The clinical–epidemiological profile of malaria patients from Southern Venezuela, a critical hotspot in Latin America

Abstract Background Venezuela accounted for 55% of the cases and 73% of the malaria deaths in the Americas in 2019. Bolivar state, in the southeast, contributes > 60% of the country's Plasmodium vivax and Plasmodium falciparum cases every year. This study describes the clinical–epidemiological characteristics of clinical malaria patients in this high-transmission area. Methods A prospective study was conducted on patients seeking medical attention in three medical centres in the state capital, Ciudad Bolivar, between June and October 2018. Malaria diagnosis was carried out using microscopy following national standards. Malaria-positive patients were examined for clinical symptoms, and haematological tests were performed at the time of diagnosis. Patients were followed up by telephone to evaluate malaria recurrences. Results Out of 287 patients, 200 (69.7%) were positive for P. vivax, 69 (24%) for P. falciparum, and 18 (6.3%) had mixed (P. vivax/P. falciparum) infections. Patients' median age was 33 years (IQR 20), 168 (69%) were men, and 40% practiced gold mining as the main occupation. Fever (96.5%), chills (91.3%), and headaches (90.6%) were the most frequent symptoms. At least one symptom associated with severe malaria was observed in 69 out of 161 patients with complete clinical evaluation (42.9%). Plasmodium vivax infections were found in 42 out of 69 (60.9%) severe cases; by contrast, P. falciparum and mixed malaria caused 34.8% (24/69) and 4.4% (3/69) of infections, respectively. Two patients died of cerebral malaria. Mean hemoglobin was lower in the patients infected with P. falciparum than those infected with P. vivax. Regardless of the parasite causing the infection, patients presented high levels of total bilirubin, aminotransferases (AST, ALT), and lactate dehydrogenase (LDH). Out of the 142 patients followed up by phone for three months (49.5% of the 287 patients), 35 (24.7%) reported recurrences. Conclusions The high malaria prevalence among young male adults practicing gold mining suggests that this occupation is a significant risk factor. The unexpected high prevalence of P. vivax patients with at least one criteria of severe clinical disease is a matter of concern. Whether it is the result of a lack of timely diagnosis and effective treatment should be explored.

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Retrospective study on the prevalence of COVID-19 confirmed cases and evidence of gender bias in Libya

One Health & Risk Management ◽

10.38045/ohrm.2022.1.04 ◽

2021 ◽

Vol 3 (1) ◽

pp. 29-37

Author(s):

Hanan AQEEHAL ◽

Ahmed ALARBI ◽

Haytham MANEEA ◽

Mahmud BENMANSUR ◽

Abdelhadi ELTURKI ◽

...

Keyword(s):

Logistic Regression ◽

Risk Factor ◽

Retrospective Study ◽

Clinical Symptoms ◽

Multinomial Logistic Regression ◽

Significant Risk ◽

Significant Risk Factor ◽

Demographic Variables ◽

High Prevalence ◽

Male Patients

Introduction. To stop SARS-CoV-2 from spreading, it's crucial to have a solid understanding of the baseline characteristics of demographic variables, clinical symptoms, and comorbidity so that quarantining and testing protocols can be developed. Material and methods. A retrospective study was conducted on COVID-19 Laboratory confirmed cases. Data were collected by using kobo toolbox, demographic variables, clinical symptoms, and Comorbidity was considered. Yates-corrected chi2 tests and Multinomial Logistic Regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI) of factors and their impact on COVID-19 prevalence. Results. A total of 6302 of which 3536(56.1%) men and 2766 (44%) women with a mean age (±SD) of 44±17.6 years were included within the study. Clinical symptoms and Comorbidity were significant for both sexes p<0.0001. Multinomial Logistic Regression confirmed that age <55, 3 or more symptoms (OR=1.130 CI95% 1.013-1.261) and 3 or more comorbidities (OR=1.035 Cl95% 0.942-1.137) were a significant risk factor for COVID-19 prevalence in male patients, among women, age 85>/=, 3 or more symptoms (p<0.0001, OR=1.995 CI95% 1.335-2.992) and 3 or more comorbidities (p<0.0001, OR=1.538 Cl95% 1.045-2.640) were significant risk factor for COVID-19 prevalence in females. Conclusions. Our study suggests that the prevalence of COVID-19 patients and symptoms was higher in men than women. The high prevalence of smoking could have contributed to the high prevalence of COVID-19 among men. Study also suggests that the presence of at least one or combined comorbidities are risk factors of COVID-19 prevalence and a potential risk factor COVID-19 - related outcomes. More efforts should be exercised to protect patients with one or more comorbidities from being exposed to infection.

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High Rates of Malaria Microscopy but Low Turnaround of Test-results Among Inpatients in Tertiary Care: With Delayed Initiation, Monotherapy and Incomplete Dosing of Antimalarials

10.21203/rs.3.rs-30045/v1 ◽

2020 ◽

Author(s):

Ronald Kiguba ◽

Charles Karamagi ◽

Sheila M. Bird

Keyword(s):

Tertiary Care ◽

Significant Risk ◽

Malaria Diagnosis ◽

Significant Risk Factor ◽

Test Results ◽

Laboratory Services ◽

Mulago National Referral Hospital ◽

Delayed Initiation ◽

National Referral Hospital ◽

Malaria Microscopy

Abstract Objectives:To describe the patterns of malaria diagnosis and antimalarial use: monotherapy, missed Day 1 dosing and risk-factors. Methods: Prospective cohort of consented adult inpatients on the medical and gynaecological wards of Uganda’s 1790-bed Mulago National Referral Hospital.Results: One in five (19%, 146/762; 95% confidence interval (CI): 16% to 22%) inpatients had an admitting or discharge malaria diagnosis or both. Microscopy was requested in 77% (108/141; 95% CI: 69% to 83%) of inpatients with an admitting malaria diagnosis; results were available for 46% (50/108; 95% CI: 37% to 56%), of whom 42% (21/50; 95% CI: 28% to 57%) were positive. Artesunate (AS) only (47%, 47/100; 95% CI: 37% to 57%) was the most frequently hospital-administered antimalarial followed by quinine (Q) only (23%, 95% CI: 15% to 32%). A quarter (25%, 25/100; 95% CI: 17% to 35%) of the inpatients missed their Day 1 dose of hospital-initiated antimalarials. Nearly half (47%, 95% CI: 34% to 61%) of 57 inpatients on AS and 18%(95% CI: 4% to 32%) of 28inpatients on Q missed at least one day of dosing in Days 1-3. Number of admitting diagnoses was a significant risk-factor for missed Day 1 dosing of hospital-initiated antimalarials (OR = 2.7, 95% CI: 1.53-4.54; P-value < 0.001).Conclusions: Half the malaria microscopy results were not available; yet, the rate of testing was high. Improvement in laboratory services, procurement, prescription, dispensing and administration of antimalarials could curb missed treatment for confirmed malaria cases, monotherapy and delayed doses.

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Serious Suicide Attempts and Risk of Suicide Death

Crisis ◽

10.1027/0227-5910/a000729 ◽

2020 ◽

pp. 1-8

Author(s):

Deepak Prabhakar ◽

Edward L. Peterson ◽

Yong Hu ◽

Simran Chawa ◽

Rebecca C. Rossom ◽

...

Keyword(s):

Suicide Attempt ◽

Suicide Attempts ◽

Significant Risk ◽

Significant Risk Factor ◽

Medical Attention ◽

Medical Visit ◽

Suicide Death ◽

Increased Risk ◽

The Us ◽

History Of

Abstract. Background: In the US, more than one million people attempt suicide each year. History of suicide attempt is a significant risk factor for death by suicide; however, there is a paucity of data from the US general population on this relationship. Aim: The objective of this study was to examine suicide attempts needing medical attention as a risk for suicide death. Method: We conducted a case–control study involving eight US healthcare systems. A total of 2,674 individuals who died by suicide from 2000 to 2013 were matched to 267,400 individuals by year and location. Results: Prior suicide attempt associated with a medical visit increases risk for suicide death by 39.1 times, particularly for women ( OR = 79.2). However, only 11.3% of suicide deaths were associated with an attempt that required medical attention. The association was the strongest for children 10–14 years old ( OR = 98.0). Most suicide attempts were recorded during the 20-week period prior to death. Limitations: Our study is limited to suicide attempts for which individuals sought medical care. Conclusion: In the US, prior suicide attempt is associated with an increased risk of suicide death; the risk is high especially during the period immediately following a nonlethal attempt.

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Risk of Thromboembolism in Patients with Paroxysmal Nocturnal Hemoglobinuria Presenting with Both Clinical Symptoms and Elevated Hemolysis

Blood ◽

10.1182/blood.v120.21.1273.1273 ◽

2012 ◽

Vol 120 (21) ◽

pp. 1273-1273

Author(s):

Jong-Wook Lee ◽

Jun Ho Jang ◽

Jin Seok Kim ◽

Sung-Soo Yoon ◽

Je Hwan Lee ◽

...

Keyword(s):

Abdominal Pain ◽

Chest Pain ◽

Pharmaceutical Company ◽

Board Of Directors ◽

Paroxysmal Nocturnal Hemoglobinuria ◽

Clinical Symptoms ◽

Significant Risk ◽

Significant Risk Factor ◽

Advisory Committees ◽

Increased Risk

Abstract Abstract 1273 Background: Paroxysmal nocturnal hemoglobinuria (PNH) is a rare and life-threatening disorder characterized by chronic complement-mediated hemolysis. Chronic hemolysis is associated with an increased risk of thromboembolism (TE), the major cause of end organ damage and early mortality in PNH. Patients with PNH frequently experience clinical symptoms such as abdominal pain, chest pain, dyspnea, and hemoglobinuria. Pain and dyspnea are a likely consequence of vasoconstriction due to sequestering of nitric oxide by free hemoglobin released during hemolysis. These symptoms not only cause patient distress but may be indicative of advanced disease and an increased risk of TE. Objective: To evaluate if the risk of TE is increased in PNH patients with increased hemolysis, measured by lactate dehydrogenase (LDH) serum levels ≥1.5-fold higher than the upper limit of normal (LDH ≥1.5×ULN), plus any of the four clinical symptoms of abdominal pain, chest pain, dyspnea, or hemoglobinuria during the course of the disease, compared with patients who had an individual clinical symptom or LDH ≥1.5×ULN alone. Methods: This study included 224 PNH patients from the South Korean national PNH registry. In patients with LDH ≥1.5×ULN at diagnosis, associations between the presence of the four individual clinical symptoms and the incidence of TE were analyzed using logistic regression. The effect of multiple symptoms including LDH ≥1.5×ULN on the TE rate was assessed using odds ratios (OR) and associated 95% confidence intervals (CIs). Results: The results of the analyses between clinical symptoms, LDH ≥1.5×ULN, and the incidence of TEs are tabulated below. The risk of TE was significantly increased in patients with LDH ≥1.5×ULN (OR: 8.57; P<0.001) or who had abdominal pain, chest pain or dyspnea (OR: range 2.74–2.86; P≤0.022) during the course of the disease compared with patients without these individual symptoms. The risk of TE was further increased in patients with both LDH ≥1.5×ULN and at least one of the four symptoms compared with patients with LDH ≥1.5×ULN alone (OR: 9.20; P=0.032). Individual symptom analyses showed that patients with each symptom and LDH ≥1.5×ULN had a significantly increased risk of TE compared with patients without the symptom and LDH <1.5×ULN. This was particularly evident for abdominal pain and chest pain (OR: 17.79 and 19.04, respectively; P≤0.006) but also seen in patients with dyspnea or hemoglobinuria (OR: 10.28 and 10.35, respectively; P≤0.025). These results suggest that the combination of LDH ≥1.5×ULN and one or more of these clinical symptoms poses a much greater risk of a TE than any of the individual factors alone. Conclusions: These data confirm that hemolysis, identified by LDH ≥1.5×ULN, is a significant risk factor for TE in PNH patients. Importantly, the risk of TE was further increased in patients with both elevated hemolysis and symptoms of abdominal pain, chest pain, dyspnea or hemoglobinuria compared with patients with elevated hemolysis alone. These results suggest that early intervention is important for PNH patients with both elevated hemolysis and clinical symptoms, and also highlight the need for careful monitoring of clinical symptoms that signal an elevated clinical risk for TE. Disclosures: Lee: Alexion Pharmaceutical Company: Honoraria, Membership on an entity's Board of Directors or advisory committees. Jang:Alexion Pharmaceutical Company: Honoraria, Membership on an entity's Board of Directors or advisory committees.

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A Case Report of Neurotoxicity After Prolonged Doses of Acyclovir in a Patient With Renal Dysfunction

Journal of Pharmacy Practice ◽

10.1177/0897190018825033 ◽

2019 ◽

Vol 33 (2) ◽

pp. 217-221 ◽

Cited By ~ 1

Author(s):

Godsfavour O. Umoru ◽

Punit J. Shah ◽

Farheen Tariq

Keyword(s):

Renal Dysfunction ◽

Viral Infections ◽

Clinical Symptoms ◽

Plasma Concentrations ◽

Significant Risk ◽

Significant Risk Factor ◽

Serum Levels ◽

Drug Induced ◽

Stage Renal Disease ◽

End Stage

Renal dysfunction is a significant risk factor for acyclovir-induced neurotoxicity and altered mentation and myoclonic movements are the most common clinical symptoms observed. In majority of reported cases, neurological sequelae associated with acyclovir-induced neurotoxicity often mimic viral infections of the central nervous system and makes diagnosis of the former challenging. Although plasma concentrations of the drug may not always correlate with neurotoxic symptoms, obtaining serum levels of acyclovir may be helpful in confirming drug-induced neurotoxicity. Hemodialysis has been shown to significantly improve altered mentation in patients with suspected or confirmed acyclovir-induced neurotoxicity. Here, we report a definite case of acyclovir-induced neurotoxicity in a patient with end-stage renal disease. Clinical improvements in neurologic symptoms were observed following discontinuation of the drug and hemodialysis.

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Feline immunodeficiency virus in Northern Ceará, Brazil

Journal of Feline Medicine and Surgery Open Reports ◽

10.1177/2055116919859112 ◽

2019 ◽

Vol 5 (2) ◽

pp. 205511691985911 ◽

Cited By ~ 2

Author(s):

Bruno Marques Teixeira ◽

Sueli Akemi Taniwaki ◽

Poliana Marisa Miranda Menezes ◽

Ana Kétylla Ponte Prado Rodrigues ◽

Andressa Nunes Mouta ◽

...

Keyword(s):

Phylogenetic Analysis ◽

Feline Immunodeficiency Virus ◽

Univariate Analysis ◽

Significant Risk ◽

Significant Risk Factor ◽

Subtype B ◽

Eastern Brazil ◽

Immunodeficiency Virus ◽

Low Prevalence ◽

Epidemiological Characteristics

ObjectivesThe objectives of this study were to confirm the prevalence of feline immunodeficiency virus (FIV) infection in domestic cats in the region north of Ceará, Brazil, and to determine the factors associated with infection and the major circulating subtypes of the virus in this area.MethodsSamples from 148 cats were collected and tested using anti-FIV antibody screening, with confirmation of positive results by PCR. Univariate analysis was performed considering the epidemiological characteristics and FIV status. Sequencing and phylogenetic analysis of the gag and pol genes were performed to confirm the FIV subtype.ResultsNine cats (6.1%) tested positive for FIV – one female (0.7%) and eight males (5.4%). Male cats were significantly more likely to be infected ( P <0.05). Phylogenetic analysis of gag and pol gene sequences indicated that the FIV isolates circulating in the study area belonged to subtype B.Conclusions and relevanceIn this study, we demonstrated a low prevalence for FIV in the northwest of Ceará, north-eastern Brazil. Male sex is a significant risk factor for FIV infection and the best predictive factor for FIV status. All isolates examined in this study clustered within subtype B, which is the predominant subtype in Brazil. This is the first report of genetic characterization of FIV in the state of Ceará, Brazil.

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Non-pharmacological therapy for infantile colic

Medical Council ◽

10.21518/2079-701x-2021-17-40-46 ◽

2021 ◽

pp. 40-46

Author(s):

S. I. Zhdanova ◽

D. M. Mustafina-Bredikhina ◽

A. V. Levadnaya ◽

D. I. Sadykova ◽

A. A. Babintseva

Keyword(s):

Randomized Trials ◽

Significant Risk ◽

Shaken Baby Syndrome ◽

Significant Risk Factor ◽

Pharmacological Therapy ◽

Medical Attention ◽

Rome Criteria ◽

Alternative Interventions ◽

Dietary Restrictions ◽

Infant Colic

Infant colic is an inconsolable cry of unknown cause in healthy babies. Observed in about 20% of infants, the most common reason for seeking medical attention at an early age. Colic is associated with maternal stress and the most significant risk factor for shaken baby syndrome, and can also cause premature breastfeeding termination. Informing and supporting parents with crying babies is increasingly important, and some guidelines recommend it as a cornerstone of intervention in families with a baby with colic. Because of the high quality randomized trials, none of the behavioral, dietary, pharmacological, or alternative interventions can be recommended as the only effective treatment. Unfortunately, many mothers around the world associate their child’s anxiety with “dietary mistakes” in their diets, leading to further dietary restrictions as a preventative measure. At the same time, according to the recommendations of the experts of the IV Rome Criteria, dietary restrictions for infant colic in breastfeeding mothers can be recommended only if there is a suspicion of suspicion of tolerance of cow’s milk protein. It is also possible for any type of feeding to prescribe fennel and chamomile preparations, in particular, in the form of aqueous infusions, and when breastfeeding it is desirable to use a bottle and excessively large volumes, which can reduce the amount of milk in a woman. It is desirable to exclude unreasonable dietary restrictions in breastfeeding mothers by excluding the so-called “gas-forming products” and ineffective therapy, in particular simethicone preparations.

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Physical Illness and Suicide Risk in Rural Residents of Contemporary China

Crisis ◽

10.1027/0227-5910/a000271 ◽

2014 ◽

Vol 35 (5) ◽

pp. 330-337 ◽

Cited By ~ 14

Author(s):

Cun-Xian Jia ◽

Lin-Lin Wang ◽

Ai-Qiang Xu ◽

Ai-Ying Dai ◽

Ping Qin

Keyword(s):

Risk Factor ◽

Family Income ◽

Rural China ◽

Significant Risk ◽

Significant Risk Factor ◽

Health Condition ◽

Physical Illness ◽

Rural Residents ◽

Increased Risk ◽

Study Population

Background: Physical illness is linked with an increased risk of suicide; however, evidence from China is limited. Aims: To assess the influence of physical illness on risk of suicide among rural residents of China, and to examine the differences in the characteristics of people completing suicide with physical illness from those without physical illness. Method: In all, 200 suicide cases and 200 control subjects, 1:1 pair-matched on sex and age, were included from 25 townships of three randomly selected counties in Shandong Province, China. One informant for each suicide or control subject was interviewed to collect data on the physical health condition and psychological and sociodemographic status. Results: The prevalence of physical illness in suicide cases (63.0%) was significantly higher than that in paired controls (41.0%; χ2 = 19.39, p < .001). Compared with suicide cases without physical illness, people who were physically ill and completed suicide were generally older, less educated, had lower family income, and reported a mental disorder less often. Physical illness denoted a significant risk factor for suicide with an associated odds ratio of 3.23 (95% CI: 1.85–5.62) after adjusted for important covariates. The elevated risk of suicide increased progressively with the number of comorbid illnesses. Cancer, stroke, and a group of illnesses comprising dementia, hemiplegia, and encephalatrophy had a particularly strong effect among the commonly reported diagnoses in this study population. Conclusion: Physical illness is an important risk factor for suicide in rural residents of China. Efforts for suicide prevention are needed and should be integrated with national strategies of health care in rural China.

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Risk factors of poor prognosis and impairment of activities of daily living in patients with hemorrhagic gastroduodenal ulcers

BMC Gastroenterology ◽

10.1186/s12876-020-01580-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Junya Arai ◽

Jun Kato ◽

Nobuo Toda ◽

Ken Kurokawa ◽

Chikako Shibata ◽

...

Keyword(s):

Risk Factors ◽

Activities Of Daily Living ◽

Daily Living ◽

Poor Prognosis ◽

Significant Risk ◽

Care Facility ◽

Significant Risk Factor ◽

Advanced Age ◽

Gastroduodenal Ulcers ◽

Poor Outcomes

Abstract Background Impairment of activities of daily living (ADL) due to hemorrhagic gastroduodenal ulcers (HGU) has rarely been evaluated. We analyzed the risk factors of poor prognosis, including mortality and impairment of ADL, in patients with HGU. Methods In total, 582 patients diagnosed with HGU were retrospectively analyzed. Admission to a care facility or the need for home adaptations during hospitalization were defined as ADL decline. The clinical factors were evaluated: endoscopic features, need for interventional endoscopic procedures, comorbidities, symptoms, and medications. The risk factors of outcomes were examined with multivariate analysis. Results Advanced age (> 75 years) was a significant predictor of poor prognosis, including impairment of ADL. Additional significant risk factors were renal disease (odds ratio [OR] 3.43; 95% confidence interval [CI] 1.44–8.14) for overall mortality, proton pump inhibitor (PPIs) usage prior to hemorrhage (OR 5.80; 95% CI 2.08–16.2), and heart disease (OR 3.05; 95% CI 1.11–8.43) for the impairment of ADL. Analysis of elderly (> 75 years) subjects alone also revealed that use of PPIs prior to hemorrhage was a significant predictor for the impairment of ADL (OR 8.24; 95% CI 2.36–28.7). Conclusion In addition to advanced age, the presence of comorbidities was a risk of poor outcomes in patients with HGU. PPI use prior to hemorrhage was a significant risk factor for the impairment of ADL, both in overall HGU patients and in elderly patients alone. These findings suggest that the current strategy for PPI use needs reconsideration.

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Neurodevelopmental outcome of healthy term newborn with serum bilirubin >15 mg/dl at one year

Journal of Neonatal-Perinatal Medicine ◽

10.3233/npm-200511 ◽

2020 ◽

pp. 1-6

Author(s):

P. Dubey ◽

J. Shrivastava ◽

B.P. Choubey ◽

A. Agrawal ◽

V. Thakur

Keyword(s):

Serum Bilirubin ◽

Tertiary Care ◽

Neurodevelopmental Outcome ◽

Significant Risk ◽

Central India ◽

Significant Risk Factor ◽

Motor Domain ◽

Medical Emergency ◽

One Year ◽

Group 1

BACKGROUND: Neonatal hyperbilirubinemia is a common medical emergency in early neonatal period. Unconjugated bilirubin is neurotoxic and can lead to lifelong neurological sequelae in survivors. OBJECTIVE: To find out the association between serum bilirubin and neurodevelopmental outcome at 1 year of age using Development Assessment Scale for Indian Infants (DASII). METHODS: A prospective cohort study was conducted in the Department of Pediatrics of a tertiary care institution of Central India between January 2018 and August 2019. Total 108 term healthy neonates, with at least one serum bilirubin value of >15 mg/dl, were included. Subjects were divided into three groups based on the serum bilirubin; group 1: (15–20 mg/dl) –85(78.7%) cases, group 2: (20–25 mg/dl) –17(15.7%), and group 3: (>25 mg/dl) –6(5.5%). Developmental assessment was done using DASII at 3, 6, 9, 12 months of age. RESULTS: Out of 108 cases, 101(93.5%) received phototherapy, and 7(6.5%) received double volume exchange transfusion. Severe delay was observed in 5(4.6%) and mild delay in 2(1.9%) cases in the motor domain of DASII at one year. Severe delay in the motor domain was associated with mean TSB of 27.940±2.89 mg/dl and mild delay with mean TSB of 22.75±1.76 mg/dl (p = 0.001). On cluster analysis, delay was observed in locomotion 1 score in 11(13%) cases (p = 0.003) and manipulation score in 6(7.1%) cases in group 1. CONCLUSION: Increased serum bilirubin was a significant risk factor for the delayed neurodevelopment in babies with neonatal jaundice. Even a moderate level of bilirubin significantly affects the developmental outcome.

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