoted through adequate hand washing, safe food preparation, access to clean water, and vaccinations. PMID:24506120

  15. Molecular surveillance of traditional and emerging pathogens associated with canine infectious respiratory disease.

    PubMed

    Decaro, Nicola; Mari, Viviana; Larocca, Vittorio; Losurdo, Michele; Lanave, Gianvito; Lucente, Maria Stella; Corrente, Marialaura; Catella, Cristiana; Bo, Stefano; Elia, Gabriella; Torre, Giorgio; Grandolfo, Erika; Martella, Vito; Buonavoglia, Canio

    2016-08-30

    A molecular survey for traditional and emerging pathogens associated with canine infectious respiratory disease (CIRD) was conducted in Italy between 2011 and 2013 on a total of 138 dogs, including 78 early acute clinically ill CIRD animals, 22 non-clinical but exposed to clinically ill CIRD dogs and 38 CIRD convalescent dogs. The results showed that canine parainfluenza virus (CPIV) was the most commonly detected CIRD pathogen, followed by canine respiratory coronavirus (CRCoV), Bordetella bronchiseptica, Mycoplasma cynos, Mycoplasma canis and canine pneumovirus (CnPnV). Some classical CIRD agents, such as canine adenoviruses, canine distemper virus and canid herpesvirus 1, were not detected at all, as were not other emerging respiratory viruses (canine influenza virus, canine hepacivirus) and bacteria (Streptococcus equi subsp. zooepidemicus). Most severe forms of respiratory disease were observed in the presence of CPIV, CRCoV and M. cynos alone or in combination with other pathogens, whereas single CnPnV or M. canis infections were detected in dogs with no or very mild respiratory signs. Interestingly, only the association of M. cynos (alone or in combination with either CRCoV or M. canis) with severe clinical forms was statistically significant. The study, while confirming CPIV as the main responsible for CIRD occurrence, highlights the increasing role of recently discovered viruses, such as CRCoV and CnPnV, for which effective vaccines are not available in the market. PMID:27527760

  16. Illnesses among recently immigrated children.

    PubMed

    Schwarzwald, Heidi

    2005-04-01

    The number of children immigrating to the United States has increased steadily during the last decade. American families are adopting a significant portion of these children, more than 20,000. Recently immigrated children face many different health risks when compared to children born in the United States. They are subject to many infectious diseases no longer seen commonly in the United States such as malaria, tuberculosis, and HIV. They are more likely to have inadequate immunity to vaccine-preventable illnesses. Recent immigrants have a higher likelihood of having malnutrition and developmental delay. Finally, many will have suffered psychological trauma in either institutions or refugee camps. These children require specialized testing, care, and treatment in the pediatric office. PMID:15825138

  17. Infectious waste feed system

    DOEpatents

    Coulthard, E. James

    1994-01-01

    An infectious waste feed system for comminuting infectious waste and feeding the comminuted waste to a combustor automatically without the need for human intervention. The system includes a receptacle for accepting waste materials. Preferably, the receptacle includes a first and second compartment and a means for sealing the first and second compartments from the atmosphere. A shredder is disposed to comminute waste materials accepted in the receptacle to a predetermined size. A trough is disposed to receive the comminuted waste materials from the shredder. A feeding means is disposed within the trough and is movable in a first and second direction for feeding the comminuted waste materials to a combustor.

  18. Infectious Diseases at High Altitude.

    PubMed

    Basnyat, Buddha; Starling, Jennifer M

    2015-08-01

    Travel to elevations above 2,500 m is an increasingly common activity undertaken by a diverse population of individuals. These may be trekkers, climbers, miners in high-altitude sites in South America, and more recently, soldiers deployed for high-altitude duty in remote areas of the world. What is also being increasingly recognized is the plight of the millions of pilgrims, many with comorbidities, who annually ascend to high-altitude sacred areas. There are also 400 million people who reside permanently in high mountain ranges, which cover one-fifth of the Earth's surface. Many of these high-altitude areas are in developing countries, for example, the Himalayan range in South Asia. Although high-altitude areas may not harbor any specific infectious disease agents, it is important to know about the pathogens encountered in the mountains to be better able to help both the ill sojourner and the native high-altitude dweller. Often the same pathogens prevalent in the surrounding lowlands are found at high altitude, but various factors such as immunomodulation, hypoxia, poor physiological adaptation, and harsh environmental stressors at high altitude may enhance susceptibility to these pathogens. Against this background, various gastrointestinal, respiratory, dermatological, neurological, and other infections encountered at high altitude are discussed. PMID:26350326

  19. Eosinophilia in Infectious Diseases

    PubMed Central

    O'Connell, Elise M.; Nutman, Thomas B.

    2015-01-01

    In determining the etiology of eosinophilia, it is necessary to consider the type of patient, including previous travel and exposure history, comorbidities, and symptoms. In this review, we discuss the approach to the patient with eosinophilia from an infectious diseases perspective based on symptom complexes. PMID:26209897

  20. Dynamics of infectious diseases

    NASA Astrophysics Data System (ADS)

    Rock, Kat; Brand, Sam; Moir, Jo; Keeling, Matt J.

    2014-02-01

    Modern infectious disease epidemiology has a strong history of using mathematics both for prediction and to gain a deeper understanding. However the study of infectious diseases is a highly interdisciplinary subject requiring insights from multiple disciplines, in particular a biological knowledge of the pathogen, a statistical description of the available data and a mathematical framework for prediction. Here we begin with the basic building blocks of infectious disease epidemiology—the SIS and SIR type models—before considering the progress that has been made over the recent decades and the challenges that lie ahead. Throughout we focus on the understanding that can be developed from relatively simple models, although accurate prediction will inevitably require far greater complexity beyond the scope of this review. In particular, we focus on three critical aspects of infectious disease models that we feel fundamentally shape their dynamics: heterogeneously structured populations, stochasticity and spatial structure. Throughout we relate the mathematical models and their results to a variety of real-world problems.

  1. Controlling Infectious Diseases.

    ERIC Educational Resources Information Center

    Porter, Wm. Lane; Fidler, David P.

    1997-01-01

    Advocates establishing programs to educate the public about the growing threat of communicable diseases and to promote effective strategies. Utilizes recent successes and failures to formulate those strategies. Profiles three recent infectious disease outbreaks that illustrate some of the current problems. Identifies four ways that lawyers can…

  2. Studying Physically Ill Elderly.

    ERIC Educational Resources Information Center

    Young, Rosalie F.; Kahana, Eva

    Research with older persons suffering from physical illness presents numerous challenges to gerontologists. Issues of conceptualization pertaining to the definition of illness, its location in the research paradigm, and the context in which illness occurs must be addressed prior to dealing with methodological problems. Access to physically ill…

  3. Diabetes after infectious hepatitis: a follow-up study.

    PubMed Central

    Oli, J M; Nwokolo, C

    1979-01-01

    Eleven patients (nine men, one woman, and one girl) aged 11-62 years who developed diabetes mellitus after an attack of infectious hepatitis during the Eastern Nigerian epidemic of 1970-2 were followed up for two to nine years. One patient aged 60 years remained diabetic after the original illness. In the remaining 10 patients the diabetes remitted after three to nine months (mean 6.7 months) but in four it recurred after a remission lasting one and a half to four years (mean 2.6 years). Results of this follow-up study seem to confirm that the pancreas is sometimes permanently damaged during infectious hepatitis. PMID:435884

  4. Percutaneous cholecystostomy in critically ill patients.

    PubMed

    Teplick, S K; Harshfield, D L; Brandon, J C; Broadwater, J R; Cone, J B

    1991-01-01

    Sixteen critically ill patients underwent percutaneous cholecystostomy because of suspected acute cholecystitis. The procedure was technically successful, although 11 of 16 patients died subsequently because of various complications of their underlying primary disorders. We reviewed this series to reassess the value of percutaneous cholecystostomy. Four of 11 patients with definite acute cholecystitis (group 1) were cured by this technique, but three required surgery because of gallbladder wall necrosis. Two of these were among four cases which had demonstrated pericholecystic fluid collections on computed tomography (CT) or ultrasound of the abdomen. There were also five patients (group 2) in whom acute cholecystitis or its relationship to patients' symptoms were not fully determined, and four of them did not improve after percutaneous cholecystostomy. We conclude that this technique has a lower success rate in critically ill patients than reported previously. PMID:2016030

  5. Biodefense and Emerging Infectious Diseases

    MedlinePlus

    ... Share this: Main Content Area Biodefense and Emerging Infectious Diseases NIAID conducts and supports basic research to better ... diagnose, treat, and prevent a wide range of infectious diseases, whether those diseases emerge naturally or are deliberately ...

  6. Infectious diseases among travellers and migrants in Europe, EuroTravNet 2010.

    PubMed

    Gautret, P; Cramer, J P; Field, V; Caumes, E; Jensenius, M; Gkrania-Klotsas, E; de Vries, P J; Grobusch, M P; Lopez-Velez, R; Castelli, F; Schlagenhauf, P; Hervius Askling, H; von Sonnenburg, F; Lalloo, D G; Loutan, L; Rapp, C; Basto, F; Santos O'Connor, F; Weld, L; Parola, P

    2012-01-01

    To investigate trends in travel-associated morbidity with particular emphasis on emerging infections with the potential for introduction into Europe, diagnoses of 7,408 returning travellers presenting to 16 EuroTravNet sites in 2010 were compared with 2008 and 2009. A significant increase in reported Plasmodium falciparum malaria (n=361 (6% of all travel-related morbidity) vs. n=254 (4%) and 260 (5%); p<0.001), P. vivax malaria (n=51 (1%) vs. n=31 (0.5%) and 38 (1%); p=0.027) and dengue fever (n=299 (5%) vs. n=127 (2%) and 127 (2%); p<0.001) was observed. Giardia lamblia was identified in 16% of patients with acute diarrhoea, with no significant annual variation. The proportion of acute diarrhoea due to Campylobacter increased from 7% in 2008 to 12% in 2010 (p=0.001). We recorded 121 patients with pulmonary tuberculosis in 2010, a threefold increase in the proportionate morbidity from 2008 to 2010. In 2010, 60 (0.8%) cases of chronic Chagas disease, 151 (2%) cases of schistosomiasis and 112 (2%) cases of cutaneous larva migrans were reported. Illness patterns in sentinel travellers, captured by EuroTravnet, continue to highlight the potential role of travellers in the emergence of infectious diseases of public health concern in Europe and the relevance of offering medical travel advice and enforcing specific and adequate prophylaxis. PMID:22790534

  7. Immunological dysfunction, vaccination and Gulf War illness

    PubMed Central

    Peakman, Mark; Skowera, Ania; Hotopf, Matthew

    2006-01-01

    One candidate cause of Gulf War illness is vaccination against infectious diseases including medical counter-measures against biological weapons. One influential theory has suggested that such mass-vaccination caused a shift in immune response to a Type 2 cytokine pattern (Th2), which it was suggested was accompanied by a chronic fatigue syndrome-like illness. This article critically appraises this theory. We start by examining epidemiological evidence, which indicates that single vaccines are unlikely to be a substantial cause of Gulf War illness, but that there was a modest relationship with multiple vaccines, which was strongest in those vaccinated while deployed to the Gulf. These relationships may be affected by recall bias. We conclude by examining the results of immunological studies carried out in veterans or in a relevant setting in vitro. The balance of evidence from immunological studies on veterans returning from the War, including those developing multi-symptom illness, is that the immune response has not become polarized towards Th2. In summary, the epidemiological evidence for a multiple vaccine effect on Gulf War-related illness remains a potentially important aetiological lead, but mechanistic studies available at this stage do not identify any immunological basis for it. PMID:16687270

  8. Management of Infections in Critically Ill Patients

    PubMed Central

    Hranjec, Tjasa

    2014-01-01

    Abstract Background: Critically ill patients have an increased risk of developing infections and infectious complications, sometimes followed by death. Despite a substantial investment of resources in outcomes improvement, optimum treatment for such patients remains unclear for practicing intensivists. Methods: We conducted a review that highlights the most recent developments in the prevention, diagnosis, and management of infection and the evaluation of its outcomes. The review examines the prevention of infection, such as through daily bathing with chlorhexidine and the addition of probiotics to treatment regimens, and questions the previous standards of care, including the monitoring of gastric residuals and treatment of severely ill patients with drotrecogin alfa (activated). It also discusses novel approaches to the treatment of severely ill infected patients with extra-corporeal membrane oxygenation and the earlier normalization of body temperature. Results: The development of new antibiotics continues at a slow pace, with the likelihood that alternative approaches to the management of infection, including changes in the quality of patient care, are producing needed improvements. Conclusions: Clinical outcomes of infection are improving slowly as medical teams strive for better patient care. Lack of reimbursement is unnecessary as a punitive approach to infectious diseases. PMID:24841214

  9. Bedbugs and Infectious Diseases

    PubMed Central

    Blanc, Véronique; Del Giudice, Pascal; Levy-Bencheton, Anna; Chosidow, Olivier; Marty, Pierre; Brouqui, Philippe

    2011-01-01

    Bedbugs are brown and flat hematophagous insects. The 2 cosmopolite species, Cimex lectularius and Cimex hemipterus, feed on humans and/or domestic animals, and recent outbreaks have been reported in occidental countries. Site assessment for bedbug eradication is complex but can be assured, despite emerging insecticide resistance, by hiring a pest-control manager. The common dermatological presentation of bites is an itchy maculopapular wheal. Urticarial reactions and anaphylaxis can also occur. Bedbugs are suspected of transmitting infectious agents, but no report has yet demonstrated that they are infectious disease vectors. We describe 45 candidate pathogens potentially transmitted by bedbugs, according to their vectorial capacity, in the wild, and vectorial competence, in the laboratory. Because of increasing demands for information about effective control tactics and public health risks of bedbugs, continued research is needed to identify new pathogens in wild Cimex species (spp) and insecticide resistance. PMID:21288844

  10. [Notable imported infectious diseases].

    PubMed

    Ohnishi, Kenji

    2011-03-01

    Japanese doctors are somewhat unfamiliar with imported infectious diseases, however, the following imported infectious diseases are notable: cholera, which is currently endemic in Haiti and which there is a possibility of it being imported to Japan from endemic areas; typhoid fever and paratyphoid fever, whose causative organisms showing low sensitivity to fluoroquinolones have become predominant; rabies, which exhibits a high mortality; avian influenza H5N1, which has the possibility of changing into a new type of human influenza; chikungunya fever, in which the number of Japanese patients is increasing; and cyclosporiasis, which led to a number of food poisonings in the USA and Canada, and as a growing number of Japanese travel abroad, the number of infected Japanese patients returning from endemic areas will increase. It is thus important to identify the presence of these diseases on diagnosis. PMID:21560415

  11. Antibiotic Dosing in Patients With Acute Kidney Injury: "Enough But Not Too Much".

    PubMed

    Lewis, Susan J; Mueller, Bruce A

    2016-03-01

    Increasing evidence suggests that antibiotic dosing in critically ill patients with acute kidney injury (AKI) often does not achieve pharmacodynamic goals, and the continued high mortality rate due to infectious causes appears to confirm these findings. Although there are compelling reasons why clinicians should use more aggressive antibiotic dosing, particularly in patients receiving aggressive renal replacement therapies, concerns for toxicity associated with higher doses are real. The presence of multisystem organ failure and polypharmacy predispose these patients to drug toxicity. This article examines the pharmacokinetic and pharmacodynamic consequences of critical illness, AKI, and renal replacement therapy and describes potential solutions to help clinicians give "enough but not too much" in these very complicated patients. PMID:25326429

  12. Immunoserology of infectious diseases.

    PubMed Central

    James, K

    1990-01-01

    The immune response to microorganisms not only participates in the elimination of unwanted organisms from the body, but also assists in diagnosis of infectious diseases. The nonspecific immune response is the first line of defense, assisting the body until the specific immune response can be mobilized to provide protective mechanisms. The specific immune response involves humoral or cell-mediated immunity or both, dependent on the nature of the organism and its site of sequestration. A variety of test systems have been developed to identify the causative organisms of infectious diseases. Test systems used in immunoserology have classically included methods of detecting antigen-antibody reactions which range from complement fixation to immunoassay methods. Relevant test systems for detecting antigens and antibodies are described. With numerous test systems available to detect antigens and antibodies, there can be confusion regarding selection of the appropriate system for each application. Methods for detecting antibody to verify immunity differ from immunologic methods to diagnose disease. Techniques to detect soluble antigens present in active infectious states may appear similar to those used to detect antibody, but their differences should be appreciated. PMID:2187592

  13. Predictive value of an abnormal hepatobiliary scan in patients with severe intercurrent illness

    SciTech Connect

    Kalff, V.; Froelich, J.W.; Lloyd, R.; Thrall, J.H.

    1983-01-01

    Ten patients had severe intercurrent illness and the gallbladder could not be seen on a hepatobiliary scan. In 4, surgery and pathological examination showed that the gallbladder was normal; 1 had chronic cholecystitis and 5 had acute acalculous cholecystitis. This study indicates that a positive hepatobiliary scan may not be indicative of acute gallbladder disease in the seriously ill patient.

  14. Five dramas of illness.

    PubMed

    Frank, Arthur W

    2007-01-01

    First-person narratives of illness experience are dramatic: the narrator, who is also the sufferer, is caught in conflicts of forces that permit understanding more than control. Among the dramas of illness, five occur frequently in autobiographical accounts of illness. These dramas overlap and have varying emphases in different people's stories. They are the drama of genesis (what instigated the illness); the drama of emotion work (what emotional displays are required or prohibited); the drama of fear and loss; the drama of meaning; and finally, the drama of self. This five-drama framework can focus critical and clinical attention on which conflicting forces the ill person is working to reconcile, what makes that work difficult, and how conceiving of one's illness as a drama can be a source of meaning and value. PMID:17660632

  15. Infectious Triggers of Chronic Lung Allograft Dysfunction.

    PubMed

    Gregson, Aric L

    2016-07-01

    Survival after lung transplantation is limited in large part due to the high incidence of chronic rejection, known as chronic lung allograft dysfunction (CLAD). Pulmonary infections are a frequent complication in lung transplant recipients, due both to immunosuppressive medications and constant exposure of the lung allograft to the external environment via the airways. Infection is a recognized risk factor for the development of CLAD, and both acute infection and chronic lung allograft colonization with microorganisms increase the risk for CLAD. Acute infection by community acquired respiratory viruses, and the bacteria Pseudomonas aeruginosa and Staphylococcus aureus are increasingly recognized as important risk factors for CLAD. Colonization by the fungus Aspergillus may also augment the risk of CLAD. Fostering this transition from healthy lung to CLAD in each of these infectious episodes is the persistence of an inflammatory lung allograft environment. PMID:27221821

  16. Predictors of Post-Infectious Chronic Fatigue Syndrome in Adolescents.

    PubMed

    Jason, Leonard A; Katz, Ben Z; Shiraishi, Yukiko; Mears, Cynthia J; Im, Young; Taylor, Renee

    2014-01-01

    This study focused on identifying risk factors for adolescent post-infectious chronic fatigue syndrome (CFS), utilizing a prospective, nested case-control longitudinal design in which over 300 teenagers with Infectious Mononucleosis (IM) were identified through primary care sites and followed. Baseline variables that were gathered several months following IM, included autonomic symptoms, days in bed since IM, perceived stress, stressful life events, family stress, difficulty functioning and attending school, family stress and psychiatric disorders. A number of variables were predictors of post-infectious CFS at 6 months; however, when autonomic symptoms were used as a control variable, only days spent in bed since mono was a significant predictor. Step-wise logistic regression findings indicated that baseline autonomic symptoms as well as days spent in bed since mono, which reflect the severity of illness, were the only significant predictors of those who met CFS criteria at 6 months. PMID:24660116

  17. Predictors of post-infectious chronic fatigue syndrome in adolescents

    PubMed Central

    Jason, Leonard A.; Katz, Ben Z.; Shiraishi, Yukiko; Mears, Cynthia J.; Im, Young; Taylor, Renee R.

    2014-01-01

    This study focused on identifying risk factors for adolescent post-infectious chronic fatigue syndrome (CFS), utilizing a prospective, nested case–control longitudinal design in which over 300 teenagers with infectious mononucleosis (IM) were identified through primary care sites and followed. Baseline variables that were gathered several months following IM, included autonomic symptoms, days in bed since IM, perceived stress, stressful life events, family stress, difficulty functioning and attending school, family stress, and psychiatric disorders. A number of variables were predictors of post-infectious CFS at six months; however, when autonomic symptoms were used as a control variable, only days spent in bed since mono was a significant predictor. Step-wise logistic regression findings indicated that baseline autonomic symptoms as well as days spent in bed since mono, which reflect the severity of illness, were the only significant predictors of those who met CFS criteria at six months. PMID:24660116

  18. Heat-related illnesses.

    PubMed

    Khosla, R; Guntupalli, K K

    1999-04-01

    The majority of clinicians will encounter patients with heat-related illness in one form or the other. Early recognition and management are important to prevent morbidity and mortality. In children and elderly, the clinical signs may be subtle and in such situations a sound knowledge of heat-related illnesses is crucial. Besides diagnosing and treating heat-related illnesses, it is equally important to know how to prevent them as they are easily preventable. PMID:10331127

  19. Is irritable bowel syndrome an infectious disease?

    PubMed

    Thompson, John Richard

    2016-01-28

    Irritable bowel syndrome (IBS) is the most common of all gastroenterological diseases. While many mechanisms have been postulated to explain its etiology, no single mechanism entirely explains the heterogeneity of symptoms seen with the various phenotypes of the disease. Recent data from both basic and clinical sciences suggest that underlying infectious disease may provide a unifying hypothesis that better explains the overall symptomatology. The presence of small intestinal bowel overgrowth (SIBO) has been documented in patients with IBS and reductions in SIBO as determined by breath testing correlate with IBS symptom improvement in clinical trials. The incidence of new onset IBS symptoms following acute infectious gastroenteritis also suggests an infectious cause. Alterations in microbiota-host interactions may compromise epithelial barrier integrity, immune function, and the development and function of both central and enteric nervous systems explaining alterations in the brain-gut axis. Clinical evidence from treatment trials with both probiotics and antibiotics also support this etiology. Probiotics appear to restore the imbalance in the microflora and improve IBS-specific quality of life. Antibiotic trials with both neomycin and rifaximin show improvement in global IBS symptoms that correlates with breath test normalization in diarrhea-predominant patients. The treatment response to two weeks of rifaximin is sustained for up to ten weeks and comparable results are seen in symptom reduction with retreatment in patients who develop recurrent symptoms. PMID:26819502

  20. Is irritable bowel syndrome an infectious disease?

    PubMed Central

    Thompson, John Richard

    2016-01-01

    Irritable bowel syndrome (IBS) is the most common of all gastroenterological diseases. While many mechanisms have been postulated to explain its etiology, no single mechanism entirely explains the heterogeneity of symptoms seen with the various phenotypes of the disease. Recent data from both basic and clinical sciences suggest that underlying infectious disease may provide a unifying hypothesis that better explains the overall symptomatology. The presence of small intestinal bowel overgrowth (SIBO) has been documented in patients with IBS and reductions in SIBO as determined by breath testing correlate with IBS symptom improvement in clinical trials. The incidence of new onset IBS symptoms following acute infectious gastroenteritis also suggests an infectious cause. Alterations in microbiota-host interactions may compromise epithelial barrier integrity, immune function, and the development and function of both central and enteric nervous systems explaining alterations in the brain-gut axis. Clinical evidence from treatment trials with both probiotics and antibiotics also support this etiology. Probiotics appear to restore the imbalance in the microflora and improve IBS-specific quality of life. Antibiotic trials with both neomycin and rifaximin show improvement in global IBS symptoms that correlates with breath test normalization in diarrhea-predominant patients. The treatment response to two weeks of rifaximin is sustained for up to ten weeks and comparable results are seen in symptom reduction with retreatment in patients who develop recurrent symptoms. PMID:26819502

  1. High Altitude Illnesses in Hawai‘i

    PubMed Central

    2014-01-01

    High Altitude Headache (HAH), Acute Mountain Sickness (AMS), and High Altitude Cerebral Edema (HACE) are all high altitude related illnesses in order of severity from the mildly symptomatic to the potentially life-threatening. High altitude illnesses occur when travelers ascend to high altitudes too rapidly, which does not allow enough time for the body to adjust. Slow graded ascent to the desired altitude and termination of ascent if AMS symptoms present are keys to illness prevention. Early recognition and rapid intervention of AMS can halt progression to HACE. Pharmacologic prophylaxis with acetazolamide is a proven method of prevention and treatment of high altitude illness. If prevention fails then treatment modalities include supplemental oxygen, supportive therapy, hyperbaric treatment, and dexamethasone. Given the multitude of visitors to the mountains of Hawai‘i, high altitude illness will continue to persist as a prevalent local condition. This paper will emphasize the prevention and early diagnosis of AMS so that the illness does not progress to HACE. PMID:25478293

  2. Radioimmunotherapy of infectious diseases

    PubMed Central

    Dadachova, Ekaterina; Casadevall, Arturo

    2009-01-01

    The need for novel approaches to treat infectious diseases is obvious and urgent. This situation has renewed interest in using monoclonal antibodies (mAbs) in therapy of infectious diseases. During the last 5 years radioimmunotherapy (RIT), a modality developed for cancer treatment, has been successfully adapted for the treatment of experimental fungal (C. neoformans and H. capsulatum), bacterial (S. pneumoniae and B. anthracis) and viral (HIV-1) infections. RIT produced none or only transient hematological toxicity in experimental animals. Investigation of radiobiological mechanisms of RIT of infections showed that microbial cells are killed by both "direct hit" and "cross-fire" radiation. MAbs radiolabeled with either alpha- or beta-emitters stimulated apoptosis-like cell death, while only mAbs radiolabeled with alpha-emitter 213Bi also decreased the metabolic activity of microbial cells. The success of this approach in laboratory studies combined with earlier nuclear medicine experience on pre-clinical and clinical studies utilizing radiolabeled organism-specific antibodies for imaging of infections provides encouragement for feasibility of therapeutically targeting microbes with labeled antibodies. We envision that first the organism-specific mAbs will be radiolabeled with imaging radionuclides such as 99mTc or 111In to localize the sites of infection with SPECT followed by RIT with 188Re- or 90Y-labeled mAb, respectively. Also, immunoPET might be utilized for imaging of infection before treatment if such positron-emitting radionuclides as 86Y (matching pair for 90Y) or 124I (matching pair for 131I) are available. It might be possible to create a so-called “pan-antibody” which would recognize an antigen shared by a particular class of human pathogens such as fungi, for example. The availability of such antibodies would eliminate the necessity of having antibodies specific for each particular microorganism and would enormously enhance the development of RIT

  3. "Infectious" Transplantation Tolerance

    NASA Astrophysics Data System (ADS)

    Qin, Shixin; Cobbold, Stephen P.; Pope, Heather; Elliott, James; Kioussis, Dimitris; Davies, Joanna; Waldmann, Herman

    1993-02-01

    The maintenance of transplantation tolerance induced in adult mice after short-term treatment with nonlytic monoclonal antibodies to CD4 and CD8 was investigated. CD4^+ T cells from tolerant mice disabled naive lymphocytes so that they too could not reject the graft. The naive lymphocytes that had been so disabled also became tolerant and, in turn, developed the capacity to specifically disable other naive lymphocytes. This process of "infectious" tolerance explains why no further immunosuppression was needed to maintain long-term transplantation tolerance.

  4. Risk of waterborne illness via drinking water in the United States.

    PubMed

    Reynolds, Kelly A; Mena, Kristina D; Gerba, Charles P

    2008-01-01

    Outbreaks of disease attributable to drinking water are not common in the U.S., but they do still occur and can lead to serious acute, chronic, or sometimes fatal health consequences, particularly in sensitive and immunocompromised populations. From 1971 to 2002, there were 764 documented waterborne outbreaks associated with drinking water, resulting in 575,457 cases of illness and 79 deaths (Blackburn et al. 2004; Calderon 2004); however, the true impact of disease is estimated to be much higher. If properly applied, current protocols in municipal water treatment are effective at eliminating pathogens from water. However, inadequate, interrupted, or intermittent treatment has repeatedly been associated with waterborne disease outbreaks. Contamination is not evenly distributed but rather affected by the number of pathogens in the source water, the age of the distribution system, the quality of the delivered water, and climatic events that can tax treatment plant operations. Private water supplies are not regulated by the USEPA and are generally not treated or monitored, although very few of the municipal systems involved in documented outbreaks exceeded the USEPA's total coliform standard in the preceding 12 mon (Craun et al. 2002). We provide here estimates of waterborne infection and illness risks in the U.S. based on the total number of water systems, source water type, and total populations exposed. Furthermore, we evaluated all possible illnesses associated with the microbial infection and not just gastroenteritis. Our results indicate that 10.7 M infections/yr and 5.4 M illnesses/yr occur in populations served by community groundwater systems; 2.2 M infections/yr and 1.1 M illnesses/yr occur in noncommunity groundwater systems; and 26.0 M infections/yr and 13.0 M illnesses/yr occur in municipal surface water systems. The total estimated number of waterborne illnesses/yr in the U.S. is therefore estimated to be 19.5 M/yr. Others have recently estimated

  5. Acute peripheral polyneuropathy with multiorgan failure: a diagnostic dilemma

    PubMed Central

    Hussain, Kosar; Abubaker, Jawed; Ahmad Dar, Javeed; Ahmed, Raees

    2014-01-01

    We describe the case of a young man who presented with abdominal pain, vomiting and acute symmetric peripheral polyneuropathy. He was noted to have high anion gap metabolic acidosis with high lactate levels and persistently high arterial and venous pO2 values. The cerebrospinal fluid was acellular with a high protein and the nerve conduction study was consistent with axonal sensorimotor neuropathy. His clinical condition deteriorated rapidly despite full supportive care and he subsequently died of multiorgan failure. An extensive workup for various infectious, autoimmune and other possible aetiologies was carried out to identify the underlying cause for his fulminant illness. All diagnostic workup was non-conclusive except for a significantly elevated serum aluminium level. We have discussed the possibility of aluminium phosphide poisoning in view of the clinical presentation. PMID:24899008

  6. Reducing Non-Infectious Risks of Blood Transfusion

    PubMed Central

    Gilliss, Brian M.; Looney, Mark R.; Gropper, Michael A.

    2011-01-01

    Summary As screening for transfusion-associated infections has improved, non-infectious complications of transfusion now cause the majority of morbidity and mortality associated with transfusion in the United States. For example, transfusion-related acute lung injury, transfusion-associated circulatory overload, and hemolytic transfusion-reactions are the first, second, and third leading causes of death from transfusion respectively. These complications and others are reviewed here and several controversial methods for prevention of non-infectious complications of transfusion are discussed; universal leukoreduction of red cell units, use of male-only plasma, and restriction of red cell storage age. PMID:21792054

  7. Wetlands and infectious diseases.

    PubMed

    Zimmerman, R H

    2001-01-01

    There is a historical association between wetlands and infectious disease that has led to the modification of wetlands to prevent disease. At the same time there has been the development of water resources projects that increase the risk of disease. The demand for more water development projects and the increased pressure to make natural wetlands economically beneficial creates the need for an ecological approach to wetland management and health assessment. The environmental and health interactions are many. There is a need to take into account the landscape, spatial boundaries, and cross-boundary interactions in water development projects as well as alternative methods to provide water for human needs. The research challenges that need to be addressed are discussed. PMID:11426273

  8. [Infectious diseases (beside AIDS)].

    PubMed

    Bellini, C; Senn, L; Zanetti, G

    2008-01-01

    A simplified version of the US guidelines for prophylaxis of infectious endocarditis was published in 2007. Changes are expected in Switzerland as well. Posaconsole is a new antifungal agent available mostly for prophylaxis in immunocompromised patients. Epidemiology of sexually transmitted infections warrants screening in young adults and after one episode. A meta-analysis clarified the impact of antibiotic therapy in patients with Campylobacter spp. infection. In the field of emerging diseases, we discuss Norovirus epidemics, community-acquired bacteria producing extended-spectrum betalactamases, extensively resistant tuberculosis, and new respiratory viruses. Finally, we address a basic research topic that may change practice in the future: the relationship between individual susceptibility to infection and innate immunity. PMID:18251213

  9. Neuralgic amyotrophy and infectious mononucleosis: a case report.

    PubMed

    Esmonde, T; Gamble, W; Patterson, V

    1995-07-01

    A 27 year old man developed neuralgic amyotrophy of the right upper limb 5 weeks after an acute febrile illness which was proven serologically to be caused by Ebstein-Barr virus. The weakness developed in a limb that had been used to perform heavy manual labour. A parallel with a similar phenomenon described in association with paralytic poliomyelitis is noted.- PMID:24283643

  10. The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness.

    PubMed Central

    Hay, Alastair D; Birnie, Kate; Busby, John; Delaney, Brendan; Downing, Harriet; Dudley, Jan; Durbaba, Stevo; Fletcher, Margaret; Harman, Kim; Hollingworth, William; Hood, Kerenza; Howe, Robin; Lawton, Michael; Lisles, Catherine; Little, Paul; MacGowan, Alasdair; O'Brien, Kathryn; Pickles, Timothy; Rumsby, Kate; Sterne, Jonathan Ac; Thomas-Jones, Emma; van der Voort, Judith; Waldron, Cherry-Ann; Whiting, Penny; Wootton, Mandy; Butler, Christopher C

    2016-01-01

    BACKGROUND It is not clear which young children presenting acutely unwell to primary care should be investigated for urinary tract infection (UTI) and whether or not dipstick testing should be used to inform antibiotic treatment. OBJECTIVES To develop algorithms to accurately identify pre-school children in whom urine should be obtained; assess whether or not dipstick urinalysis provides additional diagnostic information; and model algorithm cost-effectiveness. DESIGN Multicentre, prospective diagnostic cohort study. SETTING AND PARTICIPANTS Children < 5 years old presenting to primary care with an acute illness and/or new urinary symptoms. METHODS One hundred and seven clinical characteristics (index tests) were recorded from the child's past medical history, symptoms, physical examination signs and urine dipstick test. Prior to dipstick results clinician opinion of UTI likelihood ('clinical diagnosis') and urine sampling and treatment intentions ('clinical judgement') were recorded. All index tests were measured blind to the reference standard, defined as a pure or predominant uropathogen cultured at ≥ 10(5) colony-forming units (CFU)/ml in a single research laboratory. Urine was collected by clean catch (preferred) or nappy pad. Index tests were sequentially evaluated in two groups, stratified by urine collection method: parent-reported symptoms with clinician-reported signs, and urine dipstick results. Diagnostic accuracy was quantified using area under receiver operating characteristic curve (AUROC) with 95% confidence interval (CI) and bootstrap-validated AUROC, and compared with the 'clinician diagnosis' AUROC. Decision-analytic models were used to identify optimal urine sampling strategy compared with 'clinical judgement'. RESULTS A total of 7163 children were recruited, of whom 50% were female and 49% were < 2 years old. Culture results were available for 5017 (70%); 2740 children provided clean-catch samples, 94% of whom were ≥ 2 years old

  11. Neuroimaging of Infectious and Inflammatory Diseases of the Pediatric Cerebellum and Brainstem.

    PubMed

    Rossi, Andrea; Martinetti, Carola; Morana, Giovanni; Severino, Mariasavina; Tortora, Domenico

    2016-08-01

    Cerebellar involvement by infectious-inflammatory conditions is rare in children. Most patients present with acute ataxia, and are typically previously healthy, young (often preschool) children. Viral involvement is the most common cause and ranges from acute postinfectious ataxia to acute cerebellitis MR imaging plays a crucial role in the evaluation of patients suspected of harboring inflammatory-infectious involvement of the cerebellum and brainstem. Knowledge of the imaging features of these disorders and technical competence on pediatric MR imaging are necessary for a correct interpretation of findings, which in turn prompts further management. PMID:27423804

  12. Global mapping of infectious disease

    PubMed Central

    Hay, Simon I.; Battle, Katherine E.; Pigott, David M.; Smith, David L.; Moyes, Catherine L.; Bhatt, Samir; Brownstein, John S.; Collier, Nigel; Myers, Monica F.; George, Dylan B.; Gething, Peter W.

    2013-01-01

    The primary aim of this review was to evaluate the state of knowledge of the geographical distribution of all infectious diseases of clinical significance to humans. A systematic review was conducted to enumerate cartographic progress, with respect to the data available for mapping and the methods currently applied. The results helped define the minimum information requirements for mapping infectious disease occurrence, and a quantitative framework for assessing the mapping opportunities for all infectious diseases. This revealed that of 355 infectious diseases identified, 174 (49%) have a strong rationale for mapping and of these only 7 (4%) had been comprehensively mapped. A variety of ambitions, such as the quantification of the global burden of infectious disease, international biosurveillance, assessing the likelihood of infectious disease outbreaks and exploring the propensity for infectious disease evolution and emergence, are limited by these omissions. An overview of the factors hindering progress in disease cartography is provided. It is argued that rapid improvement in the landscape of infectious diseases mapping can be made by embracing non-conventional data sources, automation of geo-positioning and mapping procedures enabled by machine learning and information technology, respectively, in addition to harnessing labour of the volunteer ‘cognitive surplus’ through crowdsourcing. PMID:23382431

  13. 75 FR 24835 - Infectious Diseases

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-06

    ... notice ``Occupational Exposure to Tuberculosis; Proposed Rule'' (62 FR 54160-54308; October 17, 1997... seconds) and form what are called droplet nuclei (residue from evaporated droplets). These small particles.... Airborne transmission occurs when infectious droplet nuclei or particles containing infectious agents...

  14. BORDER INFECTIOUS DISEASES SURVEILLANCE PROJECT

    EPA Science Inventory

    In 1997, the Centers for Disease Control and Prevention, the Mexican Secretariat of Health, and border health officials began the development of the Border Infectious Disease Surveillance (BIDS) project, a surveillance system for infectious diseases along the U.S.-Mexico border. ...

  15. 76 FR 39041 - Infectious Diseases

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-05

    ...OSHA invites interested parties to participate in informal stakeholder meetings concerning occupational exposure to infectious diseases. OSHA plans to use the information gathered at these meetings to explore the possible development of a proposed rule to protect workers from occupational exposure to infectious agents in settings, either where workers provide direct patient care or where......

  16. Nutritional support in critical illness and recovery.

    PubMed

    Casaer, Michael P; Ziegler, Thomas R

    2015-09-01

    An adequate nutritional status is crucial for optimum function of cells and organs, and for wound healing. Options for artificial nutrition have greatly expanded in the past few decades, but have concomitantly shown limitations and potential side-effects. Few rigorous randomised controlled trials (RCTs) have investigated enteral or parenteral nutritional support, and evidence-based clinical guidance is largely restricted to the first week of critical illness. In the early stages of critical illness, whether artificial feeding is better than no feeding intervention has been given little attention in existing RCTs. Expected beneficial effects of various forms of early feeding interventions on rates of morbidity or mortality have generally not been supported by results of recent high-quality RCTs. Thus, whether nutritional interventions early in an intensive care unit (ICU) stay improve outcomes remains unclear. Trials assessing feeding interventions that continue after the first week of critical illness and into the post-ICU and post-hospital settings are clearly needed. Although acute morbidity and mortality will remain important safety parameters in such trials, primary outcomes should perhaps, in view of the adjunctive nature of nutritional intervention in critical illness, be focused on physical function and assessed months or even years after patients are discharged from the ICU. This Series paper is based on results of high-quality RCTs and provides new perspectives on nutritional support during critical illness and recovery. PMID:26071886

  17. Waterborne Diseases & Illnesses

    MedlinePlus

    ... Gases Impact on Weather Health Effects Take Action Water Pollution Water Pollution Home Chemicals and Pollutants Natural Disasters Drinking Water ... Water Treatment Videos Games Experiments For Teachers Home Water Pollution Waterborne Diseases & Illnesses Print this Page Air Pollution ...

  18. Mass Psychogenic Illness

    MedlinePlus

    ... been exposed to something harmful. An outbreak of mass psychogenic illness is a time of anxiety and worry. During an outbreak, a lot of media coverage and the presence of ambulances or emergency ...

  19. Vaccines Stop Illness

    MedlinePlus

    Skip Navigation Bar Home Current Issue Past Issues Vaccines Stop Illness Past Issues / Spring 2008 Table of ... meningitis won't infect, cripple, or kill children. Vaccine Safety In light of recent questions about vaccine ...

  20. Symptoms of Tickborne Illness

    MedlinePlus

    ... disease , southern tick-associated rash illness (STARI) , Rocky Mountain spotted fever (RMSF) , ehrlichiosis , and tularemia can result ... or neurologic symptoms. The rash seen with Rocky Mountain spotted fever (RMSF) varies greatly from person to ...

  1. Illness anxiety disorder

    MedlinePlus

    Somatic symptom disorder; Somatic symptom and related disorders; Hypochondriasis ... Illness anxiety disorder is different from somatic symptom disorder. With somatic symptom disorder, the person has physical pain or other ...

  2. Help for Mental Illnesses

    MedlinePlus

    ... Mental Health America National Alliance on Mental Illness University or medical school-affiliated programs may offer treatment options. Search on the website of local university health centers for their psychiatry or psychology departments. ...

  3. Infectious diseases following natural disasters: prevention and control measures.

    PubMed

    Kouadio, Isidore K; Aljunid, Syed; Kamigaki, Taro; Hammad, Karen; Oshitani, Hitoshi

    2012-01-01

    Natural disasters may lead to infectious disease outbreaks when they result in substantial population displacement and exacerbate synergic risk factors (change in the environment, in human conditions and in the vulnerability to existing pathogens) for disease transmission. We reviewed risk factors and potential infectious diseases resulting from prolonged secondary effects of major natural disasters that occurred from 2000 to 2011. Natural disasters including floods, tsunamis, earthquakes, tropical cyclones (e.g., hurricanes and typhoons) and tornadoes have been secondarily described with the following infectious diseases including diarrheal diseases, acute respiratory infections, malaria, leptospirosis, measles, dengue fever, viral hepatitis, typhoid fever, meningitis, as well as tetanus and cutaneous mucormycosis. Risk assessment is essential in post-disaster situations and the rapid implementation of control measures through re-establishment and improvement of primary healthcare delivery should be given high priority, especially in the absence of pre-disaster surveillance data. PMID:22149618

  4. What Is a Pediatric Infectious Diseases Specialist?

    MedlinePlus

    ... Size Email Print Share What is a Pediatric Infectious Diseases Specialist? Page Content Article Body If your child ... teen years. What Kind of Training Do Pediatric Infectious Diseases Specialists Have? Pediatric infectious diseases specialists are medical ...

  5. NON-INFECTIOUS DISORDERS OF WARMWATER FISHES

    EPA Science Inventory

    Compared with infectious diseases and disorders, few non-infectious diseases and disorders in cultured fish have severe biologic or economic impact. Culture practices, however, often establish environments that promote infectious disease by weakening the immune response or by pro...

  6. Delirium: An Emerging Frontier in Management of Critically Ill Children

    PubMed Central

    Smith, Heidi A.B.; Fuchs, D. Catherine; Pandharipande, Pratik P.; Barr, Frederick E.; Ely, E. Wesley

    2009-01-01

    OBJECTIVES Introduce pediatric delirium and provide understanding of acute brain dysfunction with its classification and clinical presentations. Understand how delirium is diagnosed and discuss current modes of delirium diagnosis in the critically ill adult population and translation to pediatrics. Understand the prevalence and prognostic significance of delirium in the adult and pediatric critically ill population. Discuss the pathophysiology of delirium as currently understood. Provide general management guidelines for delirium. PMID:19576533

  7. Development of a high throughput TaqMan assay for the detection of infectious laryngotracheitis virus in vector vaccinated chickens

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Infectious laryngotracheitis virus (ILTV) causes an acute, highly contagious upper-respiratory disease of chickens. Sensitive detection of the causative alphaherpesvirus is important in clinical investigations and experimental studies. In particular, it is essential to quantify the viral genome co...

  8. Prioritising Infectious Disease Mapping

    PubMed Central

    Pigott, David M.; Howes, Rosalind E.; Wiebe, Antoinette; Battle, Katherine E.; Golding, Nick; Gething, Peter W.; Dowell, Scott F.; Farag, Tamer H.; Garcia, Andres J.; Kimball, Ann M.; Krause, L. Kendall; Smith, Craig H.; Brooker, Simon J.; Kyu, Hmwe H.; Vos, Theo; Murray, Christopher J. L.; Moyes, Catherine L.; Hay, Simon I.

    2015-01-01

    Background Increasing volumes of data and computational capacity afford unprecedented opportunities to scale up infectious disease (ID) mapping for public health uses. Whilst a large number of IDs show global spatial variation, comprehensive knowledge of these geographic patterns is poor. Here we use an objective method to prioritise mapping efforts to begin to address the large deficit in global disease maps currently available. Methodology/Principal Findings Automation of ID mapping requires bespoke methodological adjustments tailored to the epidemiological characteristics of different types of diseases. Diseases were therefore grouped into 33 clusters based upon taxonomic divisions and shared epidemiological characteristics. Disability-adjusted life years, derived from the Global Burden of Disease 2013 study, were used as a globally consistent metric of disease burden. A review of global health stakeholders, existing literature and national health priorities was undertaken to assess relative interest in the diseases. The clusters were ranked by combining both metrics, which identified 44 diseases of main concern within 15 principle clusters. Whilst malaria, HIV and tuberculosis were the highest priority due to their considerable burden, the high priority clusters were dominated by neglected tropical diseases and vector-borne parasites. Conclusions/Significance A quantitative, easily-updated and flexible framework for prioritising diseases is presented here. The study identifies a possible future strategy for those diseases where significant knowledge gaps remain, as well as recognising those where global mapping programs have already made significant progress. For many conditions, potential shared epidemiological information has yet to be exploited. PMID:26061527

  9. Conflict and Emerging Infectious Diseases

    PubMed Central

    Legros, Dominique; Formenty, Pierre; Connolly, Maire A.

    2007-01-01

    Detection and control of emerging infectious diseases in conflict situations are major challenges due to multiple risk factors known to enhance emergence and transmission of infectious diseases. These include inadequate surveillance and response systems, destroyed infrastructure, collapsed health systems and disruption of disease control programs, and infection control practices even more inadequate than those in resource-poor settings, as well as ongoing insecurity and poor coordination among humanitarian agencies. This article outlines factors that potentiate emergence and transmission of infectious diseases in conflict situations and highlights several priority actions for their containment and control. PMID:18217543

  10. Munchausen syndrome mimicking psychiatric disease with concomitant genuine physical illness

    PubMed Central

    Almeida, Jaime; da Silva, Joaquim Alves; Xavier, Miguel; Gusmão, Ricardo

    2010-01-01

    Munchausen syndrome is a disorder in which patients intentionally produce symptoms mimicking physical or psychiatric illnesses with the aim to assume the sick role and to gain medical attention. Once a patient receives a Munchausen syndrome diagnosis every complaint made thence tends to be regarded with scepticism by clinical staff. However, it is possible that a bona fide illness, which might be disregarded, may coexist in these patients. We report a case of MS mimicking psychiatric disease with concomitant genuine acute physical illness. Despite the initial doubts about the veracity of the latter, due to its prompt recognition, treatment was successful. PMID:22798096

  11. Infectious Diseases, Urbanization and Climate Change: Challenges in Future China

    PubMed Central

    Tong, Michael Xiaoliang; Hansen, Alana; Hanson-Easey, Scott; Cameron, Scott; Xiang, Jianjun; Liu, Qiyong; Sun, Yehuan; Weinstein, Philip; Han, Gil-Soo; Williams, Craig; Bi, Peng

    2015-01-01

    China is one of the largest countries in the world with nearly 20% of the world’s population. There have been significant improvements in economy, education and technology over the last three decades. Due to substantial investments from all levels of government, the public health system in China has been improved since the 2003 severe acute respiratory syndrome (SARS) outbreak. However, infectious diseases still remain a major population health issue and this may be exacerbated by rapid urbanization and unprecedented impacts of climate change. This commentary aims to explore China’s current capacity to manage infectious diseases which impair population health. It discusses the existing disease surveillance system and underscores the critical importance of strengthening the system. It also explores how the growing migrant population, dramatic changes in the natural landscape following rapid urbanization, and changing climatic conditions can contribute to the emergence and re-emergence of infectious disease. Continuing research on infectious diseases, urbanization and climate change may inform the country’s capacity to deal with emerging and re-emerging infectious diseases in the future. PMID:26371017

  12. Infectious Diseases, Urbanization and Climate Change: Challenges in Future China.

    PubMed

    Tong, Michael Xiaoliang; Hansen, Alana; Hanson-Easey, Scott; Cameron, Scott; Xiang, Jianjun; Liu, Qiyong; Sun, Yehuan; Weinstein, Philip; Han, Gil-Soo; Williams, Craig; Bi, Peng

    2015-09-01

    China is one of the largest countries in the world with nearly 20% of the world's population. There have been significant improvements in economy, education and technology over the last three decades. Due to substantial investments from all levels of government, the public health system in China has been improved since the 2003 severe acute respiratory syndrome (SARS) outbreak. However, infectious diseases still remain a major population health issue and this may be exacerbated by rapid urbanization and unprecedented impacts of climate change. This commentary aims to explore China's current capacity to manage infectious diseases which impair population health. It discusses the existing disease surveillance system and underscores the critical importance of strengthening the system. It also explores how the growing migrant population, dramatic changes in the natural landscape following rapid urbanization, and changing climatic conditions can contribute to the emergence and re-emergence of infectious disease. Continuing research on infectious diseases, urbanization and climate change may inform the country's capacity to deal with emerging and re-emerging infectious diseases in the future. PMID:26371017

  13. Emerging infectious diseases: vulnerabilities, contributing factors and approaches.

    PubMed

    Lashley, Felissa R

    2004-04-01

    We live in an ever more connected global village linked through international travel, politics, economics, culture and human-human and human-animal interactions. The realization that the concept of globalization includes global exposure to disease-causing agents that were formerly confined to small, remote areas and that infectious disease outbreaks can have political, economic and social roots and effects is becoming more apparent. Novel infectious disease microbes continue to be discovered because they are new or newly recognized, have expanded their geographic range, have been shown to cause a new disease spectrum, have jumped the species barrier from animals to humans, have become resistant to antimicrobial agents, have increased in incidence or have become more virulent. These emerging infectious disease microbes may have the potential for use as agents of bioterrorism. Factors involved in the emergence of infectious diseases are complex and interrelated and involve all classifications of organisms transmitted in a variety of ways. In 2003, outbreaks of interest included severe acute respiratory syndrome, monkeypox and avian influenza. Information from the human genome project applied to microbial organisms and their hosts will provide new opportunities for detection, diagnosis, treatment, prevention, control and prognosis. New technology related not only to genetics but also to satellite and monitoring systems will play a role in weather, climate and the approach to environmental manipulations that influence factors contributing to infectious disease emergence and control. Approaches to combating emerging infectious diseases include many disciplines, such as animal studies, epidemiology, immunology, ecology, environmental studies, microbiology, pharmacology, other sciences, health, medicine, public health, nursing, cultural, political and social studies, all of which must work together. Appropriate financial support of the public health infrastructure

  14. BLT-esterase in infectious mononucleosis.

    PubMed Central

    Wagner, L; Wiesholzer, M; Worman, C P; Lang, G; Base, W

    1995-01-01

    Peripheral blood lymphocytes of three patients suffering from infectious mononucleosis due to Epstein-Barr virus (EBV) infection were analysed for BLT-esterase expression in peripheral blood lymphocytes by a well established cytochemical staining method. During the acute phase of disease with presence of clinical symptoms a very high level of up to 90% BLT-esterase-expressing lymphocytes were detected. The increased percentage of lymphocytes expressing BLT-esterase coincided with the time of greatest symptoms and the peak elevation of hepatocellular enzymes. The still moderately elevated level only gradually decreased to normal during the further recovery period of 2 months during which the patients described episodes of weakness. Peripheral blood lymphocyte phenotype analysis revealed a marked CD8 lymphocytosis, a CD4/CD8 ratio of about 0.2, low number of CD19+ B cells, and a high level of DR+ CD3+ lymphocytes. Reduction of BLT esterase expression during the recovery period coincided with reduction of CD8+ DR+ lymphocytes. By a combination of BLT-esterase staining with immunocytochemical phenotype analysis, 95% of CD8+ lymphocytes were found to be BLT-esterase-positive. BLT-esterase might be involved in the immunodefence against EBV in infectious mononucleosis by inducing apoptosis in EBV-transformed B cells. Images Fig. 2 PMID:7743659

  15. Introducing Infectious Agents and Cancer

    PubMed Central

    Buonaguro, Franco M; Lewis, George K; Pelicci, PierGiuseppe

    2006-01-01

    Infectious Agents and Cancer is a new open access, peer-reviewed, online journal, which encompasses all aspects of basic, clinical and translational research that provide an insight into the association between chronic infections and cancer. PMID:23509916

  16. Early Psychological Therapy in Critical Illness.

    PubMed

    Karnatovskaia, Lioudmila V; Philbrick, Kemuel L; Parker, Ann M; Needham, Dale M

    2016-02-01

    Survivors of critical illness often experience long-lasting impairments in mental, cognitive, and physical functioning. Acute stress reactions and delusional memories appear to play an important role in psychological morbidity following critical illness, and few interventions exist to address these symptoms. This review elucidates acute psychological stressors experienced by the critically ill. The effects of psychological stress and state of mind on disease are discussed using examples from the non-intensive care unit (ICU) literature, including a review of placebo and nocebo effects. After reviewing the effect of the mind on both psychological and physiological outcomes, we then focus on the role of memories-including their malleable nature and the consequences of false memories. Memory may play a role in the genesis of subsequent psychological trauma. Traumatic memories may begin forming even before the patient arrives in the ICU and during their state of unconsciousness in the ICU. Hence, practical interventions for redirecting patients' thoughts, such as positive suggestion techniques and actively involving patients in the treatment process as early as possible, are worthy of further investigation. PMID:26820280

  17. Insulin therapy in critically ill patients

    PubMed Central

    Ellahham, Samer

    2010-01-01

    Hyperglycemia frequently occurs with acute medical illness, especially among patients with cardiovascular disease, and has been linked to increased morbidity and mortality in critically ill patients. Even patients who are normoglycemic can develop hyperglycemia in response to acute metabolic stress. An expanding body of literature describes the benefits of normalizing hyperglycemia with insulin therapy in hospitalized patients. As a result, both the American Diabetes Association and the American College of Endocrinology have developed guidelines for optimal control of hyperglycemia, specifically targeting critically ill, hospitalized patients. Conventional blood glucose values of 140–180 mg/dL are considered desirable and safely achievable in most patients. More aggressive control to <110 mg/dL remains controversial, but has shown benefits in certain patients, such as those in surgical intensive care. Intravenous infusion is often used for initial insulin administration, which can then be transitioned to subcutaneous insulin therapy in those patients who require continued insulin maintenance. This article reviews the data establishing the link between hyperglycemia and its risks of morbidity and mortality, and describes strategies that have proven effective in maintaining glycemic control in high-risk hospitalized patients. PMID:21191429

  18. Infectious diseases and impaired consciousness.

    PubMed

    Wilson, Michael R; Roos, Karen L

    2011-11-01

    Any of a number of neuroinfectious diseases can cause a disorder of consciousness. The priority in the care of the patient is to identify an infectious disease that is treatable. This article examines disorders of consciousness that may be caused by a septic encephalopathy, bacterial meningoencephalitis, viral encephalitis, tick-borne bacterial disease, fungal meningitis, tuberculous meningitis, a focal infectious mass lesion, such as a brain abscess, or an autoimmune-mediated disorder as a complication of infection. PMID:22032667

  19. Abraham Lincoln's Gettysburg illness.

    PubMed

    Goldman, Armond S; Schmalstieg, Frank C

    2007-05-01

    When Abraham Lincoln delivered the Gettysburg Address, he was weak and dizzy; his face had a ghastly colour. That evening on the train to Washington, DC, he was febrile and weak, and suffered severe headaches. The symptoms continued; back pains developed. On the fourth day of the illness, a widespread scarlet rash appeared that soon became vesicular. By the tenth day, the lesions itched and peeled. The illness lasted three weeks. The final diagnosis, a touch of varioloid, was an old name for smallpox that was later used in the 20th century to denote mild smallpox in a partially immune individual. It was unclear whether Lincoln had been immunized against smallpox. Indeed, this review suggests that Lincoln had unmodified smallpox and that Lincoln's physicians tried to reassure the public that Lincoln was not seriously ill. Indeed, the successful conclusion of the Civil War and reunification of the country were dependent upon Lincoln's presidency. PMID:17551612

  20. Beethoven's creative illness.

    PubMed

    Bower, H

    1989-03-01

    One phase of Beethoven's life, between his 45th and 50th year, characterized by very low creativity and overwhelming stress situations, is subjected to a psychiatric interpretation. The historical background is briefly sketched and 5 precipitating stress factors are outlined. The symptoms of his illness are described, using Beethoven's letters as source material. A brief discussion of Beethoven's musical style prior to and after his illness is based on quotations from three eminent musical scholars. A resume of Beethoven's physical and psychological disorders during his life are given and the conclusion is reached that between 1815 and 1820, Beethoven experienced a creative illness which was psychotic in type, ended in recovery and radically changed his musical creativity. PMID:2649058

  1. Hepatitis in skunks caused by the virus of infectious canine hepatitis.

    PubMed

    Karstad, L; Ramsden, R; Berry, T J; Binn, L N

    1975-10-01

    Two cases of acute, fatal, hepatitis occurred in young, striped skunks (Mephitis mephitis) trapped in southern Ontario. Histologically, lesions in the liver were similar to infectious canine hepatitis. A virus was isolated which produced large intranuclear inclusions in dog kidney cell cultures. These inclusions were Feulgen-positive and fluoresced green with acridine orange stain. The skunk hepatitis isolate was identified as the virus of infectious canine hepatitis by virus neutralization tests. PMID:172663

  2. Acute acalculous cholecystitis.

    PubMed

    Barie, Philip S; Eachempati, Soumitra R

    2003-08-01

    Acute cholecystitis can develop without gallstones in critically ill or injured patients. However, the development of acute acalculous cholecystitis is not limited to surgical or injured patients, or even to the intensive care unit. Diabetes, malignant disease, abdominal vasculitis, congestive heart failure, cholesterol embolization, and shock or cardiac arrest have been associated with acute acalculous cholecystitis. Children may also be affected, especially after a viral illness. The pathogenesis of acute acalculous cholecystitis is a paradigm of complexity. Ischemia and reperfusion injury, or the effects of eicosanoid proinflammatory mediators, appear to be the central mechanisms, but bile stasis, opioid therapy, positive-pressure ventilation, and total parenteral nutrition have all been implicated. Ultrasound of the gallbladder is the most accurate diagnostic modality in the critically ill patient, with gallbladder wall thickness of 3.5 mm or greater and pericholecystic fluid being the two most reliable criteria. The historical treatment of choice for acute acalculous cholecystitis has been cholecystectomy, but percutaneous cholecystostomy is now the mainstay of therapy, controlling the disease in about 85% of patients. Rapid improvement can be expected when the procedure is performed properly. The mortality rates (historically about 30%) for percutaneous and open cholecystostomy appear to be similar, reflecting the severity of illness, but improved resuscitation and critical care may portend a decreased risk of death. Interval cholecystectomy is usually not indicated after acute acalculous cholecystitis in survivors; if the absence of gallstones is confirmed and the precipitating disorder has been controlled, the cholecystostomy tube can be pulled out after the patient has recovered. PMID:12864960

  3. Acute oral ulcers.

    PubMed

    Lehman, Julia S; Rogers, Roy S

    2016-01-01

    Accurate diagnosis of acute oral ulcers can be challenging. Important historic details include the pattern of recurrence, anatomic areas of involvement within the mouth and elsewhere on the mucocutaneous surface, associated medical symptoms or comorbidities, and symptomology. Careful mucocutaneous examination is essential. When necessary, biopsy at an active site without ulceration is generally optimal. Depending on the clinical scenario, supplemental studies that may be useful include cultures; perilesional biopsy for direct immunofluorescence testing; and evaluation for infectious diseases, gluten sensitivity, inflammatory bowel disease, human immunodeficiency virus infection, connective tissue diseases, or hematinic deficiencies. Clinicians should maintain a broad differential diagnosis when evaluating patients with acute oral ulcers. PMID:27343961

  4. Mentally Ill Children.

    ERIC Educational Resources Information Center

    Blai, Boris, Jr.

    Estimates suggest that about 15% of all children have some form of mental disturbance. Potential causes can be of a physical, psychological, or environmental origin. Symptoms which indicate that a child needs professional help usually involve emotional overreaction to changes. Diagnosis of a child evidencing symptoms of mental illness should take…

  5. Alienation and Illness.

    ERIC Educational Resources Information Center

    Kobasa, Suzanne C.

    Reviews of studies of four groups (business executives, lawyers, Army officers, and working women) which demonstrate the health-damaging effects of alienation in certain life situations show that, when under stress, members of these groups who feel alienated fall ill, medically and/or psychiatrically. Three models are described which may explain…

  6. Mozart's illnesses and death.

    PubMed Central

    Davies, P J

    1983-01-01

    Throughout his life Mozart suffered frequent attacks of tonsillitis. In 1784 he developed post-streptococcal Schönlein-Henoch syndrome which caused chronic glomerular nephritis and chronic renal failure. His fatal illness was due to Schönlein-Henoch purpura, with death from cerebral haemorrhage and bronchopneumonia. Venesection(s) may have contributed to his death. PMID:6352940

  7. Understanding and Reducing Disability in Older Adults Following Critical Illness

    PubMed Central

    Brummel, N.E.; Balas, M.C.; Morandi, A.; Ferrante, L.E.; Gill, T.M.; Ely, E.W.

    2015-01-01

    Objective To review how disability can develop in older adults with critical illness and to explore ways to reduce long-term disability following critical illness. Data Sources Review of the literature describing post-critical illness disability in older adults and expert opinion. Results We identified 19 studies evaluating disability outcomes in critically ill patients age 65 years and older. Newly acquired disability in activities of daily living, instrumental activities of daily living and mobility activities was commonplace among older adults who survived a critical illness. Incident dementia and less-severe cognitive impairment was also highly prevalent. Factors related to the acute critical illness, intensive care unit practices such as heavy sedation, physical restraints and immobility as well as aging physiology and coexisting geriatric conditions can combine to result in these poor outcomes. Conclusion Older adults who survive critical illness suffer physical and cognitive declines resulting in disability at greater rates than hospitalized, non-critically ill and community dwelling older adults. Interventions derived from widely available geriatric care models in use outside of the ICU, which address modifiable risk factors including immobility and delirium, are associated with improved functional and cognitive outcomes and can be used to complement ICU-focused models such as the ABCDEs. PMID:25756418

  8. The family, crisis and chronic illness: an evolutionary model.

    PubMed

    Shaw, M C; Halliday, P H

    1992-05-01

    While chronic illness has a profound impact upon the individual, an immense burden is imposed upon the family. When the competing demands of an illness and the family escalate exponentially, there may be a crisis. Traditionally, crisis theory has been applied to acute care contexts such as emergency, intensive care and mental health nursing. Yet, clinical experience with families and chronic illness supports the notion of periodic crises from the prediagnostic phase to the long-haul of the illness. Moreover, the authors hypothesize that the family's perception of the event determines whether the crisis is perceived as a threat or a challenge. This paper thus addresses the perception of crisis within the framework of chronic illness from a biological and family systems nursing perspective. First, the theory of Humberto Maturana, a Chilean biologist, is explored and applied to clinical observations regarding family, crisis and chronic illness. Second, an evolutionary model for conceptualizing crisis and chronic illness is presented. Third, the role of beliefs in the family perceptions of crisis and chronic illness is discussed. PMID:1602067

  9. Myalgic encephalomyelitis, chronic fatigue syndrome: An infectious disease.

    PubMed

    Underhill, R A

    2015-12-01

    The etiology of myalgic encephalomyelitis also known as chronic fatigue syndrome or ME/CFS has not been established. Controversies exist over whether it is an organic disease or a psychological disorder and even the existence of ME/CFS as a disease entity is sometimes denied. Suggested causal hypotheses have included psychosomatic disorders, infectious agents, immune dysfunctions, autoimmunity, metabolic disturbances, toxins and inherited genetic factors. Clinical, immunological and epidemiological evidence supports the hypothesis that: ME/CFS is an infectious disease; the causal pathogen persists in patients; the pathogen can be transmitted by casual contact; host factors determine susceptibility to the illness; and there is a population of healthy carriers, who may be able to shed the pathogen. ME/CFS is endemic globally as sporadic cases and occasional cluster outbreaks (epidemics). Cluster outbreaks imply an infectious agent. An abrupt flu-like onset resembling an infectious illness occurs in outbreak patients and many sporadic patients. Immune responses in sporadic patients resemble immune responses in other infectious diseases. Contagion is shown by finding secondary cases in outbreaks, and suggested by a higher prevalence of ME/CFS in sporadic patients' genetically unrelated close contacts (spouses/partners) than the community. Abortive cases, sub-clinical cases, and carrier state individuals were found in outbreaks. The chronic phase of ME/CFS does not appear to be particularly infective. Some healthy patient-contacts show immune responses similar to patients' immune responses, suggesting exposure to the same antigen (a pathogen). The chronicity of symptoms and of immune system changes and the occurrence of secondary cases suggest persistence of a causal pathogen. Risk factors which predispose to developing ME/CFS are: a close family member with ME/CFS; inherited genetic factors; female gender; age; rest/activity; previous exposure to stress or toxins

  10. The Thymus Is a Common Target Organ in Infectious Diseases

    PubMed Central

    Savino, Wilson

    2006-01-01

    Infectious disease immunology has largely focused on the effector immune response, changes in the blood and peripheral lymphoid organs of infected individuals, and vaccine development. Studies of the thymus in infected individuals have been neglected, although this is progressively changing. The thymus is a primary lymphoid organ, able to generate mature T cells that eventually colonize secondary lymphoid organs, and is therefore essential for peripheral T cell renewal. Recent data show that normal thymocyte development and export can be altered as a result of an infectious disease. One common feature is the severe atrophy of the infected organ, mainly due to the apoptosis-related depletion of immature CD4+CD8+ thymocytes. Additionally, thymocyte proliferation is frequently diminished. The microenvironmental compartment of the thymus is also affected, particularly in acute infectious diseases, with a densification of the epithelial network and an increase in the deposition of extracellular matrix. In the murine model of Chagas disease, intrathymic chemokine production is also enhanced, and thymocytes from Trypanosoma cruzi-infected mice exhibit greater numbers of cell migration-related receptors for chemokines and extracellular matrix, as well as increased migratory responses to the corresponding ligands. This profile is correlated with the appearance of potentially autoreactive thymus-derived immature CD4+CD8+ T cells in peripheral organs of infected animals. A variety of infectious agents—including viruses, protozoa, and fungi—invade the thymus, raising the hypothesis of the generation of central immunological tolerance for at least some of the infectious agent-derived antigens. It seems clear that the thymus is targeted in a variety of infections, and that such targeting may have consequences on the behavior of peripheral T lymphocytes. In this context, thymus-centered immunotherapeutic approaches potentially represent a new tool for the treatment of severe

  11. Physical Illness, Psychiatric Illness, and the Acceptability of Suicide.

    ERIC Educational Resources Information Center

    Deluty, Robert H.

    1989-01-01

    Assessed whether attitudes toward suicide vary as function of type of illness that precipitates suicide. College students (N=455) responded to scenarios of suicide victim. Evaluations of suicide were most favorable when it occurred in response to terminal physical illness; less favorable in response to chronic, non-terminal physical illness; and…

  12. Talking about Illness: Mothers' and Toddlers' Conversations during a Joint Book-Reading Task

    ERIC Educational Resources Information Center

    White, Carmel Parker; Bellamy, Roberta Woodlief; Powell, Monica Creech; Wittenauer, Ashley Rae

    2011-01-01

    This study examined the language used by mothers to talk about acute and chronic illness while engaged in a joint book-reading of a story where the main character had a cold. Thirty-four toddlers and their mothers participated in the study. Some of the mothers had a chronic illness, and some of the families or the children had had an acute illness…

  13. Infectious disease, endangerment, and extinction.

    PubMed

    Macphee, Ross D E; Greenwood, Alex D

    2013-01-01

    Infectious disease, especially virulent infectious disease, is commonly regarded as a cause of fluctuation or decline in biological populations. However, it is not generally considered as a primary factor in causing the actual endangerment or extinction of species. We review here the known historical examples in which disease has, or has been assumed to have had, a major deleterious impact on animal species, including extinction, and highlight some recent cases in which disease is the chief suspect in causing the outright endangerment of particular species. We conclude that the role of disease in historical extinctions at the population or species level may have been underestimated. Recent methodological breakthroughs may lead to a better understanding of the past and present roles of infectious disease in influencing population fitness and other parameters. PMID:23401844

  14. Infectious Disease, Endangerment, and Extinction

    PubMed Central

    MacPhee, Ross D. E.; Greenwood, Alex D.

    2013-01-01

    Infectious disease, especially virulent infectious disease, is commonly regarded as a cause of fluctuation or decline in biological populations. However, it is not generally considered as a primary factor in causing the actual endangerment or extinction of species. We review here the known historical examples in which disease has, or has been assumed to have had, a major deleterious impact on animal species, including extinction, and highlight some recent cases in which disease is the chief suspect in causing the outright endangerment of particular species. We conclude that the role of disease in historical extinctions at the population or species level may have been underestimated. Recent methodological breakthroughs may lead to a better understanding of the past and present roles of infectious disease in influencing population fitness and other parameters. PMID:23401844

  15. Human migration and infectious diseases.

    PubMed

    Soto, S M

    2009-01-01

    Emerging infectious diseases (EID) are defined as diseases that have appeared recently or that have recently increased in their frequency, geographical distribution or both. Commercial globalisation, population movements and environmental changes are the main factors favouring the international spread of microorganisms. Transport and communication development constitutes also a remarkable factor in the worldwide dispersion of microorganisms. The mass movement of large numbers of people creates new opportunities for the spread and establishment of common or novel infectious diseases. A surveillance system to detect emergent and re-emergent infections, a rapid responsiveness of healthcare systems and laboratories, vector control, and the provision of healthcare education programmes to inform the population of how to avoid infections are needed in order to stop the spread of infectious diseases. PMID:19220349

  16. Postoperative hospital course of patients with history of severe psychiatric illness.

    PubMed

    Solomon, S; McCartney, J R; Saravay, S M; Katz, E

    1987-09-01

    The postoperative hospital course of 54 patients with a past history of psychiatric illness was studied through chart review. Both chronic schizophrenics and chronic depressives tolerated surgical procedures well, without any unusual difficulties or exacerbation of psychiatric illness. They represented no management problems. Patients with acute, severe upset in the preoperative period (regardless of diagnosis) presented most of the management problems postoperatively. PMID:3678811

  17. [Sleep disturbances in critically ill patients].

    PubMed

    Walder, B; Haase, U; Rundshagen, I

    2007-01-01

    Sleep is an essential part of life with many important roles which include immunologic, cognitive and muscular functions. Of the working population 20% report sleep disturbances and in critically ill patients an incidence of more than 50% has been shown. However, sleep disturbances in the intensive care unit (ICU) population have not been investigated in detail. Sleep disturbances in ICU patients have a variety of reasons: e.g. patient-related pathologies like sepsis, acute or chronic pulmonary diseases, cardiac insufficiency, stroke or epilepsy, surgery, therapeutical interventions like mechanical ventilation, noise of monitors, pain or medication. Numerous scales and questionnaires are used to quantify sleep and the polysomnogramm is used to objectify sleep architecture. To improve sleep in ICU patients concepts are needed which include in addition to pharmacological treatment (pain reduction and sedation) synchronization of ICU activities with daylight, noise reduction and music for relaxation. In order to establish evidence-based guidelines, research activities about sleep and critical illness should be intensified. Questions to be answered are: 1) Which part of sleep disturbances in critically ill patients is directly related to the illness or trauma? 2) Is the grade of sleep disturbance correlated with the severity of the illness or trauma? 3) Which part is related to the medical treatment and can be modified or controlled? In order to define non-pharmacological and pharmacological concepts to improve sleep quality, studies need to be randomized and to include different ICU populations. The rate of nosocomial infections, cognitive function and respiratory muscle function should be considered in these studies as well. This will help to answer the question, whether it is useful to monitor sleep in ICU patients as a parameter to indicate therapeutical success and short-term quality of life. Follow-up needs to be long enough to detect adverse effects of

  18. Prevention of Ill Health

    PubMed Central

    Muir, D. C. F.

    1981-01-01

    The purpose and possibilities of prevention in the workplace are described. A problem solving approach begins by identifying physical, chemical or organizational factors in the work environment and personal health factors in the individual worker. Consulting experts may be required to assist in the process. Methodical assessment of the value of collecting data or of intervention policies will be required as increasing emphasis is placed on the development of truly effective preventive health policies. Major success so far must be credited to engineering and industrial hygiene endeavors. However, the occupational health professional is the only member of the team with knowledge of individual workers' health and who can thus render appropriate advice. With the employment of handicapped, disabled or recently ill workers, the physician's role will become increasingly important in the prevention of ill health at work. PMID:21289686

  19. Violence and Mental Illness

    PubMed Central

    Rueve, Marie E.; Welton, Randon S.

    2008-01-01

    Violence attracts attention in the news media, in the entertainment business, in world politics, and in countless other settings. Violence in the context of mental illness can be especially sensationalized, which only deepens the stigma that already permeates our patients’ lives. Are violence and mental illness synonymous, connected, or just coincidental phenomena? This article reviews the literature available to address this fundamental question and to investigate other vital topics, including etiology, comorbidity, risk factor management, and treatment. A psychiatrist who is well versed in the recognition and management of violence can contribute to the appropriate management of dangerous behaviors and minimize risk to patients, their families, mental health workers, and the community as a whole. PMID:19727251

  20. Mental illness: psychiatry's phlogiston.

    PubMed

    Szasz, T

    2001-10-01

    In physics, we use the same laws to explain why airplanes fly, and why they crash. In psychiatry, we use one set of laws to explain sane behaviour, which we attribute to reasons (choices), and another set of laws to explain insane behaviour, which we attribute to causes (diseases). God, man's idea of moral perfection, judges human deeds without distinguishing between sane persons responsible for their behaviour and insane persons deserving to be excused for their evil deeds. It is hubris to pretend that the insanity defence is compassionate, just, or scientific. Mental illness is to psychiatry as phlogiston was to chemistry. Establishing chemistry as a science of the nature of matter required the recognition of the non-existence of phlogiston. Establishing psychiatry as a science of the nature of human behaviour requires the recognition of the non-existence of mental illness. PMID:11579183

  1. Mental illness: psychiatry's phlogiston

    PubMed Central

    Szasz, T

    2001-01-01

    In physics, we use the same laws to explain why airplanes fly, and why they crash. In psychiatry, we use one set of laws to explain sane behaviour, which we attribute to reasons (choices), and another set of laws to explain insane behaviour, which we attribute to causes (diseases). God, man's idea of moral perfection, judges human deeds without distinguishing between sane persons responsible for their behaviour and insane persons deserving to be excused for their evil deeds. It is hubris to pretend that the insanity defence is compassionate, just, or scientific. Mental illness is to psychiatry as phlogiston was to chemistry. Establishing chemistry as a science of the nature of matter required the recognition of the non-existence of phlogiston. Establishing psychiatry as a science of the nature of human behaviour requires the recognition of the non-existence of mental illness. Key Words: Agency • alchemy • behaviour • cause • chemistry • dignity PMID:11579183

  2. Infectious causes of necrotizing enterocolitis

    PubMed Central

    Coggins, Sarah A.; Wynn, James L.; Weitkamp, Jörn-Hendrik

    2014-01-01

    Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency among premature infants. Although a large body of research has focused on understanding its pathogenesis, the exact mechanism has not been elucidated. Of particular interest is the potential causative role of infectious culprits in the development of NEC. A variety of reports describe bacterial, viral, and fungal infections occurring in association with NEC; however, no organism has emerged as being definitively involved in NEC pathogenesis. In this review, we summarize the body of research on infectious causes of necrotizing enterocolitis. PMID:25678001

  3. Infectious causes of necrotizing enterocolitis.

    PubMed

    Coggins, Sarah A; Wynn, James L; Weitkamp, Jörn-Hendrik

    2015-03-01

    Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency among premature infants. Although a large body of research has focused on understanding its pathogenesis, the exact mechanism has not been elucidated. Of particular interest is the potential causative role of infectious culprits in the development of NEC. A variety of reports describe bacterial, viral, and fungal infections occurring in association with NEC; however, no single organism has emerged as being definitively involved in NEC pathogenesis. In this review, the authors summarize the literature on infectious causes of NEC. PMID:25678001

  4. Images of Illness

    PubMed Central

    Longhurst, Mark F.

    1992-01-01

    The images we as physicians retain of our patients have a bearing on the evolution of our clinical behaviour and attributes. These images can enhance our diagnostic and therapeutic skills, increase our capacity to care for people with incurable diseases, and offer insights into our own emotional response. A recollection of five people with Parkinson's disease offers a college of images to give us further insights into the meaning of illness-for the patient and the physician. PMID:20469529

  5. Explanatory style and illness.

    PubMed

    Peterson, C; Seligman, M E

    1987-06-01

    Explanatory style is an individual difference that influences people's response to bad events. The present article discusses the possibility that a pessimistic explanatory style makes illness more likely. Several studies suggest that people who offer internal, stable, and global explanations for bad events are at increased risk for morbidity and mortality. We tentatively conclude that passivity, pessimism, and low morale foreshadow disease and death, although the process by which this occurs is unclear. PMID:3612470

  6. Cholescintigraphy in acute acalculous cholecystitis

    SciTech Connect

    Ramanna, L.; Brachman, M.B.; Tanasescu, D.E.; Berman, D.S.; Waxman, A.D.

    1984-08-01

    Acute acalculous cholecystitis is a relatively rare but potentially lethal condition if not treated promptly. Since stones are not present, diagnostic procedures such as ultrasound or other radiological procedures are frequently not helpful. Tc-99m iminodiacetic acid scan results were analyzed in 11 proven cases of acute acalculous cholecystitis. All had positive tests with nonvisualization of the gallbladder giving a sensitivity of 100%. Tc-99m iminodiacetic acid cholescintigraphy is a highly reliable test and is easily performed even in acutely ill patients and should be the test of choice in all patients predisposed to and suspected of acute acalculous cholecystitis.

  7. [Acute myocarditis].

    PubMed

    Combes, Alain

    2012-06-01

    Myocarditis is defined as inflammation of the myocardium accompanied by myocellular necrosis. Acute myocarditis must be considered in patients who present with recent-onset of cardiac failure or arrhythmia. Fulminant myocarditis is a distinct entity characterized by sudden onset of severe congestive heart failure or cardiogenic shock, usually following a flu-like illness, parvovirus B19, human herpesvirus 6, coxsackievirus and adenovirus being the most frequently viruses responsible for the disease. Treatment of myocarditis remains largely supportive, since immunosuppression has not been proven to be beneficial for acute lymphocytic myocarditis. Trials of antiviral therapies, or immunostimulants such as interferons, suggest a potential therapeutic role but require further investigation. Lastly, early recognition of patients rapidly progressing to refractory cardiac failure and their immediate transfer to a medical-surgical center experienced in mechanical circulatory support is warranted. In this setting, ECMO should be the first-line mechanical assistance. For highly unstable patients, a Mobile Cardiac Assistance Unit, that rapidly travels to primary care hospitals with a portable ECMO system and hooks it up before refractory multiorgan failure takes hold, is the preferred option. PMID:22515999

  8. [Acute myocarditis].

    PubMed

    Combes, Alain

    2013-05-01

    Myocarditis is defined as inflammation of the myocardium accompanied by myocellular necrosis. Acute myocarditis must be considered in patients who present with recent onset of cardiac failure or arrhythmia. Fulminant myocarditis is a distinct entity characterized by sudden onset of severe congestive heart failure or cardiogenic shock, usually following a flu-like illness, parvovirus B19, human herpesvirus 6, coxsackievirus and adenovirus being the most frequently viruses responsible for the disease. Treatment of myocarditis remains largely supportive, since immunosuppression has not been proven to be beneficial for acute lymphocytic myocarditis. Trials of antiviral therapies, or immunostimulants such as interferons, suggest a potential therapeutic role but require further investigation. Lastly, early recognition of patients rapidly progressing to refractory cardiac failure and their immediate transfer to a medical-surgical center experienced in mechanical circulatory support is warranted. In this setting, ECMO should be the first-line mechanical assistance. For highly unstable patients, a Mobile Cardiac Assistance Unit, that rapidly travels to primary care hospitals with a portable ECMO system and hooks it up before refractory multiorgan failure takes hold, is the preferred option. PMID:23789482

  9. Emerging infectious diseases in southeast Asia: regional challenges to control.

    PubMed

    Coker, Richard J; Hunter, Benjamin M; Rudge, James W; Liverani, Marco; Hanvoravongchai, Piya

    2011-02-12

    Southeast Asia is a hotspot for emerging infectious diseases, including those with pandemic potential. Emerging infectious diseases have exacted heavy public health and economic tolls. Severe acute respiratory syndrome rapidly decimated the region's tourist industry. Influenza A H5N1 has had a profound effect on the poultry industry. The reasons why southeast Asia is at risk from emerging infectious diseases are complex. The region is home to dynamic systems in which biological, social, ecological, and technological processes interconnect in ways that enable microbes to exploit new ecological niches. These processes include population growth and movement, urbanisation, changes in food production, agriculture and land use, water and sanitation, and the effect of health systems through generation of drug resistance. Southeast Asia is home to about 600 million people residing in countries as diverse as Singapore, a city state with a gross domestic product (GDP) of US$37,500 per head, and Laos, until recently an overwhelmingly rural economy, with a GDP of US$890 per head. The regional challenges in control of emerging infectious diseases are formidable and range from influencing the factors that drive disease emergence, to making surveillance systems fit for purpose, and ensuring that regional governance mechanisms work effectively to improve control interventions. PMID:21269678

  10. The Stigma of Mental Illness

    ERIC Educational Resources Information Center

    Overton, Stacy L.; Medina, Sondra L.

    2008-01-01

    Stigma surrounding major mental illness creates many barriers. People who experience mental illness face discrimination and prejudice when renting homes, applying for jobs, and accessing mental health services. The authors review the current literature regarding stigma and mental illness. They define stigma and review theories that explain its…

  11. Suicide in the Medically Ill.

    ERIC Educational Resources Information Center

    Hughes, Douglas; Kleespies, Phillip

    2001-01-01

    The relationship between medical illness and suicide seems to be multi-faceted. While medical illness is not the sole determinant of suicide, certain illnesses, such as HIV/AIDS and brain cancers, do appear to elevate the risk of suicide. Possible effective prevention efforts include education of primary care providers, and improved medication…

  12. Vitamin D metabolism and deficiency in critical illness.

    PubMed

    Lee, Paul

    2011-10-01

    Vitamin D deficiency is highly prevalent and has been associated with a diverse range of chronic medical conditions in the general population. In contrast, the prevalence, pathogenesis and significance of vitamin D deficiency have received little attention in acute medicine. Vitamin D deficiency is seldom considered and rarely corrected adequately, if at all, in critically ill patients. Recent recognition of the extra-skeletal, pleiotropic actions of vitamin D in immunity, epithelial function and metabolic regulation may underlie the previously under-recognized contribution of vitamin D deficiency to typical co-morbidities in critically ill patients, including sepsis, systemic inflammatory response syndrome and metabolic dysfunction. Improved understanding of vitamin D metabolism and regulation in critical illness may allow therapeutic exploitation of vitamin D to improve outcome in critically ill patients. PMID:21925077

  13. Teaching strategies for atypical presentation of illness in older adults.

    PubMed

    Gray-Miceli, Deanna; Aselage, Melissa; Mezey, Mathy

    2010-07-01

    Atypical presentation of illness is a phenomenon where "seeing is believing." Expert geriatric nurses and clinicians know all too well the early signs and symptoms of this phenomenon, which frequently masquerades bacterial infections, pain, acute myocardial infarction, heart failure, or other serious medical ailments in older adults. Students, however, as novices to clinical practice, require interactive learning approaches to reflect on the patient's illness presentations, help with developing the necessary skills to analyze and synthesize clinically relevant data, and witness resolution of an atypical presentation when found and treated. Use of a case study as an educational tool can facilitate critical thinking about a clinical problem, such as atypical presentation of illness, for students within a problem-based learning format. Furthermore, we highlight strategies for teaching students atypical presentation of illness with consideration of student learning preferences, which include visual, auditory, reading, and kinesthetic modes of learning. PMID:20608591

  14. Outbreaks of Illness Associated with Recreational Water-United States, 2011-2012

    EPA Science Inventory

    Outbreaks of illness associated with recreational water use result from exposure to chemicals or infectious pathogens in recreational water venues that are treated (e.g., pools and hot tubs or spas) or untreated (e.g., lakes and oceans). For 2011-2012, the most recent years for w...

  15. The Burden of Acute Disease in Mahajanga, Madagascar – A 21 Month Study

    PubMed Central

    Kannan, Vijay C.; Andriamalala, Clara N.; Reynolds, Teri A.

    2015-01-01

    Background Efforts to develop effective and regionally-appropriate emergency care systems in sub-Saharan Africa are hindered by a lack of data on both the burden of disease in the region and on the state of existing care delivery mechanisms. This study describes the burden of acute disease presenting to an emergency unit in Mahajanga, Madagascar. Methods and Findings Handwritten patient registries on all emergency department patients presenting between 1 January 2011 and 30 September 2012 were reviewed and data entered into a database. Data included age, sex, diagnosis, and disposition. We classified diagnoses into Clinical Classifications Software (CCS) multi-level categories. The population was 53.5% male, with a median age of 31 years. The five most common presenting conditions were 1) Superficial injury; contusion, 2) Open wounds of head; neck; and trunk, 3) Open wounds of extremities, 4) Intracranial injury, and 5) Unspecified injury and poisoning. Trauma accounted for 48%, Infectious Disease for 15%, Mental Health 6.1%, Noncommunicable 29%, and Neoplasms 1.2%. The acuity seen was high, with an admission rate of 43%. Trauma was the most common reason for admission, representing 19% of admitted patients. Conclusions This study describes the burden of acute disease at a large referral center in northern Madagascar. The Centre Hôpitalier Universitaire de Mahajanga sees a high volume of acutely ill and injured patients. Similar to other reports from the region, trauma is the most common pathology observed, though infectious disease was responsible for the majority of adult mortality. Typhoid fever other intestinal infections were the most lethal CCS-coded pathologies. By utilizing a widely understood classification system, we are able to highlight contrasts between Mahajanga’s acute and overall disease burden as well as make comparisons between this region and the rest of the globe. We hope this study will serve to guide the development of context

  16. Five Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome of Differing Etiologies

    PubMed Central

    Frankovich, Jennifer; Thienemann, Margo; Rana, Sonal

    2015-01-01

    Abstract Background: Pediatric acute-onset neuropsychiatric syndrome (PANS) is diagnosed by the abrupt onset of new obsessive compulsive disorder (OCD) or food-restricting symptoms, and at least two of a variety of other neuropsychiatric symptoms. Detailed clinical presentation of youth with this condition has not yet been provided in the literature. Methods: We review the clinical charts of five youth meeting criteria for PANS in our PANS Clinic. These five patients were selected for differing underlying causes thought to be driving an inflammatory response that appeared to impact psychiatric symptoms. Results: Five youth with varying potential etiologies impacting neuropsychiatric symptoms were identified. These youth were from 8 to 18 years old at the onset of their PANS illness, and had bacterial, autoimmune, and unknown etiologies. Treatment directed at presumed etiologies ranged from antibiotics to intravenous gamma globulin (IVIG) to other immunomodulatory regimens, and appeared to improve the psychiatric illness. Conclusions: Youth with PANS may present in differing ways, with psychiatric and physical symptoms overlapping with inflammatory or infectious diseases, pain syndromes, and other psychiatric diagnoses. Patients' psychiatric symptoms may respond to treatments targeting the underlying cause of physical illness. Faced with a pediatric patient demonstrating the abrupt onset or exacerbation of psychiatric and physical symptoms, clinicians should consider PANS in their differential diagnosis. PMID:25695942

  17. Global capacity for emerging infectious disease detection.

    PubMed

    Chan, Emily H; Brewer, Timothy F; Madoff, Lawrence C; Pollack, Marjorie P; Sonricker, Amy L; Keller, Mikaela; Freifeld, Clark C; Blench, Michael; Mawudeku, Abla; Brownstein, John S

    2010-12-14

    The increasing number of emerging infectious disease events that have spread internationally, such as severe acute respiratory syndrome (SARS) and the 2009 pandemic A/H1N1, highlight the need for improvements in global outbreak surveillance. It is expected that the proliferation of Internet-based reports has resulted in greater communication and improved surveillance and reporting frameworks, especially with the revision of the World Health Organization's (WHO) International Health Regulations (IHR 2005), which went into force in 2007. However, there has been no global quantitative assessment of whether and how outbreak detection and communication processes have actually changed over time. In this study, we analyzed the entire WHO public record of Disease Outbreak News reports from 1996 to 2009 to characterize spatial-temporal trends in the timeliness of outbreak discovery and public communication about the outbreak relative to the estimated outbreak start date. Cox proportional hazards regression analyses show that overall, the timeliness of outbreak discovery improved by 7.3% [hazard ratio (HR) = 1.073, 95% CI (1.038; 1.110)] per year, and public communication improved by 6.2% [HR = 1.062, 95% CI (1.028; 1.096)] per year. However, the degree of improvement varied by geographic region; the only WHO region with statistically significant (α = 0.05) improvement in outbreak discovery was the Western Pacific region [HR = 1.102 per year, 95% CI (1.008; 1.205)], whereas the Eastern Mediterranean [HR = 1.201 per year, 95% CI (1.066; 1.353)] and Western Pacific regions [HR = 1.119 per year, 95% CI (1.025; 1.221)] showed improvement in public communication. These findings provide quantitative historical assessment of timeliness in infectious disease detection and public reporting of outbreaks. PMID:21115835

  18. Clinical review: Special populations--critical illness and pregnancy.

    PubMed

    Neligan, Patrick J; Laffey, John G

    2011-01-01

    Critical illness is an uncommon but potentially devastating complication of pregnancy. The majority of pregnancy-related critical care admissions occur postpartum. Antenatally, the pregnant patient is more likely to be admitted with diseases non-specific to pregnancy, such as pneumonia. Pregnancy-specific diseases resulting in ICU admission include obstetric hemorrhage, pre-eclampsia/eclampsia, HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, amniotic fluid embolus syndrome, acute fatty liver of pregnancy, and peripartum cardiomyopathy. Alternatively, critical illness may result from pregnancy-induced worsening of pre-existing diseases (for example, valvular heart disease, myasthenia gravis, and kidney disease). Pregnancy can also predispose women to diseases seen in the non-pregnant population, such as acute respiratory distress syndrome (for example, pneumonia and aspiration), sepsis (for example, chorioamnionitis and pyelonephritis) or pulmonary embolism. The pregnant patient may also develop conditions co-incidental to pregnancy such as trauma or appendicitis. Hemorrhage, particularly postpartum, and hypertensive disorders of pregnancy remain the most frequent indications for ICU admission. This review focuses on pregnancy-specific causes of critical illness. Management of the critically ill mother poses special challenges. The physiologic changes in pregnancy and the presence of a second, dependent, patient may necessitate adjustments to therapeutic and supportive strategies. The fetus is generally robust despite maternal illness, and therapeutically what is good for the mother is generally good for the fetus. For pregnancy-induced critical illnesses, delivery of the fetus helps resolve the disease process. Prognosis following pregnancy-related critical illness is generally better than for age-matched non-pregnant critically ill patients. PMID:21888683

  19. Longitudinal Transcriptome Analysis Reveals a Sustained Differential Gene Expression Signature in Patients Treated for Acute Lyme Disease

    PubMed Central

    Bouquet, Jerome; Soloski, Mark J.; Swei, Andrea; Cheadle, Chris; Federman, Scot; Billaud, Jean-Noel; Rebman, Alison W.; Kabre, Beniwende; Halpert, Richard; Boorgula, Meher

    2016-01-01

    ABSTRACT Lyme disease is a tick-borne illness caused by the bacterium Borrelia burgdorferi, and approximately 10 to 20% of patients report persistent symptoms lasting months to years despite appropriate treatment with antibiotics. To gain insights into the molecular basis of acute Lyme disease and the ensuing development of post-treatment symptoms, we conducted a longitudinal transcriptome study of 29 Lyme disease patients (and 13 matched controls) enrolled at the time of diagnosis and followed for up to 6 months. The differential gene expression signature of Lyme disease following the acute phase of infection persisted for at least 3 weeks and had fewer than 44% differentially expressed genes (DEGs) in common with other infectious or noninfectious syndromes. Early Lyme disease prior to antibiotic therapy was characterized by marked upregulation of Toll-like receptor signaling but lack of activation of the inflammatory T-cell apoptotic and B-cell developmental pathways seen in other acute infectious syndromes. Six months after completion of therapy, Lyme disease patients were found to have 31 to 60% of their pathways in common with three different immune-mediated chronic diseases. No differential gene expression signature was observed between Lyme disease patients with resolved illness to those with persistent symptoms at 6 months post-treatment. The identification of a sustained differential gene expression signature in Lyme disease suggests that a panel of selected human host-based biomarkers may address the need for sensitive clinical diagnostics during the “window period” of infection prior to the appearance of a detectable antibody response and may also inform the development of new therapeutic targets. PMID:26873097

  20. Acute kidney injury in children.

    PubMed

    Merouani, A; Flechelles, O; Jouvet, P

    2012-04-01

    Acute kidney injury (AKI) affects 5% of critically ill hospitalized children and is a risk factor for increased morbidity and mortality. The current review focuses on new definitions of acute kidney injury, standardized to reflect the entire spectrum of the disease, as well as on ongoing research to identify early biomarkers of kidney injury. Its also provides an overview of current practice and available therapies, with emphasis on new strategies for the prevention and pharmacological treatment of diarrhea-associated hemolytic uremic syndrome. Furthermore, a decision-making algorithm is presented for the use of renal replacement therapies in critically ill children with AKI. PMID:22495187

  1. Facts about Infectious Diseases (ID)

    MedlinePlus

    ... and influenza. Travelers to foreign countries may require vaccinations against yellow fever, cholera, typhoid fever or hepatitis ... 1300 Wilson Boulevard Suite 300 Arlington, VA 22209 | Phone: (703) 299-0200 | Fax: (703) 299-0204 For ... | HIVMA | Contact Us © Copyright IDSA 2016 Infectious Diseases Society of America Full Site Mobile Site

  2. Diagnostic vitrectomy for infectious uveitis

    PubMed Central

    Jeroudi, Abdallah; Yeh, Steven

    2014-01-01

    The identification of an infectious or noninfectious uveitis syndrome is important to determine the range of therapeutic and prognostic implications of that disease entity. Diagnostic dilemmas arise with atypical history, atypical clinical presentations, inconclusive diagnostic workup, and persistent or worsened inflammation despite appropriate immunosuppression. More invasive intraocular testing is indicated in these situations particularly in infectious uveitis where a delay in treatment may result in worsening of the patient’s disease and a poor visual outcome. Laboratory analysis of vitreous fluid via diagnostic pars plana vitrectomy is an important technique in the diagnostic armamentarium, but the most important aspects of sample collection include rapid processing, close coordination with an ophthalmic pathology laboratory, and directed testing on this limited collected sample. Culture and staining has utility in bacterial, fungal, and nocardial infection. Polymerase chain reaction (PCR) analysis has shown promising results for bacterial endophthalmitis and infection with mycobacterium tuberculosis whereas PCR testing for viral retinitides and ocular toxoplasmosis has a more established role. Antibody testing is appropriate for toxoplasmosis and toxocariasis, and may be complementary to PCR for viral retinitis. Masquerade syndromes represent neoplastic conditions that clinically appear as infectious or inflammatory conditions and should be considered as part of the differential diagnosis. Diagnostic vitrectomy and chorioretinal biopsy are thus critical tools for the management of patients in whom an infectious etiology of uveitis is suspected. PMID:24613892

  3. Introducing Mediterranean Journal of Hematology and Infectious Diseases

    PubMed Central

    Leone, Giuseppe; Larocca, Luigi Maria; Pizzigallo, Eligio

    2009-01-01

    Summary: Mediterranean Journal of Hematology and Infectious Diseases (MJHID) is a new open access, peer-reviewed, online journal, which encompasses different aspects of clinical and translational research providing an insight into the relationship between acute and chronic infections and hematological diseases. MJHID will be a topical journal on subjects of current importance in clinical haematology and infectious diseases. Every issue should have, beside the editor in chief, a guest editor. Both editor in chief and guest editor provide to invite experts in the selected topic to performe a complete update of the arguments readily available for practising phisicians. The journal will have also a section devoted to original papers, case reports and letters to editor and Editorial comment mostly focusing on the arguments treated in the previous topical issues. PMID:21415983

  4. Infectious (Non)tolerance—Frustrated Commensalism Gone Awry?

    PubMed Central

    Nussbaum, Jesse C.; Locksley, Richard M.

    2012-01-01

    Despite advances in medicine, infectious diseases remain major causes of death and disability worldwide. Acute or chronic infectious agents mediate host tissue damage and cause a spectrum of disease as diverse as overwhelming sepsis and shock within hours to persistent tissue inflammation causing organ failure or even cancer over years. Although pathogen exposure can cause disease via host-derived inflammation, pathogens share recognized elements with harmless human commensals. Mouse models and organisms with simpler flora are revealing the dialogue between multicellular hosts and commensal flora. In some instances the persistent inflammation associated with pathogens can be interpreted within a framework of frustrated commensalism in which the host and pathogen cannot complete the requisite dialogue that establishes homeostasis. In contrast, coevolved commensals interact cooperatively with the host immune system, resulting in immunotolerance. Attempts to more thoroughly understand the molecular nature of the dialogue may uncover novel approaches to the control of inflammation and tissue damage. PMID:22456498

  5. Mental Illness And Brain Disease.

    PubMed

    Bedrick, Jeffrey D

    2014-01-01

    It has become common to say psychiatric illnesses are brain diseases. This reflects a conception of the mental as being biologically based, though it is also thought that thinking of psychiatric illness this way will reduce the stigma attached to psychiatric illness. If psychiatric illnesses are brain diseases, however, it is not clear why psychiatry should not collapse into neurology, and some argue for this course. Others try to maintain a distinction by saying that neurology deals with abnormalities of neural structure while psychiatry deals with specific abnormalities of neural functioning. It is not clear that neurologists would accept this division, nor that they should. I argue that if we take seriously the notion that psychiatric illnesses are mental illnesses we can draw a more defensible boundary between psychiatry and neurology. As mental illnesses, psychiatric illnesses must have symptoms that affect our mental capacities and that the sufferer is capable of being aware of, even if they are not always self-consciously aware of them. Neurological illnesses, such as stroke or multiple sclerosis, may be diagnosed even if they are silent, just as the person may not be aware of having high blood pressure or may suffer a silent myocardial infarction. It does not make sense to speak of panic disorder if the person has never had a panic attack, however, or of bipolar disorder in the absence of mood swings. This does not mean psychiatric illnesses are not biologically based. Mental illnesses are illnesses of persons, whereas other illnesses are illnesses of biological individuals. PMID:26444362

  6. Extracorporeal Life Support in Critically Ill Adults

    PubMed Central

    Muratore, Christopher S.

    2014-01-01

    Extracorporeal life support (ECLS) has become increasingly popular as a salvage strategy for critically ill adults. Major advances in technology and the severe acute respiratory distress syndrome that characterized the 2009 influenza A(H1N1) pandemic have stimulated renewed interest in the use of venovenous extracorporeal membrane oxygenation (ECMO) and extracorporeal carbon dioxide removal to support the respiratory system. Theoretical advantages of ECLS for respiratory failure include the ability to rest the lungs by avoiding injurious mechanical ventilator settings and the potential to facilitate early mobilization, which may be advantageous for bridging to recovery or to lung transplantation. The use of venoarterial ECMO has been expanded and applied to critically ill adults with hemodynamic compromise from a variety of etiologies, beyond postcardiotomy failure. Although technology and general care of the ECLS patient have evolved, ECLS is not without potentially serious complications and remains unproven as a treatment modality. The therapy is now being tested in clinical trials, although numerous questions remain about the application of ECLS and its impact on outcomes in critically ill adults. PMID:25046529

  7. Emerging and Re-Emerging Infectious Diseases

    MedlinePlus

    ... Content Marketing Share this: Main Content Area Emerging Infectious Diseases/Pathogens Research Introduction and Goals Despite remarkable advances ... medical research and treatments during the 20th century, infectious diseases remain among the leading causes of death worldwide. ...

  8. Sexuality and chronic illness.

    PubMed

    Steinke, Elaine E

    2013-11-01

    Sexual function is often affected in individuals living with chronic illness and their partners, and multiple comorbidities increase the likelihood of sexual dysfunction. This review focuses on the areas of cardiovascular disease, respiratory conditions, and cancer, all areas for which there are practical, evidence-based strategies to guide sexual counseling. Although nurses have been reluctant to address the topic of sexuality in practice, a growing number of studies suggest that patients want nurses to address their concerns and provide resources to them. Thus, nurses must be proactive in initiating conversations on sexual issues to fill this gap in practice. PMID:24066783

  9. Metabolism and Mental Illness.

    PubMed

    Sestan-Pesa, Matija; Horvath, Tamas L

    2016-02-01

    Over the past century, overwhelming evidence has emerged pointing to the hypothalamus of the central nervous system (CNS) as a crucial regulator of systemic control of metabolism, including appetite and feeding behavior. Appetite (or hunger) is a fundamental driver of survival, involving complex behaviors governed by various parts of the brain, including the cerebral cortex. Here, we provide an overview of basic metabolic principles affecting the CNS and discuss their relevance to physiological and pathological conditions of higher brain functions. These novel perspectives may well provide new insights into future research strategies to facilitate the development of novel therapies for treating mental illness. PMID:26776095

  10. 25 CFR 140.26 - Infectious plants.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Infectious plants. 140.26 Section 140.26 Indians BUREAU... Infectious plants. Traders shall not introduce into, sell, or spread within Indian reservations any plant... carrier of any pests of infectious, transmissible, or contagious diseases, as determined by the laws...

  11. Generation of Newcastle diease virus (NDV) recombinants expressing the infectious laryngotracheitis virus (ILTV) glycoprotein gB or gD as dual vaccines

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Infectious laryngotracheitis (ILT) is a highly contagious acute respiratory disease of chickens caused by infection of infectious laryngotracheitis virus (ILTV). The current commercial ILT vaccines are either not safe or less effective. Therefore, there is a pressing need to develop safer and more...

  12. Newcastle disease virus (NDV) recombinants expressing infectious laryngotracheitis virus (ILTV) glycoproteins gB and gD protect chickens against ILTV and NDV challenges

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Infectious laryngotracheitis (ILT) is a highly contagious acute respiratory disease of chickens caused by infectious laryngotracheitis virus (ILTV). The disease is mainly controlled through biosecurity and vaccination with live-attenuated strains of the virus and vectored vaccines based on turkey he...

  13. Locating legacy in illness.

    PubMed

    Froude, Cameron Kiely

    2016-06-01

    The author, a licensed marriage and family therapist, describes her work with Sofia, an eight-year-old Puerto Rican female with chronic and persistent abdominal pain and leg paralysis with no known organic cause. Sofia's mother, Ana, was also seen by the author. Over the course of several weeks, the family shared stories of painful medical procedures and extreme dietary plans prescribed to them by doctors to identify the etiology of Sofia's illness. Ana described her simultaneous relief and frustration when each test result indicated that there was no organic cause for Sofia's debilitating pain. They talked about the push and pull Ana's family experienced as they prayed simultaneously for abnormal and normal test results. The author told Sofia's pediatrician that she would begin to create a community genogram with the family in their next meeting. She explained that the purpose of the community genogram was to illustrate the social and historical contexts of families' lives. They learned that a seminal narrative in Sofia's family legacy connected deep understanding of others with embodiment of their immediate experience. Sofia's illness became one part of her and her family's legacy and cultural tapestry. Ana described the renewed connections that she and Sofia shared with their family members. As Sofia and Ana spoke with their family members more often, Sofia's leg paralysis and stomach pains decreased. Sofia began attending school regularly and visiting less with her pediatrician. (PsycINFO Database Record PMID:27270250

  14. Heat-related illness.

    PubMed

    Becker, Jonathan A; Stewart, Lynsey K

    2011-06-01

    Heat-related illness is a set of preventable conditions ranging from mild forms (e.g., heat exhaustion, heat cramps) to potentially fatal heat stroke. Hot and humid conditions challenge cardiovascular compensatory mechanisms. Once core temperature reaches 104°F (40°C), cellular damage occurs, initiating a cascade of events that may lead to organ failure and death. Early recognition of symptoms and accurate measurement of core temperature are crucial to rapid diagnosis. Milder forms of heat-related illness are manifested by symptoms such as headache, weakness, dizziness, and an inability to continue activity. These are managed by supportive measures including hydration and moving the patient to a cool place. Hyperthermia and central nervous system symptoms should prompt an evaluation for heat stroke. Initial treatments should focus on lowering core temperature through cold water immersion. Applying ice packs to the head, neck, axilla, and groin is an alternative. Additional measures include transporting the patient to a cool environment, removing excess clothing, and intravenous hydration. Delayed access to cooling is the leading cause of morbidity and mortality in persons with heat stroke. Identification of at-risk groups can help physicians and community health agencies provide preventive measures. PMID:21661715

  15. A gastrointestinal anti-infectious biotherapeutic agent: the heat-treated Lactobacillus LB.

    PubMed

    Liévin-Le Moal, Vanessa

    2016-01-01

    Experimental in vitro and in vivo studies support the hypothesis that heat-treated, lyophilized Lactobacillus acidophilus LB cells and concentrated, neutralized spent culture medium conserve the variety of pharmacological, antimicrobial activities of the live probiotic strain against several infectious agents involved in well-established acute and persistent watery diarrhoea and gastritis. Heat-treated cells and heat-stable secreted molecules trigger multiple strain-specific activities explaining the therapeutic efficacy of L. acidophilus LB. This review discusses the current body of knowledge on the antimicrobial mechanisms of action exerted by L. acidophilus LB demonstrated in in vitro and in vivo experimental studies, and the evidence for the therapeutic efficacy of this anti-infectious biotherapeutic agent proved in randomized clinical trials for the treatment of acute and persistent watery diarrhoea associated with several intestinal infectious diseases in humans. PMID:26770268

  16. A gastrointestinal anti-infectious biotherapeutic agent: the heat-treated Lactobacillus LB

    PubMed Central

    Liévin-Le Moal, Vanessa

    2016-01-01

    Experimental in vitro and in vivo studies support the hypothesis that heat-treated, lyophilized Lactobacillus acidophilus LB cells and concentrated, neutralized spent culture medium conserve the variety of pharmacological, antimicrobial activities of the live probiotic strain against several infectious agents involved in well-established acute and persistent watery diarrhoea and gastritis. Heat-treated cells and heat-stable secreted molecules trigger multiple strain-specific activities explaining the therapeutic efficacy of L. acidophilus LB. This review discusses the current body of knowledge on the antimicrobial mechanisms of action exerted by L. acidophilus LB demonstrated in in vitro and in vivo experimental studies, and the evidence for the therapeutic efficacy of this anti-infectious biotherapeutic agent proved in randomized clinical trials for the treatment of acute and persistent watery diarrhoea associated with several intestinal infectious diseases in humans. PMID:26770268

  17. Dodging a Bullet: WHO, SARS, and the Successful Management of Infectious Disease

    ERIC Educational Resources Information Center

    Michelson, Evan S.

    2005-01-01

    The purpose of this article is to analyze the policy decisions made by the World Health Organization (WHO) in working to fight the spread of the first truly global infectious disease, severe acute respiratory syndrome (SARS), of the 21st century. In particular, the author pays attention to the WHO's Global Outbreak Alert and Response Network…

  18. Biomechanical Analysis of Infectious Biofilms.

    PubMed

    Head, David

    2016-01-01

    The removal of infectious biofilms from tissues or implanted devices and their transmission through fluid transport systems depends in part of the mechanical properties of their polymeric matrix. Linking the various physical and chemical microscopic interactions to macroscopic deformation and failure modes promises to unveil design principles for novel therapeutic strategies targeting biofilm eradication, and provide a predictive capability to accelerate the development of devices, water lines, etc, that minimise microbial dispersal. Here, our current understanding of biofilm mechanics is appraised from the perspective of biophysics , with an emphasis on constitutive modelling that has been highly successful in soft matter. Fitting rheometric data to viscoelastic models has quantified linear and nonlinear stress relaxation mechanisms, how they vary between species and environments, and how candidate chemical treatments alter the mechanical response. The rich interplay between growth, mechanics and hydrodynamics is just becoming amenable to computational modelling and promises to provide unprecedented characterisation of infectious biofilms in their native state. PMID:27193540

  19. [Infectious agents and autoimmune diseases].

    PubMed

    Riebeling-Navarro, C; Madrid-Marina, V; Camarena-Medellín, B E; Peralta-Zaragoza, O; Barrera, R

    1992-01-01

    In this paper the molecular aspects of the relationships between infectious agents and autoimmune diseases, the mechanisms of immune response to infectious agents, and the more recent hypotheses regarding the cause of autoimmune diseases are discussed. The antigens are processed and selected by their immunogenicity, and presented by HLA molecules to the T cell receptor. These events initiate the immune response with the activation and proliferation of T-lymphocytes. Although there are several hypotheses regarding the cause of autoimmune diseases and too many findings against and in favor of them, there is still no conclusive data. All these hypothesis and findings are discussed in the context of the more recent advances. PMID:1615352

  20. [Alzheimer's disease: the infectious hypothesis].

    PubMed

    Roubaud Baudron, Claire; Varon, Christine; Mégraud, Francis; Salles, Nathalie

    2015-12-01

    Several hypotheses are proposed for understanding the Alzheimer's disease (AD) pathological mechanisms, mainly the amyloid theory, but the process inducing Aß peptide deposit, tau protein degeneration, and ultimately neuronal loss, is still to be elucidated. Alteration of the blood-brain barrier and activation of neuroinflammation seem to play an important role in AD neurodegeneration, especially in the decrease of Aß peptide clearance, therefore suggesting a role of infectious agents. Epidemiological and experimental studies on cellular or murine models related to herpes simplex virus (HSV), spirochetes, Chlamydia pneumoniae or Borrelia, and systemic inflammation are reviewed. Aß peptide or tau protein could also behave like a prion protein. Infectious agents could thus have an impact on AD by direct interaction with neurotropism or systemic inflammation. Although the results of these studies are not conclusive, they may contribute to the understanding of AD pathology. PMID:26707559

  1. Shoshin Beriberi in Critically-Ill patients: case series.

    PubMed

    Dabar, George; Harmouche, Carine; Habr, Bassem; Riachi, Moussa; Jaber, Bertrand

    2015-01-01

    Thiamine plays a fundamental role in cellular metabolism. The classical syndrome caused by thiamine deficiency is beriberi, and its fulminant variant, once considered an uncommon finding, is now encountered among the critically ill.We present a case series of four critically ill non-septic non-alcoholic patients with severe lactic acidosis and refractory cardio-circulatory collapse caused by acute fulminant beriberi, which drastically responded to thiamine administration.In critical care settings, increased awareness of this life-threatening but reversible condition is a requirement, especially among patients receiving parenteral nutrition and those with unexplained recalcitrant lactic acidosis. PMID:25982313

  2. Acute parotitis during induction therapy including L-asparaginase in acute lymphoblastic leukemia.

    PubMed

    Sica, S; Pagano, L; Salutari, P; Di Mario, A; Rutella, S; Leone, G

    1994-02-01

    In a patient affected by acute lymphoblastic leukemia (ALL) and subjected to therapy with Erwinia L-asparaginase, acute parotitis was observed. Microbiological studies excluded any infectious etiology. Regression of parotitis was spontaneous. This complication has not been previously reported and could be due to the same mechanism of pancreatic injury. The occurrence of acute parotitis needs to be promptly recognized in order to avoid the continuation of L-asparaginase. PMID:8148421

  3. Chemoprophylaxis of Tropical Infectious Diseases

    PubMed Central

    McBride, William J. H.

    2010-01-01

    Travelers to tropical countries are at risk for a variety of infectious diseases. In some cases effective vaccinations are available, but for other infections chemoprophylaxis can be offered. Malaria prevention has become increasingly complex as Plasmodium species become resistant to available drugs. In certain high risk settings, antibiotics can be used to prevent leptospirosis, scrub typhus and other infections. Post-exposure prophylaxis is appropriate for selected virulent infections. In this article the evidence for chemoprophylaxis will be reviewed.

  4. Infectious diseases of the newborn.

    PubMed

    Gillam, G L

    1978-11-01

    Despite the advent of antibiotics, infectious diseases remain a significant cause of mortality and morbidity in the neonatal period. Infection is the third commonest cause of perinatal mortality after hypoxia and malformations. Neonatal mortality rates from infection are of the order of 1:1000 live births. Although infections are theoretically preventable, there has been no significant change in incidence over the last 30 years. PMID:743019

  5. Non-infectious orbital vasculitides.

    PubMed

    Perumal, B; Black, E H; Levin, F; Servat, J J

    2012-05-01

    Non-infectious vasculitides comprise a large number of diseases. Many of these diseases can cause inflammation within the orbit and a clinical presentation, which mimics numerous other processes. Orbital disease can often be the initial presentation of a systemic process and early diagnosis can help prevent long-term, potentially fatal consequences. The evaluation and treatment of non-infectious orbital vasculitides are often complicated and require a thorough understanding of the disease and underlying systemic associations. The long-term prognosis visually and systemically must be weighed against the risks and benefits of the treatment regimen. A large variety of corticosteroid formulations currently exist and are the mainstay of initial treatment. Traditional steroid-sparing immunosuppressive agents are also an important arsenal against these vasculitides. Recently, a new class of drugs called biologics, which target the various mediators of the inflammation cascade, may potentially provide more effective and less toxic treatment. This review aims to synthesize the current literature on non-infectious orbital vasculitides. PMID:22361845

  6. Non-infectious orbital vasculitides

    PubMed Central

    Perumal, B; Black, E H; Levin, F; Servat, J J

    2012-01-01

    Non-infectious vasculitides comprise a large number of diseases. Many of these diseases can cause inflammation within the orbit and a clinical presentation, which mimics numerous other processes. Orbital disease can often be the initial presentation of a systemic process and early diagnosis can help prevent long-term, potentially fatal consequences. The evaluation and treatment of non-infectious orbital vasculitides are often complicated and require a thorough understanding of the disease and underlying systemic associations. The long-term prognosis visually and systemically must be weighed against the risks and benefits of the treatment regimen. A large variety of corticosteroid formulations currently exist and are the mainstay of initial treatment. Traditional steroid-sparing immunosuppressive agents are also an important arsenal against these vasculitides. Recently, a new class of drugs called biologics, which target the various mediators of the inflammation cascade, may potentially provide more effective and less toxic treatment. This review aims to synthesize the current literature on non-infectious orbital vasculitides. PMID:22361845

  7. The lung in sickle cell disease: a clinical overview of common vascular, infectious, and other problems.

    PubMed

    Young, R C; Castro, O; Baxter, R P; Dunn, R; Armstrong, E M; Cook, F J; Sampson, C C

    1981-01-01

    Acute pulmonary complications of sickle cell anemia are sickle cell lung disease and bacterial pneumonias. Chronic abnormalities in lung function include a restrictive ventilatory defect and perhaps increased venous admixture to the pulmonary circulation. Coexisting sarcoidosis may complicate sickle cell anemia and interact to potentiate sickling. Sickle cell lung disease, or acute "chest syndrome," occurs with greatest frequency in adults, is due primarily to pulmonary infarction, and may lead to cor pulmonale. On the other hand, bacterial pneumonia due to Streptococcus pneumoniae occurs with greater frequency in infancy and childhood. Mycoplasma and other organisms may also cause pneumonia with protracted illness and slow resolution. Bacteremia and meningitis may be further complications, particularly in children. Precise diagnosis of the acute febrile pulmonary episode is often difficult. In adults the illness is commonly self-limited. However, a vigorous diagnostic approach is warranted in all severely ill patients. PMID:7463492

  8. The occurrence of autoantibodies in infectious mononucleosis

    PubMed Central

    Sutton, R. N. P.; Emond, R. T. D.; Thomas, D. B.; Doniach, D.

    1974-01-01

    Autoantibodies were looked for by immunofluorescence (IFL) in seventy-seven cases of infectious mononucleosis (IM) at the onset of symptoms and on recovery, to determine the time of appearance, duration and range of these responses, and to correlate them with serum immunoglobulin and EB virus antibody titres. Antibodies to lymphocyte membrane demonstrated by IFL, now identified with lymphocytotoxins, were present in 46% of patients in the acute stage, persisting for less than 7 weeks. Antibodies to smooth muscle (SMA) or to contractile fibres in other tissue cells including human thyroid and rat hepatocytes, were present in over 70% of cases, some being entirely of IgM class. The highest titres occurred soon after onset and these antibodies also disappeared during convalescence. By contrast ANA, mitochondrial, microsomal and reticulin antibodies, also thyroid and gastric organ-specific reactivity were seen only occasionally owing to the young age group of the patients. In individual cases there was no correlation between the appearance of lymphocyte antibodies and SMA, or between these and the EB virus antibody titres. The autoantibodies produced in this disease are highly selected. It is suggested that clones of B cells are stimulated to make these antibodies by virtue of being infected with EB virus, and that the T-cell clones in the circulation are more likely expanded in order to terminate the infection. PMID:4619789

  9. Infectious Entry Pathway of Enterovirus B Species

    PubMed Central

    Marjomäki, Varpu; Turkki, Paula; Huttunen, Moona

    2015-01-01

    Enterovirus B species (EV-B) are responsible for a vast number of mild and serious acute infections. They are also suspected of remaining in the body, where they cause persistent infections contributing to chronic diseases such as type I diabetes. Recent studies of the infectious entry pathway of these viruses revealed remarkable similarities, including non-clathrin entry of large endosomes originating from the plasma membrane invaginations. Many cellular factors regulating the efficient entry have recently been associated with macropinocytic uptake, such as Rac1, serine/threonine p21-activated kinase (Pak1), actin, Na/H exchanger, phospholipace C (PLC) and protein kinase Cα (PKCα). Another characteristic feature is the entry of these viruses to neutral endosomes, independence of endosomal acidification and low association with acidic lysosomes. The biogenesis of neutral multivesicular bodies is crucial for their infection, at least for echovirus 1 (E1) and coxsackievirus A9 (CVA9). These pathways are triggered by the virus binding to their receptors on the plasma membrane, and they are not efficiently recycled like other cellular pathways used by circulating receptors. Therefore, the best “markers” of these pathways may be the viruses and often their receptors. A deeper understanding of this pathway and associated endosomes is crucial in elucidating the mechanisms of enterovirus uncoating and genome release from the endosomes to start efficient replication. PMID:26690201

  10. Global trends in emerging infectious diseases.

    PubMed

    Jones, Kate E; Patel, Nikkita G; Levy, Marc A; Storeygard, Adam; Balk, Deborah; Gittleman, John L; Daszak, Peter

    2008-02-21

    Emerging infectious diseases (EIDs) are a significant burden on global economies and public health. Their emergence is thought to be driven largely by socio-economic, environmental and ecological factors, but no comparative study has explicitly analysed these linkages to understand global temporal and spatial patterns of EIDs. Here we analyse a database of 335 EID 'events' (origins of EIDs) between 1940 and 2004, and demonstrate non-random global patterns. EID events have risen significantly over time after controlling for reporting bias, with their peak incidence (in the 1980s) concomitant with the HIV pandemic. EID events are dominated by zoonoses (60.3% of EIDs): the majority of these (71.8%) originate in wildlife (for example, severe acute respiratory virus, Ebola virus), and are increasing significantly over time. We find that 54.3% of EID events are caused by bacteria or rickettsia, reflecting a large number of drug-resistant microbes in our database. Our results confirm that EID origins are significantly correlated with socio-economic, environmental and ecological factors, and provide a basis for identifying regions where new EIDs are most likely to originate (emerging disease 'hotspots'). They also reveal a substantial risk of wildlife zoonotic and vector-borne EIDs originating at lower latitudes where reporting effort is low. We conclude that global resources to counter disease emergence are poorly allocated, with the majority of the scientific and surveillance effort focused on countries from where the next important EID is least likely to originate. PMID:18288193

  11. Infectious proxies and childhood leukaemia: findings from the United Kingdom Childhood Cancer Study (UKCCS).

    PubMed

    Roman, Eve; Simpson, Jill; Ansell, Pat; Lightfoot, Tracy; Smith, Alex

    2009-01-01

    The United Kingdom Childhood Cancer Study (UKCCS) was specifically designed to investigate the potential etiological role of infections as one of its objectives and information on a number of markers of infectious exposure from multiple sources was collected (www.ukccs.org). This study found that a mother's recollections of past minor illness episodes in her children were unreliable, producing systematic case-control differences. From birth onwards children diagnosed with ALL between 2-5 years were found to have had more clinically diagnosed infectious illness episodes (not fewer) than unaffected children, with those with two or more neonatal infections being diagnosed with leukaemia around 7 months earlier than those with only one or none. The findings from these analyses and their implications for future research are reviewed and discussed in this paper. PMID:19091606

  12. Mad, homeless, and unwanted. A history of the care of the chronic mentally ill in America.

    PubMed

    Grob, G N

    1994-09-01

    governments, an uninformed public, or an obsolete system that failed to incorporate the findings of medical science. If American society is to deal effectively, compassionately, and humanely with the seriously mentally ill, several elements must be taken into account. First, the seriously mentally ill include individuals with quite different disorders, prognoses, and needs. Secondly, outcomes vary considerably over time. Some schizophrenics, for example, have reasonably good outcomes; others lapse into chronicity and become progressively more disabled. Finally, serious mental disorders are often exacerbated by poverty, racism, and substance abuse. Although psychiatric therapies can alleviate symptoms and permit individuals to live in the community, there is no "magic bullet" that will cure all cases of serious mental illnesses in the same way that antibiotic drugs are effective against acute infectious diseases.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:7824381

  13. Protein requirement in critical illness.

    PubMed

    Hoffer, Leonard John

    2016-05-01

    How much protein do critically ill patients require? For the many decades that nutritional support has been used there was a broad consensus that critically ill patients need much more protein than required for normal health. Now, however, some clinical investigators recommend limiting all macronutrient provision during the early phase of critical illness. How did these conflicting recommendations emerge? Which of them is correct? This review explains the longstanding recommendation for generous protein provision in critical illness, analyzes the clinical trials now being claimed to refute it, and concludes with suggestions for clinical investigation and practice. PMID:26914090

  14. Neuroinflammation and psychiatric illness

    PubMed Central

    2013-01-01

    Multiple lines of evidence support the pathogenic role of neuroinflammation in psychiatric illness. While systemic autoimmune diseases are well-documented causes of neuropsychiatric disorders, synaptic autoimmune encephalitides with psychotic symptoms often go under-recognized. Parallel to the link between psychiatric symptoms and autoimmunity in autoimmune diseases, neuroimmunological abnormalities occur in classical psychiatric disorders (for example, major depressive, bipolar, schizophrenia, and obsessive-compulsive disorders). Investigations into the pathophysiology of these conditions traditionally stressed dysregulation of the glutamatergic and monoaminergic systems, but the mechanisms causing these neurotransmitter abnormalities remained elusive. We review the link between autoimmunity and neuropsychiatric disorders, and the human and experimental evidence supporting the pathogenic role of neuroinflammation in selected classical psychiatric disorders. Understanding how psychosocial, genetic, immunological and neurotransmitter systems interact can reveal pathogenic clues and help target new preventive and symptomatic therapies. PMID:23547920

  15. The social origins of illness: a neglected history.

    PubMed

    Waitzkin, H

    1981-01-01

    Although interest in the social origins of illness has grown recently, the sources of this concern in Marxist thought have received little attention. Friedrich Engels, Rudolf Virchow, and Salvador Allende made important early contributions to this field. Engels analyzed features of the workplace and environment that caused disability and early death for the British working class. Virchow's studies in "social medicine" and infectious diseases called for social change as a solution to medical problems. Allende traced poor health to class oppression, economic underdevelopment, and imperialism. These analysts provided divergent, though complementary, views of social etiology, multifactorial causation, the methodology of dialectic materialism, an activist role for medical scientists and practitioners, social epidemiology, health policy, and strategies of sociomedical change. The social origins of illness remain with us and reveal the scope of reconstruction needed for meaningful solutions. PMID:7016768

  16. Gender Differences in Determinants and Consequences of Health and Illness

    PubMed Central

    2007-01-01

    This paper uses a framework developed for gender and tropical diseases for the analysis of non-communicable diseases and conditions in developing and industrialized countries. The framework illustrates that gender interacts with the social, economic and biological determinants and consequences of tropical diseases to create different health outcomes for males and females. Whereas the framework was previously limited to developing countries where tropical infectious diseases are more prevalent, the present paper demonstrates that gender has an important effect on the determinants and consequences of health and illness in industrialized countries as well. This paper reviews a large number of studies on the interaction between gender and the determinants and consequences of chronic diseases and shows how these interactions result in different approaches to prevention, treatment, and coping with illness. Specific examples of chronic diseases are discussed in each section with respect to both developing and industrialized countries. PMID:17615903

  17. Chest physiotherapy in acute bronchiolitis.

    PubMed Central

    Webb, M S; Martin, J A; Cartlidge, P H; Ng, Y K; Wright, N A

    1985-01-01

    Forty four children with acute bronchiolitis were given twice daily chest physiotherapy in addition to standard supportive measures and were compared with 46 controls who were not given physiotherapy. There was no clinically discernable benefit on the course of their illness. PMID:3907510

  18. The global burden of major infectious complications following prostate biopsy.

    PubMed

    Bennett, H Y; Roberts, M J; Doi, S A R; Gardiner, R A

    2016-06-01

    We present a systematic review providing estimates of the overall and regional burden of infectious complications following prostate biopsy. A directly standardized prevalence estimate was used because it reflects the burden of disease more explicitly. Complications included sepsis, hospitalization, bacteraemia, bacteriuria, and acute urinary retention after biopsy. There were 165 articles, comprising 162 577 patients, included in the final analysis. Our findings demonstrate that transrectal biopsy was associated with a higher burden of hospitalization (1·1% vs. 0·9%) and sepsis (0·8% vs. 0·1%) compared to transperineal biopsy, while acute urinary retention was more prevalent after transperineal than transrectal biopsy (4·2% vs. 0·9%). The differences were statistically non-significant because of large heterogeneity across countries. We also demonstrate and discuss regional variations in complication rates, with Asian studies reporting higher rates of sepsis and hospitalization. PMID:26645476

  19. Hypocaloric support in the critically ill.

    PubMed

    Patiño, J F; de Pimiento, S E; Vergara, A; Savino, P; Rodríguez, M; Escallón, J

    1999-06-01

    The critically ill patient exhibits a well defined endocrine and metabolic adaptive response to stressor agents, characterized by incremented resting energy expenditure (hypermetabolism, which is believed to signify increased energy requirements), accelerated whole-body proteolysis (hypercatabolism), and lipolysis. These phenomena occur in the acute stage, which is also characterized by hyperglycemia, typically accompanied by a hyperdynamic cardiovascular reaction manifested by high cardiac output, increased oxygen consumption, high body temperature, and decrease peripheral vascular resistance. High provisions of glucose-derived calories tend to accentuate these reactions and increase the degree of hyperglycemia. We have adopted a hypocaloric-hyperproteic regimen which is provided only during the first days of the flow phase of the adaptive response to injury, sepsis, or critical illness. Our regimen includes a daily supply of 100 to 200 g of glucose and 1.5 to 2.0 g of protein (synthetic amino acids) per kilogram of ideal body weight. We have analyzed the data on 107 critically ill patients, 70 men and 37 women, who were admitted to the surgical intensive care unit and who received nutritional support by the TPN hypocaloric modality for a minimum of 3 days. We found that the high caloric loads contained in TPN regimens results in additional metabolic stress, with consequent hyperdynamic cardiorespiratory repercussion, high CO2 production, and frequently hepatic steatosis. In contrast, our hypocaloric-hyperproteic approach has resulted in a more physiologic clinical course and considerable reduction in cost. The infusion of high glucose loads, such as those used in hypercaloric TPN, does not seem to suppress the excessive endogenous production of glucose but instead markedly exacerbates the hyperglycemia of the postinjury and acute stress condition. We believe that the hypocaloric-hyperproteic regimen we utilize during the first few days of the stress situation is

  20. Infectious disease surveillance for the London 2012 Olympic and Paralympic Games.

    PubMed

    Severi, E; Heinsbroek, E; Watson, C; Catchpole, M

    2012-01-01

    The London 2012 Olympic and Paralympic Games will be one of the largest mass gathering events in British history. In order to minimise potential infectious disease threats related to the event, the Health Protection Agency (HPA) has set up a suite of robust and multisource surveillance systems. These include enhancements of already established systems (notification of infectious diseases, local and regional reporting,laboratory surveillance, mortality surveillance, international surveillance, and syndromic surveillance in primary care), as well as new systems created for the Games (syndromic surveillance in emergency departments and out-of-hours/unscheduled care,undiagnosed serious infectious illness surveillance).Enhanced existing and newly established surveillance systems will continue after the Games or will be ready for future reactivation should the need arise. In addition to the direct improvements to surveillance, the strengthening of relationships with national and international stakeholders will constitute a major post-Games legacy for the HPA. PMID:22874458