scholarly journals Meningococcal infection in children: factors influencing outcome

2019 ◽  
Vol 11 (3) ◽  
pp. 13-19 ◽  
Author(s):  
O. V. Samodova ◽  
E. A. Krieger ◽  
L. V. Titova ◽  
O. Yu. Leonteva
Keyword(s):  
Primary Care Physicians ◽  
Cox Regression ◽  
Correct Diagnosis ◽  
Fatal Outcome ◽  
Clinical Signs ◽  
Immunization Coverage ◽  
Outpatient Department ◽  
Meningococcal Infection ◽  
Factors Influencing ◽  
Mandatory Vaccination

Generalized forms of meningococcal infection are characterized by high risk of complication and fatal outcomes. In Russian Federation, 2016, meningococcal infection was the second most common cause of pediatric deaths (25%) due to infectious diseases after community associated-pneumonia. Mandatory vaccination against meninococcal infection is not regulated, and immunization coverage according to epidemic indications is insufficient. During first 6–8 hours of illness clinical signs of this infection may be non-specific, because of that it is difficult to make correct diagnosis at outpatient department. Aim of the study was to analyze mistakes of diagnostics of meningococcal infection and to assess factors influencing the disease outcome. Material and methods. Retrospective cohort study was performed including 113 pediatric cases of generalized meningococcal infection occurred in Arkhangelsk region (46 cases with fatal outcome and 67 patients, who recovered). Factors influencing the outcome were recognized using Cox regression. Results. Median age of patients was 11 months. Clinical forms were meningitis (13,3%), meningococcemia (40,7%), mixed form (46%). The diagnosis of meningococcal infection was made at outpatient department in 36,9% of cases. The main causes of diagnostic mistakes were the lack of experience among primary care physicians and non-specificic symptoms during the first hours of the disease. Age younger 2 years, septic shock and time between onset of the diseases and admission to the hospital were associated with fatal outcome. Conclusion. To manage meningococcal disease we need to have good compliance with clinical guidelines for outpatient departments and hospitals; to optimize medical students education for prevention of diagnostic mistakes. Vaccination is the most effective method of prevention of deaths associated with meningococcal infection.

scholarly journals Genetic insights in canine degenerative myelopathy

2020 ◽  
Vol 89 (5) ◽  
pp. 253-261
Author(s):  
F. Boeykens ◽  
L. Peelman ◽  
S. Bhatti ◽  
B. J. G. Broeckx
Keyword(s):  
Motor Neuron ◽  
Neurodegenerative Disorder ◽  
Late Onset ◽  
Disease Incidence ◽  
Correct Diagnosis ◽  
Fatal Outcome ◽  
Clinical Signs ◽  
Vast Number ◽  
Hind Limbs ◽  
Degenerative Myelopathy

Canine degenerative myelopathy (DM) is a late-onset, progressive, neurodegenerative disorder with a fatal outcome, occurring in a vast number of dog breeds. Most dogs are at least eight years of age when they begin to show clinical signs, starting with general proprioceptive ataxia in the hind limbs and upper motor neuron paraparesis, evolving to lower motor neuron tetraplegia and brain stem signs. A definitive diagnosis can only be made postmortem by the histopathological observation of neuronal degradation and demyelination of the spinal cord. Most DM-affected dogs are homozygous for one of the known superoxide dismutase 1 gene (SOD1) mutations (ENSCAFT00000065394.1:c.82G>A, first described as NM_001003035.1:c.118G>A). A second mutation (NM_001003035.1:c.52A>T) in the same gene has been found but occurs only in Bernese mountain dogs. Not every homozygous dog develops the disease; this indicates that the disease is incompletely penetrant and that modifier loci might be present. In this review, the authors aim to give an overview of the disease progression and the current genetic knowledge of DM, which is of paramount importance for the correct diagnosis and to help reduce the disease incidence.

scholarly journals Is obligation the proper policy to increase immunization coverage? A comparison of 16 OECD countries

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
R Thomas ◽  
L Charrier ◽  
M Bo ◽  
C M Zotti
Keyword(s):  
Action Plan ◽  
Immunization Coverage ◽  
Oecd Countries ◽  
Emergency Situations ◽  
Compulsory Vaccination ◽  
Measles Vaccination ◽  
Global Estimates ◽  
Coverage Rates ◽  
Mandatory Vaccination ◽  
Short Time

Abstract Issue Globally, between 2016 and 2018, low vaccination coverage rates led to an increase of measles cases and related deaths. The WHO European Region reported a total of 83540 measles cases and 74 deaths in 2018, versus the 5273 cases and 13 deaths in 2016, with WHO global estimates reporting 333445 cases. In order to contrast these outbreaks, the European Vaccine Action Plan 2015-2020 states that the ideal immunization coverage for measles must be 95%. Although, this rate is not reached and maintained everywhere, thus one debated solution is to adopt compulsory vaccination plans rather than recommended. Our aim is to analyse if compulsory policies may increase coverage. Description Between 2014 and 2018 3 countries (Italy, France and California) changed their measles vaccination policies from recommended to compulsory to fight low immunization. In order to describe the effects of this action, we compared their measles coverage rates in 2014 and 2018 together with other 12 OECD countries rates who adopt both recommendation and obligation, evaluating the trend variations. Data were collected from OECD's, WHO's and Ministries of Health's documents. Results After the introduction of obligation, California (91% in 2014; 95% in 2018) and Italy (87% to 94%) coverage rates increased, while France's reduced (91% to 90%). Of other mandatory countries, only Australia showed an increase (94% to 95%); totally, 37.5% mandatory countries showed an increase among the analysed ones. Through the same period, 50% of analysed countries with recommendation maintained rates over 95%, 10% increased, while 40% remained below 95%. Lessons Even if mandatory vaccinations can lead to a sharp increase of coverage in a short time in response to emergency situations, the causes and solutions of hesitancy are more complex than law enforcement. Some countries without obligation show rates constantly above 95% throughout the years, demonstrating that other measures can be taken to fight low immunization. Key messages Apart from estimates coming from WHO and OECD, it is difficult to find extensive and official information about the application and the effectiveness of vaccination policies in different countries. Low immunization coverage rates rely on different causes (information, religion, personal beliefs, trust), thus the application of mandatory vaccination alone is not sufficient to fight hesitancy.

H3K27M-mutant Diffuse Midline Gliomas should be Further Molecularly Stratified: An Integrated Analysis of 669 Patients

2021 ◽  
Author(s):  
Huy Gia Vuong ◽  
Hieu Trong Le ◽  
Tam N.M. Ngo ◽  
Kar-Ming Fung ◽  
James D. Battiste ◽  
...  
Keyword(s):  
Cox Regression ◽  
Fatal Outcome ◽  
Extent Of Resection ◽  
Tumor Location ◽  
Genetic Alterations ◽  
Integrated Analysis ◽  
Prognostic Impact ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
The Impact

Abstract Introduction: H3K27M-mutated diffuse midline gliomas (H3-DMGs) are aggressive tumors with a fatal outcome. This study integrating individual patient data (IPD) from published studies aimed to investigate the prognostic impact of different genetic alterations on survival of these patients.Methods: We accessed PubMed and Web of Science to search for relevant articles. Studies were included if they have available data of follow-up and additional molecular investigation of H3-DMGs. For survival analysis, Kaplan-Meier analysis and Cox regression models were utilized, and corresponding hazard ratios (HR) and 95% confidence intervals (CI) were computed to analyze the impact of genetic events on overall survival (OS).Result: We included 30 studies with 669 H3-DMGs. TP53 mutations were the most common second alteration among these neoplasms. In univariate Cox regression model, TP53 mutation was an indicator of shortened survival (HR = 1.446; 95% CI = 1.143-1.829) whereas ACVR1 (HR = 0.712; 95% CI = 0.518-0.976) and FGFR1 mutations (HR = 0.408; 95% CI = 0.208-0.799) conferred prolonged survival. In addition, ATRX loss was also associated with a better OS (HR = 0.620; 95% CI = 0.386-0.996). Adjusted for age, gender, tumor location, and the extent of resection, the presence of TP53 mutations, the absence of ACVR1 or FGFR1 mutations remained significantly poor prognostic factors.Conclusions: We outlined the prognostic importance of additional genetic alterations in H3-DMGs and recommended that these neoplasms should be further molecularly segregated. It could help neuro-oncologists better evaluate the risk stratification of patients and consider pertinent treatments.

scholarly journals Ehlers–Danlos syndrome: how to diagnose and when to perform genetic tests

2014 ◽  
Vol 100 (1) ◽  
pp. 57-61 ◽  
Author(s):  
Glenda Sobey
Keyword(s):  
Genetic Basis ◽  
Correct Diagnosis ◽  
Clinical Signs ◽  
Accurate Diagnosis ◽  
Connective Tissue Disorders ◽  
Internal Organs ◽  
Ehlers Danlos Syndrome ◽  
Starting Point ◽  
Life Threatening ◽  
Danlos Syndrome

The term Ehlers–Danlos syndrome (EDS) encompasses a group of inherited connective tissue disorders. The manifestations of EDS can be seen in skin, joints, blood vessels and internal organs and vary from mild to severe and life threatening. Each subtype is a separate and different condition. The genetic basis of many subtypes has now been elucidated, confirming heterogeneity. An awareness of the different conditions within this group is the starting point towards accurate diagnosis. Accurate elicitation of history and clinical signs is vital in selecting the correct confirmatory investigation. Skin biopsy with electron microscopy can be helpful in the decision process of whether and when to perform genetic testing. Correct diagnosis within the EDSs allows targeted management, family screening and prenatal diagnosis.

scholarly journals Understanding Spatial and Contextual Factors Influencing Intraregional Differences in Child Vaccination Coverage in Bangladesh

2018 ◽  
Vol 31 (1) ◽  
pp. 51-60 ◽  
Author(s):  
Priyanka Vyas ◽  
Dohyeong Kim ◽  
Alayne Adams
Keyword(s):  
Vaccination Coverage ◽  
Contextual Factors ◽  
Immunization Coverage ◽  
Policy Discourse ◽  
Remote Areas ◽  
Remote Locations ◽  
Specific Policy ◽  
Factors Influencing ◽  
Administrative Governance ◽  
Child Vaccination

In Bangladesh, policy discourse has mostly focused on regional inequities in health, including child immunization coverage. Knowledge of local geographical and contextual factors within regions, however, becomes pertinent in efforts to address these inequities. We used the Bangladesh Demographic and Health Survey 2011 to examine factors that influence intraregional differences in vaccination coverage using a multilevel analysis. We found that in spite of the provision of health facilities at each level of administrative governance, only distance to the Upazilla Health Complex was a consistent predictor for each dose of vaccine, highlighting the remote locations of the communities that remain underserved. Our analysis demonstrates the value of subregional analyses that identify the characteristics of communities that are vulnerable to incomplete immunization coverage. Unless specific policy actions are taken to increase coverage in these remote areas, geographic inequities are likely to persist within regions, and desired targets will not be achieved.

scholarly journals CLINICAL MANIFESTATIONS OF SARCOIDOSIS ON THE PROLABIUM AND ORAL MUCOSA: MANAGEMENT

2018 ◽  
pp. 34-36
Author(s):  
P.M. Skrypnikov ◽  
T.P. Skrypnikova ◽  
Yu.M. Vitko
Keyword(s):  
Oral Cavity ◽  
Oral Mucosa ◽  
Correct Diagnosis ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Morbidity Rate ◽  
Unknown Etiology ◽  
Toxic Substances ◽  
Male Population ◽  
Female Population

The statistics indicates on the tendency of morbidity rate of sarcoidosis to increase. The pathology affects young and older people notably. Sarcoidosis becomes a common chronic disease, which is often difficult to diagnose. Insufficient experience in recognition of this disease leads to misdiagnosis and ineffective treatment. All mentioned above highlights the extreme relevance of this issue. Sarcoidosis is a multisystem inflammatory nature disease of unknown etiology. The hereditary predisposition is taken to be but the whole family cases are also known. An abnormal immune response is also considered among the theories of the development of the disease. The infectious factor is also regarded as the cause of the disease. The increasing activity of lymphocytes, which start to produce substances promoting the formation of the granulomas, which are considered to be the basis for the pathological process, can initiate the onset of the disease. The maximum morbidity rate of sarcoidosis is observed between the ages of 35 to 55 years. Two age periods of the peak in male population are 35-40 years and about 55 years. The rate of sarcoidosis morbidity among female population is 65%. Up to 700 new cases of sarcoidosis are registered in Ukraine annually. The clinical signs of sarcoidosis vary. This pathology is more often manifested by the bilateral lymphadenopathy of lung roots, eyes and skin lesions. The liver, spleen, lymph nodes, heart, nervous system, muscles, bones and other organs can also be affected. In dental practice sarcoidosis can be manifested on the prolabium, oral mucosa and salivary glands. Blood laboratory indices (the increased level of calcium) are changed in sarcoidosis. Chest X-ray, MRI and CT also demonstrate changes in the lungs. The test for detection of granulomas shows positive Kveim reaction (the formation of purple-red nodules due to administration of antigen). Biopsy and bronchoscopy facilitate detection of both direct and indirect signs of sarcoidosis of the lungs. A general treatment of sarcoidosis is provided by a pulmonologist, who can assess the severity of the lesion and provide appropriate treatment. The core of treatment is based on corticosteroids. In severe cases immunosuppressors, anti-inflammatory drugs, antioxidants are prescribed. A dentist performs oral cavity sanation, professional hygiene. Mouth rinses with Dekasan solution, sublingual Lisobakt pills are prescribed to prevent inflammatory lesions. Patients with sarcoidosis are recommended to avoid solar radiation and contact with chemical and toxic substances harmful to the liver, reduction of the consumption of foods rich in calcium. Healthy life-style is crucial in prevention of exacerbations of sarcoidosis. In the remission period regular medical check-ups and oral cavity sanation are recommended. The correct diagnosis in rare diseases requires highly qualified dental professionals, the interdisciplinary approach in the diagnosing and management of patients with this pathology.

scholarly journals Assessment of the factors influencing primary care physicians’ approach to vaccination of adult risk groups in Istanbul, Turkey

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e7516
Author(s):  
Fatma Yılmaz Karadağ ◽  
Zuhal Aydan Sağlam
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Medical Training ◽  
Risk Group ◽  
Risk Groups ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Factors Influencing ◽  
Demographical Data ◽  
Adult Immunization

Background We aimed to assess the factors influencing primary care physicians’ (PCPs) approach to adult vaccination in specific risk groups and evaluate the compliance to adult immunization guidelines. Methods This cross-sectional study performed between January 2016 and April 2016 in İstanbul, Turkey. A questionnaire designed to obtain physicians’ demographical data, experience, immunization status, and attitude on prescribing or recommending vaccines for adults in the risk group. Healthy individuals older than 65 and patients suffer from chronic diseases or had splenectomy before are considered as a risk group. The questionnaire was sent via email to a randomly selected group of 1,500 PCPs. The data of 221 physicians who responded emails were recorded for statistical analysis. Results Of the 221 participants (123 women, 98 men), the majority were aged 31–40 years. Their vaccination rates were 74.2% for hepatitis B, 54.3% for seasonal influenza, and 47.1% for tetanus. Among participants, the highest recommendation and prescription rate of adult vaccines was recorded in PCPs aged 31–40 years. In addition, PCPs with <10 years occupational experience were found to prescribe adult vaccines more frequently than PCPs with longer occupational experience. Conclusions Primary care physicians with lower age and relatively less experience are more intent to prescribe adult vaccines to patients that are in risk groups. This result may be due to increased awareness of adult immunization among PCPs who had more recent medical training. However, many other factors could have caused this difference, including physicians’ approach to primary medical care.

Apparent Meningococcemia: Clinical Features of Disease Due to Haemophilus influenzae and Neisseria meningitidis

PEDIATRICS ◽  
1983 ◽  
Vol 72 (4) ◽  
pp. 469-472
Author(s):  
Richard F. Jacobs ◽  
Steven Hsi ◽  
Christopher B. Wilson ◽  
Denis Benjamin ◽  
Arnold L. Smith ◽  
...  
Keyword(s):  
Haemophilus Influenzae ◽  
Neisseria Meningitidis ◽  
Meningococcal Disease ◽  
Clinical Signs ◽  
Meningococcal Infection ◽  
Disseminated Intravascular Coagulopathy ◽  
Etiologic Agents ◽  
Intravascular Coagulopathy ◽  
Time Of Admission ◽  
Mean Time

To determine the etiology of apparent meningococcemia, all cases of sepsis with coagulopathy, purpura, and/or adrenal hemorrhage (Waterhouse-Friderichsen syndrome) with and without shock occurring over a 12-year period were reviewed. A total of 42 cases were identified; 30 cases were caused by Neisseria meningitidis and 12 cases were caused by Haemophilus influenzae. Compared with patients with disease caused by H influenzae, patients with meningococcal disease were older, more often male, more often contracted the disease in winter-spring, and had a longer duration of antecedent symptoms; however, none of these differences was statistically significant. All patients were febrile (&gt;38°C) and appeared toxic. Similar proportions in each group had shock and disseminated intravascular coagulopathy at the time of admission. Ten of 12 patients with H influenzae infection compared with 15/30 (P &lt; .05) with meningococcal infection were lethargic or comatose at the time of admission. Nine of 12 patients with H influenzae infection died compared with 5/30 with meningococcal disease (P &lt; .005); the mean time from onset of symptoms to death with H influenzae infection (20.7 ± 11.4 [SE] hours) was significantly shorter (P &lt; .05) than with meningococcal infection (120 ± 74.4 hours). Children with clinical signs of sepsis and with purpura, petechiae, or coagulopathy may have N meningitidis or H influenzae as etiologic agents. Initial antibiotic therapy should be directed against these pathogens.

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