Clinical presentations, diagnostics, treatments and treatment costs of children and adults with febrile illness in a tertiary referral hospital in south-eastern Guinea: A retrospective longitudinal cohort study

Background Febrile illness is frequent among patients in the tropics. It is caused by a wide variety of common diseases such as malaria or gastrointestinal infections but also by less common but highly contagious pathogens with epidemic potential. This study describes the clinical features of adult and paediatric patients with febrile illness in in the largest tertiary referral hospital in south-eastern Guinea, a region at high risk for viral haemorrhagic fever outbreaks. The study further compares their diagnostic characteristics, treatments and outcomes with non-febrile patients in order to contribute to the local epidemiology of febrile illness. Methods We used retrospective data collection to record demographic and clinical data of all incoming patients during a study period of three months. For the follow-up study of inpatients, we retrospectively reviewed patient charts for diagnostic characteristics, diagnoses and outcomes. Results Of the 4317 incoming patients during the study period, 9.5% had a febrile illness. The most used diagnostic measures to identify causative agents in febrile patients were point-of-care tests and most treatments relied on antibiotics. Most common discharge diagnoses for febrile inpatients were malaria (9.6% adults, 56.7% children), salmonella gastroenteritis/typhoid (10.6% adults, 7.8% children) and respiratory infection/pneumonia (5.3% adults, 18.7% children). Inpatient mortality for children was significantly higher in febrile than non-febrile children (18.5% vs. 5.1%, p<0.001) and considerably higher in febrile than non-febrile adults (29.8% vs. 25.0%, p = 0.404). Conclusions Malaria, respiratory infection and gastroenteritis are considered the main causes for febrile illness. The wide reliance on rapid diagnostic tests to diagnose febrile patients not only risks to over- or under-diagnose certain diseases but also leaves the possibility of highly infectious diseases in febrile patients unexplored. Furthermore, the heavy reliance on antibiotics risks to cause antimicrobial resistance. High mortality rates in febrile patients, especially children, should be of concern to public health authorities.

Novel volumetric capnography indices measure ventilation inhomogeneity in cystic fibrosis

BackgroundVolumetric capnography (VCap) is a simpler alternative of multiple-breath washout (MBW) to detect ventilation inhomogeneity (VI) in patients with cystic fibrosis (CF). However, its diagnostic performance is influenced by breathing dynamics. We introduce two novel VCap indices, the Capnographic Inhomogeneity Indices (CIIs) that may overcome this limitation and explore their diagnostic characteristics in a cohort of CF patients.MethodsWe analysed 320 N2-MBW trials from 50 CF patients and 65 controls (age 4-18 years) and calculated classical VCap indices, such as slope III (SIII) and the capnographic index (KPIv). We introduced novel CIIs based on a theoretical lung model, and assessed their diagnostic performance compared to classical VCap indices and the lung clearance index (LCI).ResultsBoth CIIs were significantly higher in CF patients compared with controls (mean±SD CII1 5.9±1.4% versus 5.1±1.0%, p=0.002; CII2 7.7±1.8% versus 6.8±1.4%, p=0.002) and presented strong correlation with LCI (CII1 R2=0.47 and CII2 R2=0.44 in CF patients). Classical VCap indices showed inferior discriminative ability (SIII 2.3±1.0%/L versus 1.9±0.7%/L, P=0.013; KPIv 3.9±1.3% versus 3.5±1.2%, P=0.071), while the correlation with LCI was weak (SIII R2=0.03; KPIv R2=0.08 in CF patients). CIIs showed lower intra-subject inter-trial variability, calculated as coefficient of variation for three and relative difference for two trials, than classical VCap indices, but higher than LCI (CII1 11.1±8.2% and CII2 11.0±8.0% versus SIII 16.3±13.5%; KPIv 15.9±12.8%; LCI 5.9%±4.2%).ConclusionCIIs detect VI better than classical VCap indices and correlate well with LCI. However, further studies on their diagnostic performance and clinical utility are required.

Three New Species and One New Record of Hesperoschema (Coleoptera: Staphylinidae: Staphylininae) from China

Three new species: Hesperoschema xuwangi sp. nov. from China (Sichuan), H. bii sp. nov. from China (Xizang), and H. sinicum sp. nov. from China (Guangxi) are described. Hesperoschema malaisei Scheerpeltz, 1965 is new to China (Yunnan), with the male discovered for the first time. The female of H. opacum Schillhammer, 2009 is discovered for the first time. Habitus and diagnostic characteristics of the species treated in this paper were photographed, and a key to species of Hesperoschema Scheerpeltz, 1965 is updated.

Pregnancy-Related Attack in Neuromyelitis Optica Spectrum Disorder With AQP4-IgG: A Single-Center Study and Meta-Analysis

ObjectiveThis study aimed to investigate the demographic characteristic of pregnancy-related attacks (PRAs) in neuromyelitis optica spectrum disorder (NMOSD). In addition, we investigated the predictors of PRAs as well as the effect of immunosuppressive (IS) therapy in patients with pregnancy-related NMOSD.MethodWe retrospectively analyzed data on clinical and diagnostic characteristics, therapeutic management, and pregnancy outcomes for PRAs in AQP4-IgG-positive NMOSD patients admitted to the Second Xiangya Hospital of Central South University. Moreover, we searched the literature (without any temporal restriction) to identify all such similar cohorts and performed a meta-analysis to evaluate the effectiveness and safety of IS therapy on NMOSD patients with PRAs.ResultWe collected clinical data on 117 women with AQP4 antibody-positive NMOSD; we ultimately included 33 patients (34 pregnancies). Ten patients were relapse-free during pregnancy, and 23 (69.7%) had PRA; attacks were most common during the first trimester of the postpartum period. Maintenance of IS treatment during pregnancy was found to greatly reduce PRAs in patients with NMOSD. PRAs were associated with a higher neutrophil-to-lymphocyte ratio (NLR) at relapse during pregnancy and shorter time interval between the last relapse and conception. The meta-analysis suggested that maintenance of IS treatment during pregnancy can significantly reduce the RR of NMOSD (95%CI=0.35-0.62; z=5.18, p&lt;0.0001) and had no adverse effect on the miscarriage rate. However, the unhealthy newborn occurrence among those receiving IS treatment was 3.73 times higher than that of those not receiving treatment during pregnancy (95%CI=1.40–9.91; z=2.64, p=0.008).ConclusionOur study results demonstrates that pregnancy can induce the onset or relapse of attacks in NMOSD patients. The increased NLR value and disease activity may be a predictor for PRAs in patients with NMOSD. Moreover, administration of IS treatment during pregnancy can reduce the relapse rate. However, the dosage of drugs and risks of adverse effects to the fetus need to be considered. Future prospective studies with larger sample sizes are needed to confirm and extend our findings.

The Use and Costs of Paid and Unpaid Care for People with Dementia: Longitudinal Findings from the IDEAL Cohort

Background: The drivers of costs of care for people with dementia are not well understood and little is known on the costs of care for those with rarer dementias. Objective: To characterize use and costs of paid and unpaid care over time in a cohort of people with dementia living in Britain. To explore the relationship between cohort members’ demographic and clinical characteristics and service costs. Methods: We calculated costs of health and social services, unpaid care, and out-of-pocket expenditure for people with mild-to-moderate dementia participating in three waves of the IDEAL cohort (2014– 2018). Latent growth curve modelling investigated associations between participants’ baseline sociodemographic and diagnostic characteristics and mean weekly service costs. Results: Data were available on use of paid and unpaid care by 1,537 community-dwelling participants with dementia at Wave 1, 1,199 at Wave 2, and 910 at Wave 3. In models of paid service costs, being female was associated with lower baseline costs and living alone was associated with higher baseline costs. Dementia subtype and caregiver status were associated with variations in baseline costs and the rate of change in costs, which was additionally influenced by age. Conclusion: Lewy body and Parkinson’s disease dementias were associated with higher service costs at the outset, and Lewy body and frontotemporal dementias with more steeply increasing costs overall, than Alzheimer’s disease. Planners of dementia services should consider the needs of people with these relatively rare dementia subtypes as they may require more resources than people with more prevalent subtypes.

Taxonomic Re-evaluation of Actinocephalus (Eriocaulaceae) in Light of New Morphological and Molecular Evidence

Abstract— A recent phylogenetic tree for the large paraphyletic genus Paepalanthus showed that the genus Actinocephalus is also paraphyletic with two species of Paepalanthus nested within it: Paepalanthus macrocephalus and Paepalanthus camptophyllus. These species have the diagnostic morphological traits of Actinocephalus, but they are too small to be seen in Paepalanthus macrocephalus and difficult to interpret in Paepalanthus camptophyllus, which has resulted in them being overlooked until now. Furthermore, Paepalanthus macrocephalus has a challenging circumscription, with several putative synonyms whose nomenclatural confusion has persisted for decades. Here we analyzed the morphology of Paepalanthus camptophyllus and Paepalanthus macrocephalus to confirm their relationship with other species of Actinocephalus as shown in the phylogeny and to investigate the diagnostic features that distinguish these species in Actinocephalus. The opportunity was also taken to evaluate putative synonyms of Paepalanthus macrocephalus and Paepalanthus camptophyllus, and to include the remaining variety of A. phaeocephalus (Paepalanthus phaeocephalus var. foliosus) in Actinocephalus, which was lacking in the revision of the genus. Four new combinations and eight lectotypes are provided, as well as six new synonyms. We also provide comments on diagnostic characteristics, distribution, and notes on Actinocephalus.

MORPHOLOGY AND MOLECULAR IDENTIFICATION OF THE LARVAL STAGE OF TWO SPECIES FROM THE GENUS CHRYSOBOTHRIS ESCHSCHOLTZ, 1829 (COLEOPTERA, BUPRESTIDAE)

The genus of Chrysobothris Eschscholtz, 1829 is one of the most diverse and widespread genera of the family Buprestidae of some 700 described species distributed throughout the world. In Iraq, particularly in the Kurdistan region, about 4 species had been recorded so far, many of these species are sympatric, share larval host plants, and are difficult to reliably separate morphologically. The current study investigates species limits and relationships among the recognized species occurring within the Erbil Province; mitochondrial cytochrome C oxidase (COX I) molecular analysis confirmed the monophyly of two Chrysobothris species, Ch. affinis (Fabricius, 1794) and Ch. chrysostigma (Linnaeus, 1758). Implications of the resultant larval morphology and molecular techniques are discussed. Diagnostic characteristics that are depended to identifying the species within Chrysobothris in larval stage were illustrated and then compared with the molecular data.

The status of Micronotus Hancock, 1902 species (Orthoptera: Tetrigidae)

In this contribution, we focus on the status of the genus Micronotus and its four species. After this revision, the genus only includes two of the four species, being synonymized Micronotus dubius n. syn. under M. quadriundulatus; includes within the genus M. andeanum n. comb. (transferred from the genus Tetrix) and confirming the status of M. asperulus. Micronotus is redescribed, including additional characters, and a key is provided to identify the three species considered as valid. Micronotus caudatus, is located in the new genus Danielatettix n. gen., by differing from and not fitting the diagnostic characteristics of Micronotus or another known genus of Tetriginae. The color variation of Danielatettix caudatus n. comb. is documented, and under this species its synonymized: Paratettix attenuata n. syn., P. hastata n. syn. and P. ignobilis n. syn. Finally, the distribution of the studied species and the taxonomic panorama of Tetriginae in the Neotropics are discussed.

Locus-Specific Methylation of GSTP1, RNF219, and KIAA1539 Genes with Single Molecule Resolution in Cell-Free DNA from Healthy Donors and Prostate Tumor Patients: Application in Diagnostics

The locus-specific methylation of three genes (GSTP1, RNF219, and KIAA1539 (also known as FAM214B)) in the blood plasma cell-free DNA (cfDNA) of 20 patients with prostate cancer (PCa), 18 healthy donors (HDs), and 17 patients with benign prostatic hyperplasia (BPH) was studied via the MiSeq platform. The methylation status of two CpGs within the same loci were used as the diagnostic feature for discriminating the patient groups. Many variables had good diagnostic characteristics, e.g., each of the variables GSTP1.C3.C9, GSTP1.C9, and GSTP1.C9.T17 demonstrated an 80% sensitivity at a 100% specificity for PCa patients vs. the others comparison. The analysis of RNF219 gene loci methylation allowed discriminating BPH patients with absolute sensitivity and specificity. The data on the methylation of the genes GSTP1 and RNF219 allowed discriminating PCa patients, as well as HDs, with absolute sensitivity and specificity. Thus, the data on the locus-specific methylation of cfDNA (with single-molecule resolution) combined with a diagnostic approach considering the simultaneous methylation of several CpGs in one locus enabled the discrimination of HD, BPH, and PCa patients.