Paper‐based point‐of‐care testing for cost‐effective diagnosis of acute flavivirus infections

Flavivirus infections are a serious healthcare concern in tropical and subtropical countries. Although well‐established laboratory tests can provide early diagnosis of acute dengue or Zika infections, access to these tests is limited in developing countries, presenting an urgent need to develop simple, rapid, and robust diagnostic tools. Microfluidic Paper‐based Analytical Devices (μPAD), are typically rapid, cost‐effective, user‐friendly, and they can be used as diagnostic tools for the diagnosis of these infections at Point of Care settings. Early and prompt diagnosis is crucial to improve patient management and reduce the risk of complications. In the present study, we developed and evaluated a wax‐printed paper‐based device for the detection of the dengue and Zika non‐structural NS1 viral protein in blood and plasma. Experiments have been carried out to increase specificity, while maintaining the required sensitivity. As a consequence, the quality of the raw materials and the washing steps were proved to be crucial. The μPAD was able to detect specifically in 6–8 min 10 ng/mL of protein in various sample types. A prototype for the differential detection of dengue and/or Zika NS1 protein was developed. The reading of the results was simplified by using a dedicated application on a smartphone.

     

Clinical outcomes of current medical approaches for Middle East respiratory syndrome: A systematic review and meta‐analysis

Middle East respiratory syndrome (MERS) is a respiratory disease caused by MERS coronavirus. Because of lack of vaccination, various studies investigated the therapeutic efficacy of antiviral drugs and supportive remedies. A systematic literature search from 10 databases was conducted and screened for relevant articles. Studies reporting information about the treatment of MERS coronavirus infection were extracted and analyzed. Despite receiving treatment with ribavirin plus IFN, the case fatality rate was as high as 71% in the IFN‐treatment group and exactly the same in patients who received supportive treatment only. Having chronic renal disease, diabetes mellitus and hypertension increased the risk of mortality (P < .05), and chronic renal disease is the best parameter to predict the mortality. The mean of survival days from onset of illness to death was 46.6 (95% CI, 30.5‐62.6) for the IFN group compared with 18.8 (95% CI, 10.3‐27.4) for the supportive‐only group (P = .001). Delay in starting treatment, older age group, and preexisting comorbidities are associated with worse outcomes. In conclusion, there is no difference between IFN treatment and supportive treatment for MERS patients in terms of mortality. However, ribavirin and IFN combination might have efficacious effects with timely administration and monitoring of adverse events. Large‐scale prospective randomized studies are required to assess the role of antiviral drugs for the treatment of this high mortality infection.     

Pteropine orthoreovirus infection among out‐patients with acute upper respiratory tract infection in Malaysia

This study aims to assess the incidence rate of Pteropine orthreovirus (PRV) infection in patients with acute upper respiratory tract infection (URTI) in a suburban setting in Malaysia, where bats are known to be present in the neighborhood. Using molecular detection of PRVs directly from oropharyngeal swabs, our study demonstrates that PRV is among one of the common causative agents of acute URTI with cough and sore throat as the commonest presenting clinical features. Phylogenetic analysis on partial major outer and inner capsid proteins shows that these PRV strains are closely related to Melaka and Kampar viruses previously isolated in Malaysia. Further study is required to determine the public health significance of PRV infection in Southeast Asia, especially in cases where co‐infection with other pathogens may potentially lead to different clinical outcomes. J. Med. Virol. 87:2149–2153, 2015. © 2015 Wiley Periodicals, Inc.

     

Global seroprevalence and prevalence of infection of influenza in dogs (Canis familiaris): A systematic review and meta-analysis

Influenza in dogs holds considerable public health significance due to their close companionship with humans, yet several facets of this phenomenon remain largely unexplored. This study undertook a systematic review and meta-analysis of observational studies to gauge the global seroprevalence of influenza in dogs. We also assessed whether pet dogs exhibited a higher seroprevalence of influenza compared to non-pet dogs, explored seasonal variations in seroprevalence, scrutinised the design and reporting standards of existing studies, and elucidated the geographical distribution of canine influenza virus (cIV). A comprehensive analysis of 97 studies spanning 27 countries revealed that seroprevalence of various influenza strains in dogs consistently registered below 10% and exhibited relative stability over the past decade. Significantly, we noted that seroprevalence of human influenza virus was notably higher in pet dogs compared to their non-pet counterparts, whereas seroprevalence of other influenza strains remained relatively uniform among both categories of dogs. Seasonal variations in seroprevalence of cIV were not observed. In summary, our findings indicated the global circulation of cIV strains H3N2 and H3N8, with other strains primarily confined to China. Given the lack of reported cases of the transmission of cIV from dogs to humans, our findings suggest a higher risk of reverse zoonosis than zoonosis. Finally, we strongly advocate for standardised reporting guidelines to underpin future canine influenza research endeavours.     

The impact of COVID 19 on the outcomes of thrombectomy in stroke patients: A systematic review and meta-analysis

We aimed to conduct the current meta-analysis to provide better insight into the efficacy of mechanical thrombectomy (MT) in managing COVID-19 patients suffering from a stroke. An electronic search was conducted through eight databases for collecting the current evidence about the efficacy of MT in stroke patients with COVID-19 until 18 December 2021. The results were reported as the pooled prevalence rates and the odds ratios (ORs), with their corresponding 95% confidence intervals (CI). Out of 648 records, we included nine studies. The prevalence of stroke patients with COVID-19 who received MT treatment was with TICI ≥2b 79% (95%CI: 73–85), symptomatic intracranial haemorrhage 6% (95%CI: 3–11), parenchymal haematoma type 1, 11.1% (95%CI: 5–23), and mortality 29% (95%CI: 24–35). On further comparison of MT procedure between stroke patients with COVID 19 to those without COVID-19, we found no significant difference in terms of TICI ≥2b score (OR: 0.85; 95%CI: 0.03–23; p = 0.9). However, we found that stroke patients with COVID-19 had a significantly higher mortality rate than stroke patients without COVID-19 after MT procedure (OR: 2.99; 95%CI: 2.01–4.45; p < 0.001). Stroke patients with COVID-19 can be safely and effectively treated with MT, with comparable reperfusion and complication rates to those without the disease.     

Benefits of increasing the dose of influenza vaccine in residents of long‐term care facilities: A randomized placebo‐controlled trial

Increased vaccine doses and mid‐season boosting may increase the proportion of residents with protective immunity from influenza in long‐term care facilities. In a multi‐center study (1997–1998), 815 residents from 14 long‐term care facilities were assigned at random to receive 15 or 30 µg of inactivated influenza vaccine, followed by a 15 µg booster vaccine or a placebo vaccine at Day 84. Seroresponses were re‐analyzed by hemagglutination‐inhibition (≥4‐fold titer increases, protective titer ≥40, geometric mean titers. Forty percent of the participants had pre‐vaccination titers ≥40. At Day 25 after vaccination, this increased to 66.3% after a 15 µg dose versus 73.3% after a dose of 30 µg (P = 0.049). Participants receiving a 30 µg dose followed by a 15 µg booster showed more ≥4‐fold titer increases at Day 109 (43.6% vs. 35.4%, P = 0.003) and protective titers ≥40 (74.2% vs. 64.6%, P = 0.041), compared to those receiving only a 15 µg dose. Differences were most apparent in participants with low pre‐vaccination titers. Booster vaccination after an initial 15 µg dose of the vaccine did not increase the protective rate (61.9% vs. 63.9% after placebo). The number of participants needed to vaccinate to protect one additional resident by a dose of 15 µg was 4, by a dose of 30 µg 3, and 15 when using a 30 µg dose instead of 15 µg. Doubling the dose of influenza vaccine increased protection‐related responses among residents of long‐term care facilities, especially in those with low pre‐vaccination titers. J. Med. Virol. 81:908–914, 2009. © 2009 Wiley‐Liss, Inc.     

Frameworks for understanding challenging behaviour in out‐of‐home care

Background: Challenging and disruptive behaviour is commonly reported among children placed in the out‐of‐home care sector. Little is known about how stakeholders in this sector understand or manage challenging behaviour. Method: Ninety‐two stakeholders in the South Australian out‐of‐home care sector were interviewed about their approach to supporting children with challenging behaviour. Participants were teachers, foster carers, child statutory workers, child mental health workers, and residential care workers. These semi‐structured interviews were subject to thematic analysis. Results: The analysis revealed several ways of understanding challenging behaviour: behaviour as learnt, behaviour as purposeful, behaviour as a choice, behaviour arising from constant change, behaviour reflecting strong emotions, and behaviour reflecting attachment history. Conclusions: This analysis suggests that professionals seeking to engage in collaborative casework on behalf of children may need to accommodate a range of diverse views about the origin and solution to challenging and aggressive behaviour. The possible implications of these divergent understandings for placement policy and practice are discussed. These apparently disparate frameworks are discussed in terms of their underlying assumptions, and possible “common ground” is identified and highlighted. Explicating the implicit assumptions inherent in others' accounts may provide a “way forward” in more effective work on behalf of children.     

Amoxicillin for acute lower respiratory tract infection in primary care: subgroup analysis of potential high-risk groups

Background

Antibiotics are of limited overall clinical benefit for uncomplicated lower respiratory tract infection (LRTI) but there is uncertainty about their effectiveness for patients with features associated with higher levels of antibiotic prescribing.

Aim

To estimate the benefits and harms of antibiotics for acute LRTI among those producing coloured sputum, smokers, those with fever or prior comorbidities, and longer duration of prior illness.

Design and setting

Secondary analysis of a randomised controlled trial of antibiotic placebo for acute LRTI in primary care.

Method

Two thousand and sixty-one adults with acute LRTI, where pneumonia was not suspected clinically, were given amoxicillin or matching placebo. The duration of symptoms, rated moderately bad or worse (primary outcome), symptom severity on days 2–4 (0–6 scale), and the development of new or worsening symptoms were analysed in pre-specified subgroups of interest. Evidence of differential treatment effectiveness was assessed in prespecified subgroups by interaction terms.

Results

No subgroups were identified that were significantly more likely to benefit from antibiotics in terms of symptom duration or the development of new or worsening symptoms. Those with a history of significant comorbidities experienced a significantly greater reduction in symptom severity between days 2 and 4 (interaction term −0.28, P = 0.003; estimated effect of antibiotics among those with a past history −0.28 [95% confidence interval = −0.44 to −0.11], P = 0.001), equivalent to three people in 10 rating symptoms as a slight rather than a moderately bad problem. For subgroups not specified in advance antibiotics provided a modest reduction in symptom severity for non-smokers and for those with short prior illness duration (<7 days), and a modest reduction in symptom duration for those with short prior illness duration.

Conclusion

There is no clear evidence of clinically meaningful benefit from antibiotics in the studied high-risk groups of patients presenting in general practice with uncomplicated LRTIs where prescribing is highest. Any possible benefit must be balanced against the side-effects and longer-term effects on antibiotic resistance.     

Neurolinguistic programming: a systematic review of the effects on health outcomes

Background

Neurolinguistic programming (NLP) in health care has captured the interest of doctors, healthcare professionals, and managers.

Aim

To evaluate the effects of NLP on health-related outcomes.

Design and setting

Systematic review of experimental studies.

Method

The following data sources were searched: MEDLINE®, PsycINFO, ASSIA, AMED, CINAHL®, Web of Knowledge, CENTRAL, NLP specialist databases, reference lists, review articles, and NLP professional associations, training providers, and research groups.

Results

Searches revealed 1459 titles from which 10 experimental studies were included. Five studies were randomised controlled trials (RCTs) and five were pre-post studies. Targeted health conditions were anxiety disorders, weight maintenance, morning sickness, substance misuse, and claustrophobia during MRI scanning. NLP interventions were mainly delivered across 4–20 sessions although three were single session. Eighteen outcomes were reported and the RCT sample sizes ranged from 22 to 106. Four RCTs reported no significant between group differences with the fifth finding in favour of the NLP arm (F = 8.114, P<0.001). Three RCTs and five pre-post studies reported within group improvements. Risk of bias across all studies was high or uncertain.

Conclusion

There is little evidence that NLP interventions improve health-related outcomes. This conclusion reflects the limited quantity and quality of NLP research, rather than robust evidence of no effect. There is currently insufficient evidence to support the allocation of NHS resources to NLP activities outside of research purposes.     

Epidemiology of influenza in hospitalized children with respiratory tract infection in Suzhou area from 2016 to 2019

Influenza is a contagious respiratory disease and risks public health in China, and it has caused wide public concern in recent years. Immunocompromised patients, such as children and elderly people, suffer more severe influenza complication and some extreme cases are even life threatening. To identify the influenza characteristics and its correlation with various climatic and environmental pollution factors, we collected the reported influenza epidemic of hospitalized children in Children's Hospital of Soochow University from 2016 to 2019. Our results show that the main influenza virus subtypes are A/H1N1, A/H3N2, B/BV, and B/BY. We also identified the characteristics of the prevalent influenza virus subtypes in different months, seasons, years, and patients' age. Of all the influenza infected patients, the most susceptible groups are children over 3 to 5 years of age, and more cases are reported in winter than other seasons. We also found that influenza is also highly correlated with climatic and environmental pollution factors, and the autoregressive integrated moving average model is employed for the short-term influenza prediction in Suzhou city, which can provide scientific basis for the prevention and control of influenza and public health decision-making.     

Association of the CT values of real‐time PCR of viral upper respiratory tract infection with clinical severity,Kenya

Quantitative real‐time polymerase chain reaction (qRT‐PCR) assay of the upper respiratory tract is used increasingly to diagnose lower respiratory tract infections. The cycle threshold (C_T) values of qRT‐PCR are continuous, semi‐quantitative measurements of viral load, although interpretation of diagnostic qRT‐PCR results are often categorized as positive, indeterminate, or negative, obscuring potentially useful clinical interpretation of C_T values. From 2008 to 2010, naso/oropharyngeal swabs were collected from outpatients with influenza‐like illness, inpatients with severe respiratory illness, and asymptomatic controls in rural Kenya. C_T values of positive specimens (i.e., C_T values < 40.0) were compared by clinical severity category for five viruses using Mann–Whitney U‐test and logistic regression. Among children <5 years old we tested with respiratory syncytial virus (RSV), inpatients had lower median C_T values (27.2) than controls (35.8, P = 0.008) and outpatients (34.7, P < 0.001). Among children and older patients infected with influenza virus, outpatients had the lowest median C_T values (29.8 and 24.1, respectively) compared with controls (P = 0.193 for children, P < 0.001 for older participants) and inpatients (P = 0.009 for children, P < 0.001 for older participants). All differences remained significant in logistic regression when controlling for age, days since onset, and coinfection. C_T values were similar for adenovirus, human metapneumovirus, and parainfluenza virus in all severity groups. In conclusion, the C_T values from the qRT‐PCR of upper respiratory tract specimens were associated with clinical severity for some respiratory viruses. J. Med. Virol. 85:924–932, 2013. © 2013 Wiley Periodicals, Inc.     

Medication use in European primary care patients with lower respiratory tract infection: an observational study

Background

It is largely unknown what medication is used by patients with lower respiratory tract infection (LRTI).

Aim

To describe the use of self-medication and prescribed medication in adults presenting with LRTI in different European countries, and to relate self-medication to patient characteristics.

Design and setting

An observational study in 16 primary care networks in 12 European countries.

Method

A total of 2530 adult patients presenting with LRTI in 12 European countries filled in a diary on any medication used before and after a primary care consultation. Patient characteristics related to self-medication were determined by univariable and multivariable logistic regression analysis.

Results

The frequency and types of medication used differed greatly between European countries. Overall, 55.4% self-medicated before consultation, and 21.5% after consultation, most frequently with paracetamol, antitussives, and mucolytics. Females, non-smokers, and patients with more severe symptoms used more self-medication. Patients who were not prescribed medication during the consultation self-medicated more often afterwards. Self-medication with antibiotics was relatively rare.

Conclusion

A considerable amount of medication, often with no proven efficacy, was used by adults presenting with LRTI in primary care. There were large differences between European countries. These findings should help develop patient information resources, international guidelines, and international legislation concerning the availability of over-the-counter medication, and can also support interventions against unwarranted variations in care. In addition, further research on the effects of symptomatic medication is needed.     

联苯双酯治疗慢性乙型肝炎的随机对照试验的系统评价

目的:系统评价联苯双酯治疗慢性乙型肝炎的安全性和有效性。方法:收集公开发表的近30年联苯双酯治疗慢性乙型肝炎的中文和外文文献,按纳入和排除标准选择文献,将文献中的干预措施进行亚组分析后,对肝生化指标(ALT降低量、复常率)、免疫学应答指标(HBsAg阴转率、HBeAg阴转率)、病毒学指标(HBV DNA阴转率、降低量)、肝纤维化指标[透明质酸(HA),层粘连蛋白(LN),Ⅳ型胶原(Ⅳ-C),Ⅲ型前胶原(PCⅢ)降低量]进行评价。结果:经过排除与筛选,共纳入7篇文献(1253例),均为随机设计实验,其中1篇研究注明了随机方法。结果显示:单用联苯双酯组和联苯双酯联用中药组或水飞蓟组ALT降低量均明显高于其对照组;联苯双酯+水飞蓟组HBV DNA阴转率明显高于水飞蓟组;联苯双酯滴丸+齐墩果酸片+葡醛内酯片组与齐墩果酸片+葡醛内酯片组HBV DNA降低量无明显差别;联苯双酯滴丸组HBsAg和HBeAg阴转率明显高于齐墩果酸组;联苯双酯滴丸+齐墩果酸片+葡醛内酯片组降低肝纤维化效果明显优于齐墩果酸片+葡醛内酯片组。结论:联苯双酯在降低慢性乙型肝炎ALT水平,改善其病毒学和免疫学应答指标以及肝纤维化方面疗效确切且效果显著,是一种值得进一步推广使用的药物。     

Comparison of two rapid influenza A/B test kits with reference methods showing high specificity and sensitivity for influenza A infection

The rapid detection of influenza viruses is important for forming preventative strategies, directing initiation of anti-viral therapy, detecting potential avian influenza viruses, and excluding influenza-like pathogens, such as SARS. The ImmunoCard STAT! Flu A and B Plus test (Meridian Bioscience, Cincinnati, OH) is a new point of care (POC) test utilizing influenza-specific monoclonal antibodies for rapid diagnosis. The performance of this assay was compared to the established POC Binax NowFlu A and NowFlu B test, and the reference diagnostic standards of viral culture, indirect immunofluorescence (IFA), and RT-PCR where appropriate. Testing of nasopharyngeal aspirates (NPA) from children, throat swabs, and nasal swabs from adults indicated ImmunoCard STAT! specificity of 98% and 100% for influenza A and B, respectively in 224 specimens. The Binax test showed specificity of 99% and 100%, respectively for influenza A and B. Sensitivity results were identical for both rapid detection kits (80% and 47% for Flu A and B, respectively). Overall results were very similar for both testing devices with the advantage of ImmunoCard STAT! Flu A and B Plus test detecting influenza A and B with sharp and easy to read results.     

Antibiotics for lower respiratory tract infection in children presenting in primary care (ARTIC-PC): the predictive value of molecular testing

ObjectivesThis study aimed to assess whether the presence of bacteria or viruses in the upper airway of children presenting with uncomplicated lower respiratory tract infection (LRTI) predicts the benefit of antibiotics.MethodsChildren between 6 months and 12 years presenting to UK general practices with an acute LRTI were randomized to receive amoxicillin 50 mg/kg/d for 7 days or placebo. Children not randomized (ineligible or clinician/parental choice) could participate in a parallel observational study. The primary outcome was the duration of symptoms rated moderately bad or worse. Throat swabs were taken and analyzed for the presence of bacteria and viruses by multiplex PCR.ResultsSwab results were available for most participants in the trial (306 of 432; 71%) and in the observational (182 of 326; 59%) studies. Bacterial pathogens potentially sensitive to amoxicillin (Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae) were detected among 51% of the trial placebo group and 49% of the trial antibiotic group. The median difference in the duration of symptoms rated moderately bad or worse between antibiotic and placebo was similar when potentially antibiotic-susceptible bacteria were present (median: –1 day; 99% CI, –12.3 to 10.3) or not present (median: –1 day; 99% CI, –4.5 to 2.5). Furthermore, bacterial genome copy number did not predict benefit. There were similar findings for all secondary outcomes and when including the data from the observational study.DiscussionThere was no clear evidence that antibiotics improved clinical outcomes conditional on the presence or concentration of bacteria or viruses in the upper airway. Before deploying microbiologic point-of-care tests for children with uncomplicated LRTI in primary care, rigorous validating trials are needed.