Cardiomyopathy and Death Following Chikungunya Infection: An Increasingly Common Outcome.

Chikungunya virus (CHIKV) is vectored by Aedes aegypti and Aedes albopictus mosquitoes and is found throughout tropical and sub-tropical regions. While most infections cause mild symptoms such as fever and arthralgia, there have been cases in which cardiac involvement has been reported. In adults, case reports include symptoms ranging from tachycardia and arrythmia, to myocarditis and cardiac arrest. In children, case reports describe symptoms such as arrythmia, myocarditis, and heart failure. Case reports of perinatal and neonatal CHIKV infections have also described cardiovascular compromise, including myocardial hypertrophy, ventricular dysfunction, myocarditis, and death. Myocarditis refers to inflammation of the heart tissue, which can be caused by viral infection, thus becoming viral myocarditis. Since viral myocarditis is linked as a causative factor of other cardiomyopathies, including dilated cardiomyopathy, in which the heart muscle weakens and fails to pump blood properly, the connection between CHIKV and the heart is concerning. We searched Pubmed, Embase, LILACS, and Google Scholar to identify case reports of CHIKV infections where cardiac symptoms were reported. We utilized NCBI Virus and NCBI Nucleotide to explore the lineage/evolution of strains associated with these outbreaks. Statistical analysis was performed to identify which clinical features were associated with death. Phylogenetic analysis determined that CHIKV infections with cardiac symptoms are associated with the Asian, the East Central South African, and the Indian Ocean lineages. Of patients admitted to hospital, death rates ranged from 26-48%. Myocarditis, hypertension, pre-existing conditions, and the development of heart failure were significantly correlated with death. As such, clinicians should be aware in their treatment and follow-up of patients.

Chikungunya in Infants and Children: Is Pathogenesis Increasing?

Chikungunya virus (CHIKV) was first extensively described in children during outbreaks in India and South Asia during the mid-1960s. Prior to the 2005 emergence of CHIKV on Reunion Island, CHIKV infection was usually described as a dengue-like illness with arthralgia in Africa and febrile hemorrhagic disease in Asia. Soon after the 2005 emergence, severe CNS consequences from vertical and perinatal transmission were described and as CHIKV continued to emerge in new areas over the next 10 years, severe manifestation of infection and sequelae were increasingly reported in infants and neonates. The following review describes the global reemergence and the syndromes of Chikungunya fever (CHIKF) in infants and children. The various manifestations of CHIKF are described and connected to the viral lineage that was documented in the area at the time the disease was described. The data show that certain manifestations of CHIKF occur with specific viral lineages and genetic motifs, which suggests that severe manifestations of CHIKF in the very young may be associated with the emergence of new viral lineages.

Capturing every patron interaction: the move from paper statistics to an electronic system to track the whole library.

Reference departments track patron interactions to illustrate the type and number of services provided as well as to tailor librarians' time and expertise to the interest and needs of their patrons. Until 2010 the Reference, Education, and Community Engagement Department at the Calder Memorial Library tracked statistics using a complicated system of paper tic sheets and two Excel™ spreadsheets. After considering different electronic systems, the department decided to employ an electronic form created with SurveyMonkey™ to track patron interactions. After the system had been in place for three months, the authors administered a satisfaction and use survey to collect faculty and staff feedback on the new system. Seven months later the authors undertook usability testing to collect further evaluative data on the electronic form. The patron interaction form continues to be used to collect statistics, provide data for annual reviews, and recognize the contributions of all faculty and staff at the library.

Pillbox: a solid dosage medication identification tool.

Pillbox is a tool that can be used to rapidly identify solid dosage medications. The database, created and maintained by the National Library of Medicine with the support of the Food and Drug Administration, seeks to enhance patient safety through the identification of solid dosage medication. Users enter physical characteristics of a medication, possible matches are provided, and links to additional resources are offered. A comparison with comparable resources was conducted, and future enhancements to Pillbox are discussed.