Disease burden of rotavirus gastroenteritis in children up to 5years of age in two Swiss cantons: paediatrician- and hospital-based surveillance

Rotavirus gastroenteritis (RV GE) is a leading cause of diarrhoea in young children. The purpose of this epidemiological surveillance was to measure the disease burden of RV GE among children <5years of age in two regions of Switzerland, Geneva and Lucerne. One hospital and four paediatricians participated per region. The surveillance lasted from December 2006 to June 2007. The population denominator for calculation of the RV GE incidence rate was the average of the overall study population <5years of age under surveillance during the surveillance period. At the study sites, 513 children with GE were presented. Stool sample was collected and examined in 341 cases, of which 130 were RV positive (38.1%). Informed consent to participate in the study was obtained for 113 RV positive subjects. The overall RV GE incidence rate was 0.97% in Lucerne [lower incidence interval (LCI), 0.71%; upper incidence interval (UCI), 1.2%] compared with 0.65 and in Geneva (LCI, 0.50%; UCI, 0.81%). Disease severity assessments using the Vescari score showed that the RV GE episodes were more severe in Lucerne than in Geneva (14.05 ± 3.05 vs 12.85 ± 2.87), which was confirmed by a higher hospitalisation rate in Lucerne at the study visit (82.9% vs 23.6%). More children had fever in Geneva than in Lucerne (42.9% vs 26.8%), and more children were hospitalised during the follow-up period in Geneva than in Lucerne (14.5% vs 2.5%). Genotyping of RV positive stool samples revealed that both G1 and P8 were the most prevalent types in both regions. There was a statistically significant difference in the distribution frequency of G1 between the two regions (p = 0.039). Assessment of health economic data confirmed the economic burden of RV GE episodes. In conclusion, RV GE episodes are a health burden as well as an economic burden also for the children in a developed country such as Switzerlan

Prognostic Value of Viremia in Patients with Long-Standing Human Immunodeficiency Virus Infection

Human immunodeficiency virus (HIV) viremia was evaluated in 73 patients with long-standing infection to investigate its relationship with clinical or biologic parameters and to assess its use as a predictor of clinical progression and death. After adjustment for other parameters, baseline HIV RNA level was significantly associated with baseline clinical stage and CD4 cell count. During follow-up (mean, 14.6 months), 16 patients died; 34 others had clinical progression of disease. In multivariate analysis, mortality was better predicted by baseline CD4 cell count (relative hazard [RH] for 100-cell decrease, 3.5; 95% confidence interval [CI], 1.5-8.2; P = .003) than by HIV RNA (P = .28) or clinical stage. HIV RNA level was the best predictor of clinical progression (RH for 1 log increase, 2.8; 95% CI, 1.6-4.9; P < .001). Monitoring of HIV RNA level may help to identify patients who might benefit from antiretroviral or prophylactic therap

Zoonotic Potential of Rotavirus From Swine and Bovine in South of Taiwan

Rotavirus was recognized as the virus that responsible for causing acute gastroenteritis, especially young livestock. Taiwan Center for Disease Control (CDC) confirms the majority cases of acute gastroenteritis in Taiwan on February 2015 were caused by rotavirus. In this study, we report the incidence and zoonotic impact of rotavirus strain from Taiwan. This study examined 90 (swine) and 60 (bovine) fecal samples collected from south of Taiwan in March 2015. Detection of rotavirus using VP6 gene by RT-PCR technique with amplicons 379 bp. Zoonotic potential analysis based on nucleotide sequence and phylogenetic analysis. RT-PCR utilizing the primers specific for VP6 gene detected rotavirus with positive reactions 3/30 (10%) in piglets and 1/20 (5%) in the calf. Based on the nucleotide sequences and phylogenetic analysis indicated that 1 of 3 wild strains from swine rotavirus had 85.0% - 91.1% and 1 wild strain from bovine had 78.7% - 85.9% identity relations with human strains. These findings indicated that the wild strains of swine and bovine rotavirus may broadly spread and contribute to zoonotic transmission

Etiology of community-acquired pneumonia in hospitalized children based on WHO clinical guidelines

Community-acquired pneumonia (CAP) is a major cause of death in developing countries and of morbidity in developed countries. The objective of the study was to define the causative agents among children hospitalized for CAP defined by WHO guidelines and to correlate etiology with clinical severity and surrogate markers. Investigations included an extensive etiological workup. A potential causative agent was detected in 86% of the 99 enrolled patients, with evidence of bacterial (53%), viral (67%), and mixed (33%) infections. Streptococcus pneumoniae was accounted for in 46% of CAP. Dehydration was the only clinical sign associated with bacterial pneumonia. CRP and PCT were significantly higher in bacterial infections. Increasing the number of diagnostic tests identifies potential causes of CAP in up to 86% of children, indicating a high prevalence of viruses and frequent co-infections. The high proportion of pneumococcal infections re-emphasizes the importance of pneumococcal immunizatio

Long-menu questions in computer-based assessments: a retrospective observational study

Background: Computer based assessments of paediatrics in our institution use series of clinical cases, where information is progressively delivered to the students in a sequential order. Three types of formats are mainly used: Type A (single answer), Pick N, and Long-menu. Long-menu questions require a long, hidden list of possible answers: based on the student's initial free text response, the program narrows the list, allowing the student to select the answer. This study analyses the psychometric properties of Long-menu questions compared with the two other commonly used formats: Type A and Pick N. Methods: We reviewed the difficulty level and discrimination index of the items in the paediatric exams from 2009 to 2015, and compared the Long-menu questions with the Type A and Pick N questions, using multiple-way analyses of variances. Results: Our dataset included 13 exam sessions with 855 students and 558 items included in the analysis, 212 (38 %) Long-menu, 201 (36 %) Pick N, and 140 Type A (25 %) items. There was a significant format effect associated with both level of difficulty (p = .005) and discrimination index (p < .001). Long-menu questions were easier than Type A questions(+5.2 %; 95 % CI 1.1–9.4 %), and more discriminative than both Type A (+0.07; 95 % CI 0.01–0.14), and Pick N (+0.10; 95 % CI 0.05–0.16) questions. Conclusions: Long-menu questions show good psychometric properties when compared with more common formats such as Type A or Pick N, though confirmatory studies are needed. They provide more variety, reduce the cueing effect, and thus may more closely reflect real life practice than the other item formats inherited from paper-based examination that are used during computer-based assessments

Effects of Blindfold on Leadership in Pediatric Resuscitation Simulation: A Randomized Trial

Background: Pediatric resuscitations are rare events. Simulation-based training improves clinical and non-clinical skills, as well as survival rate. We assessed the effectiveness of using blindfolds to further improve leadership skills in pediatric simulation-based training.Methods: Twelve teams, each composed of 1 pediatric emergency fellow, 1 pediatric resident, and 2 pediatric emergency nurses, were randomly assigned to the blindfold group (BG) or to the control group (CG). All groups participated in one session of five simulation-based resuscitation scenarios. The intervention was using a blindfold for the BG leader for the scenarios B, C, and D. Three evaluators, who were blinded to the allocation, assessed leadership skills on the first and last video-recorded scenarios (A and E). Questionnaires assessed self-reported changes in stress and satisfaction about skills after the first and the last scenarios.Results: Improvement in leadership skills doubled in the BG compared with the CG (11.4 vs. 5.4%, p = 0.04), whereas there was no increase in stress or decrease in satisfaction.Conclusion: Blindfold could be an efficient method for leadership training during pediatric resuscitation simulated scenarios. Future studies should further assess its effect at a follow-up and on clinical outcomes after pediatric resuscitation

Host biomarkers and combinatorial scores for the detection of serious and invasive bacterial infection in pediatric patients with fever without source.

BACKGROUND Improved tools are required to detect bacterial infection in children with fever without source (FWS), especially when younger than 3 years old. The aim of the present study was to investigate the diagnostic accuracy of a host signature combining for the first time two viral-induced biomarkers, tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) and interferon γ-induced protein-10 (IP-10), with a bacterial-induced one, C-reactive protein (CRP), to reliably predict bacterial infection in children with fever without source (FWS) and to compare its performance to routine individual biomarkers (CRP, procalcitonin (PCT), white blood cell and absolute neutrophil counts, TRAIL, and IP-10) and to the Labscore. METHODS This was a prospective diagnostic accuracy study conducted in a single tertiary center in children aged less than 3 years old presenting with FWS. Reference standard etiology (bacterial or viral) was assigned by a panel of three independent experts. Diagnostic accuracy (AUC, sensitivity, specificity) of host individual biomarkers and combinatorial scores was evaluated in comparison to reference standard outcomes (expert panel adjudication and microbiological diagnosis). RESULTS 241 patients were included. 68 of them (28%) were diagnosed with a bacterial infection and 5 (2%) with invasive bacterial infection (IBI). Labscore, ImmunoXpert, and CRP attained the highest AUC values for the detection of bacterial infection, respectively 0.854 (0.804-0.905), 0.827 (0.764-0.890), and 0.807 (0.744-0.869). Labscore and ImmunoXpert outperformed the other single biomarkers with higher sensitivity and/or specificity and showed comparable performance to one another although slightly reduced sensitivity in children < 90 days of age. CONCLUSION Labscore and ImmunoXpert demonstrate high diagnostic accuracy for safely discriminating bacterial infection in children with FWS aged under and over 90 days, supporting their adoption in the assessment of febrile patients

Inflammatory markers: are they reliable predictors of severe bacterial infections in children ?

Children arriving at the emergency department with fever is a fairly common problem in pediatric practice and the pediatrician has to detect the minority of those children with severe bacterial infection. Rapid diagnosis and treatment of these severe infections is essential since a delay in the management may lead to poorer outcome. The inflammatory markers: procalcitonin and C-reactive protein are reliable markers of severe bacterial infections such as bacteremia, meningitis, pyelonephritis and bacterial pneumonia. We created a score utilizing both procalcitonin and C-reactive protein. This Lab-score has been tested and validated as the best marker of severe bacterial infections in children with fever without a source

Identifying severe bacterial infection in children with fever without source

For decades, many investigators have attempted to identify clinical or laboratory markers that can accurately differentiate severe bacterial from self-limiting viral infections in young children with fever without source. Unfortunately, no perfect marker has been discovered so far. Many guidelines recommend white blood cell count as a screening marker in fever without source, whereas compelling evidence in the literature emphasizes the superior characteristics of C-reactive protein and procalcitonin. One way to improve predictive value is the combination of prediction rules of different tests for clinical and laboratory markers. Several clinical decision rules, reviewed in this article, have been suggested but seem to be difficult to implement in practice due to their complexity. Recently, procalcitonin, C-reactive protein and urinary dipstick were combined in a simple risk index score that displayed promising predictive value in severe bacterial infections in children. Ultimately, impact analyses still have to be performed to show improved quality of care in this setting