Management of travelers with fever and exanthema, notably dengue and chikungunya infections

Febrile exanthema frequently presents as an acute condition in travelers. Sixty-two travelers who presented with febrile exanthema were prospectively included over a 20-month period. Diagnostic tests were performed according to clinical presentation and risk exposures. Symptoms occurred after return in 56% of these travelers, and the median interval between return and symptom onset was 2 days. The 3 main travel destinations were the Indian Ocean (35%), Africa (21%), and Asia (18%). The 3 main etiologies were chikungunya (35%), dengue (26%), and African tick bite fever (ATBF) (10%). Travel to the Indian Ocean and South Africa was significantly associated with respectively chikungunya and ATBF. Arthralgias were significantly more frequent in chikungunya than in dengue, whereas leucopenia, neutropenia, and thrombopenia were significantly more frequent in dengue. Travelers presenting with febrile exanthema should therefore be screened for arboviral infections according to the area visited.     

Clinical study of a new anti-inflammatory and analgesic compound, benorylate, in rheumatic disorders.

Benorylate is obtained by esterification of acetylsalicylic acid and N-acetyl p-aminophenol (4-acetamidophenyl 2-acetoxybenzoate). Experimentally, this new product has been shown to be a good analgesic and anti-inflammatory agent. A clinical trial was carried out in order to study the efficacy, side effects and tolerance of this new product. In a group of 49 hospitalised patients aged from 20 to 70 years who were treated with this new product, 15 had ankylosing spondylitis, 11 had chronic progressive rheumatoid arthritis, 4 had Reiter's syndrome, 4 had psoriatic arthropathy, 8 had osteoarthrosis of the hip and 7 had various forms of rheumatism. The drug was administered orally in suspension form, initially three times per day, then twice, the total daily doses being 15 ml (6 g) or 20 ml (8 g). Treatment was regarded as effective in 62% of the cases, and of these 62%, 46% good and very good results were obtained. In 88% of the patients, tolerance was satisfactory and of these, it was excellent in 80%. Only in 2 cases did treatment have to be discontinued on account of side effects. From the biological point of view, uricaemia was significantly reduced in 7 patients, and in 6 patients uricuria increased. With regard to the level of salicylate in the blood assays showed that it is the same for 6 g benorylate and for 4 g aspirin. Benorylate has been shown to be an effective treatment for both inflammatory and degenerative rheumatic disorders. The results of its use can be compared with those obtained by acetylsalicylic acid, but is better tolerated. In addition, in chronic disorders it is better to have to take the product only twice per day.     

中国首次基孔肯雅热流行患者的临床特点

目的 分析基孔肯雅热患者的临床特点,为防控该病提供借鉴.方法 分析46例确诊为基孔肯雅热的住院患者的临床症状、体征.血常规,生物化学指标以及治疗方案.组间比较采用t检验.结果 46例基孔肯雅热患者中,发热、皮疹及关节痛分别为46、42和41例,分别占100.0%、91.3%和89.1%;15例患者外周血WBC下降,占32.6%,乳酸脱氢酶及血清磷酸肌酸激酶升高比例分别为45.5%(20/44)和28.9%(13/45),3例ALT升高.利巴韦林治疗与单纯对症治疗效果相比,发热时间延长(t=2.588,P=0.013).结论 基孔肯雅热主要表现为发热、皮疹、关节痛,对症治疗预后好,抗病毒治疗对缩短病程可能无益.

Abstract：

Objective To analyze clinical features of patients with chikungunya fever and provide future reference for prevention and control of the disease. Methods Forty-six confirmed chikungunya fever inpatients were included. Their clinical symptoms, signs, blood count, key biochemical indicators and treatments were analyzed. The comparison between groups were done by ttest. Results The percentages of total cases presenting with fever, rash and joint pain were 100. 0% (46/46), 91. 3% (42/46) and 89. 1% (41/46), respectively. Fifteen (32.6%) cases displayed leucopenia. Increases in lactose dehydrogenase (LDH) and creatine kinase (CK) were observed in 45. 5%(20/44) and 28. 9%(13/45) of the cases, respectively. Three cases displayed an increase of alanine aminotransferase (ALT). Administration of ribavarin extend febrile time compared to symptom-relieving treatments (t=2. 588, P = 0. 013). Conclusions Clinical features of chikungunya fever include fever, rash and joint pain. Good prognosis can be resulted from symptom-relieving treatment. Antiviral treatment may not be beneficial to reducing course of disease.     

Prevention and treatment strategies used for the community management of childhood fever in Kampala, Uganda

To assess malaria-related prevention and treatment strategies in an urban parish of Kampala, Uganda, a questionnaire was administered to 339 randomly selected primary caregivers of children 1-10 years of age. Our study population was relatively stable and well educated, with better access to health services than many in Africa. Ownership of an insecticide-treated net (ITN) was reported by 11% of households and was predicted only by greater household wealth (highest quartile versus lowest quartile: odds ratio [OR] 21.8; 95% confidence interval [CI], 2.74-173). Among women, 5% reported use of an ITN and 11% used intermittent preventive therapy (IPT) during their last pregnancy. Use of appropriate IPT during pregnancy was predicted only by completion of secondary education or higher (OR, 2.87; 95% CI, 1.13-7.21). Children of 123 (36%) caregivers had experienced an episode of fever in the past 2 weeks. Of these, 22% received an anti-malarial that could be considered "adequate" (combination therapy or quinine). Only 1% of febrile children received adequate treatment at the correct dose within 24 hours of onset of fever. The only independent predictor of treatment with an adequate anti-malarial was accessing a clinic or hospital as the first source of care. In this urban area, use of appropriate malaria control measures occurs uncommonly.     

Cytokine storm in COVID-19: pathogenesis and overview of anti-inflammatory agents used in treatment

Clinical Rheumatology - COVID-19 infection has a heterogenous disease course; it may be asymptomatic or causes only mild symptoms in the majority of the cases, while immunologic complications such...     

The anti-allergic drug, N-(3',4'-dimethoxycinnamonyl) anthranilic acid, exhibits potent anti-inflammatory and analgesic properties in arthritis

OBJECTIVES: The degradation of tryptophan by indoleamine 2,3-dioxygenase yields a number of immunomodulatory metabolites, including 3-hydroxyanthranilic acid, 3-hydroxykynurenic acid and quinolinic acid. N-(3',4'-dimethoxycinnamonyl) anthranilic acid (3,4-DAA) is a synthetic anthranilic acid derivative that has been used therapeutically in Japan for many years as an anti-allergic drug and has recently been shown to be effective in a murine model of multiple sclerosis. METHODS: In the present study, we tested the efficacy of 3,4-DAA in collagen-induced arthritis, a mouse model of rheumatoid arthritis, and analysed its mechanism of action. RESULTS: Administration of 3,4-DAA after arthritis onset reduced clinical and histological severity of arthritis and reduced pain. It completely abrogated thermal and mechanical hyperalgesia. 3,4-DAA also suppressed Th1 cell activity in lymph node cell cultures and raised serum levels of IL-10. In vitro, 3,4-DAA suppressed IFNgamma production and proliferation of both T and B lymphocytes in a manner comparable with the endogenous tryptophan metabolite, 3-hydroxyanthranilic acid, suggesting similar mechanisms of action. CONCLUSION: It is concluded that 3,4-DAA has both anti-inflammatory and analgesic properties, and may therefore be useful in filling an unmet need, in the treatment of rheumatoid and other forms of arthritis, especially in the light of its analgesic properties.     

Dengue,chikungunya and Zika virus infections among Dutch travellers to Suriname: a prospective study during the introduction of chikungunya and Zika virus, 2014 to 2017

BackgroundSuriname, a country endemic for dengue virus (DENV), is a popular destination for Dutch travellers visiting friends and relatives and tourist travellers. Chikungunya and Zika virus (CHIKV, ZIKV) were introduced in 2014 and 2015, respectively. Data on infection risks among travellers are limited.AimWe aimed to prospectively study incidence rate (IR) and determinants for DENV, ZIKV and CHIKV infection in adult travellers to Suriname from 2014 through 2017.MethodsParticipants kept a travel diary and were tested for anti-DENV, anti-ZIKV and anti-CHIKV IgG antibodies (Euroimmun). Selected samples were subjected to an in-house DENV and ZIKV PRNT50. The IR (infections/1,000 person-months of travel) and IR ratio and determinants for infection were calculated.ResultsTravel-acquired infections were found in 21 of 481 participants: 18 DENV, four ZIKV and two CHIKV, yielding an IR_DENV of 47.0 (95% CI: 29.6–74.6), IR_ZIKV of 11.6 (95% CI: 4.4–31.0) and IR_CHIKV of 5.6 (95% CI: 1.4–22.2)/1,000 person-months. In nine DENV and three ZIKV infected participants, infections were PRNT50-confirmed, yielding a lower IR_DENV of 23.3 (95% CI: 12.1–44.8) and an IR_ZIKV of 8.4 (95% CI: 2.7–26.1) per 1,000 person-months. Tourist travel was associated with DENV infection. ZIKV and CHIKV infections occurred soon after their reported introductions.ConclusionsDespite an overestimation of serologically confirmed infections, Dutch travellers to Suriname, especially tourists, are at substantial risk of DENV infection. As expected, the risk of contracting ZIKV and CHIKV was highest during outbreaks. Cross-reaction and potential cross-protection of anti-DENV and -ZIKV antibodies should be further explored.     

The pseudopterosins: anti-inflammatory and analgesic natural products from the sea whip Pseudopterogorgia elisabethae.

The Caribbean sea whip Pseudopterogorgia elisabethae (Octocorallia, Cnidaria) has been found to contain the pseudopterosins, a newly described class of natural products, which have been characterized as diterpene-pentoseglycosides. The pseudopterosins possess anti-inflammatory and analgesic properties that exceed, in our assays, the potencies of existing drugs such as indomethacin. As anti-inflammatory agents, the pseudopterosins appear to modify the arachidonic acid cascade by an as yet undefined mechanism of pharmacological action.     

Q fever during pregnancy: diagnosis, treatment, and follow-up

BACKGROUND: Q fever, caused by Coxiella burnetii, may result in abortions, premature deliveries, and stillbirths in infected pregnant women. OBJECTIVE: To evaluate the best treatment strategy for Q fever during pregnancy. METHODS: We evaluated the prognosis of 17 pregnant women who developed Q fever with and without co-trimoxazole (trimethoprim-sulfamethoxazole) treatment. RESULTS: The outcome of the pregnancy was found to depend on the trimester. Abortions occurred in 7 of 7 insufficiently treated patients infected during the first trimester vs 1 of 5 patients infected later. Co-trimoxazole given until delivery protected against abortion (0/4) but not against the development of chronic infections, and it did not significantly reduce the colonization of the placenta (2/4 vs 4/4). CONCLUSIONS: Our results show that C burnetii infections cause abortion and that women who develop Q fever while pregnant should be treated with co-trimoxazole for the duration of pregnancy, specifically when infected during the first trimester.     

Listening to Turkish classical music decreases patients＇ anxiety, pain, dissatisfaction and the dose of sedative and analgesic drugs during colonoscopy： A prospective randomized controlled trial

AIM: To determine whether listening to music decreases the requirement for dosages of sedative drugs, patients' anxiety, pain and dissatisfaction feelings during colonoscopy and makes the procedure more comfortable and acceptable. METHODS: Patients undergoing elective colonoscopy between October 2005 and February 2006 were randomized into either listening to music (Group 1, n = 30) or not listening to music (Group 2, n = 30). Anxiolytic and analgesic drugs (intravenous midazolam and meperidine) were given according to the patients' demand. Administered medications were monitored. We determined their levels of anxiety using the State-Trait Anxiety Inventory Test form. Patients' satisfaction, pain, and willingness to undergo a repeated procedure were self-assessed using a visual analog scale. RESULTS: The mean dose of sedative and analgesic drugs used in group 1 (midazolam: 2.1 +/- 1.4, meperidine: 18.1 +/- 11.7) was smaller than group 2 (midazolam: 2.4 +/- 1.0, meperidine: 20.6 +/- 11.5), but without a significant difference (P > 0.05). The mean anxiety level in group 1 was lower than group 2 (36.7 +/- 2.2 vs 251.0 +/- 1.9, P < 0.001). The mean satisfaction score was higher in group 1 compared to group 2 (87.8 +/- 3.1 vs 58.1 +/- 3.4, P < 0.001). The mean pain score in group 1 was lower than group 2 (74.1 +/- 4.7 vs 39.0 +/- 3.9, P < 0.001). CONCLUSION: Listening to music during colonoscopy helps reduce the dose of sedative medications, as well as patients' anxiety, pain, dissatisfaction during the procedure. Therefore, we believe that listening to music can play an adjunctive role to sedation in colonoscopy. It is a simple, inexpensive way to improve patients' comfort during the procedure.     

Non-steroidal anti-inflammatory drug associated ulcer: Epidemiology, causation and treatment

Epidemiological evidence consistently indicates that aspirin or non-aspirin non-steroidal anti-inflammatory drug use is associated with the occurrence of gastric ulceration, gastric and ulcer bleeding, and ulcer death. Evidence on duodenal ulcer occurrence conflicts, possibly because of differences in study populations. A wide range of mechanisms could explain the occurrence of non steroidal-induced damage. These include inhibition of bicarbonate secretion, effects on mucus formation, and vascular actions. Not all effects are dependent on cyclo-oxygenase inhibition. Short-term studies in humans provide indications of likely therapeutic effects, but cannot demonstrate clinical efficiency. Although anti-secretory drugs and prostaglandins can protect patients against the development of duodenal or gastric ulcers, but not both, there is no clinical evidence which bears upon the critical issue of protection against complications.     

Q fever in the Southern California desert: epidemiology, clinical presentation and treatment

Despite the absence of a natural reservoir for Q fever in the desert of Southern California, six cases have been identified during the past 32 years. During that period of time, two areas have been used by northern sheep ranchers from Idaho and Wyoming to import sheep to an area in the Coachella Valley through 1985. Thereafter, because of housing development, the sheep area was moved to Blythe along the Colorado River. All but two of these patients probably acquired infection by Coxiella burnetii by living or working in close proximity to these grazing areas but not directly involved with the sheep. The shift of infected patients from the Coachella Valley to Blythe (100 miles distant) seems to support that supposition. All patients with acute Q fever developed antibodies primarily to phase II antigen, whereas the only person with chronic Q fever developed phase I antibodies. All patients presented with granulomatous hepatitis. One also had a pulmonary infiltrate, and the single individual with chronic Q fever also had a mitral valve prosthesis, although echocardiography could not define endocarditis. All patients with acute infections responded to 3-5 weeks of therapy with doxycycline, whereas the patient with chronic disease failed 3 years of therapy with combination regimens. Further studies at the Eisenhower Medical Center on the prevalence of infection in Blythe, CA, and elsewhere are anticipated.     

International clinical guideline for the management of classical galactosemia: diagnosis,treatment, and follow-up

Classical galactosemia (CG) is an inborn error of galactose metabolism. Evidence-based guidelines for the treatment and follow-up of CG are currently lacking, and treatment and follow-up have been demonstrated to vary worldwide. To provide patients around the world the same state-of-the-art in care, members of The Galactosemia Network (GalNet) developed an evidence-based and internationally applicable guideline for the diagnosis, treatment, and follow-up of CG. The guideline was developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. A systematic review of the literature was performed, after key questions were formulated during an initial GalNet meeting. The first author and one of the working group experts conducted data-extraction. All experts were involved in data-extraction. Quality of the body of evidence was evaluated and recommendations were formulated. Whenever possible recommendations were evidence-based, if not they were based on expert opinion. Consensus was reached by multiple conference calls, consensus rounds via e-mail and a final consensus meeting. Recommendations addressing diagnosis, dietary treatment, biochemical monitoring, and follow-up of clinical complications were formulated. For all recommendations but one, full consensus was reached. A 93 % consensus was reached on the recommendation addressing age at start of bone density screening. During the development of this guideline, gaps of knowledge were identified in most fields of interest, foremost in the fields of treatment and follow-up.     

Microcirculation as a target for the anti-inflammatory properties of statins

Statins are inhibitors of the 3-hydroxy-3-methylglutaryl coenzyme A reductase, a ubiquitous enzyme critical for the biosynthesis of cholesterol. Because of their cholesterol-lowering properties, statins are extensively used in medical practice, and large clinical trials have shown that statins effectively reduce cardiovascular related morbidity and mortality. In the past 5 years, an important, new concept suggesting that the cardioprotective effects of statins are not necessarily related to cholesterol-lowering actions has emerged. Indeed, in vivo findings have clearly shown that statins exert anti-inflammatory and immunomodulatory effects and that they modulate vascular remodeling under normocholesterolemic conditions. These pleiotropic properties of statins affect important molecules in vascular biology and help preserve endothelial function in acute and chronic inflammatory states of the cardiovascular system, including coronary and cerebral artery diseases, diabetes, and atherosclerosis. Emerging evidence indicates that the microcirculation is a crucial target for the pleiotropic actions of statins because of its important role in regulating blood flow, leukocyte-endothelium interactions, and vascular remodeling. Accordingly, this review focuses on the role that the microcirculation plays in the vascular protective action of statins.