Prevalence and correlates of chronic fatigue syndrome and post-traumatic stress disorder after the outbreak of the COVID-19.

As the SARS-COV-2 becomes a global pandemic, many researchers have a concern about the long COVID-19 complications. Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a persistent, debilitating, and unexplained fatigue disorder. We investigated psychological morbidities such as CFS and post-traumatic stress disorder (PTSD) among survivors of COVID-19 over 6 months. All COVID-19 survivors from the university-affiliated hospital of Tehran, Iran, were assessed 6 months after infection onset by a previously validated questionnaire based on the Fukuda guidelines for CFS/EM and DSM-5 Checklist for PTSD (The Post-traumatic Stress Disorder Checklist for DSM-5 or PCL-5) to determine the presence of stress disorder and chronic fatigue problems. A total of 120 patients were enrolled. The prevalence rate of fatigue symptoms was 17.5%. Twelve (10%) screened positive for chronic idiopathic fatigue (CIF), 6 (5%) for CFS-like with insufficient fatigue syndrome (CFSWIFS), and 3 (2.5%) for CFS. The mean total scores in PCL-5 were 9.27 ± 10.76 (range:0-44), and the prevalence rate of PTSD was 5.8%. There was no significant association after adjusting between CFS and PTSD, gender, comorbidities, and chloroquine phosphate administration. The obtained data revealed the prevalence of CFS among patients with COVID-19, which is almost similar to CFS prevalence in the general population. Moreover, PTSD in patients with COVID-19 is not associated with the increased risk of CFS. Our study suggested that medical institutions should pay attention to the psychological consequences of the COVID-19 outbreak.

Pre- and postoperative quality of life and emotional/behavioural problems in children with PFAPA.

OBJECTIVE: This study aimed to evaluate the effects of surgical intervention on quality of life, emotional/behavioural problems and school absenteeism in children with periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA.) METHOD: A total of 56 children aged between 4 and 12 years, diagnosed with PFAPA and undergoing tonsillectomy with/without adenoidectomy at a tertiary hospital were included in the study. The Questionnaire for Quality of Life Assessment for Children and Adolescents Parent Form (Kid-KINDL) and the Strengths and Difficulties Questionnaires (SDQ) were used to evaluate quality of life and emotional/behavioural problems, respectively. The cases were assessed before and three months after surgery. RESULTS: The mean (SD) age of the children was 6.64 (3.03) years, and 58.9% (n = 33) were boys. The numbers of pre- and post-operative periodic fever episodes were 3.0 (1.7) and 0.6 (0.9) (p < 0.001), those for school absenteeism were 10.28 (5.53) and 2.85 (2.95) days (p < 0.001) and those for hospital presentations were 3.8 (2.5) and 1.1 (1.1) (p < 0.001), respectively, all of which were significantly lower in children with PFAPA at three months after the operation. The surgical procedures were effective in improving quality of life and emotional/behavioural problems, as evidenced by the significant differences between the pre- and post-treatment scores in outcome measures, including SDQ and Kid-KINDL (p < 0.001). CONCLUSIONS: This study demonstrated that the surgical approach exhibited positive effects in terms of improving quality of life and reducing emotional/behavioural problems and school absenteeism in children with PFAPA.

Early-life hyperthermic seizures upregulate adenosine A2A receptors in the cortex and promote depressive-like behavior in adult rats.

Febrile seizures (FS) represent one of the most frequent convulsive disorders in children which can be classified into simple and prolonged depending on the duration. Although simple FS are generally considered as benign, there is controversy about the outcome of prolonged FS. Here, we have used an animal model of prolonged FS to investigate persistent neurochemical and behavioral alterations in adult rats. Hyperthermic seizures were induced in 12-day-old rats using a warmed air stream from a hair dryer. Neonates exhibited arrest of heat-induced hyperkinesis followed by body flexion and rearing and falling over associated with hindlimb clonus seizures (stage 5 on Racine scale criteria) after hyperthermic induction. After 48 days, the animals were assayed on dark-light box and forced swim tests in order to detect if rats will show signs of anxiety or depression. Finally, animals were sacrificed 56 days after hyperthermia-induced seizures (HIS), and their effects on adenosine A2A receptor signaling and 5'-nucleotidase activity were studied in plasma membranes from the cerebral cortex by using radioligand-binding assay and by measuring the activities of adenylate cyclase and 5'-nucleotidase. Results obtained have shown that adult rats submitted to HIS during the neonatal period showed depressive-like behavior. Furthermore, animals exposed to hyperthermic insult showed an increase in A2A receptor level which was also accompanied by an increase in A2A receptor functionality.

Predicting prolonged duration of fever in children: a cohort study in primary care.

BACKGROUND: Fever in children in primary care is commonly caused by benign infections, but often worries parents. Information about the duration of fever and its predictors may help in reassuring parents, leading to diminished consultation of health care. AIM: To determine which signs and symptoms predict a prolonged duration of fever in febrile children in primary care and evaluate whether C-reactive protein (CRP) measurement has an additive predictive value for these symptoms. DESIGN AND SETTING: A prospective cohort study at a GPs' cooperative (GPC) out-of-hours service. METHOD: Children (aged 3 months to 6 years) presenting with fever as stated by the parents were included. Exclusion criteria were no communication in Dutch possible, previous enrolment in the study within 2 weeks, referral to the hospital directly after visiting the GPC, or no informed consent. The main outcome measure was prolonged duration of fever (>3 days) after initial contact. RESULTS: Four-hundred and eighty children were analysed, and the overall risk of prolonged duration was 13% (63/480). Multivariate analysis combined model of patient history and physical examination showed that 'sore throat' (OR 2.8; 95% CI = 1.30 to 6.01) and 'lymph nodes palpable' (OR 1.87; 95% CI = 1.01 to 3.49) are predictive for prolonged duration of fever. The discriminative value of the model was low (AUC 0.64). CRP had no additive value in the prediction of prolonged duration of fever (OR 1.00; 95% CI = 0.99 to 1.01). CONCLUSION: The derived prediction model indicates that only a few signs and symptoms are related to prolonged duration of fever. CRP has no additional value in this model. Overall, because the discriminative value of the model was low, the duration of fever cannot be accurately predicted.

Beyond intuition: patient fever symptom experience.

CONTEXT: Fever is an important sign of inflammation recognized by health care practitioners and family caregivers. However, few empirical data obtained directly from patients exist to support many of the long-standing assumptions about the symptoms of fever. Many of the literature-cited symptoms, including chills, diaphoresis, and malaise, have limited scientific bases, yet they often represent a major justification for antipyretic administration. OBJECTIVES: To describe the patient experience of fever symptoms for the preliminary development of a fever assessment questionnaire. METHODS: Qualitative interviews were conducted with 28 inpatients, the majority (86%) with cancer diagnoses, who had a recorded temperature of ≥38°C within approximately 12 hours before the interview. A semi-structured interview guide was used to elicit patient fever experiences. Thematic analyses were conducted by three independent research team members, and the data were verified through two rounds of consensus building. RESULTS: Eleven themes emerged. The participants reported experiences of feeling cold, weakness, warmth, sweating, nonspecific bodily sensations, gastrointestinal symptoms, headaches, emotional changes, achiness, respiratory symptoms, and vivid dreams/hallucinations. CONCLUSION: Our data not only confirm long-standing symptoms of fever but also suggest new symptoms and a level of variability and complexity not captured by the existing fever literature. Greater knowledge of patients' fever experiences will guide more accurate assessment of symptoms associated with fever and the impact of antipyretic treatments on patient symptoms in this common condition. Results from this study are contributing to the content validity of a future instrument that will evaluate patient outcomes related to fever interventions.

Hyperthermia impaired human visual short-term memory: an fMRI study.

PURPOSE: In order to investigate the effects of hyperthermia conditions on human cognitive performance, functional magnetic resonance imaging (fMRI) was employed to investigate human brain activation during visual short-term memory (VSTM) tasks under modulated hyperthermia conditions. MATERIALS AND METHODS: A total of 38 right-handed healthy young male participants were randomly divided into control and hyperthermia groups who underwent VSTM tasks by using block design. RESULTS: Compared with that of the control group, the reaction time of the hyperthermia group was longer in VSTM tasks (p = 0.019), but there was no significant difference between the two groups for the accuracy rate (p > 0.85). The fMRI data showed that the processing advantage of the right hemisphere was notably enhanced and that activity strength of the bilateral dorsolateral prefrontal cortex and right intra-parietal sulcus were significantly enhanced in the hyperthermia group. CONCLUSIONS: These data provided neuroimaging evidence of the effect of hyperthermia conditions on the brain regions and also proved heat load decreases cognitive performance.

Hyperthermia exposure impaired the early stage of face recognition: an ERP study.

We investigated the effect of hyperthermia exposure on the early stages of face processing by recording event-related potentials (ERPs) elicited by faces and non-face stimuli presented in upright and inverted orientations. Across all conditions, both the peak latencies of P1 and N170 components were earlier in the hyperthermia group than in the control participants. Although no effects of P1 amplitudes were influenced by hyperthermia, the face effect (larger amplitude for faces relative to other object categories) of the N170 was modulated by hyperthermia, whereas the face effect was significant in the control group, it was minimised in the hyperthermia group. The inversion effect of faces on N170 amplitudes, however, was not affected by hyperthermia. These data suggest that the detection of faces in the visual field and their initial streaming to face-specific structural encoding mechanisms are impaired by hyperthermia. However, subsequent face-specific configural processing revealed by the N170 inversion effect is not affected by hyperthermia. In addition, hyperthermia accelerates the early stage of visual perception, regardless of faces or non-face objects.

Hyperthermia impairs the executive function using the Attention Network Test.

PURPOSE: The primary aim of this study was to examine the effect of passive hyperthermia on the human attention system using the Attention Network Test (ANT), which has been used in both healthy controls and patients. Using target contrasts between conditions within a Flanker paradigm, the ANT can isolate three essential networks in the attention system: maintaining an alert state that is receptive to stimulus input and ready for responding; orienting, which involves selection of sensory input; and executive control, which monitors for and resolves conflict in responding or other aspects of cognitive processing. MATERIALS AND METHODS: The ANT was administered to 16 right-handed subjects in a heat stress condition (50°C, 40% relative humidity) and a control condition (20°C, 40% relative humidity), for 1 hour each. Reaction time (RT) and accuracy rate as well as mean body core temperature (T-core) and body weight loss were recorded. RESULTS: Compared to the control condition, T-cores significantly increased and body weight was not significantly reduced in the heat stress condition. Overall, there were non-significant group differences for RT and accuracy rate. Although significant changes in neither alerting nor orienting effects were modulated by the simulated hyperthermia, the executive control effect on RTs was significantly larger in the heat compared to the control condition. CONCLUSIONS: Passive hyperthermia impaired executive control function, whereas alerting and orienting effects were unaffected.

Guardian ad litem, a potentially expensive invitation to either the mismanagement or management of patients with cognitive disorders.

The children of a multiple sclerosis (MS) patient filed a guardian ad litem case to be brought against the patient. The basis for the petition was that the MS patient had a significant reduction is his mental competence. The children were not aware that hyperthermia could adversely affect the brain of MS patients. The patient's urologist recommended he have a suprapubic cystostomy done in a hospital. Passage of the two channel Foley catheter into his bladder immediately resolved his urinary tract infection, fever, and difficulty in communicating. Despite this dramatic improvement in his health from the urologic treatment, he was now faced with resolving his children's petition for a guardian ad litem that would allow them to control his estate including his residence and financial retirement assets. A judge supported this petition by requesting that the patient with MS pay for his children's attorney fees, 24 hour nursing home services that duplicated his own hired personal care assistants, the salary of the guardian ad litem, the attorney fees for the guardian ad litem, and payment for a psychological evaluation. The state law should be changed to require that the petitioner have adequate income to pay for his/her attorney as well as the salary of the guardian ad litem to prevent mismanagement of patients with cognitive disorders. In addition, the guardian ad litem should be an attorney or a registered nurse. The care of disabled individuals subjected to litigation should be coordinated by an attorney or registered nurse.

Percepção de mães sobre a síndrome da erupção dentária e suas manifestações clínicas na infância / Percepción de las madres acerca del síndrome de erupción dental y manifestaciones clínicas de la infancia / Mothers perception of dental eruption syndrome and its clinical manifestation during childhood

Objetivo Este estudo objetivou identificar a percepção de mães primíparas e multíparas sobre a erupção dentária e suas manifestações, ao mesmo tempo em que relacionou e discutiu a ocorrência destas manifestações a luz da literatura pertinente. Método Trata-se de um estudo qualitativo descritivo, onde os sujeitos foram 61 mães, com bebês na faixa etária entre 3 e 12 meses de idade, usuários do Hospital de Pediatria da UFRN, na cidade de Natal, RN, Brasil. Utilizou-se uma entrevista semi-estruturada para coleta das informações. A análise dos dados foi feita pelo Software ALCESTE 4.5, utilizando-se as variáveis primíparas, para designar mães com apenas um filho e multíparas para mães com dois filhos ou mais. Resultados A presença de sintomatologia foi relatada por 75 por cento das mães entrevistadas. A percepção das mães de ambas as classes, provavelmente reflete desconhecimento do processo de desenvolvimento infantil e convergem para a presença de sintomas clínicos atribuídos ao processo eruptivo, porém, o grande diferencial está na forma de apreensão desta realidade. As primíparas manifestam claramente que o conhecimento foi adquirido através do senso comum, enquanto que as multíparas reproduzem este mesmo conhecimento baseado na experiência com os filhos anteriores. Discussão Concluiu-se que durante essa fase de erupção dentária os profissionais tenham uma posição firme e definida, baseada em evidências fartamente colocadas pela literatura, da relação direta entre erupção dentária e sintomatologia geral, dando a devida atenção a cada paciente e suas queixas, para desmistificar e melhor compreender esse processo na sua totalidade.

Objective This study was aimed at identifying primiparous and multiparous mothers perceptions about tooth eruption and related symptoms as well as discussing such events occurrence in the light of the relevant literature. Methods The research adopted a qualitative, descriptive design; 61 mothers who had already given birth to babies aged 3 to 12 months old were studied. Their children were outpatients at Rio Grande do Norte Federal Universitys Paediatric Hospital in Natal, RN, Brazil. A semi-structured interview was used for collecting data. ALCESTE 4.5 software was used for analysing data based on primiparous and multiparous mothers as variables; the former term referred to mothers bearing a child for the first time and multiparous to those who had born more than one child. Results Symptomatology was related by 75 percent of the mothers interviewed here. The perception of the mothers from both groups probably pointed to a lack of knowledge regarding child development and the process leading to the presence of clinical symptoms due to tooth eruption. However, the great difference lay in how this reality was perceived; mothers having a single child clearly affirmed that knowledge was acquired by common sense, whilst mothers of more than one child reproduced such knowledge according to their experience with previous children. Discussion It was concluded that during this phase of tooth eruption, professionals must adopt a firm and defined position based on the literature providing evidence of the real relationship between tooth eruption and general symptoms, paying attention to every patient and their complaints to demystify and better understand this whole process.

Objetivo Este estudio tuvo como objetivo identificar la percepción de las madres primíparas y multíparas en la erupción de los dientes y sus manifestaciones, así como examinar la ocurrencia de estos hechos a la luz de la documentación pertinente. Método La investigación tuvo un diseño cualitativo descriptivo y 61 madres cuyos bebés habían entre 3 y 12 meses de edad fueron estudiadas. Sus hijos eran pacientes del Hospital de Pediatría de la Universidad Federal de Rio Grande do Norte, en la ciudad de Natal, RN, Brasil. Para recoger los datos, se utilizó una entrevista semi-estructurada. El ALCESTE 4.5 fue utilizado para analizar los datos basados en las primíparas y multíparas madres como variables. El primero se utilizó para las madres que lleven a un niño por primera vez y multíparas que los cuales habían nacido más de un niño. Resultados La sintomatología fue referida por 75 por ciento de las madres entrevistadas. La percepción de las madres de ambos grupos probablemente señala desconocimiento del desarrollo del niño y el proceso converge a la presencia de síntomas clínicos debido a la erupción del diente. Sin embargo, la gran diferencia está en la forma de recoger esta realidad. Madres de un niño afirmaron claramente que el conocimiento fue adquirido por el sentido común, mientras que las madres de más de un niño se reproducen en este mismo conocimiento de acuerdo con la experiencia basada en los niños mayores. Discusión Se concluyó que durante esta fase de la erupción de los dientes, los profesionales deben tener una postura firme definida, basados por la literatura, la relación directa entre la erupción de los dientes y los síntomas generales, prestando atención a cada paciente y sus quejas, para así desmitificar y comprender mejor este proceso en su totalidad.

Acid sensing ion channel (ASIC) inhibitors exhibit anxiolytic-like activity in preclinical pharmacological models.

RATIONALE: Acid sensing ion channels (ASICs) are proton-gated ion channels located in the central and peripheral nervous systems. Of particular interest is ASIC1a, which is located in areas associated with fear and anxiety behaviors. Recent reports suggest a role for ASIC1a in preclinical models of fear conditioning and anxiety. OBJECTIVES: The present experiments evaluated various ASIC inhibitors in preclinical models of autonomic and behavioral parameters of anxiety. In addition, neurochemical studies evaluated the effects of an ASIC inhibitor (A-317567) on neurotransmitter levels in the amygdala. RESULTS: In electrophysiological studies using hippocampal primary neuronal cultures, three ASIC inhibitors (PcTX-1, A-317567, and amiloride) produced concentration-dependent inhibition of acid-evoked currents. In the stress-induced hyperthermia model, acute administration of psalmotoxin 1 (PcTX-1; 10-56 ng, i.c.v.), A-317567 (0.1-1.0 mg/kg, i.p.), and amiloride (10-100 mg/kg, i.p.) prevented stress-induced elevations in core body temperature. In the four-plate test, acute treatment with PcTX-1 (10-56 ng, i.c.v.) and A-317567 (0.01-0.1 mg/kg, i.p.), but not amiloride (3-100 mg/kg, i.p.), produced dose-dependent and significant increases in the number of punished crossings relative to vehicle-treated animals. Additionally, PcTX-1 (56-178 ng, i.c.v.), A-317567 (0.1-10 mg/kg, i.p.), and amiloride (10-100 mg/kg, i.p.) lacked significant anxiolytic-like activity in the elevated zero maze. In neurochemical studies, an infusion of A-317567 (100 microM) into the amygdala significantly elevated the extracellular levels of GABA, but not glutamate, in this brain region. CONCLUSIONS: These findings demonstrate that ASIC inhibition produces anxiolytic-like effects in some behavioral models and indicate a potential role for GABAergic mechanisms to underlie these anxiolytic-like effects.

Behavioral characterization of the mGlu group II/III receptor antagonist, LY-341495, in animal models of anxiety and depression.

There is a growing body of evidence indicating that stimulation of metabotropic glutamate type II receptors (mGlu2/3) reduces anxiety in laboratory animals and humans. Surprisingly, it was reported that mGlu2/3 receptor antagonists have antidepressant- and anxiolytic-like activities in laboratory animal studies as well. The present study aimed to resolve this controversy by characterizing behavioral effects of a selective mGlu2/3 receptor antagonist, LY-341495, in a variety of animal models sensitive to clinically used anxiolytic and antidepressant agents. In agreement with previous reports, LY-341495 (0.3-3 mg/kg, i.p.) reduced immobility in the mouse forced swim test. LY-341495 was also effective in the marble burying test in mice, although similar effects were observed after administration of various drugs including methamphetamine. Further, LY-341495 had no effects in the elevated plus maze and stress-induced hyperthermia tests in mice, as well as on punished drinking (Geller-Seifter's test) and differential reinforcement of low rates of responding (DRL) in rats. It is concluded that behavioral profile of mGlu2/3 receptor antagonists as represented by LY-341495 is different from that of conventional anxiolytic and antidepressant drugs.

Macrophage-activating lipopeptide-2 (MALP-2) induces a localized inflammatory response in rats resulting in activation of brain sites implicated in fever.

Macrophage-activating lipopeptide-2 (MALP-2) has been identified as the pathogen-associated molecular pattern of Mycoplasma fermentans, which causes stimulation of the innate immune system through the activation of the heterodimeric Toll-like receptors (TLRs) 2 and 6. Based on the reported protective effects of MALP-2 on healing of skin wounds, the central goal of this study was to evaluate the capacity of MALP-2 to induce a localized inflammatory response in an established model of a subcutaneous air pouch. Injections of MALP-2 into the pouch caused fever and some components of sickness behavior in rats. At the subcutaneous site of localized inflammation, a massive formation of tumor necrosis factor-alpha (TNF), interleukin-6 (IL-6), and prostaglandin E2 (PGE2) could be demonstrated in response to injections of MALP-2. Moderate amounts of IL-6 and PGE2 seemed to enter the systemic circulation of MALP-2-treated rats. The IL-6, which appeared in the blood after injection of MALP-2 into the air pouch was sufficient to cause a direct activation of brain cells in areas which lack a complete blood-brain barrier, namely in the sensory circumventricular organs (sCVOs), the organum vasculosum laminae terminalis (OVLT), the subfornical organ (SFO), and the area postrema (AP). The stimulation of cells at these brain sites was revealed by demonstration of a nuclear translocation of the transcription factor STAT3 (signal transducer and activator of transcription 3). Corresponding to the circulating levels of IL-6, the nuclear STAT3 activation of cells within the sCVOs was much less pronounced after local subcutaneous when compared to systemic treatment with MALP-2. In conclusion, cells within the subcutaneous compartment are activated by the TLR2/6 agonist MALP-2. Fever and sickness behavior induced by injection of MALP-2 into subcutaneous tissue may, in part, be mediated by a spillover of IL-6 from the subcutaneous site of inflammation into the blood to cause activation of brain sites which are implicated in the manifestation of these illness responses.

Temperature measurement in children with cancer: an evaluation.

There is little agreement as to the most appropriate thermometer, the anatomical site to carry out temperature measurement in children with cancer, or the type of thermometer preferred by the patients. The authors carried out this study to assess temperature measurement in children with cancer who were admitted for febrile episodes. The body temperatures of children with cancer who were admitted consecutively between January and October 2005 to the paediatric department because of febrile episodes were measured on admission and over the next 24-36 hours using an electronic thermometer sublingually as the standard reference site. These measurements were compared with those obtained with two ear-based thermometers, a forehead thermometer, and from the axilla (representing current practice). The parents were asked about the type of thermometer they used at home and the children were asked about the type of thermometer they preferred. There were 34 admissions during this period, of which 19 (56%) were confirmed as febrile. Altogether, 108 sets of temperature measurements were obtained, producing a total of 540 measurements from these admissions. Measurements with the two ear-based thermometers in febrile children achieved higher sensitivity than that with axillary and the forehead measurements. The ear-based thermometer was the most common type used at home while the forehead thermometer was the one preferred by the children. In conclusion, ear-based temperature measurements in febrile children were more accurate than axillary and forehead temperature measurements. The current practice of axillary temperature measurement needs to be re-considered.

Fiebrefobia: conocimiento y actitud de los padres respecto de la fiebre / Fever phobia: parents' knowledge and attitude towards fever

Introducción: Algunos mitos en salud se encuentran muy arraigados, considerándose verdades irrebatibles aunque no tengan sustento científico, lo que es especialmente evidente en relación a la fiebre y sus potenciales consecuencias. Objetivos: Describir el nivel de conocimiento, interpretación, forma de medir y tratar la fiebre en padres de niños menores de 2 años que concurren a un centro privado de atención. Paciente y Método: Desde Febrero 2002 a Febrero 2005 se encuestó a 235 padres de nivel sociocultural medio que consultaron por primera vez, cuyo motivo de consulta era al menos el segundo episodio febril de su primer hijo menor de 2 años, acerca de 19 ítems sobre conocimientos, interpretación y tratamiento de la fiebre. Se usó análisis emicista de contenidos. Resultados: 30 por ciento desconoce valores normales de temperatura y 55 por ciento consideran tratar a un niño con menos de 38 ºC. El 89 por ciento refiere tener termómetro en el hogar, 90 por ciento de mercurio, pero sólo 58 por ciento lo usa bien. 26 por ciento cree que la fiebre no se autolimita y el 18 por ciento cree que puede subir sobre los 43 ºC. El 78 por ciento considera que provoca daño cerebral y 9 por ciento que puede ser letal; así, la mayoría la trata agresivamente: 80 por ciento con antipiréticos (75 por ciento paracetamol) con temperatura sobre 38,9 ºC y además el 27 popr ciento utiliza medios físicos sobre 39,5 ºC; si no desciende en una hora, 66 por ciento asocia un segundo antipirético (58 por ciento ibuprofeno) o repetir el primero; sobre 39 ºC prefieren el supositorio (86 por ciento) o los antiinflamatorios no esteroidales (AINEs) sobre el paracetamol, entre las gotas. 44 por ciento no reconoce nombres comerciales diferentes como un mismo antipirético. La fuente de información sobre antipiresis fue 46 por ciento por familiares y sólo 30 por ciento por personal de salud. Conclusiones: El temor exagerado y sin fundamento a la fiebre, fiebrefobia, existe, provoca acciones potenci...

CCK(2) receptor nullification attenuates lipopolysaccharide-induced sickness behavior.

Systemic infection produces a highly regulated set of responses such as fever, anorexia, adipsia, inactivity, and cachexia, collectively referred to as sickness behavior. Although the expression of sickness behavior requires immune-brain communication, the mechanisms by which peripheral cytokines signal the brain are unclear. Several mechanisms have been proposed for neuroimmune communication, including the interaction of cytokines with peripheral nerves. A critical role has been ascribed to the vagus nerve in mediating sickness behavior after intraperitoneally delivered immune activation, and converging evidence suggests that this communication may involve neurochemical intermediaries afferent and/or efferent to this nerve. Mice lacking functional CCK(2/gastrin) receptors (CCK(2)KO) and wild-type (WT) controls were administered LPS (50, 500, or 2,500 microg/kg; serotype 0111:B4; ip). Results indicate a role for CCK(2) receptor activation in the initiation and maintenance of LPS-induced sickness behavior. Compared with WT controls, CCK(2)KO mice were significantly less affected by LPS on measures of body temperature, activity, body weight, and food intake, with the magnitude of effects increasing with increasing LPS dose. Although activation of CCK(2) receptors at the level of the vagus nerve cannot be excluded, a possible role for these receptors in nonvagal routes of immune-brain communication is suggested.

Palliative fever management in Alzheimer patients. quality plus fiscal responsibility.

Aggressive medical treatment of infections does not affect the progressive course of dementia of the Alzheimer type (DAT) and has limited effect on the mortality rate. Utilization of health care resources and discomfort during a fever episode were compared in three differing treatment conditions: in 18 patients in a dementia special care unit (DSCU) who received palliative management, 26 patients in a DSCU who were treated aggressively, and 17 DAT patients in traditional long-term care units who were treated aggressively. Both groups of patients in the DSCU had lower discomfort scores, lower utilization of high-cost health care resources, and higher utilization of analgesics and narcotics. A nursing model of care incorporating hospice concepts into the DSCU is suggested.