Infection by Streptococcus pneumoniae in children with or without radiologically confirmed pneumonia

ObjectiveCommunity-acquired pneumonia is an important cause of morbidity in childhood, but the detection of its causative agent remains a diagnostic challenge. The authors aimed to evaluate the role of the chest radiograph to identify cases of community-aquired pneumonia caused by typical bacteria.MethodsThe frequency of infection by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis was compared in non-hospitalized children with clinical diagnosis of community acquired pneumonia aged 2–59 months with or without radiological confirmation (n = 249 and 366, respectively). Infection by S. pneumoniae was diagnosed by the detection of a serological response against at least one of eight pneumococcal proteins (defined as an increase ≥2-fold in the IgG levels against Ply, CbpA, PspA1 and PspA2, PhtD, StkP-C, and PcsB-N, or an increase ≥1.5-fold against PcpA). Infection by H. influenzae and M. catarrhalis was defined as an increase ≥2-fold on the levels of microbe-specific IgG.ResultsChildren with radiologically confirmed pneumonia had higher rates of infection by S. pneumoniae. The presence of pneumococcal infection increased the odds of having radiologically confirmed pneumonia by 2.8 times (95% CI: 1.8–4.3). The negative predictive value of the normal chest radiograph for infection by S. pneumoniae was 86.3% (95% CI: 82.4–89.7%). There was no difference on the rates of infection by H. influenzae and M. catarrhalis between children with community-acquired pneumonia with and without radiological confirmation.ConclusionsAmong children with clinical diagnosis of community-acquired pneumonia submitted to chest radiograph, those with radiologically confirmed pneumonia present a higher rate of infection by S. pneumoniae when compared with those with a normal chest radiograph.</p

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Infection by Streptococcus pneumoniae in children with or without radiologically confirmed pneumonia

Abstract Objective: Community-acquired pneumonia is an important cause of morbidity in childhood, but the detection of its causative agent remains a diagnostic challenge. The authors aimed to evaluate the role of the chest radiograph to identify cases of community-aquired pneumonia caused by typical bacteria. Methods: The frequency of infection by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis was compared in non-hospitalized children with clinical diagnosis of community acquired pneumonia aged 2-59 months with or without radiological confirmation (n = 249 and 366, respectively). Infection by S. pneumoniae was diagnosed by the detection of a serological response against at least one of eight pneumococcal proteins (defined as an increase ≥2-fold in the IgG levels against Ply, CbpA, PspA1 and PspA2, PhtD, StkP-C, and PcsB-N, or an increase ≥1.5-fold against PcpA). Infection by H. influenzae and M. catarrhalis was defined as an increase ≥2-fold on the levels of microbe-specific IgG. Results: Children with radiologically confirmed pneumonia had higher rates of infection by S. pneumoniae. The presence of pneumococcal infection increased the odds of having radiologically confirmed pneumonia by 2.8 times (95% CI: 1.8-4.3). The negative predictive value of the normal chest radiograph for infection by S. pneumoniae was 86.3% (95% CI: 82.4-89.7%). There was no difference on the rates of infection by H. influenzae and M. catarrhalis between children with community-acquired pneumonia with and without radiological confirmation. Conclusions: Among children with clinical diagnosis of community-acquired pneumonia submitted to chest radiograph, those with radiologically confirmed pneumonia present a higher rate of infection by S. pneumoniae when compared with those with a normal chest radiograph

Avaliação de larvicidas de origem microbiana no controle da traça-das-crucíferas em couve-flor Evaluation of microbiological larvicides to control diamondback moth in cauliflower

Dois inseticidas biológicos à base de Bacillus thuringiensis subspécies kurstaki (Btk) e aizawai (Bta) e um inseticida não sistêmico de origem biológica, à base de spinosad, foram avaliados em campo contra a traça-das-crucíferas, Plutella xylostella (L.)(Lep.: Plutellidae), em cultivo de couve-flor. O experimento foi realizado em Brazlândia, DF, em uma área de produção regular de hortaliças. A lavoura foi conduzida segundo manejo indicado para a região, sem qualquer intervenção que não o controle da praga. O experimento foi realizado no período de julho a setembro de 2002. O delineamento foi de blocos ao acaso, com quatro tratamentos e quatro repetições. Os produtos foram aplicados em função da média do número de furos produzidos pela praga, presentes nas quatro folhas centrais das plantas, sendo os diferentes tratamentos avaliados semanalmente. Quando a média do número de furos atingia valor igual ou superior a seis, os produtos eram aplicados. Adotando-se este procedimento, aplicou-se três vezes o inseticida spinosad e seis vezes os inseticidas Btk e Bta. Os três tratamentos com inseticidas não diferiram entre si, mas diferiram significativamente da testemunha quanto à produção. As áreas tratadas com Btk produziram 78,1% de cabeças comercializáveis, as tratadas com Bta 76,5% e as tratadas com spinosad 75,5%. No controle houve perda de 34,4% da produção. A utilização dos produtos aumentou a receita da cultura da couve-flor em relação à testemunha, nos valores de R$2.505,19 com o Btk, R$ 1.954,55 com o Bta e R$1.891,65 com spinosad.<br>Two bioinsecticides based on Bacillus thuringiensis sub species kurstaki (Btk) and aizawai (Bta) and non-systemic insecticide of biological origin based on spinosad were evaluated on cauliflower crop for diamondback moth, Plutella xylostella (L.) (Lep.:Plutellidae) control. The experiment was conducted in a vegetable production area of Brazlândia, Brazil. The crop was conducted using the same technology of production adopted by farmers for pest control management. The experiment was conducted between July and September 2002. Randomized blocks with four treatments and four replications were used. Six holes per plant in the four central leaves, were used as a parameter to indicate the necessity of applying insecticides. The number of holes was evaluated weekly. Based on this parameter spinosad was applied three times and Btk and Bta six times. Similar results were obtained in the treatments using insecticides. However significant differences in production were observed between treatments in which insecticide was used and the untreated control. The area treated with Btk produced 78.1$ 785.32; for Btk U$592.99 for spinosal and U$ 612.71 for Bta