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1.
Ann Hematol ; 103(6): 2089-2102, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38691145

RESUMEN

Infection post-hematopoietic stem cell transplantation (HSCT) is one of the main causes of patient mortality. Fever is the most crucial clinical symptom indicating infection. However, current microbial detection methods are limited. Therefore, timely diagnosis of infectious fever and administration of antimicrobial drugs can effectively reduce patient mortality. In this study, serum samples were collected from 181 patients with HSCT with or without infection, as well as the clinical information. And more than 80 infectious-related microRNAs in the serum were selected according to the bulk RNA-seq result and detected in the 345 time-pointed serum samples by Q-PCR. Unsupervised clustering result indicates a close association between these microRNAs expression and infection occurrence. Compared to the uninfected cohort, more than 10 serum microRNAs were identified as the combined diagnostic markers in one formula constructed by the Random Forest (RF) algorithms, with a diagnostic accuracy more than 0.90. Furthermore, correlations of serum microRNAs to immune cells, inflammatory factors, pathgens, infection tissue, and prognosis were analyzed in the infection cohort. Overall, this study demonstrates that the combination of serum microRNAs detection and machine learning algorithms holds promising potential in diagnosing infectious fever after HSCT.


Asunto(s)
Fiebre , Trasplante de Células Madre Hematopoyéticas , Aprendizaje Automático , Humanos , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Femenino , Masculino , Adulto , Persona de Mediana Edad , Fiebre/etiología , Fiebre/diagnóstico , Fiebre/sangre , Algoritmos , MicroARNs/sangre , Biomarcadores/sangre , Adolescente , Adulto Joven
2.
BMC Pregnancy Childbirth ; 24(1): 341, 2024 May 03.
Artículo en Inglés | MEDLINE | ID: mdl-38702618

RESUMEN

INTRODUCTION: Epidural analgesia has been associated with intrapartum maternal fever development. Epidural-related maternal fever (ERMF) is believed to be based on a non-infectious inflammatory reaction. Circulating cell-free mitochondrial deoxyribonucleic acid (mtDNA) is one of the possible triggers of sterile inflammatory processes; however, a connection has not been investigated so far. Therefore, this study aimed to investigate cell-free mtDNA alterations in women in labour with ERMF in comparison with non-febrile women. MATERIAL AND METHODS: A total of 60 women in labour were assessed for maternal temperature every 4 h and blood samples were obtained at the beginning and after delivery. Depending on the analgesia and the development of fever (axillary temperature ≥ 37.5 °C), the women were allocated either to the group of no epidural analgesia (n = 17), to epidural analgesia no fever (n = 34) or to ERMF (n = 9). Circulating cell-free mtDNA was analysed in the maternal plasma for the primary outcome whereas secondary outcomes include the evaluation of inflammatory cytokine release, as well as placental inflammatory signs. RESULTS: Of the women with epidural analgesia, 20% (n = 9) developed ERMF and demonstrated a decrease of circulating mtDNA levels during labour (p = 0.04), but a trend towards higher free nuclear DNA. Furthermore, women with maternal pyrexia showed a 1.5 fold increased level of Interleukin-6 during labour. A correlation was found between premature rupture of membranes and ERMF. CONCLUSIONS: The pilot trial revealed an evident obstetric anaesthesia phenomenon of maternal fever due to epidural analgesia in 20% of women in labour, demonstrating counterregulated free mtDNA and nDNA. Further work is urgently required to understand the connections between the ERMF occurrence and circulating cell-free mtDNA as a potential source of sterile inflammation. TRIAL REGISTRATION: NCT0405223 on clinicaltrials.gov (registered on 25/07/2019).


Asunto(s)
Analgesia Epidural , ADN Mitocondrial , Fiebre , Humanos , Femenino , ADN Mitocondrial/sangre , Proyectos Piloto , Embarazo , Adulto , Fiebre/sangre , Analgesia Obstétrica , Trabajo de Parto/sangre , Ácidos Nucleicos Libres de Células/sangre
3.
J Infect Chemother ; 30(11): 1134-1140, 2024 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-38679384

RESUMEN

BACKGROUND: Meningitis, especially of bacterial origin, is a medical emergency that must be diagnosed promptly. However, due to the associated risks of complications of lumbar puncture, it is crucial to identify individuals who truly need it. The aim of this study was to assess the diagnostic role of inflammatory markers in distinguishing among patients without meningitis, those with aseptic meningitis, and those with bacterial meningitis. METHODS: This was a retrospective, diagnostic study at an acute care hospital, involving adult patients who presented to either ambulatory care or the emergency department with fever and headache, but without altered mental status or neurological deficits. Inflammatory markers (C-reactive protein [CRP], mean platelet volume, neutrophil-lymphocyte ratio, and red cell distribution width) were assessed as index tests. An expert panel classified patients into three groups: no meningitis, aseptic meningitis, and bacterial meningitis using predefined criteria. RESULTS: Of the 80 patients, 52 had no meningitis, 27 had aseptic meningitis, and 1 had bacterial meningitis. Of the inflammatory markers investigated, only CRP showed potential usefulness in differentiating these three diagnostic groups, with median values of 5.6 (interquartile range [IQR] 2.1, 11.3) mg/dL in those without meningitis, 0.2 (IQR 0.1, 1.2) mg/dL in those with aseptic meningitis, and notably elevated at 21.7 mg/dL in the patient with bacterial meningitis. CONCLUSION: In adult patients presenting with fever and headache in an emergency setting, CRP was the only marker that demonstrated potential diagnostic utility in distinguishing among those with no meningitis, aseptic meningitis, and bacterial meningitis.


Asunto(s)
Biomarcadores , Proteína C-Reactiva , Fiebre , Cefalea , Meningitis Aséptica , Meningitis Bacterianas , Humanos , Masculino , Femenino , Proteína C-Reactiva/análisis , Cefalea/sangre , Cefalea/diagnóstico , Estudios Retrospectivos , Biomarcadores/sangre , Meningitis Bacterianas/diagnóstico , Meningitis Bacterianas/sangre , Persona de Mediana Edad , Fiebre/sangre , Fiebre/diagnóstico , Adulto , Meningitis Aséptica/diagnóstico , Meningitis Aséptica/sangre , Anciano , Diagnóstico Diferencial
4.
Acta Med Indones ; 56(2): 199-205, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-39010771

RESUMEN

BACKGROUND: Diagnosis of infection in advanced solid tumor patients can be challenging since signs and symptoms might be overlapping due to paraneoplastic condition. Delay diagnosis of existing infection can lead to more severe conditions and increased mortality. Procalcitonin (PCT) has been used to support the diagnosis of bacterial infection and sepsis. Unfortunately, PCT also increases in malignancy even without an infection. We investigated the diagnostic accuracy of PCT in advanced solid tumor patients with fever to diagnose sepsis. METHODS: A cross-sectional study was conducted in solid advanced tumor patients with fever patients who were admitted to Cipto Mangunkusumo Hospitals, Indonesia between June 2016 and April 2018. Sepsis was defined using 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference criteria. The diagnostic accuracy of PCT was determined using the receiver operating characteristic (ROC) curve. RESULTS: A total of 194 subjects were enrolled in this study. 60.3% were female with a mean age of 49.47±12.87 years old. 143 patients (73.7%) with advanced solid tumors. Among this latter group, 39 patients (27%) were sepsis. The ROC curve showed that the levels of PCT for sepsis in advanced solid tumor patients with fever were in the area under the curve (AUC) 0.853 (95%CI 0.785 - 0.921). The Cut-off of PCT in advanced solid tumor patients with fever to classify as sepsis was 2.87 ng/mL, with a sensitivity of 79.5%, and a specificity of 79.8%. CONCLUSION: PCT has good diagnosis accuracy in advanced solid tumor patients with fever to classify as sepsis, however a higher cut-off compared to non-cancerous patients should be used.


Asunto(s)
Fiebre , Neoplasias , Polipéptido alfa Relacionado con Calcitonina , Curva ROC , Sepsis , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Área Bajo la Curva , Biomarcadores/sangre , Estudios Transversales , Fiebre/etiología , Fiebre/sangre , Fiebre/diagnóstico , Indonesia , Neoplasias/complicaciones , Neoplasias/sangre , Polipéptido alfa Relacionado con Calcitonina/sangre , Sensibilidad y Especificidad , Sepsis/diagnóstico , Sepsis/sangre , Sepsis/complicaciones
5.
Oncology (Williston Park) ; 36(2): 115-119, 2022 02 08.
Artículo en Inglés | MEDLINE | ID: mdl-35180339

RESUMEN

Neoadjuvant systemic therapy is a preferred treatment approach for a number of tumor types due to many potential advantages over upfront surgery, including tumor downstaging, early treatment of micrometastatic disease, and providing an in vivo test of tumor biology. For colon cancer, current standard of care is upfront surgery followed by adjuvant systemic therapy in high-risk patients. Concerns about inaccurate radiological staging and tumor progression during preoperative treatment, as well the lack of randomized data demonstrating benefit, are among the reasons for the limited use of neoadjuvant therapy in this disease. Locally advanced colon cancer, defined as primary colon cancer with direct invasion into the adjacent structures or extensive regional lymph node involvement, is not always amenable to pathological complete resection, and when attempted it comes with high incidence of postoperative morbidity and mortality because of the required multivisceral resection. Clinical trials of neoadjuvant chemotherapy for colon cancer to date have been promising with downstaging of disease and higher rates of R0 resection. Here, we report a case of a patient with locally advanced, unresectable, mismatch repair deficient sigmoid colon cancer who was treated with neoadjuvant chemoimmunotherapy followed by surgical resection leading to a complete pathologic response after preoperative systemic chemoimmunotherapy.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Fiebre/sangre , Interleucina-6/sangre , Neoplasias del Colon Sigmoide/tratamiento farmacológico , Anticuerpos Monoclonales Humanizados/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Camptotecina/administración & dosificación , Camptotecina/análogos & derivados , Fiebre/inducido químicamente , Fluorouracilo/administración & dosificación , Fluorouracilo/efectos adversos , Humanos , Leucovorina/administración & dosificación , Leucovorina/efectos adversos , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante , Compuestos Organoplatinos/administración & dosificación , Compuestos Organoplatinos/efectos adversos , Oxaliplatino/administración & dosificación , Oxaliplatino/efectos adversos , Neoplasias del Colon Sigmoide/patología
6.
J Pediatr Hematol Oncol ; 44(1): e138-e143, 2022 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-34486540

RESUMEN

Children with cancer require central venous access which carries risk for line-related infections. The necessity of peripheral and central blood cultures is debated for those with fevers. We evaluated and described results for first episode of paired blood cultures from children with cancer who have a central venous line using retrospective database. Blood culture results, laboratory data, and medical outcomes were included. Descriptive analyses of blood culture results and clinical data were performed. There were 190 episodes of paired positive blood cultures with 167 true positive episodes. Of the true positive episodes, 104 (62.3%) were positive in both central and peripheral cultures, 42 (25.1%) were positive in central only cultures, and 21 (12.6%) were positive in peripheral cultures only. Intensive care unit admission within 48 hours after blood cultures (n=33) differed significantly: 28.7% for both central and peripheral, 10% for central only, and 0% for peripheral only (P=0.009). Central line removal (n=34) differed by type of positivity but was not significant: 22.1% for both central and peripheral, 23.8% for central only, and 4.8% for peripheral only (P=0.15). Peripheral blood cultures provided important medical information yet had differences in short-term clinical outcomes. Further evaluation of medical decision making is warranted.


Asunto(s)
Cultivo de Sangre , Infecciones Relacionadas con Catéteres , Fiebre , Unidades de Cuidados Intensivos , Neoplasias , Adolescente , Infecciones Relacionadas con Catéteres/sangre , Infecciones Relacionadas con Catéteres/microbiología , Niño , Preescolar , Femenino , Fiebre/sangre , Fiebre/microbiología , Fiebre/terapia , Humanos , Lactante , Recién Nacido , Masculino , Neoplasias/sangre , Neoplasias/microbiología , Neoplasias/terapia , Estudios Retrospectivos
7.
J Pediatr Hematol Oncol ; 44(1): e194-e198, 2022 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-34001793

RESUMEN

Fever in a neutropenic pediatric oncology patient requires prompt assessment due to the risk of infectious complications. The appropriate management of fever in non-neutropenic patients, however, is not well-established. We describe the rate of bacteremia in a cohort of non-neutropenic pediatric oncology patients with fever at a large institution. Patients were included if they presented to the emergency department or outpatient clinic between 2009 and 2014 with fever, had a central venous catheter (CVC), and were not neutropenic. Three hundred eighty-six episodes of fever occurring in 159 patients were included in the data analysis. Fifty-nine percent of patients were male, 41% had a diagnosis of acute lymphoblastic leukemia, and 90% had a port-a-cath as CVC. The rate of bacteremia was 3.4%; presence of a port-a-cath was protective against bacteremia whereas a white blood cell count >20,000/mm3 was associated with a higher likelihood of bacteremia. Gram-positive microorganisms were most commonly isolated (64.3%) and frequently resistant to cephalosporins. In summary, in our study, the rate of bacteremia was low among non-neutropenic, well-appearing pediatric cancer patients with a CVC and was not associated with any serious medical complications. Prospective research is needed to determine the most appropriate management of these patients.


Asunto(s)
Antibacterianos/administración & dosificación , Bacteriemia , Fiebre , Neoplasias , Bacteriemia/sangre , Bacteriemia/tratamiento farmacológico , Bacteriemia/epidemiología , Bacteriemia/microbiología , Cateterismo Venoso Central , Catéteres Venosos Centrales , Niño , Preescolar , Femenino , Fiebre/sangre , Fiebre/tratamiento farmacológico , Fiebre/epidemiología , Fiebre/metabolismo , Humanos , Masculino , Neoplasias/sangre , Neoplasias/tratamiento farmacológico , Neoplasias/epidemiología , Neoplasias/microbiología , Estudios Retrospectivos
8.
Mol Syst Biol ; 16(11): e9888, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33210468

RESUMEN

Neisseria meningitidis is a major cause of meningitis and septicaemia. A MenB vaccine (4CMenB) was licensed by the European Medicines Agency in January 2013. Here we describe the blood transcriptome and proteome following infant immunisations with or without concomitant 4CMenB, to gain insight into the molecular mechanisms underlying post-vaccination reactogenicity and immunogenicity. Infants were randomised to receive control immunisations (PCV13 and DTaP-IPV-Hib) with or without 4CMenB at 2 and 4 months of age. Blood gene expression and plasma proteins were measured prior to, then 4 h, 24 h, 3 days or 7 days post-vaccination. 4CMenB vaccination was associated with increased expression of ENTPD7 and increased concentrations of 4 plasma proteins: CRP, G-CSF, IL-1RA and IL-6. Post-vaccination fever was associated with increased expression of SELL, involved in neutrophil recruitment. A murine model dissecting the vaccine components found the concomitant regimen to be associated with increased gene perturbation compared with 4CMenB vaccine alone with enhancement of pathways such as interleukin-3, -5 and GM-CSF signalling. Finally, we present transcriptomic profiles predictive of immunological and febrile responses following 4CMenB vaccine.


Asunto(s)
Fiebre/genética , Inmunidad/genética , Vacunas Meningococicas/inmunología , Animales , Análisis Químico de la Sangre , Vacuna contra Difteria, Tétanos y Tos Ferina/efectos adversos , Vacuna contra Difteria, Tétanos y Tos Ferina/inmunología , Femenino , Fiebre/sangre , Fiebre/epidemiología , Fiebre/etiología , Perfilación de la Expresión Génica , Vacunas contra Haemophilus/efectos adversos , Vacunas contra Haemophilus/inmunología , Interacciones Huésped-Patógeno/genética , Interacciones Huésped-Patógeno/inmunología , Humanos , Incidencia , Lactante , Masculino , Infecciones Meningocócicas/prevención & control , Vacunas Meningococicas/efectos adversos , Ratones , Ratones Endogámicos C57BL , Análisis por Micromatrices , Vacunas Neumococicas/efectos adversos , Vacunas Neumococicas/inmunología , Vacuna Antipolio de Virus Inactivados/efectos adversos , Vacuna Antipolio de Virus Inactivados/inmunología , Proteoma/análisis , Transcriptoma , Vacunación/efectos adversos , Vacunas Conjugadas/efectos adversos , Vacunas Conjugadas/inmunología
9.
J Pediatr Hematol Oncol ; 43(4): e543-e545, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-32496445

RESUMEN

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare disease characterized by variable and diverse symptoms including the classic triad of hemolytic anemia, thrombosis, and bone marrow failure. It is a disorder primarily seen in the adult population. The authors report a unique case of an 8-year-old girl diagnosed with PNH after initially presenting with a febrile illness and acute kidney injury. Though rare in children, PNH should remain in the differential diagnosis of a child presenting with acute kidney injury. The disease has serious long-term complications, mandating timely diagnosis and appropriate therapy.


Asunto(s)
Lesión Renal Aguda/diagnóstico , Hemoglobinuria Paroxística/diagnóstico , Lesión Renal Aguda/sangre , Niño , Diagnóstico Diferencial , Femenino , Fiebre/sangre , Fiebre/diagnóstico , Hemoglobinuria Paroxística/sangre , Humanos , Pancitopenia/sangre , Pancitopenia/diagnóstico
10.
J Pediatr Hematol Oncol ; 43(2): 47-51, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-32604334

RESUMEN

Children with cancer and non-neutropenic fever (NNF) episodes are often treated as outpatients if they appear well. However, a small subset have bloodstream infections (BSIs) and must return for further evaluation. These patients may be directly admitted to inpatient units, whereas others are first evaluated in outpatient settings before admission. The best practice for securing care for patients discovered to have outpatient bacteremia are unclear. To determine outcomes and compare time to antibiotics between the 2 disposition, we retrospectively reviewed all NNF initially treated as outpatients and later had positive blood cultures from 2012 to 2016. Of 845 NNF cases initially treated in outpatient settings, 48 episodes (n=43 patients) had BSIs. Of those, 77.1% (n=37) were re-evaluated as outpatients and admitted; 14.6% (n=7) were direct admissions. The median time to antibiotic did not significantly differ between outpatient re-evaluations (119 min) and direct admissions (191 min), P=0.11. One patient met sepsis criteria upon return and required intensive care unit admission for vasopressor support. No patient died within 1 week of the febrile episode. Most patients with NNF and BSIs initially discharged are stable upon return. Institutions should evaluate their patient flows to ensure that patients receive timely care.


Asunto(s)
Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Fiebre/tratamiento farmacológico , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Neoplasias/terapia , Sepsis/tratamiento farmacológico , Adolescente , Adulto , Bacteriemia/sangre , Bacteriemia/epidemiología , Bacteriemia/microbiología , Niño , Preescolar , Femenino , Fiebre/sangre , Fiebre/epidemiología , Fiebre/microbiología , Estudios de Seguimiento , Humanos , Lactante , Masculino , Neoplasias/patología , Pronóstico , Estudios Retrospectivos , Sepsis/sangre , Sepsis/epidemiología , Sepsis/microbiología , Estados Unidos/epidemiología , Adulto Joven
11.
Med Sci Monit ; 27: e930853, 2021 Apr 12.
Artículo en Inglés | MEDLINE | ID: mdl-33844678

RESUMEN

BACKGROUND COVID-19 has become a worldwide epidemic disease and is a public health crisis. We aim to provide evidence for clinical diagnosis and assessment of severity by analyzing patients' clinical data and early laboratory results and exploring the correlation between laboratory results and clinical classification. MATERIAL AND METHODS We enrolled 283 cases of suspected and diagnosed COVID-19 from 16 hospitals in Jiangsu Province from January to April 2020. The routine laboratory blood examinations, T lymphocyte subsets, and biochemical and coagulation function among different populations were contrasted by t test and chi-square (χ²) test. RESULTS Cough, fever, and dyspnea could be helpful to diagnose COVID-19 infection (P<0.05). Patients who were older or had comorbidities tended to become severe and critical cases. Among all the patients, the most obvious abnormal laboratory results were higher neutrophil count, CRP, total bilirubin, BUN, CRE, APTT, PT, and D-dimer, and lower blood platelet and lymphocyte count. CD3⁺ T cell, CD4⁺ T cell, and CD8⁺ T cell counts gradually decreased with exacerbation of the disease (P<0.05). CONCLUSIONS Cough and fever were the most common symptom. Patients with comorbidities were in more serious condition. The detection of inflammatory indexes, coagulation function, lymphocyte subsets, and renal function can help diagnose and assess the severity of COVID-19.


Asunto(s)
COVID-19/diagnóstico , Tos/epidemiología , Fiebre/epidemiología , SARS-CoV-2/inmunología , Índice de Severidad de la Enfermedad , Adulto , Anciano , Anciano de 80 o más Años , Coagulación Sanguínea/inmunología , COVID-19/sangre , COVID-19/complicaciones , COVID-19/epidemiología , China/epidemiología , Comorbilidad , Tos/sangre , Tos/inmunología , Tos/virología , Femenino , Fiebre/sangre , Fiebre/inmunología , Fiebre/virología , Humanos , Inflamación/sangre , Inflamación/diagnóstico , Inflamación/inmunología , Inflamación/virología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , SARS-CoV-2/aislamiento & purificación , Subgrupos de Linfocitos T/inmunología , Adulto Joven
12.
J Clin Lab Anal ; 35(1): e23620, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33118666

RESUMEN

AIMS: To investigate the eosinophil cell (EC) expression in peripheral blood of patients infected with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) and its clinical significance of diagnosis and prognosis. METHODS: 95 patients, whose nucleic acid test of SARS-CoV-2 was positive to make a definite diagnosis of COVID-19, were selected as the study group. They were admitted at the Chengdu Public Health Clinical Medical Center from January 21 to March 2, 2020. Another 95 healthy subjects and 95 non-infectious fever patients during the same period were selected as the control group. The BC-6900 blood cell analyzer was used to continuously observe and detect ECs in 95 patients with COVID-19 and the control group. The differences in expression levels of ECs in peripheral blood were analyzed. RESULTS: ECs were significantly decreased in 95 (75.8%) COVID-19 patients (P < .01). The absolute EC count IQR was 0.01 × 109/L (0 × 109/L - 0.04 × 109/L), and the EC percentage IQR was 0.3% (0.1% - 0.8%). As the patients' condition improved, the ECs returned to normal, but for those without improvement, ECs continued to decline. CONCLUSIONS: ECs decreased remarkably in patients with COVID-19, and gradually returned to normal after the improvement of the patients' condition, while EC continued to decrease in patients without improvement. It is suggested that ECs have certain clinical significance in the diagnosis and prognosis of COVID-19, and may be a useful index in the early warning of acute infectious diseases.


Asunto(s)
COVID-19/sangre , Eosinófilos , Proteína C-Reactiva/análisis , Linfocitos T CD4-Positivos , Linfocitos T CD8-positivos , COVID-19/mortalidad , Estudios de Casos y Controles , Fiebre/sangre , Humanos , Recuento de Linfocitos , Tratamiento Farmacológico de COVID-19
13.
J Enzyme Inhib Med Chem ; 36(1): 1230-1235, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34074197

RESUMEN

The ongoing Covid-19 is a contagious disease, and it is characterised by different symptoms such as fever, cough, and shortness of breath. Rising concerns about Covid-19 have severely affected the healthcare system in all countries as the Covid-19 outbreak has developed at a rapid rate all around the globe. Intriguing, a clinically used drug, acetazolamide (a specific inhibitor of carbonic anhydrase, CA, EC 4.2.1.1), is used to treat high-altitude pulmonary oedema (HAPE), showing a high degree of clinical similarities with the pulmonary disease caused by Covid-19. In this context, this preliminary study aims to provide insights into some factors affecting the Covid-19 patients, such as hypoxaemia, hypoxia as well as the blood CA activity. We hypothesise that patients with Covid-19 problems could show a dysregulated acid-base status influenced by CA activity. These preliminary results suggest that the use of CA inhibitors as a pharmacological treatment for Covid-19 may be beneficial.


Asunto(s)
Acetazolamida/uso terapéutico , Antivirales/uso terapéutico , Tratamiento Farmacológico de COVID-19 , Inhibidores de Anhidrasa Carbónica/uso terapéutico , Anhidrasas Carbónicas/sangre , Equilibrio Ácido-Base/efectos de los fármacos , Mal de Altura/sangre , Mal de Altura/tratamiento farmacológico , Anticonvulsivantes/uso terapéutico , Bicarbonatos/sangre , COVID-19/sangre , COVID-19/diagnóstico por imagen , COVID-19/virología , Dióxido de Carbono/sangre , Tos/sangre , Tos/tratamiento farmacológico , Tos/patología , Tos/virología , Reposicionamiento de Medicamentos , Disnea/sangre , Disnea/tratamiento farmacológico , Disnea/patología , Disnea/virología , Fiebre/sangre , Fiebre/tratamiento farmacológico , Fiebre/patología , Fiebre/virología , Humanos , Concentración de Iones de Hidrógeno , Hipertensión Pulmonar/sangre , Hipertensión Pulmonar/tratamiento farmacológico , Hipoxia/sangre , Hipoxia/tratamiento farmacológico , Hipoxia/patología , Hipoxia/virología , Oximetría , Proyectos de Investigación , SARS-CoV-2/patogenicidad , SARS-CoV-2/fisiología , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X
14.
J Infect Dis ; 222(5): 847-852, 2020 08 04.
Artículo en Inglés | MEDLINE | ID: mdl-32242626

RESUMEN

BACKGROUND: Zika virus (ZIKV) was discovered over 70 years ago in East Africa, but little is known about its circulation and pathogenesis there. METHODS: We screened 327 plasma samples collected 2-12 months after febrile illness in Western and coastal Kenya (1993-2016) for binding and neutralizing antibodies to distinguish ZIKV and dengue virus (DENV) responses, which we found were common in coastal Kenya. RESULTS: Two cases had durable ZIKV-specific antibodies and 2 cases had ZIKV antibodies at similar levels as DENV antibodies. CONCLUSIONS: This suggests low-level ZIKV circulation in Kenya over 2 decades and sets a baseline for future surveillance efforts in East Africa.


Asunto(s)
Anticuerpos Neutralizantes/sangre , Anticuerpos Antivirales/sangre , Virus del Dengue/inmunología , Fiebre/sangre , Infección por el Virus Zika/epidemiología , Virus Zika/inmunología , Coinfección/sangre , Coinfección/epidemiología , Femenino , Humanos , Kenia/epidemiología , Prevalencia , Infección por el Virus Zika/sangre
15.
J Infect Dis ; 221(1): 91-101, 2020 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-31428794

RESUMEN

BACKGROUND: Micronutrients are known to modulate host immunity, and there is limited literature on this association in the context of dengue virus infection (DENV). METHODS: Using a nested case-control design in a surveillance program, we measured the following: anthropometry; nutritional biomarkers including serum ferritin, soluble transferrin receptor, retinol-binding protein (RBP), 25-hydroxy vitamin D, folate, and vitamin B12; and a panel of immune response markers. We then compared these measures across 4 illness categories: healthy control, nonfebrile DENV, other febrile illness (OFI), and apparent DENV using multivariate polytomous logistic regression models. RESULTS: Among 142 participants, serum ferritin (ng/mL) was associated with apparent DENV compared to healthy controls (odds ratio [OR], 2.66; confidence interval [CI], 1.53-4.62; P = .001), and RBP concentrations (µmol/L) were associated with apparent DENV (OR, 0.03; CI, 0.00-0.30; P = .003) and OFI (OR, 0.02; CI, 0.00-0.24; P = .003). In a subset of 71 participants, interleukin-15 levels (median fluorescent intensity) were positively associated with apparent DENV (OR, 1.09; CI, 1.03-1.14; P = .001) and negatively associated with nonfebrile DENV (OR, 0.89; CI, 0.80-0.99; P = .03) compared to healthy controls. CONCLUSIONS: After adjusting for the acute-phase response, serum ferritin and RBP concentrations were associated with apparent DENV and may represent biomarkers of clinical importance in the context of dengue illness.


Asunto(s)
Dengue/sangre , Dengue/inmunología , Interleucina-15/sangre , Vigilancia de la Población , Adolescente , Biomarcadores/sangre , Índice de Masa Corporal , Tamaño Corporal , Proteína C-Reactiva/metabolismo , Estudios de Casos y Controles , Ecuador , Femenino , Ferritinas/sangre , Fiebre/sangre , Fiebre/virología , Humanos , Masculino , Micronutrientes , Estado Nutricional , Orosomucoide/metabolismo , Proteínas Plasmáticas de Unión al Retinol/metabolismo , Vitamina D/sangre , Adulto Joven
16.
J Mol Cell Cardiol ; 146: 12-18, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32634388

RESUMEN

BACKGROUND: Kawasaki Disease (KD) is an acute vasculitis of unknown etiology in children that can lead to coronary artery lesions (CAL) in 25% of untreated patients. There is currently no diagnostic test for KD, and the clinical presentation is often difficult to differentiate from other febrile childhood illnesses. Circulating microRNAs (miRNAs) are small noncoding RNA molecules that control gene expression by inducing transcript degradation or by blocking translation. We hypothesize that the expression of circulating miRNAs will differentiate KD from non-KD febrile illnesses in children. METHODS: Circulating miRNA profiles from 84 KD patients and 29 non-KD febrile controls (7 viral and 22 bacterial infections) were evaluated. 3 ul of serum from each subject was submitted to 3 freeze/heat cycles to ensure miRNA release from microvesicles or interaction with serum proteins. miRNAs were reverse transcribed using a pool of primers specific for each miRNA. Real-time PCR reactions were performed in a 384 well plate containing sequence-specific primers and TaqMan probes in the ABI7900. '. RESULTS: KD patients (3.6 ± 2.2 yrs., 58% male) were found to have a unique circulating miRNA profile, including upregulation of miRNA-210-3p, -184, and -19a-3p (p < .0001), compared to non-KD febrile controls (8.5 ± 6.1 yrs., 72% male). CONCLUSIONS: Circulating miRNAs can differentiate KD from infectious febrile childhood diseases, supporting their potential as a diagnostic biomarker for KD.


Asunto(s)
MicroARN Circulante/sangre , Fiebre/sangre , Fiebre/genética , Infecciones/sangre , Infecciones/genética , Síndrome Mucocutáneo Linfonodular/sangre , Síndrome Mucocutáneo Linfonodular/genética , Biomarcadores/sangre , Estudios de Casos y Controles , Niño , Preescolar , MicroARN Circulante/genética , Femenino , Fiebre/complicaciones , Redes Reguladoras de Genes , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Lactante , Infecciones/complicaciones , Masculino , Síndrome Mucocutáneo Linfonodular/tratamiento farmacológico
17.
Blood Cells Mol Dis ; 84: 102445, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32480243

RESUMEN

INTRODUCTION: Febrile neutropenia is a common cause in morbidity and mortality during treatment of hematological neoplasms. METHODS: Subjects included all cases admitted under hematology department with febrile neutropenia from February to June 2018. Each febrile episode was investigated by standard investigations (Blood culture, Chest x ray etc.); Procalcitonin (PCT) and c reactive protein (CRP) was sent at fever onset 0, 24, 48 h, day 7 and day 14. RESULTS: Data was analyzed for 52 febrile episodes in 50 patients. PCT cut off value at 24 h of ≤1.2 ng/ml had a sensitivity and specificity of 62.5% and 87.5% for discriminating Invasive fungal infection (IFI) and Microbiologically documented infection (MDI) (p = 0.033). PCT had a negative predictive value of 70% for the diagnosis of IFI as compared to MDI. CRP cut off >160 mg/dl at 48 h was suggestive of fever due to fungal infection with a sensitivity of 100%, specificity of 48%, PPV of 33.3% and NPV of 100%. CRP at 24 and 48 h of fever was useful to distinguish non-infectious causes of fever from infectious causes. CONCLUSION: PCT at 24 h and CRP at 48 h was useful in identifying fungal infection. CRP was a better marker when compared to PCT for identifying disease fever.


Asunto(s)
Proteína C-Reactiva/análisis , Neutropenia Febril/sangre , Fiebre/sangre , Polipéptido alfa Relacionado con Calcitonina/sangre , Adolescente , Adulto , Biomarcadores/sangre , Neutropenia Febril/diagnóstico , Neutropenia Febril/etiología , Femenino , Fiebre/diagnóstico , Fiebre/etiología , Neoplasias Hematológicas/complicaciones , Humanos , India/epidemiología , Masculino , Micosis/complicaciones , Estudios Prospectivos , Centros de Atención Terciaria , Adulto Joven
18.
J Med Virol ; 92(7): 731-739, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32219871

RESUMEN

Coronavirus disease 2019 (COVID-19) is a novel type of highly contagious pneumonia caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite the strong efforts taken to control the epidemic, hundreds of thousands of people were infected worldwide by 11 March, and the situation was characterized as a pandemic by the World Health Organization. Pregnant women are more susceptible to viral infection due to immune and anatomic alteration, though hospital visits may increase the chance of infection, the lack of medical care during pregnancy may do more harm. Hence, a well-managed system that allows pregnant women to access maternal health care with minimum exposure risk is desired during the outbreak. Here, we present the managing processes of three pregnant women who had fever during hospitalization in the gynecology or obstetrics department, and then, we further summarize and demonstrate our maternal health care management strategies including antenatal care planning, patient triage based on the risk level, admission control, and measures counteracting emergencies and newly discovered high-risk cases at in-patient department. In the meantime, we will explain the alterations we have done throughout different stages of the epidemic and also review relative articles in both Chinese and English to compare our strategies with those of other areas. Although tens of COVID-19 cases were confirmed in our hospital, no nosocomial infection has occurred and none of the pregnant women registered in our hospital was reported to be infected.


Asunto(s)
Betacoronavirus/patogenicidad , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Brotes de Enfermedades , Fiebre/diagnóstico , Accesibilidad a los Servicios de Salud/organización & administración , Neumonía Viral/diagnóstico , Embarazo Ectópico/diagnóstico , Adulto , Betacoronavirus/genética , Biomarcadores/sangre , COVID-19 , Prueba de COVID-19 , China/epidemiología , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Diagnóstico Diferencial , Femenino , Fiebre/sangre , Fiebre/epidemiología , Fiebre/virología , Hospitalización/estadística & datos numéricos , Humanos , Salud Materna , Pandemias , Neumonía Viral/sangre , Neumonía Viral/epidemiología , Neumonía Viral/virología , Embarazo , Embarazo Ectópico/sangre , Embarazo Ectópico/epidemiología , Embarazo Ectópico/virología , SARS-CoV-2 , Tomografía Computarizada por Rayos X , Triaje/organización & administración
19.
J Med Virol ; 92(6): 577-583, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32162702

RESUMEN

The aim of this study was to analyze the clinical data, discharge rate, and fatality rate of COVID-19 patients for clinical help. The clinical data of COVID-19 patients from December 2019 to February 2020 were retrieved from four databases. We statistically analyzed the clinical symptoms and laboratory results of COVID-19 patients and explained the discharge rate and fatality rate with a single-arm meta-analysis. The available data of 1994 patients in 10 literatures were included in our study. The main clinical symptoms of COVID-19 patients were fever (88.5%), cough (68.6%), myalgia or fatigue (35.8%), expectoration (28.2%), and dyspnea (21.9%). Minor symptoms include headache or dizziness (12.1%), diarrhea (4.8%), nausea and vomiting (3.9%). The results of the laboratory showed that the lymphocytopenia (64.5%), increase of C-reactive protein (44.3%), increase of lactic dehydrogenase (28.3%), and leukocytopenia (29.4%) were more common. The results of single-arm meta-analysis showed that the male took a larger percentage in the gender distribution of COVID-19 patients 60% (95% CI [0.54, 0.65]), the discharge rate of COVID-19 patients was 52% (95% CI [0.34,0.70]), and the fatality rate was 5% (95% CI [0.01,0.11]).


Asunto(s)
Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Pandemias , Alta del Paciente/estadística & datos numéricos , Neumonía Viral/epidemiología , Neumonía Viral/fisiopatología , Betacoronavirus/patogenicidad , Biomarcadores/sangre , Proteína C-Reactiva/metabolismo , COVID-19 , China/epidemiología , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Tos/sangre , Tos/diagnóstico , Tos/fisiopatología , Disnea/sangre , Disnea/diagnóstico , Disnea/fisiopatología , Femenino , Fiebre/sangre , Fiebre/diagnóstico , Fiebre/fisiopatología , Humanos , Incidencia , Linfopenia/sangre , Linfopenia/diagnóstico , Linfopenia/fisiopatología , Masculino , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , SARS-CoV-2 , Factores Sexuales , Análisis de Supervivencia
20.
J Med Virol ; 92(10): 2146-2151, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32401361

RESUMEN

This study aims to observe the clinical characteristics of recovered patients from Coronavirus Disease 2019 (COVID-19) with positive in reverse transcription-polymerase chain reaction (RT-PCR) or serum antibody. The profile, clinical symptoms, laboratory outcomes, and radiologic assessments were extracted on 11 patients, who tested positive for COVID-19 with RT-PCR or serum antibody after discharged and was admitted to Hubei No. 3 People's Hospital of Jianghan University for a second treatment in March 2020. The average interval time between the first discharge and the second admission measured 16.00 ± 7.14 days, ranging from 6 to 27 days. In the second hospitalization, one patient was positive for RT-PCR and serum antibody immunoglobulin M (IgM)-immunoglobulin G (IgG), five patients were positive for both IgM and IgG but negative for RT-PCR. Three patients were positive for both RT-PCR and IgG but negative for IgM. The main symptoms were cough (54.55%), fever (27.27%), and feeble (27.27%) in the second hospitalization. Compared with the first hospitalization, there were significant decreases in gastrointestinal symptoms (5 vs 0, P = .035), elevated levels of both white blood cell count (P = .036) and lymphocyte count (P = .002), remarkedly decreases in C-reactive protein and serum amyloid A (P < .05) in the second hospitalization. Additionally, six patients' chest computed tomography (CT) exhibited notable improvements in acute exudative lesions. There could be positive results for RT-PCR analysis or serum IgM-IgG in discharged patients, even with mild clinical symptoms, however, their laboratory outcomes and chest CT images would not indicate the on-going development in those patients.


Asunto(s)
COVID-19/diagnóstico , Adulto , Anciano , COVID-19/sangre , COVID-19/inmunología , COVID-19/virología , China , Tos/sangre , Tos/diagnóstico , Tos/inmunología , Tos/virología , Femenino , Fiebre/sangre , Fiebre/diagnóstico , Fiebre/inmunología , Fiebre/virología , Hospitalización , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Masculino , Persona de Mediana Edad , Pandemias , Readmisión del Paciente , Neumonía Viral/diagnóstico , Neumonía Viral/inmunología , Neumonía Viral/virología , SARS-CoV-2/inmunología , SARS-CoV-2/patogenicidad
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