Similar severity of influenza primary and re-infections in pre-school children requiring outpatient treatment due to febrile acute respiratory illness: prospective, multicentre surveillance study (2013–2015)

Background Influenza virus infections in immunologically naïve children (primary infection) may be more severe than in children with re-infections who are already immunologically primed. We compared frequency and severity of influenza virus primary and re-infections in pre-school children requiring outpatient treatment. Methods Influenza-unvaccinated children 1–5 years of age presenting at pediatric practices with febrile acute respiratory infection < 48 h after symptom onset were enrolled in a prospective, cross-sectional, multicenter surveillance study (2013–2015). Influenza types/subtypes were PCR-confirmed from oropharyngeal swabs. Influenza type/subtype-specific IgG antibodies serving as surrogate markers for immunological priming were determined using ELISA/hemagglutination inhibition assays. The acute influenza disease was defined as primary infection/re-infection by the absence/presence of influenza type-specific immunoglobulin G (IgG) and, in a second approach, by the absence/presence of subtype-specific IgG. Socio-demographic and clinical data were also recorded. Results Of 217 influenza infections, 178 were due to influenza A (87 [49%] primary infections, 91 [51%] re-infections) and 39 were due to influenza B (38 [97%] primary infections, one [3%] re-infection). Children with “influenza A primary infections” showed fever with respiratory symptoms for a shorter period than children with “influenza A re-infections” (median 3 vs. 4 days; age-adjusted p = 0.03); other disease characteristics were similar. If primary infections and re-infections were defined based on influenza A subtypes, 122 (87%) primary infections (78 “A(H3N2) primary infections”, 44 “A(H1N1)pdm09 primary infections”) and 18 (13%) re-infections could be classified (14 “A(H3N2) re-infections” and 4 “A(H1N1)pdm09 re-infections”). Per subtype, primary infections and re-infections were of similar disease severity. Children with re-infections defined on the subtype level usually had non-protective IgG titers against the subtype of their acute infection (16 of 18; 89%). Some patients infected by one of the influenza A subtypes showed protective IgG titers (≥ 1:40) against the other influenza A subtype (32/140; 23%). Conclusions Pre-school children with acute influenza A primary infections and re-infections presented with similar frequency in pediatric practices. Contrary to expectation, severity of acute “influenza A primary infections” and “influenza A re-infections” were similar. Most “influenza A re-infections” defined on the type level turned out to be primary infections when defined based on the subtype. On the subtype level, re-infections were rare and of similar disease severity as primary infections of the same subtype. Subtype level re-infections were usually associated with low IgG levels for the specific subtype of the acute infection, suggesting only short-time humoral immunity induced by previous infection by this subtype. Overall, the results indicated recurring influenza virus infections in this age group and no or only limited heterosubtypic antibody-mediated cross-protection.

Fosfomycin versus Ertapenem for Outpatient Treatment of Complicated Urinary Tract Infections: A Multicenter, Retrospective Cohort Study

Objectives We sought to determine the comparative efficacy of fosfomycin vs. ertapenem for outpatient treatment of complicated urinary tract infections (cUTI). Methods We conducted a multi-centered, retrospective cohort study involving patients with cUTI treated with outpatient oral fosfomycin vs. intravenous ertapenem at three public hospitals in Los Angeles County between January 2018 and September 2020. The primary outcome was resolution of clinical symptoms 30 days after diagnosis. Results We identified 322 patients with cUTI treated with fosfomycin (n = 110) or ertapenem (n = 212) meeting study criteria. Study arms had similar demographics, although patients treated with ertapenem more frequently had pyelonephritis or bacteremia while fosfomycin-treated patients had more retained catheters, nephrolithiasis, or urinary obstruction. Most infections were due to extended-spectrum β-lactamase-producing E. coli and Klebsiella pneumoniae; 80-90% of which were resistant to other oral options. Adjusted odds ratios for clinical success at 30 days, clinical success at last follow up, and relapse were 1.21 (0.68 to 2.16), 0.84 (0.46 to 1.52), and 0.94 (0.52 to 1.70), for fosfomycin vs. ertapenem, respectively. Patients treated with fosfomycin had significant reductions in length of hospital stay and length of antimicrobial therapy, and fewer adverse events (1 vs. 10). Fosfomycin outcomes were similar irrespective of duration of lead-in IV therapy or fosfomycin dosing interval (daily, every other day, every third day). Conclusion These results would support the conduct of a randomized controlled trial to verify efficacy. In the meantime, they suggest fosfomycin may be a reasonable stepdown from IV antibiotics for cUTI.

Yoga in Psychiatry: feasibility of a yoga-intervention for severely affected children and young adults with non-internalizing psychiatric disorders

Yoga-based interventions are increasingly being introduced to improve the lives of individuals with widely varying psychiatric diagnoses and symptoms. We developed a yoga-program for two severely affected populations at our psychiatric department: young adults with psychosis from our inpatient clinic, and children with severe developmental disorders and/or behavioral problems from our inpatient clinic or outpatient treatment program. The participants, clinic staff and yoga-instructors assessed the feasibility of our yoga program. They participated in evaluation meetings and gave feedback. Participants also filled in an evaluation form before and after every session. Results showed that our yoga-program is feasible for severely affected populations. The program can and should be tailored to meet the differing needs of individuals. Participants benefitted from and enjoyed sessions and reported feeling calmer, more goal-oriented and more relaxed after the sessions.

Influence of outpatient treatment newly diagnosed pulmonary tuberculosis on the development of familial tuberculosis (epidemic situation)

The incidence of tuberculosis in our country, according to statistics, seems to be declining. However, it should be remembered that the figures of the Crimean Autonomous Republic and the temporarily occupied territories of Donetsk and Luhansk oblasts are excluded from the digital data. Of particular concern are the significant worldwide morbidity and infant mortality rate of 700 people per day.The problem’s urgency is due to the data and the increase in the number of patients with common and destructive forms of pulmonary tuberculosis. The leading factor is the constant increase in the number of patients with multidrug­resistant conditions, the effectiveness of treatment of which does not reach 50%. In comparison, the WHO considers the critical limit for stabilizing the epidemic situation «effective treatment» at 85 %. Objective — to study the features of familial tuberculosis on the background of outpatient treatment of patients with newly diagnosed tuberculosis. Materials and methods. We observed 157 families with various forms of pulmonary tuberculosis. Radiation, bacteriological, immuno­genetic methods were used in the examination. Family members were examined every six months. Results and discussion. Among the TB contacts after this period, tuberculosis was found in 162 people. Sources of tuberculosis (157) were bacillary in 49.7 %, TB contacts — in 43.8 %. Among patients in the group of heads of tuberculosis, there were 28 (35.9 %) people on MRTB, and in the group of TB contacts — 32 (45.1 %), р < 0.05. Thus, tuberculosis’s cause in TB contacts was not isolated from the family of patients with newly diagnosed tuberculosis. Conclusions. Based on the results obtained, it is safe to say that if at least fixed bacillary patients were hospitalized, there could be no family TB contact patients. Comparing all sources of tuberculosis patients (157), it can be imagined that cases of familial tuberculosis (162) could be avoided. Nature «responded» to ignoring one part of the epidemic process (transmission of infection that increases with contact) by increasing the number of patients with familial tuberculosis by 5 people. We note: it was only about the Sumy region and only for a limited time.

Causes and Management of Acute Pyelonephritis

Acute pyelonephritis is a bacterial infection that causes kidney inflammation. Pyelonephritis is a kidney infection that develops as a result of an ascending urinary tract infection that travels from the bladder to the kidneys. Acute pyelonephritis affects over 250,000 people each year, resulting in more than 100,000 hospitalizations. Infection with Escherichia coli is the most prevalent cause. Fever, vomiting, abdomen or loin discomfort, and fatigue are all symptoms of acute pyelonephritis, however Fever is the most clinically useful symptom. Escherichia coli is the causative agent in more than 80% of instances of acute pyelonephritis. Staphylococcus saprophyticus, and enterococci are among the other etiologic factors. While Infections caused by Klebsiella, Enterobacter, Clostridium, or Candida are more common in diabetic patients. Acute pyelonephritis can be treated as an outpatient or as an inpatient procedure. Outpatient treatment is available for healthy, young, non-pregnant women with uncomplicated pyelonephritis. The choice of first-line oral antibiotics depends on local antibiotic resistance characteristics, although trimethoprim alone or in combination with sulphamethoxazole, cephalexin, or amoxicillin-clavulanic acid. In this article we will be looking the causes and management of acute pyelonephritis.

Orally administered epeleuton inhibits SARS-CoV-2 viral load, replication and pathology in the Syrian Hamster model

Early treatment of patients with confirmed COVID-19 presenting mild symptoms can reduce the number that progress to more severe disease and require hospitalization. Considering the potential for the development of drug resistance to existing therapies and the emergence of new SARS-CoV-2 variants, there is a need for an expanded armamentarium of treatment options for COVID-19. Epeleuton is a novel orally administered second-generation n-3 fatty acid with potential direct antiviral and immunomodulatory actions, and a favourable clinical safety profile. In this study we show that epeleuton inhibits SARS-CoV-2 infectious viral load, replication and disease pathology in the lungs and upper airways in the Syrian hamster model of SARS-CoV-2 infection. These data support the potential utility of epeleuton in the early treatment and prevention of SARS-CoV-2 infection. Clinical trials are needed to evaluate the efficacy of epeleuton as an outpatient treatment and prevention of COVID-19.

Effectiveness and Coverage of Treatment for Severe Acute Malnutrition Delivered by Community Health Workers in the Guidimakha Region, Mauritania

Geographical and economic access barriers to health facilities (HF) have been identified as some of the most important causes of the low coverage of severe acute malnutrition (SAM) treatment. The objective of this study is to assess the effectiveness and coverage of SAM treatment delivered by community health workers (CHWs) in the Guidimakha region in Mauritania, compared to the HF based approach. This study was a nonrandomized controlled trial, including two rural areas. The control group received outpatient treatment for uncomplicated SAM from HF, whilst the intervention group received outpatient treatment for uncomplicated SAM from HF or CHWs. A total of 869 children aged 6–59 months with SAM without medical complications were included in the study. The proportion of cured children was 82.3% in the control group, and 76.4% in the intervention group, we found no significant difference between the groups. Coverage in the intervention zone increased from 53.6% to 71.7%. In contrast, coverage remained at approximately 44% in the control zone from baseline to end-line. This study is the first to demonstrate in Mauritania that the decentralization model of CHWs treating SAM improves acute malnutrition treatment coverage and complies with the international quality standards for community treatment of acute malnutrition. The non-randomized study design may limit the quality of the evidence, but these results could be used by political decision-makers as a first step in revising the protocol for acute malnutrition management.