Delayed presentation is associated with serious bacterial infections among febrile infants: A prospective cohort study.

Introduction: Febrile young infants are at risk of serious bacterial infections (SBIs), which are potentially life-threatening. This study aims to investigate the association between delayed presentation and the risk of SBIs among febrile infants. Method: We performed a prospective cohort study on febrile infants ≤90 days old presenting to a Singapore paediatric emergency department (ED) between November 2017 and July 2022. We defined delayed presentation as presentation to the ED >24 hours from fever onset. We compared the proportion of SBIs in infants who had delayed presentation compared to those without, and their clinical outcomes. We also performed a multivariable logistic regression to study if delayed presentation was independently associated with the presence of SBIs. Results: Among 1911 febrile infants analysed, 198 infants (10%) had delayed presentation. Febrile infants with delayed presentation were more likely to have SBIs (28.8% versus [vs] 16.3%, P<0.001). A higher proportion of infants with delayed presentation required intravenous antibiotics (64.1% vs 51.9%, P=0.001). After adjusting for age, sex and severity index score, delayed presentation was independently associated with the presence of SBI (adjusted odds ratio [AOR] 1.78, 95% confidence interval 1.26-2.52, P<0.001). Conclusion: Febrile infants with delayed presentation are at higher risk of SBI. Frontline clinicians should take this into account when assessing febrile infants.

Diagnostic biomarkers in ovarian cancer: advances beyond CA125 and HE4.

Ovarian cancer (OC) is the most lethal gynaecologic malignancy, attributed to its insidious growth, non-specific symptoms and late presentation. Unfortunately, current screening modalities are inadequate at detecting OC and many lack the appropriate specificity and sensitivity that is desired from a screening test. Nearly 70% of cases are diagnosed at stage III or IV with poor 5-year overall survival. Therefore, the development of a sensitive and specific biomarker for early diagnosis and screening for OC is of utmost importance. Currently, diagnosis is guided by CA125, the patient's menopausal status and imaging features on ultrasound scan. However, emerging evidence suggests that a combination of CA125 and HE4 (another serum biomarker) and patient characteristics in a multivariate index assay may provide a higher specificity and sensitivity than either CA125 and HE4 alone in the early detection of OC. Other attempts at combining various serum biomarkers into one multivariate index assay such as OVA1, ROMA and Overa have all shown promise. However, significant barriers exist before these biomarkers can be implemented in clinical practice. This article aims to provide an up-to-date review of potential biomarkers for screening and early diagnosis of OC which may have the potential to transform its diagnostic landscape.

Socially induced plasticity in sensorimotor gating in the African cichlid fish Astatotilapia burtoni.

Deficits in prepulse inhibition (PPI), social defeat and social withdrawal are hallmark features of several neurological and neuropsychiatric disorders. However, the link between social environment and PPI i.e., the possible role of social defeat in driving PPI plasticity, is far from clear. Here we explored these questions in the African cichlid fish Astatotilapia burtoni, where males exist as two distinct yet reversible phenotypes. In fish communities, DOMs exhibit frequent aggressive and territorial behaviors, threatening and attacking SUBs, which respond either by engaging in fights and fleeing, or by avoiding interaction with DOMs altogether. Social phenotypes were selected using focal observations of dominant and submissive behaviors. Tests of auditory PPI showed markedly decreased PPI in SUBs as compared to DOMs at prepulse/pulse interstimulus interval of ISI 50ms. Interestingly, further analysis showed the PPI reduction in SUBs was driven by males with low social interactivity. Testing males before and after social transitions revealed increasing and decreasing PPI in ascending and descending males, respectively. In an open field paradigm, SUBs also showed higher levels of wall hugging (thigmotaxis) and freezing when compared to DOMs i.e., an increase in anxiety-related behavior. Together the results suggest distinct yet reversible behavioral PPI phenotypes in A. burtoni males, and that social defeat drives PPI plasticity. The fact that PPI deficits are readily reversible by status change implies PPI plasticity may reflect an adaptive response to challenges in the social environment.