scholarly journals Concomitant Transmission of Dengue, Chikungunya, and Zika Viruses in Brazil: Clinical and Epidemiological Findings From Surveillance for Acute Febrile Illness

2018 ◽  
Vol 69 (8) ◽  
pp. 1353-1359 ◽  
Author(s):  
Monaíse M O Silva ◽  
Laura B Tauro ◽  
Mariana Kikuti ◽  
Rosângela O Anjos ◽  
Viviane C Santos ◽  
...  
Keyword(s):  
Clinical Diagnosis ◽  
Medical Records ◽  
Point Of Care ◽  
Acute Infection ◽  
Febrile Illness ◽  
Northeastern Brazil ◽  
Arboviral Diseases ◽  
Arboviral Transmission ◽  
Epidemiological Characteristics ◽  
Multiplex Diagnostics

Abstract Background Since their emergence in the Americas, chikungunya (CHIKV) and Zika (ZIKV) viruses co-circulate with dengue virus (DENV), hampering clinical diagnosis. We investigated clinical and epidemiological characteristics of arboviral infections during the introduction and spread of CHIKV and ZIKV through northeastern Brazil. Methods Surveillance for arboviral diseases among febrile patients was performed at an emergency health unit of Salvador, Brazil, between September 2014 and July 2016. We interviewed patients to collect data on symptoms, reviewed medical records to obtain the presumptive diagnoses, and performed molecular and serological testing to confirm DENV, CHIKV, ZIKV, or nonspecific flavivirus (FLAV) diagnosis. Results Of 948 participants, 247 (26.1%) had an acute infection, of which 224 (23.6%) were single infections (DENV, 32 [3.4%]; CHIKV, 159 [16.7%]; ZIKV, 13 [1.4%]; and FLAV, 20 [2.1%]) and 23 (2.4%) coinfections (DENV/CHIKV, 13 [1.4%]; CHIKV/FLAV, 9 [0.9%]; and DENV/ZIKV, 1 [0.1%]). An additional 133 (14.0%) patients had serological evidence for a recent arboviral infection. Patients with ZIKV presented with rash and pruritus (69.2% each) more frequently than those with DENV (37.5% and 31.2%, respectively) and CHIKV (22.9% and 14.7%, respectively) (P < .001 for both comparisons). Conversely, arthralgia was more common in CHIKV (94.9%) and FLAV/CHIKV (100.0%) than in DENV (59.4%) and ZIKV (53.8%) (P < .001). A correct presumptive clinical diagnosis was made for 9%–23% of the confirmed patients. Conclusions Arboviral infections are frequent causes of febrile illness. Coinfections are not rare events during periods of intense, concomitant arboviral transmission. Given the challenge to clinically distinguish these infections, there is an urgent need for rapid, point-of-care, multiplex diagnostics.

scholarly journals Questing one Brazilian query: reporting 16 cases of Q fever from Minas Gerais, Brazil

2006 ◽  
Vol 48 (1) ◽  
pp. 5-9 ◽  
Author(s):  
Paulo Sérgio Gonçalves da Costa ◽  
Marco Emilio Brigatte ◽  
Dirceu Bartolomeu Greco
Keyword(s):  
Phase I ◽  
Phase Ii ◽  
Fever Of Unknown Origin ◽  
Q Fever ◽  
Acute Infection ◽  
Case Series ◽  
Febrile Illness ◽  
Unknown Origin ◽  
Clinical Form ◽  
Chronic Q Fever

Q fever has been considered non-existing in Brazil where reports of clinical cases still cannot be found. This case-series of 16 patients is a result of a systematic search for such illness by means of clinical and serologic criteria. Serologic testing was performed by the indirect microimmunofluorescence technique using phase I/II C. burnetii antigens. Influenza-like syndrome was the most frequent clinical form (eight cases - 50%), followed by pneumonia, FUO (fever of unknown origin), mono-like syndrome (two cases - 12.5% each), lymphadenitis (one case - 6.3%) and spondylodiscitis associated with osteomyelitis (one case - 6.3%). The ages varied from four to 67 years old with a median of 43.5. All but one patient had positive serologic tests for phase II IgG whether or not associated with IgM positivity compatible with acute infection. One patient had both phase I and phase II IgG antibodies compatible with chronic Q fever. Seroconvertion was detected in 10 patients. Despite the known limitations of serologic diagnosis, the cases here reported should encourage Brazilian doctors to include Q fever as an indigenous cause of febrile illness.

scholarly journals Epidemiological characteristics of neonatal admissions in a public maternity / Características epidemiológicas das internações neonatais em uma maternidade pública / Características epidemiológicas de admisión neonatal en una maternidad..

2018 ◽  
Vol 6 (4) ◽  
pp. 28
Author(s):  
Danubia Jacomo Da Silva Cardoso ◽  
Beatriz Schumacher
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Medical Records ◽  
Preterm Labor ◽  
Neonatal Intensive Care ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Maternal Complications ◽  
Epidemiological Characteristics

Descriptive retrospective Research with quantitative approach. Aims: Meet the epidemiological characteristics of hospitalization in Neonatal intensive care unit, relating them to the possible maternal factors, in a public maternity in southern Brazil. Performed with newborns that they put in the NICU, forwarded with the clinical summary to the Municipal program precious baby. The data were collected, with the following variables: maternal age, type of birth, number of pre-natal consultations, complications in pregnancy, and number of days of hospitalization in neonatal intensive care unit, in the period from January to December 2013. Were analyzed medical records 72, prematurity was the most prevalent with 61% of the babies, and their consequences such as the use of mechanical ventilation and apneas 55.5% were repeated and 52.7% respectively. Among the most frequent maternal complications was observed the Preterm Labor (31.3%) and premature rupture of membranes (23.8%). Thus the identification of the factors that lead to preterm labor and premature rupture of membranes, could meet the maternal background and consequently reduce the prematurity and low birth weight.

scholarly journals Evaluation of a Genus Specific rGroEL 1-524 IgM-ELISA and Commercially ELISA Kits During Course of Leptospirosis in Thailand

2021 ◽  
Author(s):  
Santi Maneewatchararangsri ◽  
Galayanee Doungchawee ◽  
Thareerat Kalambaheti ◽  
Viravarn Luvira ◽  
Ngamphol Soonthornworasiri ◽  
...  
Keyword(s):  
Early Detection ◽  
Early Diagnosis ◽  
Screening Test ◽  
Scrub Typhus ◽  
Acute Infection ◽  
Febrile Illness ◽  
High Sensitivity ◽  
Elisa Assay ◽  
Igm Elisa ◽  
Post Onset

Abstract This work, we developed a genus-specific rGroEL1-524 IgM-ELISA assay for using as screening diagnosis of suspected leptospirosis among acute undifferentiated febrile illness patients during acute fever. Ddiagnostic accuracies of rGroEL1–524 IgM-ELISA, and commercial Panbio IgM-ELISA, and Virion-Serion Classic IgG-ELISA were evaluated with Thai 107 leptospirosis sera, and 189 controls, compared to reference culture and/or MAT methods. Sensitivities were 91.7%, 59.6%, and 17.7% for acute- infection, and were 97.1%, 54.8%, and 9.7% for early detection at 1-3 days post-onset of symptoms (DPO1-3), and the specificities were 87.5%, 86.6%, and 74.8% among controls, respectively. The rGroEL1-524 IgM-ELISA had high sensitivity, at 95.9% and 91.2% among culture and MAT negative cases. Impaired specificity on scrub typhus, possibly from antibody-cross reaction to ortholog GroEL. Commercial Panbio IgM-ELISA had sensitivities of 50%, 63.2%, and 89.9% compared with culture, MAT-negative and single MAT-positive cases whereas Virion-Serion IgG-ELISA provided sensitivities of 13.3%, 10.5% and 71.4%, respectively. A rGroEL1-524 IgM-ELISA could be useful as a screening test for early diagnosis. The performance of the commercial ELISA suggests the applicability of IgM-ELISA for diagnosis, while IgG-ELISA is useful for seroprevalence surveys. However, confirmation by reference tests is recommended.

Transformer + GAN based Traditional Chinese Medicine inpatient prescription recommendation (Preprint)

2021 ◽  
Author(s):  
Hong Zhang
Keyword(s):  
Decision Making ◽  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Electronic Medical Records ◽  
Clinical Diagnosis ◽  
Medical Records ◽  
Training Data ◽  
Diagnosis And Treatment ◽  
Test Results ◽  
Treatment Scheme

BACKGROUND Clinical diagnosis and treatment decision making support is at the core of medical artificial intelligent research, in which Traditional Chinese Medicine (TCM) decision making is an important part. Traditional Chinese Medicine is a traditional medical system originated from China, of which the main clinical model is to conduct individualized diagnosis and treatment by relying on the four-diagnosis information. One of the key tasks of the TCM artificial intelligence research is to develop techniques and methods of clinical prescription decision making which takes all the relevant information of a patient as input, and produces a diagnosis and treatment scheme as output. Given the complexity of TCM clinical diagnosis and treatment schemes, decision making support of clinical diagnosis and treatment schemes remains as a research challenge for lacking of an effective solution. Fortunately, as the volume of the massive clinical data in the form of electronic medical records increases rapidly, it becomes possible for the computer to produce personalized diagnosis and treatment scheme recommendation through machine learning on the basis of the clinical big data. OBJECTIVE The objective of this research is to develop a real-time diagnosis and treatment scheme recommendation model for TCM inpatients. This is accomplished by using historical clinical medical records as training data to train a Transformer network. Furthermore, to alleviate the issue of overfitting, a Generative Adversarial Network is used to generate noise-added samples from the original training data. These noise-added samples along with the original samples form the complete train data set. METHODS valid information, such as the patient’s current sickness situation, medicines taken, nursing care given, vital signs, examinations and test results, is extracted from the patient’s electronic medical records, then the obtained information is sorted chronically, to produce a sequence of data of each patient. These time-sequence data is then used as input to the Transformer network. The output of the network would be the prescription information a physician would give. Overfitting is a common problem in machine learning, and becomes especially server when the network is complex with insufficient training data. In this research, a Generative Adversarial Network, is used to double the number of training samples by producing noise-added samples from the original samples. This, to a great extent, lessens the overfitting problem. RESULTS A total of 21,295 copies of inpatient electronic medical records from Guang’anmen traditional Chinese medicine hospital was used in this research. These records were created between January 2017 and December 2018, covering a total of 6352 kinds of medicines. These medicines were sorted into 829 types of first category medicines based on the class relationships among medicines. As shown by the test results, the performance of a fully trained Transformer model can have an average precision rate of 80.58%，and an average recall rate of 68.49%. CONCLUSIONS As shown by the preliminary test results, the Transformer-based TCM prescription recommendation model outperforms the existing conventional methods. The extra training samples generated by the GAN network helps to overcome the overfitting issue, leading a further improved recall rate and precision rate.

scholarly journals Clinical and epidemiological characterization of dengue hemorrhagic fever cases in northeastern, Brazil

2010 ◽  
Vol 43 (4) ◽  
pp. 355-358 ◽  
Author(s):  
Luciano Pamplona de Góes Cavalcanti ◽  
Ivo Castelo Branco Coelho ◽  
Dina Cortez Lima Feitosa Vilar ◽  
Susana Glória Silveira Holanda ◽  
Kiliana Nogueira Farias da Escóssia ◽  
...  
Keyword(s):  
Public Health Problem ◽  
Hemorrhagic Fever ◽  
Northeastern Brazil ◽  
World Health ◽  
Important Public Health Problem ◽  
Susceptible Population ◽  
Risk Of Progression ◽  
Care Structure ◽  
Health Organization ◽  
Epidemiological Characteristics

INTRODUCTION: The dengue hemorrhagic dengue (DHF) remains an important public health problem in Brazil. The objective of this study was to analyze the epidemiological characteristics of DHF cases during the 2003 epidemic in Ceará. METHODS: Suspected DHF cases with onset of symptoms between January and December 2003 were investigated. RESULTS: 37,964 classic dengue cases and 291 DHF cases were reported. Among the cases discarded, 75.5% were serologically positive but did not meet the criteria recommended by the World Health Organization (WHO). The DHF patients' median age was 30 years (2 - 88). Among the hemorrhagic manifestations, petechiae were the most (32.6%) frequent. Cases of gastrointestinal bleeding, ascites, pericardial pleural effusion, hepatomegaly, hypotension and shock showed higher risk of progression to death (p <0.05). CONCLUSIONS: The introduction of a new serotype (DENV-3) in Ceará, which encountered a susceptible population and high vector density, may have been the primary agent responsible for the magnitude of the epidemic. Timely and appropriate medical care, along with an organized care structure are essential for reducing its lethality.

scholarly journals Development of an E2 ELISA Methodology to Assess Chikungunya Seroprevalence in Patients from an Endemic Region of Mexico

Viruses ◽  
2019 ◽  
Vol 11 (5) ◽  
pp. 407 ◽  
Author(s):  
Young Chan Kim ◽  
César López-Camacho ◽  
Nallely Garcia-Larragoiti ◽  
Alan Cano-Mendez ◽  
Karina Guadalupe Hernandez-Flores ◽  
...  
Keyword(s):  
Acute Infection ◽  
Febrile Illness ◽  
Population Based ◽  
Cross Sectional Study ◽  
Elisa Assay ◽  
Serum Samples ◽  
Endemic Region ◽  
Cross Sectional ◽  
Healthy Donors ◽  
Epidemiological Information

Chikungunya fever is a debilitating disease caused by Chikungunya virus (CHIKV) that can result in long-lasting arthralgias. The early diagnosis of CHIKV relies on PCR during the acute infection phase to allow differential diagnosis with other co-circulating arboviruses such as dengue and Zika. Alternatively, serology can support diagnosis and provide epidemiological information on current and past outbreaks. Many commercial serological ELISA assays are based on the inactivated whole CHIKV, but their sensitivity and specificity show great variability. We produced recombinant CHIKV E2 that is suitable for ELISA assays, which was used for the serodiagnosis of CHIKV infections occurring in an arbovirus endemic Mexican region within Michoacán state. A cross-sectional study was conducted in 2016–2017; sera was obtained from 15 healthy donors and 68 patients presenting undifferentiated febrile illness. Serum samples were screened by RT-PCR and by our in-house ELISA assay. Our results indicate that IgM and IgG anti-CHIKV E2 antibodies were detected with our ELISA assay with higher sensitivity than a commercially available CHIKV ELISA kit. Our simple and sensitive ELISA assay for the serodiagnosis of CHIKV infections can be applied to population-based seroprevalence surveys and has potential for monitoring vaccine immunogenicity in CHIKV vaccine clinical trials.

scholarly journals Searching and Finding the Hidden Treasure: A Retrospective Analysis of Rickettsial Disease Among Dutch International Travelers

2020 ◽  
Author(s):  
Sophia G de Vries ◽  
Louise E van Eekeren ◽  
Hans van der Linden ◽  
Benjamin J Visser ◽  
Martin P Grobusch ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Medical Records ◽  
Scrub Typhus ◽  
Spotted Fever ◽  
Febrile Illness ◽  
Empiric Antibiotic Therapy ◽  
Spotted Fever Group ◽  
Orientia Tsutsugamushi ◽  
Rickettsial Disease ◽  
Empiric Antibiotic

Abstract Background Rickettsial disease (RD) is a prevalent and underestimated cause of febrile illness worldwide, especially in the absence of an inoculation eschar. We attempted to quantify this underestimation at our clinic, by investigating past cases of febrile illness in travelers who had tested negative for leptospirosis, a disease that can initially present similarly to non-eschar RD, and which we routinely consider when other important causes of unspecified febrile illness have tested negative. Methods We performed a retrospective analysis in febrile returned travelers from Asia, Africa, or the Americas between 2010 and 2017, who had tested negative for leptospirosis. Serologic immunofluorescence assays were performed for Orientia tsutsugamushi (scrub typhus), typhus group, and spotted fever group RD. We performed a medical records review of all patients who tested positive. In case of a fitting medical history, cases were deemed either confirmed (based on convalescent serology) or suspected (based on single serology). Results Among 97 patients, convalescent serology was available in 16 (16.5%) patients, and a single serology in 81 (83.5%) patients. RD was the likely diagnosis in 8 of 16 (50.0%) patients with convalescent serology, and in 8 of 81 (9.9%) with single serology. Of the 16 confirmed/suspected cases, 11 (69%) had been missed and 7 (44%) had not received adequate empiric antibiotic therapy. Conclusions This study shows that non-eschar RD is an important and poorly recognized cause of illness in travelers, even in a specialized travel clinic. A lower threshold to test and treat for RD is warranted in returning travelers with febrile illness.

scholarly journals Diagnosing heart failure with NT-proBNP point-of-care testing: lower costs and better outcomes. A decision analytic study

BJGP Open ◽  
2018 ◽  
Vol 2 (3) ◽  
pp. bjgpopen18X101596 ◽  
Author(s):  
Christoffer Bugge ◽  
Erik Magnus Sether ◽  
Andreas Pahle ◽  
Sigrun Halvorsen ◽  
Ivar Sonbo Kristiansen
Keyword(s):  
Heart Failure ◽  
Clinical Diagnosis ◽  
Point Of Care ◽  
Adult Population ◽  
Delayed Diagnosis ◽  
Clinical Findings ◽  
Sensitivity Analyses ◽  
Tree Model ◽  
Diagnostic Strategies ◽  
Point Of Care Test

BackgroundAfflicting 1–2% of the adult population, heart failure (HF) is a condition with considerable morbidity and mortality. While echocardiography may be considered the gold standard diagnostic test, GPs have relied on symptoms and clinical findings in diagnosing the condition.AimThe aim of this study was to estimate 1-year health outcome and costs of three diagnostic strategies: 1) history and clinical findings ('clinical diagnosis'); 2) clinical diagnosis supplemented with NTproBNP point-of-care test ('POC test') in the GP’s surgery; or (3) in hospital laboratory ('hospital test').Design & settingA decision tree model was developed to simulate 1-year patient courses with each strategy in Norway.MethodSensitivity and specificity of clinical diagnosis (56% and 68%), and of N-terminal pro B-type natriuretic peptide test ([NT-proBNP] 90% and 65%), were based on published literature. The probabilities of referral to hospital were based on a survey of Norwegian GPs (n = 103). The costs were based on various Norwegian fee schedules. Sensitivity analyses were conducted to examine the uncertainty of the results.ResultsThe 1-year per person societal costs were €543, €505, and €607 for clinical diagnosis, POC test, and hospital test, respectively. Even though POC entails higher laboratory costs, the total primary care costs were lower because of fewer re-visits with the GP and less use of spirometry. While 38% of patients had a delayed diagnosis with clinical diagnosis, the proportions were 22% with both POC test and hospital test. Results were most sensitive to the probability of use of spirometry.ConclusionPOC testing results in earlier diagnosis and lower costs than the other diagnostic modalities.

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