scholarly journals Reduction in Severity of All-Cause Gastroenteritis Requiring Hospitalisation in Children Vaccinated against Rotavirus in Malawi

Viruses ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2491
Author(s):  
Jonathan J. Mandolo ◽  
Marc Y. R. Henrion ◽  
Chimwemwe Mhango ◽  
End Chinyama ◽  
Richard Wachepa ◽  
...  
Keyword(s):  
Severity Score ◽  
Rotavirus Vaccine ◽  
Rt Pcr ◽  
Arm Circumference ◽  
Severity Scores ◽  
Severe Gastroenteritis ◽  
Stool Samples ◽  
One Year ◽  
Mid Upper Arm Circumference ◽  
The Impact

Rotavirus is the major cause of severe gastroenteritis in children aged <5 years. Introduction of the G1P[8] Rotarix® rotavirus vaccine in Malawi in 2012 has reduced rotavirus-associated hospitalisations and diarrhoeal mortality. However, the impact of rotavirus vaccine on the severity of gastroenteritis presented in children requiring hospitalisation remains unknown. We conducted a hospital-based surveillance study to assess the impact of Rotarix® vaccination on the severity of gastroenteritis presented by Malawian children. Stool samples were collected from children aged <5 years who required hospitalisation with acute gastroenteritis from December 2011 to October 2019. Gastroenteritis severity was determined using Ruuska and Vesikari scores. Rotavirus was detected using enzyme immunoassay. Rotavirus genotypes were determined using nested RT-PCR. Associations between Rotarix® vaccination and gastroenteritis severity were investigated using adjusted linear regression. In total, 3159 children were enrolled. After adjusting for mid-upper arm circumference (MUAC), age, gender and receipt of other vaccines, all-cause gastroenteritis severity scores were 2.21 units lower (p < 0.001) among Rotarix®-vaccinated (n = 2224) compared to Rotarix®-unvaccinated children (n = 935). The reduction in severity score was observed against every rotavirus genotype, although the magnitude was smaller among those infected with G12P[6] compared to the remaining genotypes (p = 0.011). Each one-year increment in age was associated with a decrease of 0.43 severity score (p < 0.001). Our findings provide additional evidence on the impact of Rotarix® in Malawi, lending further support to Malawi’s Rotarix® programme.

scholarly journals Reduction in severity of all-cause gastroenteritis requiring hospitalisation in children vaccinated against rotavirus in Malawi

2021 ◽  
Author(s):  
Jonathan J Mandolo ◽  
Marc Henrion ◽  
Chimwemwe Mhango ◽  
End Chinyama ◽  
Richard Wachepa ◽  
...  
Keyword(s):  
Low Income ◽  
Severity Score ◽  
Age Groups ◽  
Rotavirus Vaccine ◽  
Low Income Country ◽  
Arm Circumference ◽  
Severity Scores ◽  
Severe Gastroenteritis ◽  
One Year ◽  
Mid Upper Arm Circumference

Background: Rotavirus is the major cause of severe gastroenteritis in children aged <5 years. Introduction of Rotarix rotavirus vaccine (RV1) in Malawi in 2012 has reduced rotavirus-associated hospitalisations and diarrhoeal mortality. However, RV1 impact on gastroenteritis severity remains unknown. We conducted a hospital-based surveillance study to assess RV1 impact on gastroenteritis severity in children aged <5 years, in Malawi. Methods: Stool samples were collected from children hospitalised with acute gastroenteritis from December 2011 to October 2019. Gastroenteritis severity was determined using Ruuska and Vesikari scores. Rotavirus was detected in stool using Enzyme Immunoassay. Rotavirus genotypes were determined using nested RT-PCR. Associations between RV1 vaccination and gastroenteritis severity were investigated using adjusted linear regression. Results: In total, 3,159 children were recruited. After adjusting for Mid-Upper Arm Circumference, age, weight, gender and receipt of other vaccines, all-cause gastroenteritis severity scores were 2.21 units lower (95% CI 1.85, 2.56; p<0.001) among RV1-vaccinated (n=2,224) compared to RV1-unvaccinated children (n=935); the decrease was comparable between rotavirus-positive and rotavirus-negative cases in all age groups. The reduction in severity score was observed against every rotavirus genotype, although the magnitude was smaller among those infected with G12P[6] compared to the remaining genotypes (p=0.011). Other than RV1 vaccination, age was the only variable associated with gastroenteritis severity. Each one-year increment in age was associated with a decrease of 0.43 severity score (95% CI 0.26, 0.60; p<0.001). Conclusion: Our findings provide additional evidence of RV1 impact in a high disease burden, low-income country, lending further support to rotavirus vaccine programme in Malawi.

scholarly journals The impact of intensive care admission criteria on elderly mortality

2019 ◽  
Vol 65 (7) ◽  
pp. 1015-1020 ◽  
Author(s):  
Marco Túlio Gualberto Cintra ◽  
Dinah Belém ◽  
Edgar Nunes Moraes ◽  
Fernando Antônio Botoni ◽  
Maria Aparecida Camargos Bicalho
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Severity Score ◽  
Intensive Therapy ◽  
The Elderly ◽  
Admission Criteria ◽  
Severity Scores ◽  
Retrospective Cohort Studies ◽  
The Impact

SUMMARY OBJECTIVE To review systematically the influence of admission criteria on the mortality of elderly patients under intensive therapy. METHODS We performed a search on the PUBMED and BIREME databases by using the MeSH and DeCS terms “intensive care units”, “patient admission”, and “aged” in Portuguese, English, and Spanish. Only prospective and retrospective cohort studies were included. We analyzed the severity score, type of hospital admission, quality of life, co-morbidities, functionality, and elderly institutionalization. RESULTS Of the 1,276 articles found, thirteen were selected after evaluation of the inclusion and exclusion criteria. It was observed that the severity score, functionality, and co-morbidities had an impact on mortality. It was not possible to determine which severity score was more suitable. CONCLUSION We suggest that analysis of functionality, co-morbidities, and severity scores should be conducted to estimate the elderly mortality in relation to the admission to intensive care units.

scholarly journals Potential consequences of expanded MUAC-only programs on targeting of acutely malnourished children and ready-to-use-therapeutic-food allocation: lessons from cross-sectional surveys

2019 ◽  
Author(s):  
Benjamin Guesdon ◽  
Alexia Couture ◽  
Danka Pantchova ◽  
Oleg Bilukha
Keyword(s):  
A Priori ◽  
Acute Malnutrition ◽  
Case Definitions ◽  
Cross Sectional ◽  
Number Of Children ◽  
Malnourished Children ◽  
Arm Circumference ◽  
Mid Upper Arm Circumference ◽  
The Impact ◽  
Therapeutic Food

Abstract Background: Some of the recently piloted innovative approaches for the management of acute malnutrition in children use the “expanded MUAC-only” approach, with Mid Upper Arm Circumference (MUAC) <125mm as the sole anthropometric criterion for screening and admission, classification of cases as severe using the 115mm cut-off, and use Ready-to-Use-Therapeutic-Food (RUTF) for the management of both moderate (MAM) and severe (SAM) cases of acute malnutrition. Our study aimed at exploring the potential consequences of this “expanded MUAC-only” program scenario on the eligibility for treatment and RUTF allocation, as compared with the existing WHO normative guidance. Methods: We analyzed data from 550 population representative cross-sectional cluster surveys conducted since 2007. We retrieved all children classified as SAM and MAM according to currently used case definitions, and calculated the proportions of SAM children who would be excluded from treatment, misclassified as MAM, or whose specific risks (because of having both MUAC and weight-for height deficits) would be ignored. We also analyzed the expected changes in the number and demographics (sex, age) of children meant to receive RUTF according to the new approach. Results: We found that approximately one quarter of SAM children would not be detected and eligible for treatment under the “expanded MUAC-only” scenario, and another 20% would be classified as MAM. A further 17% of the total SAM children would be admitted and followed only according to their MUAC or oedema status, while they also present with a severe weight-for height deficit on admission. Considering MAM targeting, about half of the MAM children would be left undetected. This scenario also shows a 2.5 time increase in the number of children targeted with RUTF, with approximately 70% of MAM and 30% of SAM cases among this new RUTF target. Conclusions: This empirical evidence suggests that adoption of “expanded MUAC-only” programs would likely lead to a priori exclusion from treatment or misclassifying as MAM a large proportion of SAM cases, while redirecting programmatic costs in favor of those less in need. It underscores the need to explore other options for improving the impact of programs addressing the needs of acutely malnourished children.

scholarly journals Comparison of chest HRCT severity score in PCR positive and PCR negative clinically suspected COVID-19 Patients

2021 ◽  
Vol 21 (4) ◽  
pp. 1558-66
Author(s):  
Hina Hanif Mughal ◽  
Syed Muhammad Jawad Zaidi ◽  
Hamza Waqar Bhatti ◽  
Madiha Maryum ◽  
Maria Khaliq ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Severity Score ◽  
Clinical Symptoms ◽  
False Negative ◽  
Left Lung ◽  
Lung Damage ◽  
Rt Pcr ◽  
Chain Reaction ◽  
Severity Scores ◽  
Polymerase Chain

Background: The limitations and false-negative results of Real-time Polymerase chain reaction (RT PCR) in diagnosing COVID-19 infection demand the need for imaging modalities such as chest HRCT to improve the diagnostic accuracy andassess the severity of the infection. Objectives: The study aimed to compare the chest HRCT severity scores in RT-PCR positive and negative cases of COVID-19. Methods: This cross-sectional study included 50 clinically suspected COVID-19 patients. Chest HRCT and PCR testing of all 50 patients were done and the chest HRCT severity scores for each lung and bronchopulmonary segments were compared in patients with positive and negative PCR results. Chi-square and Mann Whitney U test were used to assess differences among study variables. Results: Chest HRCT severity score was more in PCR negative patients than in those with PCR positive results . However, the difference was not significant (p=0.11). There was a significant association in severity scores of the anterior basal segment of the left lung (p=0.022) and posterior segment upper lobe of right lung (p=0.035) with PCR results. This association was insignificantfor other bronchopulmonary segments (p>0.05). Conclusion: CR negativity does not rule out infection in clinically suspected COVID-19 patients. The use of chest HRCT helps to determine the extent of lung damage in clinically suspected patients irrespective of PCR results. Guidelines that consider clinical symptoms, chest HRCT severity score and PCR results for a confirmed diagnosis of COVID-19 in suspected patientsare needed. Keywords: Chest High resolution computed tomography (HRCT); COVID-19; Polymerase Chain Reaction (PCR).

scholarly journals Nutritional Status of the Underfive Children at The Pediatric Ward of Dr. Pirngadi Hospital, Medan

2019 ◽  
Vol 32 (5-6) ◽  
pp. 135-43
Author(s):  
Kaswadharma K. C. ◽  
Arizal Arizal ◽  
Endang D. Hamid ◽  
Iskandar Z. Lubis ◽  
Sjarika T. Tarigan
Keyword(s):  
Observational Study ◽  
Nutritional Status ◽  
Severe Malnutrition ◽  
Upper Arm ◽  
Supplementary Food ◽  
Pediatric Ward ◽  
Arm Circumference ◽  
Duration Of Hospitalization ◽  
One Year ◽  
Mid Upper Arm Circumference

An observational study on the assesment of nutritional status of the underfive children at the pediatric ward of Dr. Pirngadi hospital, Medan was conducted during February to March 1990. Nutritional status was determined usi11.g the parameters of Weight/Age (WIA), Weight/Height (WIH) and Mid upper Arm Circumference (MUAC) in accordance with the Seminar on Nutritional Anthropometry 1975. One-hundred and eighty patients were included in this study, consisting of 115 (67, 6%) children less than one year and 65 (32, 4%) children 1 - 5 years. According to the Weight/Age parameter there were 46.7% wellnourished children 42.8% with moderate and 10.5% with severe malnutrition on admission, while on discharge they were 48.3%, 42.8% and 8.9% (p > 0.05) respectively. Weight/Height and Mid upper Arm Circumference parameters also failed to reveal significant differences. The duration of hospitalization ranged from 1 to 3 0 days (mean 5 days). The most predominant disease was gastroenteritis with dehydration (68.9%). In 54.4% of patients, breast-feeding had been given until 6 month of age, while supplementary food starting before the age of 2 months was found in 52.2% . The incidence of undernutrition in underfive children was high.

scholarly journals Correlation between Chest CT Severity Scores and the Clinical Parameters of Adult Patients with COVID-19 Pneumonia

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Ghufran Aref Saeed ◽  
Waqar Gaba ◽  
Asad Shah ◽  
Abeer Ahmed Al Helali ◽  
Emadullah Raidullah ◽  
...  
Keyword(s):  
Severity Score ◽  
Length Of Hospital Stay ◽  
Chest Ct ◽  
Clinical Severity ◽  
Rt Pcr ◽  
Original Cohort ◽  
Severity Scores ◽  
The Mean ◽  
Oxygen Requirements ◽  
Serum Crp

Purpose. Our aim is to correlate the clinical condition of patients with COVID-19 infection with the 25-point CT severity score by Chang et al. (devised for assessment of ARDS in patients with SARS in 2005). Materials and Methods. Data of consecutive symptomatic patients who were suspected to have COVID-19 infection and presented to our hospital were collected from March to April 2020. All patients underwent two consecutive RT-PCR tests and had a noncontrast HRCT scan done at presentation. From the original cohort of 1062 patients, 160 patients were excluded leaving a total number of 902 patients. Results. The mean age was 44.2 ± 11.9 years (85.3% males, 14.7% females). CT severity score was found to be positively correlated with lymphopenia, increased serum CRP, d-dimer, and ferritin levels ( p < 0.0001 ). The oxygen requirements and length of hospital stay were increasing with the increase in scan severity. Conclusion. The 25-point CT severity score correlates well with the COVID-19 clinical severity. Our data suggest that chest CT scoring system can aid in predicting COVID-19 disease outcome and significantly correlates with lab tests and oxygen requirements.

scholarly journals Very Early Anthropometric Changes After Antiretroviral Therapy Predict Subsequent Survival, in Karonga, Malawi

2012 ◽  
Vol 6 (1) ◽  
pp. 36-44 ◽  
Author(s):  
David Maman ◽  
Judith R Glynn ◽  
Amelia C Crampin ◽  
Katharina Kranzer ◽  
Jacqueline Saul ◽  
...  
Keyword(s):  
Large Scale ◽  
Cox Regression ◽  
Scale Up ◽  
First Year ◽  
Clinical Criteria ◽  
Arm Circumference ◽  
Stage 4 ◽  
Detailed Assessment ◽  
One Year ◽  
Mid Upper Arm Circumference

Background: Antiretroviral (ART) scale-up in Malawi has been achieved on a large scale based mainly on clinical criteria. Simple markers of prognosis are useful, and we investigated the value of very early anthropometric changes in predicting mortality. Methods: Principal findings: Adult patients who initiated ART in Karonga District, northern Malawi, between September 2005 and August 2006 were included in a prospective cohort study, and followed for up to one year. We used Cox regression to examine the association between anthropometric changes at 2 and 6 weeks and deaths within the first year. 573 patients were included, of whom 59% were women; the median age at initiation was 37 and 64% were in WHO stage 4. Both body mass index (BMI) and mid-upper arm circumference (MUAC) increased linearly with increased time on ART, and were closely correlated with each other. There were 118 deaths. After 2 weeks on ART, a BMI increase of <0.5 kg/m2 (HR 2.47, 95%CI 1.24-4.94, p=0.005) or a MUAC increase of <0.5cm (HR 2.79, 95%CI 1.19-6.55, p=0.008) were strong predictors of death, and these associations were stronger after adjusting for baseline charactertistics. Similar results were found after 6 weeks on ART. Conclusions: Very early anthropometric changes, after 2 and 6 weeks on ART, are strong predictors of survival, independent of baseline characteristics. This should help identify patients requiring more detailed assessment where facilities are limited. MUAC is particularly valuable, requiring the simplest equipment and being appropriate for patients who have problems standing.

scholarly journals Epidemiological Trends of Five Common Diarrhea-Associated Enteric Viruses Pre- and Post-Rotavirus Vaccine Introduction in Coastal Kenya

Pathogens ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. 660
Author(s):  
Arnold W. Lambisia ◽  
Sylvia Onchaga ◽  
Nickson Murunga ◽  
Clement S. Lewa ◽  
Steven Ger Nyanjom ◽  
...  
Keyword(s):  
Rainy Season ◽  
Hospitalized Children ◽  
Rotavirus Vaccine ◽  
Rt Pcr ◽  
Vaccine Introduction ◽  
Coastal Kenya ◽  
Group A ◽  
Stool Samples ◽  
Norovirus Gii ◽  
Epidemiological Trends

Using real-time RT-PCR, we screened stool samples from children aged <5 years presenting with diarrhea and admitted to Kilifi County Hospital, coastal Kenya, pre- (2003 and 2013) and post-rotavirus vaccine introduction (2016 and 2019) for five viruses, namely rotavirus group A (RVA), norovirus GII, adenovirus, astrovirus and sapovirus. Of the 984 samples analyzed, at least one virus was detected in 401 (40.8%) patients. Post rotavirus vaccine introduction, the prevalence of RVA decreased (23.3% vs. 13.8%, p < 0.001) while that of norovirus GII increased (6.6% vs. 10.9%, p = 0.023). The prevalence of adenovirus, astrovirus and sapovirus remained statistically unchanged between the two periods: 9.9% vs. 14.2%, 2.4% vs. 3.2 %, 4.6% vs. 2.6%, (p = 0.053, 0.585 and 0.133), respectively. The median age of diarrhea cases was higher post vaccine introduction (12.5 months, interquartile range (IQR): 7.9–21 vs. 11.2 months pre-introduction, IQR: 6.8–16.5, p < 0.001). In this setting, RVA and adenovirus cases peaked in the dry months while norovirus GII and sapovirus peaked in the rainy season. Astrovirus did not display clear seasonality. In conclusion, following rotavirus vaccine introduction, we found a significant reduction in the prevalence of RVA in coastal Kenya but an increase in norovirus GII prevalence in hospitalized children.

Sign in / Sign up

Export Citation Format

Share Document