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BACKGROUND: Pyogenic liver abscess (LA) is difficult to distinguish from intrahepatic mass-forming cholangiocarcinoma (IMCC) in the emergency department (ED). We evaluated the predictive ability of white blood cells (WBC) and C-reactive protein (CRP) levels, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and delta neutrophil index (DNI) in LA and IMCC in the ED. METHODS: Forty patients with IMCC between January 2011 and December 2018 were included in this study. For each patient with IMCC, two control patients with LA were enrolled based on matching age and sex,-i.e., 80 patients with LA. RESULTS: Inflammatory markers, including WBC, PLR, NLR, DNI, and CRP were significantly higher in the LA group than in the IMCC group. For both groups, the area under the curve (AUC) of the initial CRP value was significantly higher (AUC: 0.909) than that of the initial serum WBC count, PLR, and DNI levels. On multivariable logistic regression analysis with inflammatory markers, serum CRP (odds ratio, 1.290; 95% confidence interval, 1.148-1.449, p < 0.001) was the only significant predictor for differentiation between the LA and IMCC groups. CONCLUSION: Serum CRP may be a potential inflammatory marker to differentiate IMCC from LA in the ED.
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OBJECTIVE: To estimate the effectiveness of the influenza vaccine under different criteria for selecting patients for swabbing. METHOD: A case-control study was performed of laboratory-confirmed cases (n=909) and negative controls for influenza (n=732) in the 2010-2011 to 2012-2013 seasons in Navarre (Spain). The adjusted vaccine effectiveness was estimated by including all swabs from patients with influenza-like-illness and selecting only the first two cases per physician and week. RESULTS: The first two patients per physician and week were less frequently vaccinated against influenza (7.9% vs. 12.5%, p=0.021) and less often received confirmation of influenza (53.6% vs. 66.4%, p <0.001) than subsequent patients. These differences decreased after adjustment for covariates. The effectiveness of the influenza vaccine was 49% (95% CI: 23-66%) when all swabs were included and was 55% (95% CI: 27-72%) when we selected the first two swabs per week and physician. CONCLUSION: The selection of the first two patients per physician and week may bias assessment of the effectiveness of the influenza vaccine, although this bias was small in the seasons analyzed.
Assuntos
Vacinas contra Influenza/imunologia , Influenza Humana/prevenção & controle , Nasofaringe/virologia , Orthomyxoviridae/isolamento & purificação , Seleção de Pacientes , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Pré-Escolar , Humanos , Lactente , Pessoa de Meia-Idade , Adulto JovemRESUMO
ABSTRACT:In recent years ,there has been high prevalence of murine typhus in Yunnan Province ,People's Republic of China .A large outbreak of murine typhus occurred in Xishuangbanna Prefecture ,Yunnan Province in 2010 .However ,not all cases were confirmed by laboratory assays ;therefore ,field epidemiologic and laboratory investigations of murine typhus in Xishuangbanna Prefecture were conducted in 2011 .Blood samples were collected from clinical diagnostic cases at the acute and convalescence stages of murine typhus in Xishuangbanna Prefecture ,Yunnan Province ,from June to September of 2011 ,and blood and spleen samples were collected from mice sharing the same habitats as the patients .Immunofluorescence assays were used to test for the presence of IgM and IgG antibodies against Rickettsia typhi in sera from patients and mice .Real‐time PCR was used to detect the groEL gene of R .typhi in blood clots from patients at the acute stage and in spleen tissue from mice .A total of 1 157 clinically diagnosed murine typhus cases occurred in Xishuangbanna Prefecture ,Yunnan Province in 2011 ,with an incidence of 102 .10/100 000 .Of these cases ,80 were investigated by laboratory assays and 74 of 80 patients were confirmed to have murine typhus .The coincidence rate between the clinical diagnosis and laboratory detection was 92 .50% .The positivi‐ty rate for IgG antibodies against R .typhi was 14 .0% (14/100) for Rattus f lavipectus ,while the rate by PCR was 9 .0%(9/100) .That laboratory diagnoses confirmed that the severity of the murine typhus outbreak in Xishuangbanna cannot be ig‐nored .The distribution of host animals transmitting R .typhi underscores this conclusion .
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Las queratomicosis por hongos filamentosos son una de las causas de daño en la córnea en los países de climas tropicales y subtropicales y se consideran dentro de las micosis de difícil tratamiento. El presente estudio evalúa la etiología de las queratitis sicóticas en Tucumán (R. Argentina) para determinar su incidencia e importancia clínica regional. En un lapso de 5 años se estudiaron 48 muestras (biopsias, raspados cornéales y/o aspirados oculares) recogidas por el oftalmólogo y enviadas al laboratorio para análisis micológico. Mediante examen directo, cultivos y estudios macro y micromorfológicos se confirmó etiología micótica en 13 pacientes (27 por ciento). De ellos, se identificaron 7 cultivos como Fusarium solani complex, 4 F. oxysporum y 2 F. verticillioides. Estos hallazgos permiten profundizar el conocimiento de los agentes etiológicos locales involucrados y los factores de riesgo, dos aspectos importantes en la prevención y la terapéutica de estas micosis.
Keratomycosis caused by filamentous fungi is one of the agents of damage to the cornea in subtropical and tropical climate countries and belongs to those mycoses identified as of difficult treatment. This study evaluates the etiology of mycotic keratitis in Tucumán (R. Argentina) with the purpose of assessing its incidence and regional and clinical significance. In a 5-year period, 48 samples (biopsy, corneal scrapes and/or ocular aspiration) collected by the oculist were examined and sent to the laboratory for a mycological analysis. By means of direct exam, macro and micromorphological cultures and studies of the presence of mycotic etiology in 13 patients (27 por ciento) was confirmed. Among them 7 cultures such as a Fusarium solani complex, 4 F. oxysporum and 2 F. verticillioides were identified. These findings allow to enlarge the knowledge of the local etiological agents involved as well as the risk factors, two elements that are significant in the prevention and therapeutics of these mycoses.
