Clinical Predictors of Acute Bacterial Diarrhea in Young Children

PEDIATRICS ◽  
1985 ◽  
Vol 76 (4) ◽  
pp. 551-556
Author(s):  
Thomas G. DeWitt ◽  
Kim F. Humphrey ◽  
Paul McCarthy
Keyword(s):  
High Probability ◽  
Bacterial Pathogen ◽  
Abrupt Onset ◽  
Stool Culture ◽  
Outpatient Setting ◽  
Polymorphonuclear Cells ◽  
Clinical Predictors ◽  
Predictive Values ◽  
Culture Positive ◽  
Very High

This prospective study assessed the value of presenting history, physical examination, and screening laboratory tests in predicting whether diarrhea in a young child is associated with a stool culture positive for a bacterial pathogen. Acutely ill children less than 4 years old were studied in a hospital outpatient setting. Two hundred patients were seen in a 9½-month period, which encompassed the seasons of summer, fall, and winter. One hundred ninety-five patients had cultures completed and twenty-nine (15%) had a bacterial pathogen isolated. The best predictive variable for a stool culture positive for a bacterial pathogen was the presence of polymorphonuclear cells in the stool, with a sensitivity of 85%, a specificity of 88%, and positive and negative predictive values of 59% and 97%, respectively. A cluster of three historical variables—abrupt onset of diarrhea, greater than four stools per day, and no vomiting before the onset of diarrhea—was identified that delineated a subpopulation of patients with an increased probability of having a stool culture positive for a bacterial pathogen (27% v 4% if any of the three variables was absent). It is suggested that these findings can be combined in a stepwise manner using the historical cluster as an initial screening, followed by examination for stool polymorphonuclear cells in the high probability subgroup, to identify those patients with a very high probability of having a bacterial pathogen isolated in their stool.

Costs and Benefits of the Transition to Low-carbon Economyin Russia: Perspectives up to 2050

2014 ◽  
pp. 70-91 ◽  
Author(s):  
I. Bashmakov ◽  
A. Myshak
Keyword(s):  
Emission Reduction ◽  
High Probability ◽  
Ghg Emissions ◽  
Mitigation Measures ◽  
Low Carbon ◽  
Costs And Benefits ◽  
Ghg Emission ◽  
Research Groups ◽  
Emissions Mitigation ◽  
Very High

This paper investigates costs and benefits associated with low-carbon economic development pathways realization to the mid XXI century. 30 scenarios covering practically all “visions of the future” were developed by several research groups based on scenario assumptions agreed upon in advance. It is shown that with a very high probability Russian energy-related GHG emissions will reach the peak before 2050, which will be at least 11% below the 1990 emission level. The height of the peak depends on portfolio of GHG emissions mitigation measures. Efforts to keep 2050 GHG emissions 25-30% below the 1990 level bring no GDP losses. GDP impact of deep GHG emission reduction - by 50% of the 1990 level - varies from plus 4% to minus 9%. Finally, very deep GHG emission reduction - by 80% - may bring GDP losses of over 10%.

scholarly journals Antibiotic-associated diarrhea in children: how to identify, what to do and how to treat?

2016 ◽  
Vol 1 (1) ◽  
pp. 78-89
Author(s):  
I. N. Zakharova ◽  
I. V. Berezhnaya ◽  
E. B. Mumladze
Keyword(s):  
High Risk ◽  
Antibiotic Therapy ◽  
Intestinal Microbiota ◽  
High Probability ◽  
Pseudomembranous Colitis ◽  
Inflammatory Diseases ◽  
Pediatric Practice ◽  
Antibiotic Associated Diarrhea ◽  
New Generation ◽  
Very High

Rational antibiotic therapy is one of the most important components in the treatment of children with various infectious and inflammatory diseases. However, wide and sometimes unjustified use of AB in pediatric practice often leads to the development of a variety of complications. Children receiveing AB, especially during the first 5 years of life, are at a very high risk of developing antibiotic-associated diarrhea (AAD) which manifests itself in three or more episodes of unformed stools for two or more consecutive days or for 8 weeks after withdrawal. The most relevant pathogen of AAD is C. difficile which, according to various data, causes from 10 to 25% of AAD cases and 90 to 100% of all cases of pseudomembranous colitis (PMC). Given the high probability of developing dangerous complications such as PMC, special attention should be paid to the prevention of the infection associated with C. difficile by reducing the frequency of uncontrolled and unjustified use of AB. A new generation of eco-antibiotics can be recommended which allow to maintain diversity of the intestinal microbiota and are less likely to cause complications.

Flow Cytometry: An Important Diagnostic Tool in Critically Ill Preterm Neonates with Suspected Sepsis

2020 ◽  
Author(s):  
Sneha Goswami ◽  
Richa Gupta ◽  
Siddarth Ramji
Keyword(s):  
Flow Cytometry ◽  
Blood Culture ◽  
Clinical Signs ◽  
Human Leukocyte ◽  
Preterm Neonates ◽  
Suspected Sepsis ◽  
Predictive Values ◽  
Flow Cytometric ◽  
Time Flow ◽  
Culture Positive

Objective Sepsis is a major cause of neonatal mortality. The gold standard for diagnosis is blood culture which suffers from low sensitivity and huge turn-around time. Flow cytometry has been extensively applied to malignant disorders and is an upcoming tool for diagnosis of nonmalignant disorders due to its rapidity and accuracy in detecting cells, cell products, and their functional states. The aim of this study was to investigate the utility of flow cytometric expression of neutrophil CD64, monocyte human leukocyte antigen (HLA-DR) and CD16 in diagnosis in suspected preterm neonates. Study Design In total, 100 preterm neonates with clinical signs of sepsis were enrolled in the study. Blood culture, C-reactive protein (CRP) and flow cytometry for nCD64, mHLA-DR, and mCD16 were performed. The neonates were divided into two groups: culture positive and culture negative and CRP and flow cytometric findings compared. ROC analysis was performed to determine the best cut-off for nCD64, mHLA-DR, and mCD16 values along with estimation of sensitivity, specificity, and predictive values. Probability of <0.05 was taken as significant. Results Out of the 100 enrolled neonates, 34 (34%) were culture positive. CRP was not found to be significantly different in the two groups. Expression of nCD64 (p = 0.03) was significantly upregulated in the blood culture positive cases with a cut-off mean fluorescence intensity (MFI) value = 4.72 and sensitivity of 92% and specificity of 52%. Expression of mCD16 (p = 0.02) was also upregulated in the blood culture positive cases with a cut-off MFI value = 4.9, with sensitivity of 41%, specificity of 83%. Conclusion The study concluded that nCD64 and mCD16 can be potential biomarkers for early diagnosis of neonatal sepsis with a high sensitivity and specificity. Key Points

scholarly journals Comparative Evaluation of Enteric Bacterial Culture and a Molecular Multiplex Syndromic Panel in Children with Acute Gastroenteritis

2019 ◽  
Vol 57 (6) ◽  
Author(s):  
Thomas Kellner ◽  
Brendon Parsons ◽  
Linda Chui ◽  
Byron M. Berenger ◽  
Jianling Xie ◽  
...  
Keyword(s):  
Pathogen Detection ◽  
Rectal Swab ◽  
Bacterial Pathogen ◽  
Positive Culture ◽  
Content Type ◽  
Negative Culture ◽  
Percent Agreement ◽  
Stool Samples ◽  
Culture Positive ◽  
Culture Negative

ABSTRACTAlthough enteric multianalyte syndromic panels are increasingly employed, direct comparisons with traditional methods and the inclusion of host phenotype correlations are limited. Luminex xTAG gastrointestinal pathogen panel (GPP) and culture results are highly concordant. However, phenotypic and microbiological confirmatory testing raises concerns regarding the accuracy of the GPP, especially forSalmonellaspp. A total of 3,089 children with gastroenteritis submitted stool specimens, rectal swab specimens, and clinical data. The primary outcome was bacterial pathogen detection agreement for shared targets between culture and the Luminex xTAG GPP. Secondary analyses included phenotype assessment, additional testing of GPP-negative/culture-positive isolate suspensions with the GPP, and in-house and commercial confirmatory nucleic acid testing of GPP-positive/culture-negative extracts. The overall percent agreement between technologies was >99% for each pathogen.Salmonellaspp. were detected in specimens from 64 participants: 12 (19%) by culture only, 9 (14%) by GPP only, and 43 (67%) by both techniques. Positive percent agreement forSalmonellaspp. was 78.2% (95% confidence interval [CI], 64.6%, 87.8%). Isolate suspensions from the 12 participants with specimens GPP negative/culture positive forSalmonellatested positive by GPP. Specimens GPP positive/culture negative forSalmonellaoriginated in younger children with less diarrhea and more vomiting. GPP-positive/culture-negative specimen extracts tested positive using additional assays for 0/2Campylobacter-positive specimens, 0/4Escherichia coliO157-positive specimens, 0/9Salmonella-positive specimens, and 2/3Shigella-positive specimens. For both rectal swab and stool samples, the median cycle threshold (CT) values, determined using quantitative PCR, were higher for GPP-negative/culture-positive samples than for GPP-positive/culture-positive samples (for rectal swabs, 36.9 [interquartile range {IQR}, 33.7, 37.1] versus 30.0 [IQR, 26.2, 33.2], respectively [P = 0.002]; for stool samples, 36.9 [IQR, 33.7, 37.1] versus 29.0 [IQR, 24.8, 30.8], respectively [P = 0.001]). GPP and culture have excellent overall agreement; however, for specific pathogens, GPP is less sensitive than culture and, notably, identifies samples false positive forSalmonellaspp.

scholarly journals Prevalence of voriconazole-resistant invasive aspergillosis and its impact on mortality in haematology patients

2019 ◽  
Vol 74 (9) ◽  
pp. 2759-2766 ◽  
Author(s):  
Agustin Resendiz-Sharpe ◽  
Toine Mercier ◽  
Pieter P A Lestrade ◽  
Martha T van der Beek ◽  
Peter A von dem Borne ◽  
...  
Keyword(s):  
Invasive Aspergillosis ◽  
Resistance Mutations ◽  
Icu Patients ◽  
High Prevalence ◽  
High Risk Populations ◽  
Haematology Patients ◽  
Culture Positive ◽  
Very High ◽  
Multicentre Cohort ◽  
Overall Mortality

Abstract Background Increasing resistance of Aspergillus fumigatus to triazoles in high-risk populations is a concern. Its impact on mortality is not well understood, but rates from 50% to 100% have been reported. Objectives To determine the prevalence of voriconazole-resistant A. fumigatus invasive aspergillosis (IA) and its associated mortality in a large multicentre cohort of haematology patients with culture-positive IA. Methods We performed a multicentre retrospective study, in which outcomes of culture-positive haematology patients with proven/probable IA were analysed. Patients were stratified based on the voriconazole susceptibility of their isolates (EUCAST broth microdilution test). Mycological and clinical data were compared, along with survival at 6 and 12 weeks. Results We identified 129 A. fumigatus culture-positive proven or probable IA cases; 103 were voriconazole susceptible (79.8%) and 26 were voriconazole resistant (20.2%). All but one resistant case harboured environment-associated resistance mutations in the cyp51A gene: TR34/L98H (13 cases) and TR46/Y121F/T289A (12 cases). Triazole monotherapy was started in 75.0% (97/129) of patients. Mortality at 6 and 12 weeks was higher in voriconazole-resistant cases in all patients (42.3% versus 28.2%, P = 0.20; and 57.7% versus 36.9%, P = 0.064) and in non-ICU patients (36.4% versus 21.6%, P = 0.16; and 54.4% versus 30.7%; P = 0.035), compared with susceptible ones. ICU patient mortality at 6 and 12 weeks was very high regardless of triazole susceptibility (75.0% versus 66.7%, P = 0.99; and 75.0% versus 73.3%, P = 0.99). Conclusions A very high prevalence of voriconazole resistance among culture-positive IA haematology patients was observed. The overall mortality at 12 weeks was significantly higher in non-ICU patients with voriconazole-resistant IA compared with voriconazole-susceptible IA.

scholarly journals Low-cost infrared sensor for wildlife detection in vegetation

2017 ◽  
Vol 63 (Special Issue) ◽  
pp. S13-S17
Author(s):  
Lev Jakub ◽  
Shapoval Vadym ◽  
Bartoška Jan ◽  
Kumhála František
Keyword(s):  
High Speed ◽  
High Probability ◽  
Low Cost ◽  
Low Noise ◽  
Infrared Sensor ◽  
Direct Sunlight ◽  
Infrared Technology ◽  
Wildlife Detection ◽  
Infrared Array ◽  
Very High

The protection of wild animals from mutilation or being killed during haymaking is still a serious problem connected with high working speeds and widths of modern harvesting machines. That is why the main aim of this study was to test low-cost, high-speed and low-noise infrared array sensor Melexis MLX90621 for the application of wildlife detection with the potential to be used in front of the mower equipment. The tests with two different crops with or without a hidden dog were made. Results showed that the sensor is able to detect an animal hidden in the crop with very high probability. Nevertheless, direct sunlight conditions can cause the problems when using infrared technology. A simultaneous use of other sensors working on different principle than infrared technology can be thus recommended.

scholarly journals Surjectivity of near-square random matrices

2019 ◽  
Vol 29 (2) ◽  
pp. 267-292
Author(s):  
Hoi. H. Nguyen ◽  
Elliot Paquette
Keyword(s):  
Random Matrices ◽  
High Probability ◽  
Sparse Matrices ◽  
Integral Lattice ◽  
Integral Matrix ◽  
Random Integral ◽  
Very High ◽  
Dependent Entries ◽  
Independent And Identically Distributed

AbstractWe show that a nearly square independent and identically distributed random integral matrix is surjective over the integral lattice with very high probability. This answers a question by Koplewitz [6]. Our result extends to sparse matrices as well as to matrices of dependent entries.

scholarly journals An Atypical Presentation of Pediatric Acute Neuropsychiatric Syndrome Responding to Plasmapheresis Treatment

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Drew H. Barzman ◽  
Hannah Jackson ◽  
Umesh Singh ◽  
Marcus Griffey ◽  
Michael Sorter ◽  
...  
Keyword(s):  
Treatment Options ◽  
Abrupt Onset ◽  
Acute Onset ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Acute Infections ◽  
The Family ◽  
Work Up ◽  
Severe Anxiety ◽  
Very High

Here we report a case of a 15-year-old female who had originally been diagnosed and treated unsuccessfully for schizophrenia, psychosis, severe anxiety, and depression. More in-depth history revealed an abrupt onset of her symptoms with remote acute infections and many exhibited characteristics of obsessive compulsive disorder with rituals. Work-up for underlying infectious, immunodeficiency, and autoimmune causes was unrevealing except for very high levels of anti-neuronal antibodies which have been linked to Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). Treatment options were discussed with the family and it was decided to use a course of plasmapheresis based on previous studies demonstrating efficacy and its safety profile. After course of therapy, there was a dramatic resolution of her psychosis, OCD traits, and anxiety. She was able to stop all of her antipsychotic and anxiety medications and resume many of her previous normal daily activities. The effect of this treatment has been sustained to the present time. This case emphasizes the importance of exploring nontraditional treatments for severe, treatment-resistant mental illness which requires a multidisciplinary approach. Further research is warranted in larger populations to investigate pathomechanisms and treatment of PANs/PANDAs.

Administrative Data Fail to Accurately Identify Cases of Healthcare-Associated Infection

2006 ◽  
Vol 27 (4) ◽  
pp. 332-337 ◽  
Author(s):  
Eileen R. Sherman ◽  
Kateri H. Heydon ◽  
Keith H. St. John ◽  
Eva Teszner ◽  
Susan L. Rettig ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Administrative Data ◽  
Active Surveillance ◽  
Predictive Value ◽  
Healthcare Associated Infection ◽  
Cross Sectional ◽  
Policy Makers ◽  
Predictive Values ◽  
Healthcare Associated ◽  
Very High

Objective.Some policy makers have embraced public reporting of healthcare-associated infections (HAIs) as a strategy for improving patient safety and reducing healthcare costs. We compared the accuracy of 2 methods of identifying cases of HAI: review of administrative data and targeted active surveillance.Design, Setting, and Participants.A cross-sectional prospective study was performed during a 9-month period in 2004 at the Children's Hospital of Philadelphia, a 418-bed academic pediatric hospital. “True HAI” cases were defined as those that met the definitions of the National Nosocomial Infections Surveillance System and that were detected by a trained infection control professional on review of the medical record. We examined the sensitivity and the positive and negative predictive values of identifying HAI cases by review of administrative data and by targeted active surveillance.Results.We found similar sensitivities for identification of HAI cases by review of administrative data (61%) and by targeted active surveillance (76%). However, the positive predictive value of identifying HAI cases by review of administrative data was poor (20%), whereas that of targeted active surveillance was 100%.Conclusions.The positive predictive value of identifying HAI cases by targeted active surveillance is very high. Additional investigation is needed to define the optimal detection method for institutions that provide HAI data for comparative analysis.

Sign in / Sign up

Export Citation Format

Share Document